Evidence-based practice is the idea that occupational practices ought to be based on

scientific evidence Scientific evidence is evidence that serves to either support or counter a scientific theory or hypothesis, although scientists also use evidence in other ways, such as when applying theories to practical problems. "Discussions about empirical ev ...

. The movement towards evidence-based practices attempts to encourage and, in some instances, require professionals and other decision-makers to pay more attention to evidence to inform their decision-making. The goal of evidence-based practice is to eliminate unsound or outdated practices in favor of more-effective ones by shifting the basis for decision making from tradition, intuition, and unsystematic experience to firmly grounded scientific research. The proposal has been controversial, with some arguing that results may not specialize to individuals as well as traditional practices. Evidence-based practices have been gaining ground since the formal introduction of

evidence-based medicine Evidence-based medicine (EBM) is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. It means integrating individual clinical expertise with the best available exte ...

in 1992 and have spread to the

allied health professions Allied health professions (AHPs) are a category of health professionals that provide a range of diagnostic, preventive, therapeutic, and rehabilitative services in connection with health care. While there is no international standard for defining ...

education Education is the transmission of knowledge and skills and the development of character traits. Formal education occurs within a structured institutional framework, such as public schools, following a curriculum. Non-formal education als ...

management Management (or managing) is the administration of organizations, whether businesses, nonprofit organizations, or a Government agency, government bodies through business administration, Nonprofit studies, nonprofit management, or the political s ...

law Law is a set of rules that are created and are enforceable by social or governmental institutions to regulate behavior, with its precise definition a matter of longstanding debate. It has been variously described as a science and as the ar ...

public policy Public policy is an institutionalized proposal or a Group decision-making, decided set of elements like laws, regulations, guidelines, and actions to Problem solving, solve or address relevant and problematic social issues, guided by a conceptio ...

architecture Architecture is the art and technique of designing and building, as distinguished from the skills associated with construction. It is both the process and the product of sketching, conceiving, planning, designing, and construction, constructi ...

, and other fields. In light of studies showing problems in scientific research (such as the

replication crisis The replication crisis, also known as the reproducibility or replicability crisis, refers to the growing number of published scientific results that other researchers have been unable to reproduce or verify. Because the reproducibility of empir ...

), there is also a movement to apply evidence-based practices in scientific research itself. Research into the evidence-based practice of science is called

metascience Metascience (also known as meta-research) is the use of scientific methodology to study science itself. Metascience seeks to increase the quality of scientific research while reducing inefficiency. It is also known as "research on research" and ...

. An individual or organisation is justified in claiming that a specific practice is evidence-based if, and only if, three conditions are met. First, the individual or organisation possesses comparative evidence about the effects of the specific practice in comparison to the effects of at least one alternative practice. Second, the specific practice is supported by this evidence according to at least one of the individual's or organisation's preferences in the given practice area. Third, the individual or organisation can provide a sound account for this support by explaining the evidence and preferences that lay the foundation for the claim.

History

For most of history, professions have based their practices on expertise derived from experience passed down in the form of

tradition A tradition is a system of beliefs or behaviors (folk custom) passed down within a group of people or society with symbolic meaning or special significance with origins in the past. A component of cultural expressions and folklore, common e ...

. Many of these practices have not been justified by evidence, which has sometimes enabled

quackery Quackery, often synonymous with health fraud, is the promotion of fraudulent or Ignorance, ignorant medicine, medical practices. A quack is a "fraudulent or ignorant pretender to medical skill" or "a person who pretends, professionally or public ...

and poor performance. Even when overt quackery is not present, the quality and efficiency of tradition-based practices may not be optimal. As the

scientific method The scientific method is an Empirical evidence, empirical method for acquiring knowledge that has been referred to while doing science since at least the 17th century. Historically, it was developed through the centuries from the ancient and ...

has become increasingly recognized as a sound means to evaluate practices, evidence-based practices have become increasingly adopted.

Medicine

One of the earliest proponents of evidence-based practice was

Archie Cochrane Archibald Leman Cochrane (12 January 1909 – 18 June 1988) was a Scottish physician noted for his book, ''Effectiveness and Efficiency: Random Reflections on Health Services'', which advocated the use of randomized controlled trials (RCTs) t ...

