Clinical (or patient-centered or foreground) questions ask for knowledge in relation to individual patients or case scenarios. They differ from background questions because they focus on etiology, diagnosis, therapy, and/or prognosis; answers are usually found in research databases, such as PubMed and Embase, or clinical consult tools, such as Dynamed, or BMJ Best Practice.
Clinical questions tend to be more complex than background questions, and usually require higher level search skills. How to ask (structure) clinical questions and efficiently search for answers to them will be the focus this year (in ICS 4-6)
One way to categorize the questions that come up in clinical practice is to ask whether they require background or clinical (patient-centered) information to answer them.
Background questions ask for general knowledge (who, what, how, why, when) about a health condition, syndrome, issue or disease.
Example: Does / how does exercise strengthen the heart?
Example: When do complications of whooping cough usually occur and in what age groups?
Example: How well do creatine or iron supplements work as a substitute for food sources of these nutrients?
Clinical (patient-centered) questions ask for specific information to facilitate clinical decision-making. See the other section of this box to learn more about clinical questions.
In reality, what begins as a background question may spill over into a foreground question and vice versa. As your basic medical knowledge grows, you'll be asking fewer background questions and more patient-centered ones.
PICO is a mnemonic device that can help you formulate a clinically-answerable question, organize your thoughts for a database search or evaluate the findings of individual studies. The clearer you are about what you're searching for, the easier it will be to find it.
This brief video will walk you through the steps. (Courtesy of Physiotherapy Assn. of British Columbia)
Steps to answers for clinical questions:
1st: Frame your patient issue in the form of a statement or question.
Example: Is there any research looking at regular exercise for depression that would benefit my patient, a 15 y.o. girl.
2nd: Identify the PICO components as specifically as possible. See Easy as PICO tab (above).
PICO
Patient population or Problem: For which patient, group or health condition do you need information?
Teenage females experiencing mild to moderate depression.
Intervention (or Exposure): Which medical event or therapy do you need to study the effect of?
Regular exercise.
Comparison (if known): With what will you compare the intervention's results?
No regular exercise.
Outcomes: What are the relevant effects (outcomes) you'll be monitoring?
Lower levels of depression reported by the patient (usually on a validated qualitative perception scale).
Clinical Question: Does regular exercise reduce depression in teenage females?
You don't need to use all of the elements from your PICO and/or clinical question in the database search; in many cases, information from PICO's P and I may be sufficient. Also, some aspects of your search, such as publication date, study type, age and gender, can best be captured with the database's Limits or Filter feature.
Example: Does regular exercise reduce depression in young adult females?
Possible database search query: exercise AND depression
Set applicable filters for sex or gender, ages, publication date, type of study, etc. and run your search.
Scan results, revise search by adding or deleting terms as necessary, and rerun it.
Note: See the Database Tutorials tab for PubMed, CINAHL and Embase search examples.
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