Cut through the noise: Making EBVM work in everyday practice

Careful scrutiny of research ensures better outcomes for patients. Evidence-based decisions begin with taking the time to examine the facts closely. Photo: Bigstock/Ramann1975 Utilizing evidence-based veterinary medicine (EBVM) practices involves intentionally using the most reliable, accurate, reproducible, validated, and generalizable medical evidence in clinical decision-making. However, in addition to employing and incorporating current evidence, we must also consider clinical experience, a client’s values, and each patient’s circumstances (including signalment, disease/condition, etc.) and client situations (including finances, interpretation of the human-animal bond, available resources, and more). No two cases, as we all know, are exactly alike. In human medicine, evidence-based practices are well established. Because human studies are often higher-powered (larger sample sizes), better funded, and allow patients to report symptoms, concerns, and complaints, and to take an active role in their care, practicing evidence-based medicine may be easier. Veterinary evidence-based practices, while present, may not have been taught to practitioners out in the field for a while, or at all. Thus, evaluating the evidence may be daunting without some guidance.1 Ultimately, evidence-based medicine (EBM) requires veterinarians (and physicians) to incorporate well-formed clinical questions, the best available scientific recommendations and research, and the ability to critically appraise the validity, quality, and generalizability of the available literature, while applying this information to individual cases and assessing response to treatment and care.2 Central to this discourse is the recognition decision-making should not rely on the interpretation or critical analysis of individual studies, but should instead be grounded in a firm grasp of the strengths and weaknesses of the existing body of evidence and the insights gained from synthesizing the research findings.3 Evidence-based practices: Not a novel concept Is EBVM new? Not at all. Evidence-based veterinary practices have been established for more than 20 years. However, the insufficient rigor of a lot of the veterinary scientific research, the inability to utilize the research for various populations, reporting guideline concerns, a lack of sufficient author instructions for publications, and other factors have led to low-quality evidence, conflicting results (when of poor quality), or simply a lack of sufficient data to permit extrapolation to large populations or various species and to the establishment of sound medical guidelines.4 Additionally, the paucity of suitable research on veterinary interventions, funding scarcity, and the high prevalence of observational studies over randomized control trials (RCTs) also contribute to the challenges faced in EBVM. However, veterinary medicine has come a long way in the past 20 years. Improved research methods and reporting in the literature, along with more robust studies, are enhancing our profession’s ability to collate and disseminate cohesive recommendations on numerous key topics in veterinary medicine.5,6 By engaging in evidence-based practices, we improve the care we provide our patients using recommendations and guidelines developed by specialists and those with the expertise to synthesize the evidence. Gone are the days when we simply prescribed something because that was how we had always done it. Instead, it is our responsibility to base our prescribing practices, procedural care, and other medical and surgical applications upon sound, trustworthy medical information. However, most practitioners do not have hours to spend combing through research journals and veterinary literature to determine best practices. Furthermore, no one expects an individual veterinarian to research each drug prescribed, test utilized or recommended surgical procedure. However, by employing resources from reputable sources, such as guidelines and procedural recommendations provided by the American College of Veterinary Internal Medicine (ACVIM), the American Animal Hospital Association (AAHA) the Feline Veterinary Medical Association (FVMA), formerly known as themerican Association of Feline Practitioners), the WSAVA (World Small Animal Veterinary Association (AAFP), and the International Society for Companion Animal Infectious Diseases (ISCAID), veterinarians can remain current on recommendations based on synthesized evidence. Evidence synthesis helps establish industry guidelines Specialists and leaders in the veterinary field develop and update guidelines. They critically appraise the literature and often conduct systematic reviews and meta-analyses to summarize and synthesize the evidence, in