Open Access Open Access  Restricted Access Subscription or Fee Access

The Roadmap: a blueprint for evidence literacy within a Scientifically Informed Medical Practice and LEarning model

Suzana Alves Silva, Peter Wyer


Background: A model of clinical practice that encompasses clinical relationships and choices as well as the use of clinical research has yet to be elaborated. We sought a model for Scientifically Informed Medical Practice and Learning (SIMPLE) through integrating concepts borrowed from narrative medicine with the results of a competency-based assessment project.

Methods: The SIMPLE model started by subordinating the cognitive skills within an information literacy model (‘ask’, ‘acquire’, ‘appraise’ and ‘apply’) to the content of clinical actions (‘therapy’, ‘diagnosis’, ‘prognosis’ and ‘harm’).  This enabled a description of problem delineation. The content of these components was developed through an iterative, reflexive approach, elaborating distinctions across all action domains. This led to the “Road Map” component of the model. Clinical action domains were defined within a relational construct.

Results: We defined 3 sub-categories of Problem (utility, performance and likelihood) leading to shared Actions, Choices and Targets (PACT) within the SIMPLE model as a bridge between relational and information literacy fields. The enabling skill ‘ask’ and the “Patients, Interventions, Comparisons, Outcomes” (PICO) format, was applied uniformly across these categories. ‘Acquire’ was elaborated using a 3-S format (Summaries, Syntheses, Single studies) that links study designs to electronic sources (published synopses, filtered databases and large bibliographical databases). ‘Appraise’ involved evaluation of design-specific susceptibility to error and of importance of the results classified as measures of frequency, effect, impact and precision. Finally, ‘apply’ included assessment of directness of evidence, contextual issues and overall benefits versus risks. Translation of knowledge into action involved constructed priorities and preferences within the relational field.

Conclusion: The Road Map enables linkage of a broad range of patient and practitioner concerns related to clinical action to a comparably broad spectrum of contemporary clinical research. It may usefully guide curricular and instructional approaches. Empirical validation in improving learning outcomes is required.

Full Text:



Guyatt, G.H. (1991). Evidence-Based Medicine (editorial) American College of Physicians Journal Club. Annals of Internal Medicine 114 (Supplement 2) A-16.

Evidence-Based Medicine Working Group. (1992). Evidence-based medicine: A new approach to teaching the practice of medicine. Journal of the American Medical Association 268 (17) 2420-2425.

Haynes, R.B., McKibbon, K.A., Walker, C.J., Mousseau, J., Baker, L.M., Fitzgerald, D., Guyatt, G. & Norman, G.R. (1985). Computer searching of the medical literature. An evaluation of MEDLINE searching systems. Annals of Internal Medicine 103 (5) 812-816.

Feinstein, A.R. (1968). Clinical epidemiology I. The populational experiments of nature and of main in human illness. Annals of Internal Medicine 69, 807-820.

Sackett, D. (1981). How to read clinical journals: I. Why to read them and how to start reading them critically. Canadian Medical Association Journal 124, 555–558.

Feinstein, A.R. & Horwitz, R.I. (1997). Problems in the “Evidence” of “Evidence-based Medicine” American Journal of Medicine 103, 529-535.

Wyer, P.C. & Silva, S.A. (2009). Where Is The Wisdom: I. A Conceptual History of Evidence Based Medicine. Journal of Evaluation in Clinical Practice 15, 891-898.

Sestini, P. (2010). Epistemology and ethics of evidence-based medicine: putting goal-setting in the right place. Journal of Evaluation in Clinical Practice 16, 301-305.

Dawes, M., Summerskill, W., Glasziou, P., et al. (2005). Sicily statement on evidence-based practice. BMC Medical Education 5 (1) 1.

Kingsley, K.V. & Kingsley, K. (2009). A case study for teaching information literacy skills. BMC Medical Education 9, 7.

Presidential Committee on Information Literacy. Final Report. 1989. Published Last Modified Date|. Accessed 20 November 2011.

Elwyn, G., Rosenberg, W., Edwards, A., Chatham, W., Jones, K., Matthews, S. & Macbeth, F. (2000). Diaries of evidence-based tutors: beyond `numbers needed to teach'. Journal of Evaluation in Clinical Practice 6, 149-154.

Wyer, P.C., Naqvi, Z., Dayan, P.S., Celentano, J.J., Eskin, B. & Graham, M.J. (2009). Do workshops in evidence-based practice equip participants to identify and answer questions requiring consideration of clinical research? A diagnostic skill assessment. Advances in Health Sciences Education. Theory and Practice 14 (4) 515-533.

