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Evidence-based practice

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Evidence-based practice

Evidence-based practice is the idea that occupational practices ought to be based on scientific evidence. 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 The goal of evidence-based practice is to eliminate unsound or outdated practices in favor of more-effective ones by shifting the basis for decision making from tradition, intuition, and unsystematic experience to firmly grounded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 introduction of evidence-based medicine and have spread to the allied health professions, education, management, law, public policy, architecture, and other fields. In light of studies showing problems in scientific research (such as the replication crisis), 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.

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.

For most of history, professions have based their practices on expertise derived from experience passed down in the form of tradition. Many of these practices have not been justified by evidence, which has sometimes enabled quackery 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 has become increasingly recognized as a sound means to evaluate practices, evidence-based practices have become increasingly adopted.

One of the earliest proponents of evidence-based practice was Archie Cochrane, an epidemiologist 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 "evidence-based medicine" was introduced by Gordon Guyatt 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, and studying the effectiveness of modern and accepted treatments. There has been a push for evidence-based practices in medicine by insurance 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.

More recently, there has been a push for evidence-based education. The use of evidence-based learning techniques such as spaced repetition can improve students' rate of learning. Some commentators[who?] 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.

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

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