, an

epidemiologist Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and determinants of health and disease conditions in a defined population, and application of this knowledge to prevent diseases. It is a cornerstone ...

who authored the book ''Effectiveness and Efficiency: Random Reflections on Health Services'' in 1972. Cochrane's book argued for the importance of properly testing health care strategies, and was foundational to the evidence-based practice of medicine. Cochrane suggested that because resources would always be limited, they should be used to provide forms of health care which had been shown in properly designed evaluations to be effective. Cochrane maintained that the most reliable evidence was that which came from randomised controlled trials. The term "

" was introduced by

Gordon Guyatt Gordon Henry Guyatt (born November 11, 1953) is a Canadian physician. He is also a Distinguished University Professor in the Departments of Health Research Methods, Evidence and Impact (formerly Clinical Epidemiology & Biostatistics) and Medicine ...

in 1990 in an unpublished program description, and the term was later first published in 1992. This marked the first evidence-based practice to be formally established. Some early experiments in evidence-based medicine involved testing primitive medical techniques such as

bloodletting Bloodletting (or blood-letting) was the deliberate withdrawal of blood from a patient to prevent or cure illness and disease. Bloodletting, whether by a physician or by leeches, was based on an ancient system of medicine in which blood and othe ...

, and studying the effectiveness of modern and accepted treatments. There has been a push for evidence-based practices in medicine by

insurance Insurance is a means of protection from financial loss in which, in exchange for a fee, a party agrees to compensate another party in the event of a certain loss, damage, or injury. It is a form of risk management, primarily used to protect ...

providers, which have sometimes refused coverage of practices lacking systematic evidence of usefulness. It is now expected by most clients that medical professionals should make decisions based on evidence, and stay informed about the most up-to-date information. Since the widespread adoption of evidence-based practices in medicine, the use of evidence-based practices has rapidly spread to other fields.

Education

More recently, there has been a push for evidence-based education. The use of evidence-based learning techniques such as

spaced repetition ''Spaced'' is a British television sitcom created, written by and starring Simon Pegg and Jessica Stevenson, and directed by Edgar Wright, about the comedic, and sometimes surreal and action-packed, misadventures of Daisy Steiner and Tim Bis ...

can improve students' rate of learning. Some commentators have suggested that the lack of any substantial progress in the field of education is attributable to practice resting in the unconnected and noncumulative experience of thousands of individual teachers, each re-inventing the wheel and failing to learn from hard scientific evidence about 'what works'. Opponents of this view argue that it is hard to assess teaching methods because it depends on a host of factors, not least those to do with the style, personality and beliefs of the teacher and the needs of the particular children. Others argue the teacher experience could be combined with research evidence, but without the latter being treated as a privileged source. This is in line with a school of thought suggesting that evidence-based practice has limitations and a better alternative is to use ''Evidence-informed Practice (EIP)''. This process includes quantitative evidence, does not include non-scientific prejudices, but includes qualitative factors such as clinical experience and the discernment of practitioners and clients.

Versus tradition

Evidence-based practice is a philosophical approach that is in opposition to

. Some degree of reliance on "the way it was always done" can be found in almost every profession, even when those practices are contradicted by new and better information. Some critics argue that since research is conducted on a population level, results may not generalise to each individual within the population. Therefore, evidence-based practices may fail to provide the best solution for each individual, and traditional practices may better accommodate individual differences. In response, researchers have made an effort to test whether particular practices work better for different subcultures, personality types etc. Some authors have redefined evidence-based practice to include practice that incorporates common wisdom, tradition, and personal values alongside practices based on evidence.

Evaluating evidence

Evaluating scientific research is extremely complex. The process can be greatly simplified with the use of a

heuristic A heuristic or heuristic technique (''problem solving'', '' mental shortcut'', ''rule of thumb'') is any approach to problem solving that employs a pragmatic method that is not fully optimized, perfected, or rationalized, but is nevertheless ...

that ranks the relative strengths of results obtained from scientific research, which is called a

hierarchy of evidence A hierarchy of evidence, comprising levels of evidence (LOEs), that is, evidence levels (ELs), is a heuristic used to rank the relative strength of results obtained from experimental research, especially medical research. There is broad agreemen ...

