Journal of Evidence-Based Practice

Evolution of evidence-based medicine: toward digital evidence ecosystems and artificial intelligence: Soo Young Kim; J Evid-Based Pract 2026;2(2):56-61. Published online September 29, 2026; DOI: https://doi.org/10.63528/jebp.2026.00016

Evidence-based medicine (EBM) has transformed clinical decision-making by integrating the best available research evidence with clinical expertise and patients’ values and preferences. Over the past three decades, EBM has evolved from the critical appraisal of individual studies into a broader framework encompassing evidence synthesis, clinical practice guidelines, assessment of evidence certainty, research transparency, and shared decision-making. Despite these advances, contemporary EBM faces important challenges, including the rapidly increasing volume of research, delays in evidence synthesis and implementation, limited applicability of randomized controlled trials to heterogeneous real-world populations, and difficulties in individualizing population-level evidence. Emerging approaches—including real-world evidence, living evidence, learning health systems, precision medicine, and artificial intelligence (AI)—offer opportunities to address these limitations. Together, these approaches may enable a transition from static to continuously updated evidence, from population-average to more personalized evidence, and from a linear evidence pipeline to a learning evidence ecosystem in which clinical practice both uses and generates evidence. AI may further accelerate evidence retrieval, synthesis, updating, and individualized decision support, while introducing challenges related to reliability, bias, transparency, reproducibility, and accountability. Next-generation EBM should therefore be conceptualized not as a replacement for traditional EBM but as its evolution into a digitally connected, continuously learning evidence ecosystem. In the AI era, the foundational principles of EBM—source verification, critical appraisal, uncertainty assessment, integration of patient preferences, and accountable human judgment—will become increasingly important.

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Beyond the funnel plot: editorial and reviewer perspectives on publication bias in systematic reviews and meta-analyses in clinical medicine: Hyun Kang; J Evid-Based Pract 2026;2(2):45-55. Published online September 29, 2026; DOI: https://doi.org/10.63528/jebp.2026.00014

Publication bias is a fundamental threat to the validity of systematic reviews and meta-analyses in clinical medicine. Yet current practice often reduces its assessment to the mechanical application of funnel plots, asymmetry tests, or single adjustment procedures, with limited attention to the underlying assumptions, alternative explanations, or implications for evidence certainty. This narrative methodological article reframes publication bias assessment as an interpretive and editorial responsibility rather than a purely technical problem. We examine what commonly used methods can and cannot reliably support. Detection tools function as nonspecific stress tests that identify deviations from simplified models; they do not diagnose selective publication but highlight situations in which the underlying assumptions require closer inspection. Adjustment approaches, including trim-and-fill, selection models, and regression-based methods, generate hypothetical estimates under unverifiable assumptions**, and therefore provide** sensitivity analyses rather than corrections that recover the true underlying effect. Divergence across adjustment methods is particularly informative, signaling inferential fragility rather than analytical failure. We identify five recurring misinterpretations encountered in peer review: equating asymmetry with proof of publication bias; privileging bias-adjusted estimates as inherently more credible; relying on a single adjustment method without examining assumption dependence; ignoring the plausibility of adjustment direction and magnitude; and overlooking implications for certainty of evidence. Editors and reviewers should prioritize transparency of assumptions, seriously consider alternative explanations, and calibrate conclusions proportionately. Viewing publication bias assessment as an interpretive responsibility rather than a methodological checklist promotes more disciplined inference and strengthens trust in clinical evidence synthesis.

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Current status and challenges of Evidence-Based Medicine education in Korean medical schools: a cross-sectional survey of 21 institutions: Hyun Jung Kim, Mookyung Oh, Jae Hung Jung, Geun Joo Choi, Heather Swan, Soo Young Kim; J Evid-Based Pract 2026;2(2):84-90. Published online September 29, 2026; DOI: https://doi.org/10.63528/jebp.2026.00010

Background
Evidence-based medicine (EBM) is an important element of medical education. However, nationwide data on EBM education in Korean medical schools are limited. This study aimed to describe the organizational structure, content, methods, and assessment of EBM education, together with barriers and support needs, and to explore factors associated with variation across schools.
Methods
A 26-item questionnaire was administered to EBM education leaders or course directors at 21 Korean medical schools. Data were analyzed descriptively, and differences by structural and exogenous characteristics were explored using cross-tabulation.
Results
Twenty-one of 40 medical schools responded. All responding institutions offered EBM as a mandatory subject, but 42.9% had no dedicated organizing unit. Coverage of classic EBM steps was high (formulating clinical questions: 95.2%; literature searching: 95.2%; critical appraisal: 76.2%), whereas AI-assisted evidence summarization was included in only 19.0%. Only 19.0% reported systematic theory–clinical integration, and 57.1% left bedside EBM to preceptor discretion. Demand for a standardized curriculum guide (90.5%) and faculty development (76.2%) was high, and 100% were willing to use externally developed materials. Variation in key outcomes was associated with organizational governance but was not explained by exogenous structural characteristics such as class size, clinical infrastructure, establishment type, or region.
Conclusions
EBM education in Korean medical schools is universally mandatory but uneven in organization, theory–clinical integration, faculty capacity, assessment, and AI integration. These differences appeared to reflect governance more than resource size, suggesting that society-level support should include organizational models alongside standardized curricula, assessment tools, and faculty development.

