Evidence Based Medicine

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This is a common question in the NHS/HSE Interviews. You should be able to define evidence based medicine and also give examples from your clinical practice relating to it.

Common Questions

  • What do you understand by “Evidence Based Medicine’?
  • How do you use EBM in your daily practice?

Question #1: What is Evidence Based Medicine?

Always be careful when you are asked to define something. DO NOT use ready-made definations as these will be too common and will not make you stand out among other candidates. The interviewers are looking for your understanding of the concept not how well have you crammed the defination. If you are well versed in the defination; however fail to make an impression on the interviewer that you understand the basics of the concept, you will not score good in this question.

Defination

Evidence based medicine is using the best and latest available research evidence along with your own current clinical expertise and judgment, and applying this to specific case while taking care of patient’s concerns and values.

Levels of Evidence Available

Systematic review or meta-analysis of randomised controlled trials
Randomised control trial
One cohort study
One well-designed controlled study without randomization
Case control studies and case series
Expert reports and opinions


Question #2: What are the steps of evidence based medicine

These are the general steps involved in this process. If possible, use them along with a specific example from your clinical practice.

Steps:

  1. Case of a patient on whom normal guidelines do not exactly fit or were out of date
  2. A well-defined clinical question is made regarding the case
  3. Search of existing literature and evidence by using appropriate resources
  4. Evidence is then evaluated for its validty and applicability
  5. The evidence is then used alongwith physicians clinical pracitce and patient’s values
  6. A practical solution is found to the original problem

Example Answer

I had a patient with chronic kidney disease who required treatment for hypertension, but the standard guidelines did not fully address the patient’s comorbidities and specific needs.

In my case, the clinical question was, “In patients with chronic kidney disease and hypertension, what is the best antihypertensive treatment to minimize both cardiovascular and renal complications?”. I searched for recent studies comparing antihypertensive drugs in patients with kidney disease, looking for evidence on safety and effectiveness.

For my patient, I found a meta-analysis comparing ACE inhibitors and ARBs in patients with chronic kidney disease, which had strong validity and relevance to the case. I discussed the potential treatment options with the patient, explaining the benefits and risks of each choice, while considering their lifestyle and values.

Finally, I used the evidence to make an informed decision and prescribed an ACE inhibitor, which was supported by current literature and aligned with the patient’s values and overall health needs.