the hope that they will ultimately lead to best-practice standards and sound medical recommendations. Additionally, evidence syntheses provide the basis for knowledge translation tools, the development of policy briefs, clinical practice guidelines, and patient decision aids, such as algorithms.7,8 However, recognizing that recommendations change over time means that each veterinarian must remain vigilant for updates and modifications to established standards. Consider One Health issues, such as antimicrobial use guidelines to prevent the development of antimicrobial resistance (AMR) and prevent adverse health outcomes. New recommendations continue to be made as further research improves our understanding of antimicrobial use and its consequences. Another area where new or updated guidelines arise from re-evaluation of the literature and new research includes recommendations on diagnostics, testing, and treatment for infectious and zoonotic diseases, e.g., leptospirosis, rabies, respiratory, and GI parasites. Figure 1: The Most Well-Recognized Current Hierarchy of Scientific Evidence: The Logic of Science. September 3, 2020. One Line Image. Creative Commons. The evidence-based hierarchy: interpreting research Where evidence-based guidelines or practice standards don’t exist, individual veterinarians need to know the quality of individual pieces of evidence and understand study designs. It is easy to say just follow the evidence, but there is a lot more to it than that. One needs to recognize the various types of research and their role in the evidence hierarchy (See Figure 1). Of course, one’s clinical experience has value, but it is among the lowest forms of evidence. Hopefully, recently graduated veterinarians received education in EBM, including the role of statistics, the types of study designs, evaluating a research paper, the power of the study, the role of financial disclosure, and more. However, most clinicians still leave school with little knowledge of evaluating research and interpreting evidence, let alone how to apply that knowledge to formulate EBVM practices cohesively. With any luck, we can start helping change that and build self-efficacy, improving practitioners’ confidence in reading and interpreting the literature.9 The types of research: Study designs Often, a research hypothesis is sparked by a case report or case series. Something unique happens, and we seek to understand it or reproduce the same results. Alternatively, we may test new hypotheses (e.g., a new type of drug). We test out, refine, and formulate a hypothesis using descriptive studies.10 Descriptive studies describe an outcome occurrence. They do not show causal relationships and may describe multiple health outcomes (i.e., results or effects of an implemented intervention). Descriptive studies include case series, ecological studies, cross-sectional studies, and case reports. Once a hypothesis has been carefully honed, testing for confirmation, validation, and generalizability is conducted through various analytical studies. Analytical studies “describe an association between the exposure and an outcome.”11 (See Figure 2, schematic of study designs.) These studies include observational studies—cohort, case-control, case-cross-over, cross-sectional—and analytical experimental studies, including community trials and RCTs, which are the most robust study designs.10-11 Figure 2: Study Design Sequence. Erica Tramuta-Drobnis 2023 Collating and assessing data A thorough examination of the existing body of evidence is the initial measure to mitigate any potential bias from the selective inclusion or exclusion of research. Once we have numerous studies on a specific topic, we want to analytically appraise them individually, compare them to identify commonalities and differences, and synthesize the data into cohesive recommendations, best practices, dos and don’ts, and more. For this, we utilize systematic reviews and meta-analyses. Both systematic reviews and meta-analyses have robust methods for synthesizing evidence with globally established standards. This global standard helps unify the evaluation of evidence and provides a benchmark for assessing its quality. Systematic reviews comprehensively summarize the existing evidence for a research topic. Globally established methods and transparent reporting practices help minimize bias and facilitate the collation of numerous studies under a single umbrella, enabling broader conclusions in favor of or against a given treatment modality, procedure, or other intervention. Systematic reviews provide a synthesis of primary research studies by following a robustly defined set of steps that readers can easily evaluate, thereby helping minimize bias.10,12 While systematic reviews employ broader methodologies, meta-analyses