Evidence-based medicine. A new approach to teaching the practice of medicine.

A new paradigm for medical practice is emerging. Evidence-based medicine de-emphasizes intuition, unsystematic clinical experience, and pathophysiologic rationale as sufficient grounds for clinical decision-making, and stresses the examination of evidence from clinical research. Evidence-based medicine requires new skills of the physician, including efficient literaturesearching, and the application of formal rules of evidence in evaluating the clinical literature. An important goal of our medical residency program is to educate physicians in the practice of evidence-based medicine. Strategies include a weekly formal academic half-day for residents, devoted to learning the necessary skills; recruitment into teaching roles of physicians who practice evidence-based medicine; sharing among faculty of approaches to teaching evidence-based medicine; and providing faculty with feedback on their performance as role -models and teachers of evidence-based medicine. The influence of evidence-based medicine on clinical practice and medical education is increasing. Introduction A junior medical resident working in a teaching hospital admits a 43 year old previously well man who experienced a witnessed grand mal seizure. He had never had a seizure before and had not had any recent head trauma. He drank alcohol once or twice a week and had not had alcohol on the day of the seizure. Physical examination is negative. The patient is given an loading dose of phenytoin intravenously and the drug is continued orally. A computed tomographic head scan is completely normal and an electroencephalogram shows only nonspecific findings. The patient is very concerned about his risk of seizure recurrence. How might she proceed?