Research, Evidence-Based Practice, and Quality Improvement
Evidence-based practice triad
EBP integrates best available evidence, clinical expertise, and patient values. Know the hierarchy of evidence (systematic reviews and RCTs above cohort, case-control, case series, expert opinion) and that hierarchy is not absolute; study quality matters.
Study design and statistics
Understand RCTs (randomization, blinding, intention-to-treat), cohort and case-control designs, and threats to validity (selection, confounding, bias). Know key statistics: sensitivity, specificity, likelihood ratios, number needed to treat, confidence intervals, and p-values. Be able to interpret effect sizes and recognize that statistical significance is not clinical significance.
Appraisal and application
Appraise validity, results, and applicability to your patient. Know the difference between internal and external validity. Understand how to translate findings into practice while accounting for patient preferences.
Quality improvement
Know basic QI concepts: Plan-Do-Study-Act cycles, process versus outcome measures, and using data to improve care. Distinguish QI from research (QI improves local practice; research generates generalizable knowledge).
Traps
Questions may overstate a single study or confuse correlation with causation. Favor answers that weigh study quality and applicability, and avoid absolute claims from limited evidence.
Rule of thumb
When asked what to do with conflicting evidence, choose the answer that critically appraises quality and integrates patient values rather than blindly following the newest study.