. The design of the study and the endpoints measured (such as survival or

quality of life Quality of life (QOL) is defined by the World Health Organization as "an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards ...

) affect the strength of the evidence. Typically,

systematic review A systematic review is a scholarly synthesis of the evidence on a clearly presented topic using critical methods to identify, define and assess research on the topic. A systematic review extracts and interprets data from published studies on ...

s and

meta-analysis Meta-analysis is a method of synthesis of quantitative data from multiple independent studies addressing a common research question. An important part of this method involves computing a combined effect size across all of the studies. As such, th ...

rank at the top of the hierarchy while

randomized controlled trials A randomized controlled trial (or randomized control trial; RCT) is a form of scientific experiment used to control factors not under direct experimental control. Examples of RCTs are clinical trials that compare the effects of drugs, surgical ...

rank above

observational studies In fields such as epidemiology, social sciences, psychology and statistics, an observational study draws inferences from a sample to a population where the independent variable is not under the control of the researcher because of ethical conc ...

, and expert opinion and

case report In medicine, a case report is a detailed report of the symptoms, signs, diagnosis, treatment, and follow-up of an individual patient. Case reports may contain a demographic profile of the patient, but usually describe an unusual or novel occurrenc ...

s rank at the bottom. There is broad agreement on the relative strength of the different types of studies, but there is no single, universally-accepted hierarchy of evidence. More than 80 different hierarchies have been proposed for assessing medical

evidence Evidence for a proposition is what supports the proposition. It is usually understood as an indication that the proposition is truth, true. The exact definition and role of evidence vary across different fields. In epistemology, evidence is what J ...

Applications

Medicine

Evidence-based medicine is an approach to medical practice intended to optimize

decision-making In psychology, decision-making (also spelled decision making and decisionmaking) is regarded as the Cognition, cognitive process resulting in the selection of a belief or a course of action among several possible alternative options. It could be ...

by emphasizing the use of

from well-designed and well-conducted

research Research is creative and systematic work undertaken to increase the stock of knowledge. It involves the collection, organization, and analysis of evidence to increase understanding of a topic, characterized by a particular attentiveness to ...

. Although all medicine based on

science Science is a systematic discipline that builds and organises knowledge in the form of testable hypotheses and predictions about the universe. Modern science is typically divided into twoor threemajor branches: the natural sciences, which stu ...

has some degree of

empirical Empirical evidence is evidence obtained through sense experience or experimental procedure. It is of central importance to the sciences and plays a role in various other fields, like epistemology and law. There is no general agreement on how t ...

support, evidence-based medicine goes further, classifying evidence by its epistemologic strength and requiring that only the strongest types (coming from

meta-analyses Meta-analysis is a method of synthesis of quantitative data from multiple independent studies addressing a common research question. An important part of this method involves computing a combined effect size across all of the studies. As such, th ...

s, and

randomized controlled trial A randomized controlled trial (or randomized control trial; RCT) is a form of scientific experiment used to control factors not under direct experimental control. Examples of RCTs are clinical trials that compare the effects of drugs, surgical ...

s) can yield strong recommendations; weaker types (such as from case-control studies) can yield only weak recommendations. The term was originally used to describe an approach to teaching the practice of medicine and improving decisions by individual physicians about individual patients. Use of the term rapidly expanded to include a previously described approach that emphasized the use of evidence in the design of guidelines and policies that apply to groups of patients and populations ("evidence-based practice policies"). Whether applied to medical education, decisions about individuals, guidelines and policies applied to populations, or administration of health services in general, evidence-based medicine advocates that to the greatest extent possible, decisions and policies should be based on evidence, not just the beliefs of practitioners, experts, or administrators. It thus tries to ensure that a

clinician A clinician is a health care professional typically employed at a skilled nursing facility or clinic. Clinicians work directly with patients rather than in a laboratory, community health setting or in research. A clinician may diagnose, treat a ...