use a specific statistical technique to combine multiple studies for interpretation and evaluation. Data must be readily available and compatible to permit evaluation and pooling. Meta-analyses require the establishment of unbiased and comprehensive data, as provided by a systematic review, to be properly conducted.10,12 These two study types provide a summary of research based on pre-specified eligibility criteria set by the researchers. Their goal is to provide a scientific synthesis of a specific topic, e.g., how to test, interpret, and treat dogs positive for Lyme disease with and without clinical manifestation of disease; staging of cardiac valvular disease in small animal patients; antimicrobial stewardship practices and recommendations for treating common ailments such as diarrhea, respiratory, and urinary tract diseases. The quality of research Veterinary research isn’t inherently of poorer quality than human medicine. However, a higher proportion of poor study design, including inadequate randomization, insufficient sample size, failure to establish clinical relevance (statistical significance alone isn't sufficient), improper or missing a control group(s), failure to blind clients and researchers, and poor reporting of methods and findings, has led to several inadequacies and limitations.13–16 Publication bias (e.g., publishing more positive than negative results), data manipulation, and insufficient or absent peer review further undermine the quality of veterinary research and its presentation. Regardless of the study type —from a single case report to an RCT —interpreting research is a science unto itself.17–20 Research quality affects recommendations for medical advice. If the evidence is low-grade quality, the impact and clinical relevance may be negligible. Should guidelines be established based solely on lower-quality evidence? Making broad recommendations based solely on low-grade evidence may be detrimental to our patients and our profession, potentially causing harm. Thus, understanding how to interpret the quality of the research is paramount. While assessing research quality can be challenging, several guidelines can help evaluate a study’s validity, bias, and generalizability. Evidence grading taxonomies that have merit in veterinary medicine include Grading of Recommendations Assessment, Development, and Evaluation (GRADE; most commonly utilized)21 and the United States Preventive Services Task Force (USPSTF)’s Guide to Clinical Preventive Services. The latter makes recommendations for human medicine; however, its methods can be easily applied to the veterinary literature and public health/One Health-related issues if desired.22,23 Grading evidence GRADE uses the following scheme to estimate the level of evidence provided by an article, systematic review, research, or related materials. The grade ranges for evidence are: A—high B—moderate C—low D—very low At the highest level of evidence, further research would have minimal to no effect on the estimation of effect (the outcome response that arises as a result of a provided intervention) or on one’s confidence associated with the evidence. In contrast, D-level evidence has inherent uncertainty in effect estimation and would include topics with a lack of clinical research, expert opinion, or only a single or a few studies with significant limitations.22,24,25 “Science is a cumulative process that develops iteratively. Few studies by themselves are sufficiently persuasive to change practice or policy. The evidence base in any field needs to mature and be synthesized before an observer can reliably understand its implications.” Evidence-based resources The following resources can provide helpful information on interpreting and applying evidence-based medicine: The GRADE Working Group: “The working group has developed a common, sensible, and transparent approach to grading quality (or certainty) of evidence and strength of recommendations.” By aiding in establishing whether the evidence is of high or low grade (quality), it provides the interested party, g., the veterinarian, with a transparent and systematic framework for producing judgments, guidelines, or related entities that help mitigate errors, improve information conveyance, and enhance the critical evaluation of these judgments/recommendations.21 BestBETS for Vets: This initiative of the University of Nottingham supports veterinarians in implementing evidence-based practices.27 Royal College of Veterinary Surgeons Trust (RCVS Knowledge): This group assists organizations, educators, and veterinary teams through collaboration, research translation, and dissemination. Its mission is “to advance the quality of veterinary care for the benefit of animals, the public, and society.”28 They have a toolkit that veterinarians