Evidence-based practice (EBP) 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 ...

. While seemingly obviously desirable, 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". The aim of EBM is to integrate the experience of the clinician, the values of t ...

in 1992 and have spread to the

allied health professions Allied health professions are health care professions distinct from optometry, dentistry, nursing, medicine, and pharmacy. They provide a range of diagnostic, technical, therapeutic, and support services in connection with health care. Definitio ...

education Education is a purposeful activity directed at achieving certain aims, such as transmitting knowledge or fostering skills and character traits. These aims may include the development of understanding, rationality, kindness, and honesty. Va ...

management Management (or managing) is the administration of an organization, whether it is a business, a nonprofit organization, or a government body. It is the art and science of managing resources of the business. Management includes the activities o ...

law Law is a set of rules that are created and are enforceable by social or governmental institutions to regulate behavior,Robertson, ''Crimes against humanity'', 90. with its precise definition a matter of longstanding debate. It has been vario ...

public policy Public policy is an institutionalized proposal or a decided set of elements like laws, regulations, guidelines, and actions to solve or address relevant and real-world problems, guided by a conception and often implemented by programs. Public p ...

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 constructing building ...

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

replication crisis The replication crisis (also called the replicability crisis and the reproducibility crisis) is an ongoing methodological crisis in which the results of many scientific studies are difficult or impossible to reproduce. Because the reproducibili ...

), 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''" ...

. 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.

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 belief or behavior (folk custom) passed down within a group or society with symbolic meaning or special significance with origins in the past. A component of cultural expressions and folklore, common examples include holidays or ...

. 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 ignorant medical practices. A quack is a "fraudulent or ignorant pretender to medical skill" or "a person who pretends, professionally or publicly, to have skill, ...

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

scientific method The scientific method is an empirical method for acquiring knowledge that has characterized the development of science since at least the 17th century (with notable practitioners in previous centuries; see the article history of scientific m ...

has become increasingly recognized as a sound means to evaluate practices, evidence-based practices have become increasingly adopted. One of the earliest proponents of EBP was

Archie Cochrane Archibald Leman Cochrane (12 January 1909 – 18 June 1988) was a Scottish doctor noted for his book ''Effectiveness and Efficiency: Random Reflections on Health Services''. This book advocated the use of randomized control trials to make med ...

, 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. It is a cornerstone of public health, and shapes policy decisions and evidenc ...

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 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 t ...

s. The term "

" was introduced by

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

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) is the 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 other bodily flu ...

, 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 hedge ...

providers, which have sometimes refused coverage of practices lacking in 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. More recently, there has been a push for

evidence-based education Evidence-based education (EBE) is the principle that education practices should be based on the best available scientific evidence, rather than tradition, personal judgement, or other influences. Evidence-based education is related to evidence-bas ...

. The use of

evidence-based learning Evidence-based education (EBE) is the principle that education practices should be based on the best available scientific evidence, rather than tradition, personal judgement, or other influences. Evidence-based education is related to evidence-base ...

techniques such as

spaced repetition Spaced repetition is an evidence-based learning technique that is usually performed with flashcards. Newly introduced and more difficult flashcards are shown more frequently, while older and less difficult flashcards are shown less frequently i ...

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 inline with a school of thought suggesting that EBP 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 to 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 EBP 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 by greatly simplified with the use of a

heuristic A heuristic (; ), or heuristic technique, is any approach to problem solving or self-discovery that employs a practical method that is not guaranteed to be optimal, perfect, or rational, but is nevertheless sufficient for reaching an immediate, ...

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

hierarchy of evidence A hierarchy of evidence (or levels of evidence) is a heuristic used to rank the relative strength of results obtained from scientific research. There is broad agreement on the relative strength of large-scale, epidemiological studies. More than 80 ...

. 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 Literature review, 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 publ ...

s and

meta-analysis A meta-analysis is a statistical analysis that combines the results of multiple scientific studies. Meta-analyses can be performed when there are multiple scientific studies addressing the same question, with each individual study reporting me ...

rank at the top of the hierarchy while randomized controlled trials rank above

observational studies In fields such as epidemiology, social sciences, psychology and statistics, an observational study draws inferences from a sample (statistics), sample to a statistical population, population where the dependent and independent variables, independ ...

, and

expert opinion An expert witness, particularly in common law countries such as the United Kingdom, Australia, and the United States, is a person whose opinion by virtue of education, training, certification, skills or experience, is accepted by the judge a ...

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 occurrence ...

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 this proposition. It is usually understood as an indication that the supported proposition is true. What role evidence plays and how it is conceived varies from field to field. In epistemology, evidenc ...

Applications

Medicine

Evidence-based medicine (EBM) 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 "creativity, 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 att ...

. Although all medicine based on

science Science is a systematic endeavor that builds and organizes knowledge in the form of testable explanations and predictions about the universe. Science may be as old as the human species, and some of the earliest archeological evidence for ...

has some degree of

empirical Empirical evidence for a proposition is evidence, i.e. what supports or counters this proposition, that is constituted by or accessible to sense experience or experimental procedure. Empirical evidence is of central importance to the sciences and ...

support, EBM goes further, classifying evidence by its

epistemologic Epistemology (; ), or the theory of knowledge, is the branch of philosophy concerned with knowledge. Epistemology is considered a major subfield of philosophy, along with other major subfields such as ethics, logic, and metaphysics. Episte ...

strength and requiring that only the strongest types (coming from

meta-analyses A meta-analysis is a statistical analysis that combines the results of multiple scientific studies. Meta-analyses can be performed when there are multiple scientific studies addressing the same question, with each individual study reporting me ...

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 te ...