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Patient values and preferences in guideline development: Su-Hyun Kim; J Evid-Based Pract 2026;2(1):8-15. Published online March 30, 2026; DOI: https://doi.org/10.63528/jebp.2026.00001

Clinical practice guidelines (CPGs) are critical for translating research into clinical practice; however, high-quality evidence alone does not ensure optimal care. The integration of patient values and preferences is essential for developing recommendations that are both relevant and applicable, yet many guidelines continue to underrepresent patient perspectives and lack transparent incorporation of preference research. This review delineates the distinction between values and preferences, examines their influence on preference-sensitive decisions, and evaluates methods for eliciting patient input, such as utility-based measurements, discrete-choice experiments, and qualitative studies. Systematic integration of this evidence through guideline development enhances both credibility and patient-centeredness. Persistent challenges include issues of representativeness, methodological uncertainty, and cultural barriers. Implementing practical strategies to address these challenges will improve transparency, relevance, and acceptance of clinical practice guidelines.

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The use of evidence in decision-making in the context of Korean healthcare: a review: Sang-il Lee; J Evid-Based Pract 2025;1(2):51-61. Published online September 29, 2025; DOI: https://doi.org/10.63528/jebp.2025.00007

This paper examines some examples of not well integrating evidence into healthcare decision-making within the Republic of Korea, a nation characterized by a rapidly evolving and financially strained healthcare system. The review introduces various conceptual frameworks of evidence-based practice, including Evidence-Based Medicine (EBM), Evidence-Based Public Health (EBPH), and Evidence-Based Health Policy (EBHP), alongside a nuanced typology of scientific (context-free and context-sensitive) and colloquial evidence. Through brief literature reviews, the paper identifies significant barriers and crucial facilitators to effective evidence utilization. These include deficiencies in research infrastructure, accessibility gaps, the influence of political and value-based considerations, and the pervasive challenge of "decision-based evidence making." The report concludes by proposing actionable recommendations aimed at strengthening the evidence ecosystem, fostering deliberative processes, enhancing Health Technology Assessment (HTA) integration, and cultivating a robust culture of evidence-informed policy-making in Korea.

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Development of evidence-based medicine and introduction to Korea: Ga-yeon Goo, Byung-joo Park; J Evid-Based Pract 2025;1(2):31-39. Published online September 29, 2025; DOI: https://doi.org/10.63528/jebp.2025.00005

Evidence-Based Medicine (EBM) demands systematic changes across the healthcare system, essential for enhancing patient safety and quality of medical care. To address the question, "Are we adopting scientific methods to optimize patient safety and enhance treatment efficacy?", assessing the level of EBM implementation is crucial. The adoption rate of evidence-based medical practices varies across countries and medical fields, often being lower in resource-limited settings. In South Korea, there have been several documented cases where the adoption of non-evidence-based practices, such as CARVAR surgical procedures not based on scientific evidence, has led to severe patient safety issues, thereby raising significant concerns about the quality of medical care provided. Conversely, the ABBA Study exemplifies successful application of EBM, demonstrating how scientific research assessed the risk of intracranial hemorrhage in patients with low-dose PPA in OTC cold medicines. This study not only confirmed the associated risks but also influenced health policy, resulting in the withdrawal for PPA-containing OTC cold medicines in Korea. This positive example highlights the imperative for governments, healthcare institutions, and medical schools to expedite the transition to evidence-based, patient-centered healthcare by fostering a robust commitment to systematic reviews and enhanced support for clinical research. The Korean Society of Evidence-Based Medicine (KSEBM) is expected to play a significant role in embedding these core strategies domestically

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Beyond the paywall: the role of preprints in overcoming publication bias: Hyun Kang; J Evid-Based Pract 2025;1(1):7-11. Published online March 31, 2025; DOI: https://doi.org/10.63528/jebp.2025.00002

Preprints have become a transformative tool in scientific communication, addressing critical challenges of traditional publishing, including long peer-review timelines, high costs, and systemic publication bias. Publication bias, which disproportionately favors studies with positive or statistically significant results, undermines the comprehensiveness and accuracy of the scientific record. By offering an open platform for sharing all research findings, preprints ensure that studies with null or negative results are also represented, mitigating the selective publication that skews research fields and meta-analyses. The COVID-19 pandemic highlighted the importance of preprints, as they facilitated the rapid dissemination of urgent findings while maintaining accessibility. Unlike traditional journals, preprints bypass lengthy review processes, enabling immediate access to data and fostering timely feedback, collaboration, and application. This inclusivity and transparency enhance trust in the research process while democratizing access to scientific knowledge. Despite their advantages, preprints face challenges, such as inconsistent quality standards, discrepancies between preprints and final publications, and risks associated with unverified findings. These challenges can complicate their use in systematic reviews and evidence-based medicine, requiring careful consideration and handling.This paper explores the interplay between preprints and publication bias, detailing how preprints can reduce bias while identifying limitations that must be addressed.

Citations

Citations to this article as recorded by

Correcting what cannot be corrected: rethinking publication bias analysis methods in clinical meta-analyses
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