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)
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.
Foreground questions are best suited to the PICO format. These are clinical questions that focus on the care of a specific patient or population and generally require a search of the primary medical literature.
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, such as UpToDate or DynaMed.