Silva, S.A., Charon, R., Wyer, P.C. (2011). The marriage of evidence and narrative: scientific nurturance within clinical practice. Journal of Evaluation in Clinical Practice 17, 585-593.

Chatterji, M., Graham, M.J. & Wyer, P.C. (2009). Mapping Cognitive Overlaps between Practice-Based Learning and Improvement and Evidence-based Medicine: An Operational Definition for Assessing Resident Physician Competence. Journal of Graduate Medical Education 1, 287-298.

Sackett, D.L. & Haynes, R.B. (2002). The architecture of diagnostic research. British Medical Journal 324 (7336) 539-541.

Guyatt, G.H., Oxman, A.D., Vist, G.E., Kunz, R., Falck-Yttery, Y., Alonso-Coello, P., Schünemann, H.J. & GRADE Working Group/ (2008). GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. British Medical Journal 336, 924-926.

Epstein, R.M. & Peters, E. (2009). Beyond Information: Exploring Patient's Preferences. Journal of the American Medical Association 302, 195-197.

Guyatt, G., Cook, D., Devereaux, P.J., Meade, M. & Straus, S. (2002). Therapy. In: Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice. (Guyatt, G. & Rennie, D. eds.) pp. 55-79. Chicago: AMA Press.

Green, R.C., Roberts, J.S., Cupples, L.A., Relkin, N.R., Whitehouse, P.J., Brown, T., Eckert, S.L., Butson, M., Sadovnick, A.D., Quaid, K.A., Chen, C., Cook-Deegan, R., Farrer, L.A. & REVEAL Syudy Group. (2009). Disclosure of APOE Genotype for Risk of Alzheimer’s Disease. New England Journal of Medicine 361, 245-254.

Snyderman, R. & Yoediono, Z. (2008). Prospective Health Care and the Role of Academic Medicine: Lead, Follow, or Get Out of the Way. Academic Medicine 83, 707-714.

Leor, J., Rotstein, Z., Vared, Z., Kaplinsky, E., Truman, S. & Eldar, M. (1994). Absence of tachycardia during tilt test predicts failure of b-blocker therapy in patients with neurocardiogenic syncope. American Heart Journal 127, 1539-1543.

The NINDS t-PA Stroke Study Group. (1997). Intracerebral Hemorrhage After Intravenous t-PA Therapy for Ischemic Stroke. Stroke 28, 2109-2118.

Richardson, W.S., Wilson, M.C., Guyatt, G.H., Cook, D.J. & Nishikawa, J. (1999). Users' guides to the medical literature: XV. How to use an article about disease probability for differential diagnosis. Evidence-Based Medicine Working Group. Journal of the American Medical Association 281 (13) 1214-1219.

Stiell, I.G., Clement, C.M., Perry, J.J., Vallancourt, C., Symington, C., Dickinson, G., Birnie, D. & Green, M.S. (2010). Association of the Ottawa Aggressive Protocol with rapid discharge of emergency department patients with recent-onset atrial fibrillation or flutter. Canadian Journal of Emergency Medicine 12, 181-191.

Eddy, D.M. (1990). Practice policies; Where do they come from? Journal of the American Medical Association 263, 1266-1275.

Chatterji, M. (2003). Designing and Using Tools for Educational Assessment. Boston, MA: Allyn & Bacon.

McKibbon, A. & Wyer, P. (2008). Finding the Evidence. In: Users' Guides to the Medical Literature. (Guyatt, G., Rennie, D., Meade, M.O. & Cook, D.J., eds.) pp. 29-58. New York: McGraw-Hill.

Guyatt, G., Rennie, D., Meade, M.O. & Cook, D.J. (2008). Users' Guides to the Medical Literature: A Manual for Evidence Based Clinical Practice. 2nd edn. New York: McGraw-Hill.

Richardson, W.S., Wilson, M.C., Keitz, S.A. & Wyer, P.C. (2008). Tips for teachers of evidence-based medicine: making sense of diagnostic test results using likelihood ratios. Journal of General Internal Medicine 23 (1) 87-92.

Porter, M.E. (2010). What is value in health care? New England Journal of Medicine 366, 2477-2481.

Chou, R., Aronson, N., Atkins, D., Ismaila, A.L., Santaguida, P., Smith, D.H., Whitlock, E., Wilt, T.J. & Moher, D. (2010). AHRQ Series Paper 4: Assessing harms when comparing medical interventions: AHRQ and the Effective Health-Care Program. Journal of Clinical Epidemiology 63, 502-512.

