How to Choose a Resource
You should always use the highest-quality evidence available to answer your clinical question. This Evidence-Based Medicine (EBM) Pyramid helps you decide where to look and how to assess the quality of evidence you have found.
Evidence-Based Medicine is the integration of best research evidence with clinical expertise and patient values. (Sackett DL, Straus SE, Richardson WS, et al. Evidence-based medicine: how to practice and teach EBM. 2nd ed. Edinburgh: Churchill Livingstone, 2000.)
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How to use this model:
This model helps you find the best evidence in a systematic way.
When answering a clinical question, start searching at the top of the pyramid (highest quality evidence).
If you can't find relevant information at the top of the pyramid, work your way down to the next tier. This might happen if your area of investigation is quite niche or quite new.
Read more below about the different levels of evidence, and which SHIRP resources retrieve each level of evidence.
Filtered Information
Filtered resources appraise the quality of studies and often make recommendations for practice.
What is a Systematic Review?
Authors of a systematic review ask a specific clinical question, perform a comprehensive literature search, eliminate poorly done studies, and attempt to make practice recommendations based on the well-done studies. A meta-analysis is a systematic review that combines all the results of the single studies into a single statistical analysis of the results.
SHIRP Resources to find Systematic Reviews:
Cochrane reviews represent the highest level of evidence on which to base clinical treatment decisions. CDSR includes all Cochrane Reviews prepared by Cochrane Review Groups. Each Cochrane Review is a systematic review that has been prepared and supervised by an editorial team. It attempts to identify, appraise and synthesize all the empirical evidence that meets pre-specified eligibility criteria to answer a specific research question.
Learn how to use the Cochrane Library.
This database provides access to more than 24 million records from more than 5500 journals from around the world. Subjects include biomedicine, life sciences, behavioural sciences, chemical sciences, bioengineering, allied-health, as well as humanities and information sciences as they relate to health care and medicine. Content is updated and new titles are added regularly.
Medline includes all kinds of studies. Steps to search Medline for only Systematic Reviews:
This database provides access to more than 3.8 million records from more than 770 journals. Subjects include nursing, biomedicine, consumer health, complementary and alternative medicine, and 17 allied health disciplines (athletic training, chiropractic, occupational therapy, orthotics and prosthetics, physical therapy, recreation therapy, nutrition and dietetics, and more).
CINAHL includes all kinds of studies. Steps to search CINAHL for only Systematic Reviews:
Bibliographic database "providing abstracts and citations to the scholarly literature in the psychological, social, behavioral, and health sciences."
PsycInfo includes all kinds of studies. Steps to search PsycInfo for only Systematic Reviews:
Searching in any of these databases will retrieve articles owned by SHIRP, as well as articles not owned by SHIRP. Learn more about viewing your results.
What is a Critically-Appraised Topic?
Authors of critically-appraised topics evaluate and synthesize multiple research studies.
SHIRP Resources to find Critically-Appraised Topics:
DynaMed Plus is a medical database that provides access to the most current, evidence-based clinical information on thousands of topics and specialties to healthcare professionals. It provides comprehensive coverage and current, relevant clinical updates, bringing vital knowledge to physicians and healthcare professionals at the point of care.
An authoritative source on integrative medicine providing high quality, evidence-based information about complementary and alternative therapies.
Other Sources for Critically-Appraised Topics:
High-quality Clinical Practice Guidelines will offer credible summaries on clinical topics. Find freely available CPGs through these sites.
Clinical Practice Guidelines from the Canadian Medical Association.
A non-profit, independent organization developing guidelines. Free account sign up required.
Evidence-based recommendations developed in the UK by independent committees of professionals, lay people, and other stakeholders.
What are Critically-Appraised Articles?
Authors of critically-appraised individual articles evaluate and synopsize individual research studies.
SHIRP Resources to find Critically-Appraised Articles:
The editors of this journal screen the top 100+ clinical journals and identify studies that are methodologically sound and clinically relevant. An enhanced abstract, with conclusions clearly stated, and a commentary are provided for each selected article. Published by the American College of Physicians-American Society of Internal Medicine.
Providing synopses of systematic reviews and original research.
Providing synopses of systematic reviews and original research.
Providing synopses of systematic reviews and original research.
Unfiltered Information
Evidence is not always available via filtered resources. Searching the primary literature (unfiltered resources) may be required.
Unfiltered Information: RCTs, Cohort Studies, Case-Controlled Studies, Case Series, Reports
Depending on how well-researched your area of inquiry is, there may not always be filtered resources available. Searching the primary literature (the types of studies as listed above) may be required. When searching the primary literature, continue to work from higher up the pyramid to lower down as needed. This will ensure you are finding the highest quality evidence possible for your topic.
SHIRP Resources to find Unfiltered Information/Primary Literature:
This database provides access to more than 24 million records from more than 5500 journals from around the world. Subjects include biomedicine, life sciences, behavioural sciences, chemical sciences, bioengineering, allied-health, as well as humanities and information sciences as they relate to health care and medicine. Content is updated and new titles are added regularly.
Use these comprehensive training videos to learn how to search MEDLINE. You can also learn advanced techniques here.
This database provides access to more than 3.8 million records from more than 770 journals. Subjects include nursing, biomedicine, consumer health, complementary and alternative medicine, and 17 allied health disciplines (athletic training, chiropractic, occupational therapy, orthotics and prosthetics, physical therapy, recreation therapy, nutrition and dietetics, and more).
Learn how to use CINAHL to find research articles.
Bibliographic database "providing abstracts and citations to the scholarly literature in the psychological, social, behavioral, and health sciences."
Searching in any of these databases will retrieve articles owned by SHIRP, as well as articles not owned by SHIRP. Learn more about viewing your results.
Background Information/Expert Opinion
This category includes resources like textbooks, other books, and editorials. Evidence in these resources may vary from expert opinion to high levels of evidence, so you will need to assess the quality of the resource you have chosen in this category.
SHIRP resources to find Background Information/Expert Opinion:
A collection of more than 60 core medical titles with the latest updated content, thousands of images and illustrations, interactive self-assessment, case files, diagnostic tools, a comprehensive search platform, and the ability to download content to a mobile device.
A full text, cross-searchable database of 17 medical, pharmaceutical, and dental reference titles from authoritative publishers for coverage of medical and pharmaceutical information, including diagnosis, treatment, drug interaction and use.
A collection of electronic books covering the health sciences, including medicine, nursing and pharmacology, from a variety of publishers and years.
Filtered vs. Unfiltered Information
The higher levels of evidence on the EBM Pyramid are filtered information. This means the evidence has already been evaluated for quality, and these resources often make recommendations for practice. When possible, use filtered resources.
TRIP searches all levels of evidence at the same time. It clearly categorizes evidence so quality is easy to assess. TRIP is free for anyone to use and does not require a SHIRP account.