Prof. Gordon Guyatt – Pioneer of Evidence-Based Medicine and the GRADE Framework
Author(s): Scott Douglas Jacobsen
Publication (Outlet/Website): The Good Men Project
Publication Date (yyyy/mm/dd): 2025/07/31
Professor Gordon Guyatt is a Canadian physician, health researcher, and Distinguished Professor at McMaster University, widely recognized as the pioneer of evidence-based medicine (EBM). He coined the term “evidence-based medicine” in 1991, fundamentally transforming how clinicians worldwide evaluate research and make patient care decisions. Guyatt has authored or co-authored thousands of influential papers and is among the most cited health scientists globally. He has also led the development of the GRADE framework for grading evidence and guidelines. His leadership, mentorship, and prolific contributions have profoundly shaped modern clinical epidemiology and guideline development, cementing his legacy in global health research.
Scott Douglas Jacobsen: So, last time we talked, you had received the Henry G. Friesen International Prize in Health Research. You gave a lecture as part of that recognition. Could you describe the content of that lecture and the feedback you received?
Professor Gordon Guyatt: It has turned out to be a series of eight lectures because — as far as I know — this is a unique Canadian award that requires the laureate to travel across the country and deliver the Friesen Lecture at multiple Canadian medical schools. So far, I have done it at McMaster, Waterloo, Ottawa, Toronto, Winnipeg, Calgary, and Edmonton.
In a little while, I will be giving my eighth and final Lecture in Vancouver. It has been an enjoyable experience — I have met people in each city. As I have delivered the lecture multiple times, I have refined it to be more interactive, which the audience consistently appreciates. Overall, it has been a fun and enriching experience.
Jacobsen: Now, when you look at the current generation of medical students — as a related question — how has their training changed compared to when you were a student, especially about epidemiology and evidence-based medicine?
Guyatt: Well, there have been some significant changes. When I was in training, residents typically worked one night in three. After being on call overnight, you would often stay until 5 p.m. or later the following day. That would be unheard of now. Today, work-hour restrictions are much tighter, and training is organized more around shift work.
Another significant change is the structure of attending service. Earlier in my career, when I was in clinical service, I would be on for a whole month at a time. Then, it was reduced to two weeks. Now, for many services, attending physicians are scheduled for just one week at a time. This is not ideal for continuity of patient care — you barely get to know the house staff before either they or you rotate off the service.
I sound like a dinosaur, but back then, it was different. This shorter time commitment does not foster the same level of continuity or, arguably, the same level of dedication to patient care. Whether that change comes from the trainees themselves or the system is a matter of debate. Still, the system certainly does not encourage the same depth of commitment.
Those are some of the significant structural changes. If you look specifically at evidence-based medicine, today’s students have no sense of what the world was like before EBM.
Jacobsen: For context, before EBM, clinical decisions were often made based on expert consensus — what some have jokingly called the “GOBSAT” approach (Good Old Boys Sat Around the Table).
Guyatt: Nowadays, students do not necessarily know or care much about the development of evidence-based medicine (EBM) or guideline standards. Still, they fully expect recommendations to be grounded in evidence. They might not dig deeply into the evidence themselves, but they rely on guidelines and assume they are evidence-based. I once gave a talk to a group of medical students in Toronto — virtually — and the first question at the end was, “How did you get interested in EBM?”— as if it had always existed! No kidding.
Jacobsen: I love that. I love that so much. You are one of the most cited people in Canadian academic history. When you go down the field, how does that feel? “Also — as an aside — what is your name?” I could understand if they asked me that, but not you! They are completely ahistorical.
Guyatt: Yes, I get that a lot in interviews.
Jacobsen: And it is not just in epidemiology — it is true across disciplines. Pick any field. This has been facilitated by social media and the Internet, providing you with immediate access to vast amounts of information. Still, it is all presented in an achronological manner. So, it is a net of information, which ideally gets filtered into usable knowledge — but there is no sense of timeline. That is part of it. From a media or sociological standpoint, it is fascinating.
It is such a reflection of how the world has changed. I have asked this before, but giving the lecture for the award is different from receiving the award itself. The second part, where you are now travelling and delivering this series of lectures — how does it feel to be at this stage of your career, being called upon to do this national lecture circuit and seeing the process from this vantage point?
Guyatt: Well, I feel like I am cashing in on all the work I have done over the years. I am, by citation count, the most cited Canadian health scientist, and evidence-based medicine has become something to which everyone must at least pay lip service. People know that I helped get it started, so they think of me as a legend.
So, wherever I go, people say, “Oh, it is such an honour to be talking with you.” But back in the early days, it was not always like that! When I first started promoting EBM, the reception was far from universally warm. I might have told you this story before, but once, in the States, I visited a department where they did not like being told that they had missed the boat.
Our message was: “You were trained in a particular way, and you think you have expertise, but real expertise means knowing how to assess the evidence — and you were not taught that.” Unsurprisingly, a lot of the senior experts did not appreciate hearing this.
There was one bright young immunologist in that department who did not take kindly to it. I met with him and a couple of residents. Typically, in those sessions, the expert asks a question to the junior resident. The senior resident finally offers the answer.
Well, this fellow asked the junior resident, then the senior resident, and if they did not get it, he asked me. I never knew the answer — not once. Zero. He was trying to embarrass me, but it did not bother me at all.
And the next time I ran into him — purely by chance while walking around the campus — I said, “Hey! Thanks for that educational session you invited me to!” Learned a lot. It was a great session. Anyway, the guy did a double-take because he thought he had delivered a major put-down, and it did not bother me in the slightest — which he did not expect! Anyway, that is just one story of the hostility that sometimes arose — understandably, in a way — because you are telling people, “Sorry, you missed the boat,” and that is not pleasant to hear.
Jacobsen: Thank you for the opportunity and your time, Gordon.
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