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Doctor of Medical Science : Research Guidance

This guide is designed to support students and faculty in the Doctor of Medical Science program by providing access to essential resources and tools for academic success. Here you will find a curated collection of books, journals, databases, and web resou

Evidence-Based Practice

Framing the Clinical Question using PICO

   

PICO is an acronym to help researchers create focused, clinical questions. Each part of the PICO is a key concept in a clinical question

P - Patient/Problem/Population: How would you describe the patient or problem? This could include gender, age, disease, etc.

I - Intervention: What change or difference are you applying? Interventions could include medications, surgeries, 

C - Comparison: What are you comparing your intervention to? This could be an alternative intervention or even a placebo. The comparison might not be necessary in all PICO questions.

O - Outcome: What are you trying to accomplish or measure? 

T - The time it takes to demonstrate an outcome (e.g. the time it takes for the intervention to achieve an outcome or how long participants are observed).

Note: Not every question will have an intervention (as in a meaning question) or time (when it is implied in another part of the question) component.

 

Using parts of the PICO question as search keywords can help build a quality search query to find the best evidence-based information. 

 

Example: 

Are women ages 25-40 (P) who take oral contraceptives (I) at greater risk for developing blood clots (O) compared with women ages 25-40 (P) who use IUDs for contraception (C) over a 5 year time frame (T)?

Databases

Types of Questions

Before beginning your search of the literature, it's important to understand the difference between background and foreground questions. This will guide you to the correct resource to aid you in answering your question.

Background question: Seek to answer foundational knowledge about a condition, illness, disease, etc.

Foreground question: Seek to answer specific knowledge regarding a clinical decision, usually concerning a specific patient, population, or intervention. According to Guyatt et al. there are 5 types of foreground questions: therapy, harm, differential diagnosis, diagnosis, and prognosis.

  1. Therapy: determining the effect of interventions on patient-important outcomes (symptoms, function, morbidity, mortality, and costs)
  2. Harm: ascertaining the effects of potentially harmful agents (including therapies from the first type of question) on patient-important outcomes
  3. Differential diagnosis: in patients with a particular clinical presentation, establishing the frequency of the underlying disorders
  4. Diagnosis: establishing the power of a test to differentiate between those with and without a target condition or disease
  5. Prognosis: estimating a patient's future course

Guyatt, G, Rennie, D, Meade, MO, Cook, DJ. Users' Guide to the Medical Literature: Essentials of Evidence-based Clinical Practice. 3rd ed. New York, NY: McGraw Hill Education, 2015.

Patient Intervention Comparator Outcome (PICO) Framework Tutorials