What Needs To Be Done:
- Briefly describe a clinical case scenario encountered during one of your clerkship rotations that you would like to further research for the evidence.
- Construct a well-built, patient-oriented clinical question derived from your case scenario according to the PICO framework.
- Decide the category of your clinical question (e.g., therapy, diagnosis, etiology/harm) and the ideal study type that contains the best evidence (e.g., randomized controlled trial, cohort study)
- Identify possible search terms from your PICO question and incorporate them into a PubMed search strategy.
The PICO framework
P = Patients / Population and Problem
I = Intervention: a treatment, a diagnostic test, or an exposure (to a known or presumed risk factor, etc.
C = Comparison: a standard or alternate treatment, placebo, gold standard diagnostic test, absence of risk factor, etc.
O = Outcome of interest
The Most Common Types of Clinical Questions
- Therapy / Prevention
- Diagnosis / Screening
- Prognosis
- Etiology/Harm
- Cost-benefit Analysis
Examples of Well-built Clinical Quesitons
- A question about Therapy: In females diagnosed with breast cancer suitable for breast conserving surgery, what is the efficacy and safety of partial breast irradiation as compared to whole-breast irradiation?
- P = Females diagnosed with breast cancer suitable for breast conserving surgery
- I = Partial breast irradiation
- C = Whole-breast irradiation
- O = efficacy and safety of partial breast irradiation
- A questions about Prevention: Does placement of postpartum contraceptive implant decrease rapid repeat pregnancy?
- P = Postpartum mothers
- I = Immediate placement of contraceptive implants
- C = Delayed or no placement of contraceptive implants
- O = Decrease rapid repeat, unintended pregnancy
- A question about Diagnosis: For patients with suspicious breast calcification, what is the accuracy and safety of percutaneous ultrasound-guided vs. stereotactic biopsy?
- P = Patients with nonpalpable breast lesions
- I = Ultrasound-guided
- C = Stereotactic
- O = Sensitivity and specificity of the breast biopsies
- A question about Prognosis: Would secondhand smoke exposure during pregnancy increase the risk of asthma among offspring?
- P = Pregnancy women
- I = secondhand smoke exposure
- C = Smoke-free environment
- O = increase the risk of asthma among offspring
- A question about Etiology/Harm: Does Estrogen therapy increase the risk of blood clots and strokes in patients with menopausal symptoms?
- P =Patients with menopausal symptoms
- I = Estrogen therapy
- C = No treatment / placebo
- O = increase the risk of blood clots and strokes
- A question about Cost-benefit Analysis: What are the clinical and socioeconomic benefits of increasing access to reproductive health services and supplies for women with substance abuse disorders?
- P = Reproductive age females with substance abuse disorders
- I = Contraceptive care & services (family planning program, counseling, contraceptive supplies, patient education programs, etc.)
- C = Unmet needs for contraception or reproductive health
- O = Socioeconomic factors (e.g., reduce health care cost, unintended pregnancy, HIV infections, abortion rates, etc.)
Resources & Tools
- Collections of case scenarios
