Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Aug;21(4):125-7.
doi: 10.1136/ebmed-2016-110401. Epub 2016 Jun 23.

New Evidence Pyramid

Free PMC article

New Evidence Pyramid

M Hassan Murad et al. Evid Based Med. .
Free PMC article


A pyramid has expressed the idea of hierarchy of medical evidence for so long, that not all evidence is the same. Systematic reviews and meta-analyses have been placed at the top of this pyramid for several good reasons. However, there are several counterarguments to this placement. We suggest another way of looking at the evidence-based medicine pyramid and explain how systematic reviews and meta-analyses are tools for consuming evidence—that is, appraising, synthesising and applying evidence.

Keywords: EDUCATION & TRAINING (see Medical Education & Training); EPIDEMIOLOGY; GENERAL MEDICINE (see Internal Medicine).


Figure 1
Figure 1
The proposed new evidence-based medicine pyramid. (A) The traditional pyramid. (B) Revising the pyramid: (1) lines separating the study designs become wavy (Grading of Recommendations Assessment, Development and Evaluation), (2) systematic reviews are ‘chopped off’ the pyramid. (C) The revised pyramid: systematic reviews are a lens through which evidence is viewed (applied).

Comment in

  • Evidence pyramids.
    Kaufmann J. Kaufmann J. Evid Based Med. 2016 Dec;21(6):238. doi: 10.1136/ebmed-2016-110553. Epub 2016 Oct 24. Evid Based Med. 2016. PMID: 27777251 No abstract available.

Similar articles

See all similar articles

Cited by 60 articles

See all "Cited by" articles


    1. Paul M, Leibovici L. Systematic review or meta-analysis? Their place in the evidence hierarchy. Clin Microbiol Infect 2014;20:97–100. 10.1111/1469-0691.12489 - DOI - PubMed
    1. Agoritsas T, Vandvik P, Neumann I, et al. Finding current best evidence. In: Guyatt G, Rennie D, Meade MO, et al. eds Users’ guides to the medical literature: a manual for evidence-based clinical practice. 3rd edn New York, NY: McGraw-Hill, 2015:29–50.
    1. Tomlin G, Borgetto B. Research Pyramid: a new evidence-based practice model for occupational therapy. Am J Occup Ther 2011;65:189–96. 10.5014/ajot.2011.000828 - DOI - PubMed
    1. Resources for Evidence-Based Practice: The 6S Pyramid. Secondary Resources for Evidence-Based Practice: The 6S Pyramid Feb 18, 2016 4:58 PM.
    1. Vandenbroucke JP. Observational research and evidence-based medicine: what should we teach young physicians? J Clin Epidemiol 1998;51:467–72. 10.1016/S0895-4356(98)00025-0 - DOI - PubMed

MeSH terms