Date: August 20, 2012
Welcome back to TheSGEM. Our goal remains to shorten the knowledge translation (KT) window from 10 years down to 1 year. TheSGEM uses the Best Evidence in Emergency Medicine (BEEM) content as the basis for its podcasts.
This episode of TheSGEM looks at the history of EBM, different levels of EBM, and the discuss the Leaky Pipe model of EBM. We hope by understanding some of the background of EBM it help you be skeptical of the medical literature and develop critical thinking skills. The next podcast in TheSGEM series will start using BEEM reviews of specific articles relevant to emergency medicine.
Brief History of EBM:
– first blinded trail
– where the term Mesmerized comes from
– people are still being mesmerized today
Dr. Hamliton
– trial from 1816 demonstrating the need to control allocation bias
– 80.9% alive if blood letting performed vs. 96.7% alive with no blood letting
– 19.1% died if blood letting vs 3.3% alive with no blood letting
– The Cochrane Collaboration is named in honour of Dr. Archie Cochrane, a medical researcher who contributed greatly to the science called epidemiology
Drs. David Sackett, Gordon Guyatt and Brian Haynes
– The guys from McMaster University
– Dr. Gord Guyatt coined the term Evidence Based Medicine in 1992
– EBM one of the top medical milestones in the last 166 years
(error: not last 140 years but last 166 years, it was from 1840 when the BMJ started)
– Started the Best Evidence in Emergency Medicine (BEEM)
– started the BEST emergency medicine journal club
Introduction to the Levels of Evidence:
– illustrates seven levels of EBM
– lowest form being expert opinion and the highest form of evidence being systematic reviews
Centre for Evidence Based Medicine (a more complex table showing the levels of evidence)
Leaky Pipe Model of Knowledge Translation:
– Dr. Pathman first put forward a model of describing the 4 stages of putting evidence into action
– Pathman DE, Konrad TR, Freed GL, Freeman VA, Koch GG. The awareness-to-adherence model of the steps to clinical guideline compliance: the case of pediatric vaccine recommendations. Med Care. 1996; 34:873–89.
– This was further described by Dr. Brian Haynes editorial in the ACP journal identifying seven “A”s (awareness, acceptance, applicable, able, act on, agree and adhere)
– Diner, Carpenter et al modified the Pathman pipeline and Haynes editorial into the Leaky Pipe model of knowledge translation
So after this you should have some knowledge concerning the history of EBM, the various levels of evidence and an understanding of the Leaky Pipe model.
The next podcast will start the series of BEEM content. We will be providing a case, reviewing an article on the topic raised and providing a BEEM summary and bottom line.
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Consider all the information available not just what you hear on TheSGEM to provide your patient with the best possible emergency care.
First rule of Emergency Medicine…Don’t Panic. No one stays in v.fib forever.
Talk with you next time on the Skeptics Guide to Emergency Medicine.

Remember to be skeptical of anything you learn, even if you heard it on the Skeptics’ Guide to Emergency medicine.