The article discusses the traditional evidence-based medicine (EBM) pyramid, which ranks studies from weakest (basic science, case series) to strongest (systematic reviews and meta-analyses). However, the authors argue that this hierarchy is flawed and propose a revised pyramid. They suggest that systematic reviews and meta-analyses are not the top of the pyramid but rather tools for appraising, synthesizing, and applying evidence. The traditional pyramid is too simplistic and does not account for the variability in study quality and the importance of factors like certainty of evidence and external validity. The authors propose two modifications to the pyramid. First, the straight lines separating study designs should be replaced with wavy lines to reflect the GRADE approach, which allows for rating evidence up or down based on various domains. Second, systematic reviews should be removed from the top of the pyramid and used as a lens through which other studies are viewed, emphasizing their role in consuming and applying evidence rather than being the highest form of evidence. The article highlights the limitations of the traditional pyramid, including the potential for bias and the influence of study design on evidence quality. It also discusses the implications of these changes for stakeholders, such as patients and clinicians, and the importance of considering the quality of evidence when making clinical decisions. The revised pyramid can serve as a teaching tool to explain how evidence is evaluated and applied in practice. The authors emphasize the need for a more nuanced understanding of evidence quality and the role of systematic reviews in evidence-based practice.The article discusses the traditional evidence-based medicine (EBM) pyramid, which ranks studies from weakest (basic science, case series) to strongest (systematic reviews and meta-analyses). However, the authors argue that this hierarchy is flawed and propose a revised pyramid. They suggest that systematic reviews and meta-analyses are not the top of the pyramid but rather tools for appraising, synthesizing, and applying evidence. The traditional pyramid is too simplistic and does not account for the variability in study quality and the importance of factors like certainty of evidence and external validity. The authors propose two modifications to the pyramid. First, the straight lines separating study designs should be replaced with wavy lines to reflect the GRADE approach, which allows for rating evidence up or down based on various domains. Second, systematic reviews should be removed from the top of the pyramid and used as a lens through which other studies are viewed, emphasizing their role in consuming and applying evidence rather than being the highest form of evidence. The article highlights the limitations of the traditional pyramid, including the potential for bias and the influence of study design on evidence quality. It also discusses the implications of these changes for stakeholders, such as patients and clinicians, and the importance of considering the quality of evidence when making clinical decisions. The revised pyramid can serve as a teaching tool to explain how evidence is evaluated and applied in practice. The authors emphasize the need for a more nuanced understanding of evidence quality and the role of systematic reviews in evidence-based practice.