EBM notebook Practice corner: setting EBM in motion

In addition to time pressures that we encounter when searching for evidence to support care decisions for individual patients, it may be difficult for clinicians to apply the evidence that we find. The rate limiting step may not be doing the search, but the steps needed in “setting evidence-based medicine (EBM) in motion.” We present an example of a search for evidence by a Physician Assistant (PA) student that highlights this challenge. PAs receive accelerated training in the medical model and work in teams under physician supervision. Approximately 40 000 PAs currently work in the US in a wide range of settings and specialties. Practising EBM has become an important component of training for PAs. During an internal medicine rotation, a PA student encountered a common clinical practice unsupported by current evidence—administration of nebulised albuterol in patients with community acquired pneumonia (CAP).While this practice may be justified in patients with underlying chronic obstructive pulmonary disease (COPD) who also present with CAP, this student questioned the grounds for its use in patients with CAP who do not have COPD.