Toward a Transdisciplinary Model of Evidence-Based Practice

Division of General Internal Medicine, University of California, 400 Parnassus Ave, A-405, San Francisco, CA 94143-0320, USA.
Milbank Quarterly (Impact Factor: 3.38). 07/2009; 87(2):368-90. DOI: 10.1111/j.1468-0009.2009.00561.x
Source: PubMed


This article describes the historical context and current developments in evidence-based practice (EBP) for medicine, nursing, psychology, social work, and public health, as well as the evolution of the seminal "three circles" model of evidence-based medicine, highlighting changes in EBP content, processes, and philosophies across disciplines.
The core issues and challenges in EBP are identified by comparing and contrasting EBP models across various health disciplines. Then a unified, transdisciplinary EBP model is presented, drawing on the strengths and compensating for the weaknesses of each discipline.
Common challenges across disciplines include (1) how "evidence" should be defined and comparatively weighted; (2) how and when the patient's and/or other contextual factors should enter the clinical decision-making process; (3) the definition and role of the "expert"; and (4) what other variables should be considered when selecting an evidence-based practice, such as age, social class, community resources, and local expertise.
A unified, transdisciplinary EBP model would address historical shortcomings by redefining the contents of each model circle, clarifying the practitioner's expertise and competencies, emphasizing shared decision making, and adding both environmental and organizational contexts. Implications for academia, practice, and policy also are discussed.

Download full-text


Available from: Edward Mullen,
  • Source
    • "Key concepts and principles from evidence-based medicine have had a substantial influence on related professions, but also in fields far beyond their medical origins (Satterfield et al. 2009). However, the labeling of the concept differs. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Against the backdrop of the transformations in the entire framing of professional work, social work has come under close scrutiny in many countries, including Sweden. Doubts have been raised about practitioners’ existing know­ ledge base, and the importance of practitioners engaging in learning and the renewal and extension of professional capacities has been emphasized. The present thesis concerns knowledge use and learning in the daily practices of child investigation work. The aim is to explore processes of knowledge use and learning in practice. The study is based on a mix of qualitative approaches, basic­ ally from ethnography, comprising methods such as participant observations, interviews, reflective dialogues and documentary analysis of case data. The main findings demonstrate that investigation work is characterized mainly by the use of practice­based knowledge. Research­based knowledge is predominantly used as a means of explaining a client’s situation or to underpin and legitimize one’s own beliefs and decisions made on other grounds. Profes­ sional learning is largely adaptive in character, as the social workers learn to handle tasks in a fairly routinized way on the basis of rules or procedures that draw on existing knowledge in the practice setting. Two conclusions are drawn: First, the use of knowledge in child investigation work bears little resemblance to principles of evidence­based practice. Second, the reproduction of professional knowledge is largely implicit and taken for granted. The study offers insight into the much­discussed topic of putting knowledge into practice, which is of importance to strategies for organizing professional learning and knowledgeable practice.
    06/2015, Degree: Doctoral, Supervisor: Per-Erik Ellström, Per Nilsen
  • Source
    • "o , because practitioners often do not embrace the scientific process , they do not use much of our published evidence ( Giluk & Rynes , 2012 ) . Although EBMgt does not solely depend on trustworthy scientific evidence , such evidence is an integral and funda - mental part of it ( Briner et al . , 2009 ; Pfeffer & Sutton , 2006 ; Rousseau , 2006 ; Satterfield et al . , 2009 ) . We note that some of our recommendations may not adequately address all potential threats to the trustworthiness of our cumulative knowl - edge and ensure that EBMgt continues to grow and be successful . Our recommendations require changes in the way we teach and conduct re - search . There are costs to many of our suggestions , but"
    [Show abstract] [Hide abstract]
    ABSTRACT: The promise of evidence-based management (EBMgt) is that educators and practitioners can access cumulative scientific information to guide their teaching and decision making. We argue that the EBMgt movement may be unable to live up to this promise to the extent that our cumulative scientific knowledge is not trustworthy. We review why the management discipline may not have trustworthy evidence and how this widens the divide among educators, practitioners, and researchers. Next, we review the implications of untrustworthy cumulative knowledge, focusing on how educators can critically assess evidence and teach this process in the classroom. We close with recommendations for improving the trustworthiness of our literature to enhance teaching and practice from an evidence-based perspective. Suggestions include increasing the reproducibility and replication of primary studies, changing the editorial review process, and focusing on the production and dissemination of practically relevant and actionable knowledge.
    Academy of Management Learning and Education, The 09/2014; 13(3):446-466. DOI:10.5465/amle.2013.0193 · 4.80 Impact Factor
  • Source
    • "This is a well-recognised issue with unidirectional analyses of behaviour (Bandura 1978; Hineline 1980). Evidence-based practice has become a key concept for clinicians (Satterfield et al. 2009), and the development of comparative models by PCORI (the "
    [Show abstract] [Hide abstract]
    ABSTRACT: Humans possess great capacity for behavioral and cultural change, but our ability to manage change is still limited. This article has two major objectives: first, to sketch a basic science of intentional change centered on evolution; second, to provide examples of intentional behavioral and cultural change from the applied behavioral sciences, which are largely unknown to the basic sciences community. All species have evolved mechanisms of phenotypic plasticity that enable them to respond adaptively to their environments. Some mechanisms of phenotypic plasticity count as evolutionary processes in their own right. The human capacity for symbolic thought provides an inheritance system having the same kind of combinatorial diversity as does genetic recombination and antibody formation. Taking these propositions seriously allows an integration of major traditions within the basic behavioral sciences, such as behaviorism, social constructivism, social psychology, cognitive psychology, and evolutionary psychology, which are often isolated and even conceptualized as opposed to one another. The applied behavioral sciences include well-validated examples of successfully managing behavioral and cultural change at scales ranging from individuals to small groups to large populations. However, these examples are largely unknown beyond their disciplinary boundaries, for lack of a unifying theoretical framework. Viewed from an evolutionary perspective, they are examples of managing evolved mechanisms of phenotypic plasticity, including open-ended processes of variation and selection. Once the many branches of the basic and applied behavioral sciences become conceptually unified, we are closer to a science of intentional change than one might think.
    Behavioral and Brain Sciences 08/2014; 37(5):395. DOI:10.1017/S0140525X13001593 · 20.77 Impact Factor
Show more