can use to apply EBVM. Evidence Syntheses: These resources provide access to meta-analyses and systematic reviews. Evidence-based syntheses appraise primary research studies and support clinical decision-making. These resources allow searching for available evidence; however, in some cases, only the abstracts may be available with the articles behind a paywall. These resources include VetSRev Database of Veterinary Systematic Reviews PubMed PubMed Clinical Queries CAB Abstracts Various organizations offer membership and support for applying EBVM in practice. Evidence-Based Veterinary Medical Association (EBVMA): This International non-profit and volunteer organization was founded to “better organize the emerging research, training and practice of evidence-based veterinary medicine.”29 Centre for Evidence-based Veterinary Medicine (U. of Nottingham): The group’s aim is “to increase the awareness and use of evidence-based principles in the veterinary profession.” In four key research areas: population research, evidence synthesis, practice-based research, and education and information exchange.30 Using EBVM in practice One can take a course on how to read a scientific paper and learn to interpret a journal article step by step. However, as individual practitioners, achieving work-life balance can be hard enough as it is. Before selecting a specific primary research study, seek comprehensive syntheses of existing data, such as systematic reviews or practice guidelines, when available. Then, when you do pick up an article, GRADE the evidence provided. Evaluate the study, including its limitations, biases, financial disclosures, conflict of interest, methods, and ask yourself if they established and properly tested their hypothesis with well-defined outcome measures. This can help guide medical decisions for you, your practice, and your patients and their pet parents. Using EBVM to help ensure we practice high-quality care. Before reaching for a new medication immediately after release, don’t just take the drug representative’s recommendations and run with them. Consider the evidence. The more we examine and publish the evidence, the more likely it is that researchers will improve their reporting, which, in turn, will lead to more concise, consensus-based recommendations for future use. As past president of the EBVA, Brennen McKenzie, MA, MSc, VMD, cVMA, wrote in a 2022 Veterinary Practice News article, “Scientific research is itself flawed and sometimes misleading, but it is a lot more likely to get us to the truth than belief founded on experience, anecdote, theory, and tradition.”31 Using EBVM takes that experience, tradition, and theory and incorporates the science to ensure we provide the best possible care while minimizing or eliminating harm. Recognizing that recommendations change over time and allowing oneself to stay up to date and modify one’s clinical practices, when properly informed and aware of the evidence as new information becomes available, ensures we keep our patients’ and clients’ best interests in mind. Erica Tramuta-Drobnis, VMD, CPH, is the CEO and founder of ELTD One Health Consulting, LLC. Dr. Tramuta-Drobnis works as a public health professional, emergency veterinarian, freelance writer, consultant, and researcher. She is passionate about One Health issues and believes that addressing pet health, food safety, agricultural health, and other related concerns can help highlight the interconnection of human, animal, and environmental health. Veterinarians are primed to be at the forefront of One Health initiatives, and she is passionate about issues from antimicrobial resistance to infectious disease control, vaccination health, and wildlife conservation. She is a strong advocate of evidence-based veterinary medicine and the president-elect of the Evidence Based Veterinary Medical Association (EBVMA). She hopes to promote the use of evidence-based practices through her writing and clinical work, preserving the human-animal bond and improving health outcomes within a One Health context. References Toews L. The information infrastructure that supports evidence-based veterinary medicine: a comparison with human medicine. J Vet Med Educ. 2011;38(2):123-134. doi:10.3138/jvme.38.2.123 Hussong-Christian U. LibGuides: *Evidence-Based Veterinary Medicine*: What is EBVM. Oregan State University. Accessed December 9, 2024. https://guides.library.oregonstate.edu/c.php?g=1081101&p=7878962 Canadian Institutes of Health Research, Government of Canada. A Guide to Knowledge Synthesis -. Canadian Institutes of Health Research. March 25, 2010. Accessed November 1, 2025. https://www.cihr-irsc.gc.ca/e/41382.html Mills D, Reiss M, Campbell M. Evidence-based veterinary medicine at 20 – a commentary on historical, philosophical, practical and ethical aspects. Vet Evid. 2025;10(3). doi:10.18849/ve.v10i3.710 Block G. Evidence‐based veterinary medicine—potential, practice, and pitfalls. J Vet Intern Med. 2024;38(6):3261-3271. doi:10.1111/jvim.17239 Martello E, Morrow L, Moberly H, Grindlay D, Brennan M. Enhancing veterinary systematic and scoping reviews reporting for better identification and dissemination in VetSRev. Vet Evid. 2025;10(4). doi:10.18849/ve.v10i4.721 Tricco AC, Tetzlaff J, Moher D. The art and science of knowledge synthesis. J Clin Epidemiol. 