Creating Content


UpToDate® has a systematic process for identifying, reviewing and synthesizing the medical literature as it applies to a clinical question. Our in-house physician deputy editors, all of whom are specialists in the field they edit and receive training in clinical epidemiology, oversee the integrity and consistency of the process.

While other clinical information resources may use — or claim to use — the best available evidence, UpToDate excels in determining how that evidence is applied to the individual patient (per the definition above). More than 6,500 world-renowned experts with extensive patient care experience assist in applying the evidence to specific patient situations.

Evidence alone is never sufficient to make a clinical decision — expertise is required to move from evidence to recommendations.


Since 2001, UpToDate has worked extensively with Dr. Gordon Guyatt to improve the clarity and transparency of the evidence supporting our recommendations. Dr. Guyatt is a member of the GRADE Working Group that was created to develop a common, sensible and transparent approach to grading quality of evidence and strength of recommendations. The GRADE system has become the most widely used clinical recommendation grading system in the world. In 2006 UpToDate began grading recommendations using the GRADE format.

Clinical recommendations are a key strength of UpToDate, and grading the strength of these recommendations, in addition to the strength of the evidence, is critical. This is a complicated and challenging process, requiring additional levels of peer review from physicians highly trained in implementing GRADE. In addition, Dr. Guyatt comes to Massachusetts regularly to continue to educate our physician editors about evidence-based medicine and grading.

Read our in-depth Grading Guide and view a step-by-step Grading Tutorial.

Review Process

Peer Review
All content in UpToDate, including new topics, updates, and recommendations, undergoes at least three levels of review, including the Author of the topic, and the Deputy Editor plus Editor-in-Chief and/or Section Editors assigned to the topic. In addition, each UpToDate specialty has assembled a group of peer reviewers, often in conjunction with a sponsoring specialty society, who are responsible for reviewing selected topics in each specialty. Finally, any comments from users of UpToDate are formally addressed, with changes and/or additions incorporated as necessary. This multi-layer review process is unparalleled for a clinical resource and critical to ensure the accuracy of the content.

Policy Review
Our policies and procedures are continuously reviewed in consultation with our Evidence-Based Medicine Advisory Group. Members of this group include Dr. Gordon Guyatt and Dr. Roman Jaeschke from McMaster University, Dr. Holger Schünemann from the Italian National Cancer Institute in Rome/McMaster University, and Dr. Yngve Falck-Ytter from Case Western Reserve University.

Journals Reviewed

Our community of more than 6,500 physicians read, summarize, and incorporate clinical information from multiple sources, including hand-searching over 440 medical journals.