's opinion, which may be limited by knowledge gaps or biases, is supplemented with all available knowledge from the

scientific literature Scientific literature encompasses a vast body of academic papers that spans various disciplines within the natural and social sciences. It primarily consists of academic papers that present original empirical research and theoretical ...

so that

best practice A best practice is a method or technique that has been generally accepted as superior to alternatives because it tends to produce superior results. Best practices are used to achieve quality as an alternative to mandatory standards. Best practice ...

can be determined and applied. It promotes the use of formal, explicit methods to analyze evidence and makes it available to decision makers. It promotes programs to teach the methods to medical students, practitioners, and policymakers. A process has been specified that provides a standardised route for those seeking to produce evidence of the effectiveness of interventions. Originally developed to establish processes for the production of evidence in the housing sector, the standard is general in nature and is applicable across a variety of practice areas and potential outcomes of interest.

Mental health

To improve the dissemination of evidence-based practices, th
Association for Behavioral and Cognitive Therapies (ABCT)
and the Society of Clinical Child and Adolescent Psychology ( SCCAP, Division 53 of the

American Psychological Association The American Psychological Association (APA) is the main professional organization of psychologists in the United States, and the largest psychological association in the world. It has over 170,000 members, including scientists, educators, clin ...

) maintain updated information on their websites on evidence-based practices in psychology for practitioners and the general public. An evidence-based practice consensus statement was developed at a summit on mental healthcare in 2018. As of June 23, 2019, this statement has been endorsed by 36 organizations.

Metascience

There has since been a movement for the use of evidence-based practice in conducting scientific research in an attempt to address the

and other major issues affecting scientific research. The application of evidence-based practices to research itself is called

, which seeks to increase the quality of scientific research while reducing waste. It is also known as "research on research" and "the science of science", as it uses

research methods Research is creative and systematic work undertaken to increase the stock of knowledge. It involves the collection, organization, and analysis of evidence to increase understanding of a topic, characterized by a particular attentiveness to ...

to study how research is done and where improvements can be made. The five main areas of research in metascience are methodology, reporting,

reproducibility Reproducibility, closely related to replicability and repeatability, is a major principle underpinning the scientific method. For the findings of a study to be reproducible means that results obtained by an experiment or an observational study or ...

evaluation In common usage, evaluation is a systematic determination and assessment of a subject's merit, worth and significance, using criteria governed by a set of Standardization, standards. It can assist an organization, program, design, project or any o ...

, and incentives. Metascience has produced a number of reforms in science such as the use of study pre-registration and the implementation of reporting guidelines with the goal of bettering scientific research practices.

Education

Evidence-based education (EBE), also known as ''evidence-based interventions'', is a model in which policy-makers and educators use empirical evidence to make informed decisions about education interventions (policies, practices, and programs). In other words, decisions are based on scientific evidence rather than opinion. EBE has gained attention since English author David H. Hargreaves suggested in 1996 that education would be more effective if teaching, like medicine, was a "research-based profession". Since 2000, studies in Australia, England, Scotland and the US have supported the use of research to improve educational practices in teaching reading. In 1997, the National Institute of Child Health and Human Development convened a national panel to assess the effectiveness of different approaches used to teach children to read. The resulting National Reading Panel examined quantitative research studies on many areas of reading instruction, including phonics and whole language. In 2000 it published a report entitled ''Teaching Children to Read: An Evidence-based Assessment of the Scientific Research Literature on Reading and its Implications for Reading Instruction'' that provided a comprehensive review of what was known about best practices in reading instruction in the U.S. This occurred around the same time as such international studies as the

Programme for International Student Assessment The Programme for International Student Assessment (PISA) is a worldwide study by the Organisation for Economic Co-operation and Development (OECD) in member and non-member nations intended to evaluate educational systems by measuring 15-year ...

in 2000 and the

Progress in International Reading Literacy Study The Progress in International Reading Literacy Study (PIRLS) is an international study of reading (comprehension) achievement in 9–10 year olds. It has been conducted every five years since 2001 by the International Association for the Evaluati ...

in 2001. Subsequently, evidence-based practice in education (also known as Scientifically based research), came into prominence in the U.S. under the

