In fact, internal and external types of evidence differ by the source of information. On the one hand, the internal evidence is collected through medicine professionals’ observations and clients’ claims. These resources have a significant degree of subjectivity but have a closer relation to the patient’s situation than other evidence sources (Davis et al., 2019). On the other hand, external evidence is a formal information source usually obtained through scientific literature readings and statistical data analysis. This source might provide a general situation about the problem and even propose certain approaches for a treatment course, and usually represented as objective.
When it comes to the evidence levels definition, it is critical to admit that there are five major evidence levels: an experimental study, quasi-experimental study, non-experimental study, respected authorities’ opinion, and experiential, non-research evidence. Firstly, in clinical practice, experimental study, which is widely represented as a randomized controlled trial (RCT), demonstrates the highest quality of information and should prevail above other evidence levels in case of data misalignment (Padilha et al., 2019). The second level represents almost the same aspects of evidence-based practice (EBP) but might interchange experiments for the theoretical or quasi-experimental case study. Thirdly, the non-experimental study is usually found in ‘systematic review’ form, where the author considers different experiments and makes theoretical assumptions based on their results. The fourth level is associated with governmental recommendations for clinical practice, derived from the first-level sources and adjusted to the current system of law and regulation (Buckwalter et al., 2017). Last but not least, subjective judgment based on the first and second information levels represents some personal reviews and recommendations concerning experimental studies. Due to the active evidence levels’ implementation into clinical practice, they are critical for medical professionals. More specifically, they help clinical workers to immediately assess the level of information credibility even before reading the evidence. As a result, it allows medical professionals to put a higher value on the first levels of EBS in case of evidence misalignments.
References
Buckwalter, K. C., Cullen, L., Hanrahan, K., Kleiber, C., McCarthy, A. M., Rakel, B., Steelman, V., Tripp-Reimer, T., & Tucker, S. (2017). Iowa model of evidence-based practice: Revisions and validation. Worldviews on Evidence-Based Nursing, 14(3), 175–182.
Davis, E., Wolff, J., Murdock, R., Lopez, M. J., & Murphy, K. A. (2019). The utilization of internal and external memory strategies in evidence-based practice. EBP Briefs, 14(1), 1–10.
Padilha, J. M., Machado, P. P., Ribeiro, A., Ramos, J., & Costa, P. (2019). Clinical virtual simulation in nursing education: Randomized controlled trial. Journal of Medical Internet Research, 21(3).