Goyal, R.K., Charon, R., Lekas, H., Fullilove, M.T., Devlin, M.J., Falzon, L. & Wyer, P.C. (2008). ‘A local habitation and a name’: how narrative evidence-based medicine transforms the translational research paradigm. Journal of Evaluation in Clinical Practice 14, 732-741.

Letelier, L.M., Udal, K., Ena, J., Weaver, B. & Guyatt, G.H. (2003). Effectiveness of Amiodarone for Conversion of Atrial Fibrillation to Sinus Rhythm. Archives of Internal Medicine 163, 777-785.

Nichol, G., McAlister, F., Pham, B., Laupacis, A., Shea, B., Green, M., Tang, A. & Wells, G. (2002). Meta-analysis of randomised controlled trials of the effectiveness of antiarrhythmic agents at promoting sinus rhythm in patients with atrial fibrillation. Heart 87, 535-543.

Keogh, C., Wallace, E., Dillon, C., Dimitrov, B.D. & Fahey, T. (2011). Validation of the CHADS2 clinical prediction rule to predict ischaemic stroke: A systematic review and meta-analysis. Journal of Thrombosis and Haemostasis 106 (3) 528-538.

Ortiz, M.R., Romo, E., Mesa, D., Delgado, M., Anquita, M., Castillo, J.C., Arizón. J.M. & Suárez De Lezo, J. (2010). Oral Anticoagulation in Nonvalvular Atrial Fibrillation in Clinical Practice: Impact of CHADS 2 Score on Outcome. Cardiology 115, 200-204.

Charles, C., Gafni, A. & Freeman, E. (2011). The evidence-based medicine model of clinical practice: scientific teaching or belief-based preaching? Journal of Evaluation in Clinical Practice 17 (4) 597-605.

Guyatt, G.H., Oxman, A., Kunz, R., Woodcock, J., Brozek, J., Helfand, M., Alonso-Coello, P., Falck_Ytter, Y., Jaeschke, R., Vist G., Akl, E.A., Post, P.N., Norris, S., Meerpohl, J., Shukla, V.K., Nasser, M., Schünemann, H.J. & GRADE Working Group. (2011). GRADE guidelines: 8. Rating the quality of evidence: indirectness. Journal of Clinical Epidemiology 64 (12) 1303-1310.

Guyatt, G.H., Oxman, A.D., Kunz, R., Vist, G.E., Falck-Ytter, Y. & Schünemann, H.J. & GRADE Working Group. (2008). What is "quality of evidence" and why is it important to clinicians? British Medical Journal 336 (7651) 995-998.

Eddy, D.M. (2005). Evidence-based medicine: A unified approach. Health Affairs 24, 9-17.

Sox, H.C. (2009). Comparative effectiveness research: A report from the Institute of Medicine. Annals of Internal Medicine 151, 203-205.

Freire, P. (1974). Education for Critical Consciousness. New York: Continuum.

Silva, S.A. & Wyer, P.C. (2009). Where is the wisdom? II – Evidence-based medicine and the epistemological crisis in clinical medicine. Exposition and commentary on Djulbegovic, B., Guyatt, G. H. & Ashcroft, R. E. (2009). Cancer Control 16, 158–168. Journal of Evaluation in Clinical Practice 15, 899-906.

Djulbegovic, B., Guyatt, G.H. & Ashcroft, R.E. (2009). Epistemologic Inquiries in Evidence-Based Medicine. Cancer Control 16, 158-168.

Chatterji, M., Graham, M.J. & Wyer, P.C. (2009). Mapping Cognitive Overlaps Between Practice-Based Learning and Improvement and Evidence-Based Medicine: An Operational Definition for Assessing Resident Physician Competence. Journal of Graduate Medical Education 1, 287-298.

Beach, M.C. & Inui, T. (2006). Relationship-centered Care: A Constructive Reframing. Journal of General Internal Medicine 21 (Suuplement 1) S3-S8.

O'Grady, L. & Jadad, A. (2010). Shifting from shared to collaborative decision making: a change in thinking and doing. Journal of Participatory Medicine 2, e13.

Frankovich, J., Longhurst, C.A. & Sutherland, S.M. (2011). Evidence-Based Medicine in the EMR Era. New England Journal of Medicine 365 (19) 1758-1759.



  • There are currently no refbacks.