EVIDENCE-BASED MEDICINE
How to Practice & Teach EBM, 2nd Edition
David L. Sackett, Sharon E. Straus,
W. Scott Richardson,
William Rosenberg, R. Brian Haynes
Churchill Livingstone 2000
Edinburgh, London, New York, Philadelphia, St. Louis, Sydney, Toronto
ISBN 0 443 06240 4
Reviewed by Barry Goldlist
This is a new edition of the classic text on evidence-based medicine, first published in 1997 by Sackett and his colleagues. The question for the prudent (i.e. penny wise) physician is this: should I buy this book if I already own the wonderful first edition? To answer this question I pulled my first edition off the shelf, and started comparing. My first edition is from the United Kingdom, so results of your own comparison test might vary slightly.
The new edition is wider, but is not as thick as its predecessor. This results in much better "page appeal" with a less cluttered look. Despite this, it still fits easily into a standard lab coat pocket, an important point for trainees in particular. A new author has also been added, Sharon E. Straus, a Canadian Geriatrician and expert on evidence-based medicine. The "cheat" cards tucked into a slot on the back cover are organized in a more logical manner than they were in the first edition, and are larger and more legible and of better quality. Some cards have been much improved and have even been expanded to two cards. New cards on "Screening and Case-finding" and "Useful URLs on the Internet" have been added. The one quibble with the cards is that the chart of the likelihood ratio nomogram is much smaller than the chart in the earlier edition, and is the only card in the new edition which is harder to read than its predecessor.
The new edition has a CD-ROM tucked into the front cover. The entire contents of the book are contained on the CD-ROM, which is very easy to set up and use. As well, it has clinical examples, critical appraisals, and background papers from 14 other health disciplines. The section on EBM in Geriatrics is written by Dr. Straus and, as expected, is superb. As well, the CD-ROM has extended descriptions and sample web pages of many of the current evidence sources regularly consulted by the authors. The book even has a website (www.library.utoronto.ca/medicine/ebm/>), where updates to the text, links to other evidence-based sites, and communication to the authors can occur. This should suffice until the 3rd edition is published!
However, a text of this kind is likely to be most frequently used in a more traditional manner. I use it to review particular aspects of EBM, or when I am reading an article and want to critically appraise it. For these functions, the cards and the written text are most useful. In this edition the introduction is shorter and, to my view, more positive and effective. The chapters are broken down into more manageable sections (5 in the old text, 9 in the new) and are extensively updated. The section on teaching methods is new and helpful for those in academic medicine, and the section on evaluation is helpful to all physicians.
In summary, an already excellent text has been significantly revised and upgraded. The new edition is easier to read and easier to use. The addition of a CD-ROM is also helpful. You will not regret buying the 2nd edition.
