Understanding Evidence-Based Medicine as a Medical Assistant

Evidence-based medicine (EBM) is the application of scientifically sound research to clinical practice to help guide decision-making when caring for patients.¹ Applying EBM when providing medical care is associated with enhanced patient outcomes, such as improved disease prognosis, reduced risk of death or other adverse events, and an overall better understanding of the implications of new technologies and clinical workflows.

It is outside the Medical Assistant’s scope to independently make patient care decisions; however, Medical Assistants are still regularly impacted by changes brought on by discoveries in evidence-based medicine, such as the introduction of new medical devices/ medications or a new standardized process in the medical office that has been proven to be effective elsewhere. Patients may also present published scientific research supporting or rejecting treatment options for their diagnoses. In these situations, Medical Assistants should defer to their provider; however, they should be familiar with scientific research to have a competent discussion about the validity of the research presented. In addition, given the volume of misinformation in the media, it is important that Medical Assistants can effectively digest the information presented by news outlets and draw accurate conclusions. 

Types of Research 

Research is characterized based on the design of the study and the methods of data collection. There are three main categories of research that Medical Assistants should be aware of. Experimental studies include research methodologies that assign participants to an intervention or exposure. Randomized control trials (RCTs) are the primary form of experimental studies in medical literature. During a randomized control trial, study investigators randomly assign participants to one treatment or another and follow the participants to determine differences in outcomes between groups. 

In contrast, during observational studies, researchers will observe the natural disease processes that occur in a population without a planned intervention. Cohort, case-control, cross-sectional, and case studies are all forms of observational research used in medicine. Although still informative, observational trials typically provide a lower level of evidence than experimental studies. After multiple studies, investigators have researched a similar topic, and the individual studies can be synthesized in a review. A systematic review involves using a reproducible procedure to search research databases for all relevant articles and compare the results in text. A step up from a systematic review is a meta-analysis, which employs similar methods but uses statistical analyses to combine all the individual study results into a single-point estimate. Meta-analyses provide a high level of evidence and often drive clinical changes. 

Bias

Bias is a systematic error in research that leads to a deviation from the truth.¹ Bias can occur at any point in a research study, including the design phase, recruitment, data collection, analysis, and/or during the interpretation of results. Internal validity measures how accurately the study reflects the truth (which is usually unknown) in the study population. When evaluating the internal validity of a study, the two groups being compared must be similar at baseline (typically, you can see this in Table 1 of research articles). For example, a cohort study may compare the risk of death in patients who received chemotherapy before surgery to patients who received chemotherapy after surgery. When recruiting participants, the study investigators noticed that the patients in the chemotherapy after-surgery group were sicker at baseline and then concluded that receiving chemotherapy after surgery increases a patient’s risk of death. These results are biased as the investigators were comparing apples to oranges. The investigators should mention adjusting the results to reduce the risk of bias in this scenario. External validity measures how applicable the results are in other populations, also known as generalizability. Before incorporating research into your clinical practice or workflows, it is important to check if the study participants are similar to those you see at your clinic or if the research is conducted in a similar setting. If not, the research may not be applicable. 

Understanding the Results

Perhaps the most important part of research for Medical Assistants to understand is how to interpret the researcher’s results. Graphs and tables are often used to visualize data trends in research and news articles as they offer a quick way for readers to review large quantities of data. Unfortunately, it is easy to manipulate figures to tell the story that the author wants, not what is always the truth.  When reviewing figures, make sure to look at the axis, titles, and the type of graph being presented. If the results seem unexpected, take a minute to read through the article to better understand what the researchers did. 

 

References:

Evidence-based Medicine. UpToDate. (2023, April 27). https://www.uptodate.com/contents/evidence-based-medicine