Background: Recent research has highlighted the obstacles that face clinicians wishing to attain advanced skills in evidence based medicine techniques. Burdened by time constraints as well as apathy towards obtaining a sophisticated understanding of how to construct evidence-based decisions, clinicians may find a solution to this problem in the use of pre-appraised evidence. This could take the form of evidence based clinical practice guidelines. In a recent survey of general practitioners, respondents believed that the best policy for achieving an evidence- based practice was by using evidence based guidelines developed by colleagues. All respondents exhibited a low level of awareness of the sources of pre-appraised evidence. The synthesis of research evidence into clinical practice guidelines continues to grow. The methodology of guideline development is an emerging and evolving discipline. When searching for guidelines to assist evidence-based clinical practice an understanding of the methodology behind their production is essential tool for effective validity and quality appraisal. Three criteria have been suggested for reviewing guideline methodology; systematic review, multidisciplinary development groups, and explicit links between the strength of evidence and grade of recommendation. Guidelines produced by speciality societies, such as the Royal College of Obstetricians and Gynaecologists, tend to be published both in paper and electronic guideline formats, as they are not usually submitted to peer review journals for publication, they do not receive an index on bibliographic databases, such as Medline. This publication bias has led some authors to conclude that specialty society guidelines are of poor methodological quality.

Methods: Since 1998 the RCOG has produced seven national evidence based guidelines, the methodology of the guideline development conforms to best practice and has been independently assessed. We searched Embase and Medline 1997-2000. Of the seven guidelines, one was indexed on both Medline and Embase and one on Medline alone. Citations were for summaries of the guidelines published in a journal, it would be necessary to obtain reprints from the journal to obtain a reference to the complete guideline.

Conclusions: If clinical practice guidelines and systematic reviews are to fulfil their potential to improve patient care they need to be both effectively disseminated and accessible to those clinicians searching for them. Those producing and searching for evidence based guidelines need to develop a greater awareness of secondary research sources and utilise them effectively to increase accessibility and uptake of the evidence. Unless guidelines (or at least their summaries) are presented to peer reviewed journals for publication, searching MEDLINE will inevitably lead to under-ascertainment. The authors suggest the use of methodological filters when searching bibliographic databases such as MEDLINE. However, to avoid this ascertainment bias systematic searches need to include alternative information sources such as the internet based National Guideline Clearinghouse which has strict quality criteria for inclusion. Many organisations make details of their guidelines available via their web-sites and are searchable via the Internet. To facilitate searching the Internet for guidelines the authors provide a suggested list of web-sites and propose that guideline developers make certain that their guidelines are available across a variety of media, and that the methodology employed in their development is explicit to aid appraisal.