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Evidence Based Medicine: Ask

Ask a Clinical Question

Asking clinical questions

One of the basic skills required for practicing EBM is developing of well-built clinical questions. These questions need to be relevant to patients’ problems and phrased in ways that facilitate your acquisition of relevant and precise answers. Well-built clinical questions usually contain up to four elements. PICO is an acronym/mnemonic of these elements and it identifies and organizes the key aspects of a complex patient presentation: P=Patient or Population and Problem; I=Intervention or Indicator; C=Comparison or Control (not part of all questions); O=Outcome.

Adding the two T's (Type of Question, Type of Study) to the PICO framework addresses that different types of study designs are used to answer different types of questions. 

When to use PICO?

Background questions concern general knowledge.   These types of questions generally have only 2 parts: A question root (who, what, when, where, how, why) and a disorder, test, treatment, or other aspect of health care.  Often these questions can best be answered by using a textbook or consulting a clinical database.

Foreground questions are specific knowledge questions that affect clinical decisions, including a broad range of biologic, psychological, and sociologic issues.  These are the questions that generally require a search of the primary medical literature and that are best suited to the PICO format.

Adapted from CEBM (Oxford) 
 

PICO Worksheets