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 assure 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 or as a researcher. A clinician may diagnose, treat, and otherwise care for pa ...

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

scientific literature : ''For a broader class of literature, see Academic publishing.'' Scientific literature comprises scholarly publications that report original empirical and theoretical work in the natural and social sciences. Within an academic field, scient ...

so that

best practice A best practice is a method or technique that has been generally accepted as superior to other known alternatives because it often produces results that are superior to those achieved by other means or because it has become a standard way of doing ...

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 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 largest scientific and professional organization of psychologists in the United States, with over 133,000 members, including scientists, educators, clinicians, consultants, and students. It ha ...

) 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 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 "creativity, 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 att ...

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, also known as 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 in a ...

evaluation Evaluation is a systematic determination and assessment of a subject's merit, worth and significance, using criteria governed by a set of standards. It can assist an organization, program, design, project or any other intervention or initiative ...

, 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 David Hargreaves FAcSS (born 1939) was educated at Bolton School and Christ’s College, Cambridge. He was Associate Director for Development and Research of the Specialist Schools and Academies Trust (SSAT). He is a Fellow Emeritus of Wolfson Colle ...

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 USA have supported the use of research to improve educational practices in teaching reading. In 1997, the

National Institute of Child Health and Human Development The ''Eunice Kennedy Shriver'' National Institute of Child Health and Human Development (NICHD) is one of the National Institutes of Health (NIH) in the United States Department of Health and Human Services. It supports and conducts research aime ...

(NICHD) convened a national panel to assess the effectiveness of different approaches used to teach children to read. The resulting

National Reading Panel The National Reading Panel (NRP) was a United States government body. Formed in 1997 at the request of Congress, it was a national panel with the stated aim of assessing the effectiveness of different approaches used to teach children to read. ...

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-yea ...

(PISA) in 2000 and the

Progress in International Reading Literacy Study The IEA's Progress in International Reading Literacy Study (PIRLS) is an international study of reading (comprehension) achievement in fourth graders. It has been conducted every five years since 2001 by the International Association for the Evalu ...

(PIRLS) in 2001. Subsequently, evidence-based practice (EBP) in education (also known as

Scientifically based research Evidence-based education (EBE) is the principle that education practices should be based on the best available scientific evidence, rather than tradition, personal judgement, or other influences. Evidence-based education is related to evidence-base ...

), came into prominence in the U.S.A. under the

No child left behind act The No Child Left Behind Act of 2001 (NCLB) was a U.S. Act of Congress that reauthorized the Elementary and Secondary Education Act; it included Title I provisions applying to disadvantaged students. It supported standards-based education ...

of 2001, replace in 2015 by the

Every Student Succeeds Act The Every Student Succeeds Act (ESSA) is a US law passed in December 2015 that governs the United States K–12 public education policy. The law replaced its predecessor, the No Child Left Behind Act (NCLB), and modified but did not eliminate pr ...

(ESSA). In 2002 the

U.S. Department of Education The United States Department of Education is a Cabinet-level department of the United States government. It began operating on May 4, 1980, having been created after the Department of Health, Education, and Welfare was split into the Department ...

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 practice ...

(IES) to provide scientific evidence to guide education practice and policy . English author

Ben Goldacre Ben Michael Goldacre (born 20 May 1974) is a British physician, academic and science writer. He is the first Bennett Professor of Evidence-Based Medicine and director of the Bennett Institute for Applied Data Science at the University of Oxford ...

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 organisation which gathers evidence and research to inform educational policy and school services. The foundation is not an examination board, however they provi ...

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

British Educational Research Association The British Educational Research Association (BERA) is a member-led charity to encourage educational research and its application for the improvement of practice and public benefit. It is an association promoting a researching culture within the ...

(BERA) and the

Royal Society of Arts The Royal Society for the Encouragement of Arts, Manufactures and Commerce (RSA), also known as the Royal Society of Arts, is a London-based organisation committed to finding practical solutions to social challenges. The RSA acronym is used m ...

(RSA) 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'' (BEE) is a free website created by the

Johns Hopkins University Johns Hopkins University (Johns Hopkins, Hopkins, or JHU) is a private university, private research university in Baltimore, Maryland. Founded in 1876, Johns Hopkins is the oldest research university in the United States and in the western hem ...

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 American English expression that indicates the range of years of publicly supported primary and secondary education found in the United States, which is similar to publicly supported school grade ...

. The reviews cover programs in areas such as ''Mathematics, Reading, Writing, Science, Comprehensive school reform, and Early childhood Education''; and includes such topics as ''effectiveness of technology and struggling readers''. * ''The Education Endowment Foundation'' was established in 2011 by The Sutton Trust, as a lead charity in partnership with Impetus Trust, together being the government-designated What Works Centre for UK Education. * ''Evidence for ESSA'' began in 2017 and is produced by the Center for Research and Reform in Education (CRRE) at

Johns Hopkins University School of Education The Johns Hopkins School of Education is one of nine academic divisions of the Johns Hopkins University. Established as a separate school in 2007, its origins can be traced back to the 1909 founding of Johns Hopkins’ College Courses for Teacher ...

. 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

(ESSA) (the United States K–12 public education policy signed by President Obama in 2015).. It also provides information on programs that do meet ESSA standards as well as those that do not. * ''What Works Clearinghouse'' (WWC), 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 (NCEE), part of

(IES) * ''Social programs that work'' is administered by the

Arnold Ventures LLC Arnold Ventures LLC (formerly known as The Laura and John Arnold Foundation) is focused on evidence-based giving in a wide range of categories including: criminal justice, education, health care, and public finance. The organization was founded by ...

'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