EVIDENCE-BASED CRITICAL CARE MEDICINE - A POTENTIAL TOOL FOR CHANGE

This issue of New Horizons is about change. While our traditional appr enticeship model of physician training has served us well, adaptation is required for the new millennium. Among several sectoral trends in m edicine, two are particularly relevant for intensivists: a) the inform ation explosion and b) increased accountability to society regarding e ffective, efficient, compassionate, and culturally sensitive care. Evi dence-based medicine (EBM) (or any other single initiative, for that m atter) is not going to address all of tomorrow's challenges. However, EBM does help by enhancing clinical informatics and critical appraisal skills so that clinicians are better able to keep up with the growing literature, and decide whether, and if so, this literature applies to individual patients. In addition, EBM can help to highlight the deter minants of clinical decisions, which may include contributions of care giver knowledge, patient pathophysiology, research evidence, patient a nd societal values, and increasingly, costs. While EBM is best practic ed at the individual level, its application to other aspects of health care is growing.