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Ideally, EBVM methods should be a core part of veterinary medical training. The habits of identifying specific information needs and then finding and critically evaluating scientific evidence are extremely useful once established, but some formal training and practice are required to develop these habits.

The basic steps in the process of integrating research evidence into clinical decision making are as follows.

1 Ask specific, answerable questions.

2 Locate relevant evidence.

3 Assess the reliability and applicability of this evidence.

4 Draw a conclusion.

5 Assign a level of confidence to this conclusion.

This is an iterative process that must be repeated as information needs change and new evidence becomes available.

Of course, in a busy clinical practice it is not possible to apply such a formal method to every question for every patient in real time. The goal of applied EBVM is to develop a personal knowledge base derived from explicit, critical assessment of scientific evidence which the veterinarian can then apply to individual patients as appropriate, guided by the unique circumstances of each case, the goals and resources of the owner, and the judgment of the clinician. The meaningful difference between this process and opinion‐based medicine is that the knowledge base a clinician uses to make recommendations is not a haphazard collection of information gleaned from sources of uncertain reliability but a set of conclusions with known provenance and a clearly established degree of uncertainty.

Figure 2.1.1 illustrates common types of evidence used to guide clinical decisions. Such evidence pyramids are helpful in establishing a degree of confidence in our conclusions. A recommendation based only on low‐quality evidence at high risk of bias, such as clinical experience or expert opinion, should be qualified, and the inherent uncertainty of the supporting evidence must be disclosed to clients. Recommendations based on more reliable evidence, such as systematic reviews or clinical practice guidelines, can be presented with much greater confidence.

Figure 2.1.1 An evidence pyramid illustrating the variable reliability and risk of bias of different types of scientific evidence.

Clinicians must always use their individual judgment in drawing conclusions from scientific evidence and applying these to specific patients. However, the hierarchy of evidence makes it easier for veterinarians to identify the reliability of specific types of evidence and of conclusions based on this evidence and to then communicate the degree of uncertainty to pet owners.