Fluency-not competency or expertise-is needed to incorporate evidence into practice.

Twenty years ago JAMA published an article describing a “new approach to teaching the practice of medicine”: evidence-based medicine. The ability to apply research to practice is a licensing requirement at both the undergraduate and postgraduate level and an ongoing practice competency requirement. The EBM process of assessing the patient, asking the question, acquiring the evidence then assessing and applying that evidence and finally evaluating the whole process, seeks to provide a framework for the integration of evidence into clinical practice.