No child left behind act The No Child Left Behind Act of 2001 (NCLB) was a 2002 United States Act of Congress promoted by the presidential administration of George W. Bush. It reauthorized the Elementary and Secondary Education Act and included Title I provisio ...

of 2001, replace in 2015 by the Every Student Succeeds Act. In 2002 the U.S. Department of Education founded the

Institute of Education Sciences The Institute of Education Sciences (IES) is the independent, non-partisan statistics, research, and evaluation arm of the U.S. Department of Education. IES' stated mission is to provide scientific evidence on which to ground education practic ...

to provide scientific evidence to guide education practice and policy . English author Ben Goldacre advocated in 2013 for systemic change and more

s to assess the effects of educational interventions. In 2014 the

National Foundation for Educational Research The National Foundation for Educational Research (NFER) is an educational research charity which creates a range of insights on educational policy and practice that aim to strengthen practice in the classroom and inform and influence policymake ...

, Berkshire, England published a report entitled ''Using Evidence in the Classroom: What Works and Why''. In 2014 the British Educational Research Association and the

Royal Society of Arts The Royal Society for the Encouragement of Arts, Manufactures and Commerce, commonly known as the Royal Society of Arts (RSA), is a learned society that champions innovation and progress across a multitude of sectors by fostering creativity, s ...

advocated for a closer working partnership between teacher-researchers and the wider academic research community.

Reviews of existing research on education

The following websites offer free analysis and information on education research: * ''The Best Evidence Encyclopedia'' is a free website created by the

Johns Hopkins University The Johns Hopkins University (often abbreviated as Johns Hopkins, Hopkins, or JHU) is a private university, private research university in Baltimore, Maryland, United States. Founded in 1876 based on the European research institution model, J ...

School of Education's Center for Data-Driven Reform in Education (established in 2004) and is funded by the

, U.S. Department of Education. It gives educators and researchers reviews about the strength of the evidence supporting a variety of English programs available for students in grades

K–12 K–12, from kindergarten to 12th grade, is an English language expression that indicates the range of years of publicly supported primary and secondary education found in the United States and Canada, which is similar to publicly supported sch ...

. The reviews cover programs in areas such as ''Mathematics, Reading, Writing, Science, Comprehensive school reform, and Early childhood Education''; and include such topics as the ''effectiveness of technology and struggling readers''. * ''The

Education Endowment Foundation The Education Endowment Foundation (EEF) is a charity established in 2011 to improve the educational attainment of the poorest pupils in English schools. It aims to support teachers and senior leaders by providing evidence-based resources designe ...

'' was established in 2011 by The

Sutton Trust The Sutton Trust is an educational Charitable organization, charity in the United Kingdom which aims to improve social mobility and address educational disadvantage. The charity was set up by educational philanthropist, Sir Peter Lampl in 1997. ...

, as a lead charity in partnership with Impetus Trust, together being the government-designated What Works Centre for UK Education. * ''Evidence for the Every Student Succeeds Act'' began in 2017 and is produced by the Center for Research and Reform in Education at Johns Hopkins University School of Education. It offers free up-to-date information on current PK-12 programs in reading, writing, math, science, and others that meet the standards of the Every Student Succeeds Act (the United States K–12 public education policy signed by President Obama in 2015). It also provides information on programs that do meet the Every Student Succeeds Act standards as well as those that do not. * ''What Works Clearinghouse'', established in 2002, evaluates numerous educational programs, in twelve categories, by the quality and quantity of the evidence, and the effectiveness. It is operated by the federal National Center for Education Evaluation, and Regional Assistance, part of the

* ''Social programs that work'' is administered by Arnold Ventures LLC's Evidence-Based Policy team. The team is composed of the former leadership of the ''Coalition for Evidence-Based Policy'', a nonprofit, nonpartisan organization advocating the use of well-conducted ''

s'' (RCTs) in policy decisions.http://toptierevidence.org/ Social programs that work It offers information on twelve types of social programs including education. A variety of other organizations offer information on research and education.

References

External links

* {{DEFAULTSORT:Evidence-Based Practice Health care quality Scientific method

History

Medicine

Education

Versus tradition

Evaluating evidence

Applications

Medicine

Mental health

Metascience

Education

Reviews of existing research on education

See also

References

External links