2011;64(1):11-20. doi:10.1016/j.jclinepi.2009.11.007 Royal College of Surgeons of England. Dissecting the literature: the importance of critical appraisal. Royal College of Surgeons of England. March 31, 2023. Accessed November 1, 2025. https://www.rcseng.ac.uk/library-and-publications/library/blog/dissecting-the-literature/ Shurtz S, Fajt V, Heyns EP, Norton HF, Weingart S. Teaching Evidence-Based Veterinary Medicine in the US and Canada. J Vet Med Educ. 2017;44(4):660-668. doi:10.3138/jvme.1215-199R Sargeant JM, Kelton DF, O’Connor AM. Study Designs and Systematic Reviews of Interventions: Building Evidence Across Study Designs. Zoonoses Public Health. 2014;61(S1):10-17. doi:10.1111/zph.12127 Tramuta-Drobnis EL. How to Read a Scientific Study. PowerPoint presented at: PVMA’s 3 Rivers Symposium; November 13, 2023; Mars, PA. Glogowski J. GSU Library Research Guides: Literature Reviews: Types of Clinical Study Designs. Accessed January 30, 2021. https://research.library.gsu.edu/c.php?g=115595&p=755213 Giuffrida MA. Defining the primary research question in veterinary clinical studies. J Am Vet Med Assoc. 2016;249(5):547-551. doi:10.2460/javma.249.5.547 Sargeant J m., Thompson A, Valcour J, et al. Quality of Reporting of Clinical Trials of Dogs and Cats and Associations with Treatment Effects. J Vet Intern Med. 2010;24(1):44-50. doi:10.1111/j.1939-1676.2009.0386.x Wareham KJ, Hyde RM, Grindlay D, Brennan ML, Dean RS. Sponsorship bias and quality of randomised controlled trials in veterinary medicine. BMC Vet Res. 2017;13(1):234. doi:10.1186/s12917-017-1146-9 Sargeant J m., Thompson A, Valcour J, et al. Quality of Reporting of Clinical Trials of Dogs and Cats and Associations with Treatment Effects. J Vet Intern Med. 2010;24(1):44-50. doi:10.1111/j.1939-1676.2009.0386.x Block G. Evidence-based veterinary medicine—potential, practice, and pitfalls. J Vet Intern Med. 2024;38(6):3261-3271. doi:10.1111/jvim.17239 Rufiange M, Rousseau-Blass F, Pang DSJ. Incomplete reporting of experimental studies and items associated with risk of bias in veterinary research. Vet Rec Open. 2019;6(1):e000322. doi:10.1136/vetreco-2018-000322 Strasak AM, Zaman Q, Pfeiffer KP, Göbel G, Ulmer H. Statistical errors in medical research - a review of common pitfalls. Swiss Med Wkly. 2007;137(0304):44-44. doi:10.4414/smw.2007.11587 Guyatt GH, Oxman AD, Montori V, et al. GRADE guidelines: 5. Rating the quality of evidence—publication bias. J Clin Epidemiol. 2011;64(12):1277-1282. doi:10.1016/j.jclinepi.2011.01.011 GRADE Working Group. GRADE: From evidence to recommendations – transparent and sensible. GRADE. 2024. Accessed December 8, 2024. https://www.gradeworkinggroup.org/ John Wiley & Sons, Inc. Essential Evidence Plus (Wiley). Evidence grading taxonomies. Accessed December 9, 2024. https://www.essentialevidenceplus.com/Home/Loe?show=Sort Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924-926. doi:10.1136/bmj.39489.470347.AD Guyatt G, Oxman AD, Akl EA, et al. GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64(4):383-394. doi:10.1016/j.jclinepi.2010.04.026 Balshem H, Helfand M, Schünemann HJ, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011;64(4):401-406. doi:10.1016/j.jclinepi.2010.07.015 Veterinary Prescriber: An Online Veterinary Medicine Academy. Veterinary Prescriber: VetRx. February 6, 2024. Accessed December 8, 2024. https://www.veterinaryprescriber.org BestBETS for Vets. BestBETS for Vets. Accessed December 8, 2024. https://bestbetsforvets.org/search?text=evidence+based+medicine&go=Search Royal College of Veterinary Surgeons (RCVS). Evidence-Based Veterinary Medicine. RCVS Knowledge. Accessed December 9, 2024. https://knowledge.rcvs.org.uk/evidence-based-veterinary-medicine/ Evidence-Based Veterinary Medicine Association (EBVMA). EBVMA - About Us. EBVMA. Accessed October 24, 2025. https://ebvma.wildapricot.org/about-us Centre for Evidence-Based Veterinary Medicine (CEVM). Centre for Evidence-Based Veterinary Medicine Aims. The University of Nottingham’s Centre for Evidence-Based Veterinary Medicine (CEVM). Accessed October 24, 2025. https://www.nottingham.ac.uk/cevm/about-the-cevm/cevm-aims.aspx McKenzie B. The value of EBVM and a move forward. Vet Pract News. 2022;October 2022:44-45.

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