Teaching evidence-based principles in Rheumatology

Evidence-based medicine (EBM) integrates the best available evidence with clinical expertise and patients’ values and preferences to support high-quality, patient-centered care. While early EBM education emphasized critical appraisal of primary studies, it has progressively shifted toward a pragmatic approach that prioritizes the use of evidence summaries to enable timely, informed clinical decisions. Accordingly, EBM training may benefit from an emphasis on developing skills related to interpreting effect sizes, appreciating the certainty of the evidence, understanding the strength of recommendations, and applying research findings in clinical contexts through shared decision-making. This evolution reflects the realities of contemporary healthcare, in which time constraints and the exponential growth of the medical literature limit the feasibility of relying on individual studies for routine clinical decision-making. In Rheumatology, these competencies are particularly important for selecting synthetic or biologic disease-modifying antirheumatic drugs or targeted therapies, and for diagnostic decisions involving classification criteria, imaging, and biomarkers, where the certainty of evidence often varies. Moreover, rheumatology practice relies heavily on clinical practice guidelines that frequently issue conditional recommendations, underscoring the need to contextualize evidence in light of patient preferences, comorbidities, and treatment burden.