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Module 3: Asking a Clinical Question

Formulate the Question

The second phase of evidence based medicine.

Construct a relevant, answerable question derived from the clinical situation using PICO. A good clinical question must be directly related to the patient or situation at hand and structured in such a way as to facilitate the search for an answer. Remember, PICO helps identify the key components of the question.

Clinical Question Template

Once you have identified your PICO components, you can format them into a question statement or clinical question. Although there is no singular model for structuring your clinical question, you want to ensure that your statement includes all of the PICO components.

In (Patient/Population or Problem), how does (Intervention) affect (Outcome) when compared to (Comparison/Control).

The examples below are based on cases drawn from the second edition of the Users' Guide to the Medical Literature: A Manual for Evidence-Based Clinical Practice. Note: in order to improve the overall flow of the clinical question, the comparison, if available, has been placed after the outcome.

Question Type Patient/Population or Problem Intervention Outcome Comparison
Therapy In adult intravenous drug users w/ endocarditis  Are oral antibiotics  As effective in treating infection and reducing complications or mortality  As intravenous antibiotics?
Prognosis  In middle-aged patients who present with transient loss of consciousness Within the year after presentation What is the relative risk of morbidity (such as seizures or strokes) or death? N/a
Diagnosis In older patients with suspected cognitive impairment Does a brief screening tool for dementia Have sensitivity, specificity and predictive values Similar to the standard screening tool, MMSE?
Etiology/Harm Do adults Who binge drink Have higher mortality rates Than those who do not binge drink?

Check out the remaining tabs in this box for templates and examples that you can use to create a well-built clinical question statement.

Content is adapted from: Evidence Based Medicine Guide: PICO & the Question Statement. Created by librarians from the Levy Library, Icahn School of Medicine at Mount Sinai. 

Question Type: Therapy 

Librarian note: questions that relate to therapy may occasionally include an element that corresponds to time or timeframe (T). The inclusion of time in your question statement may be prudent if the original prompt has a time or time-sensitive component. 

In _______(P), what is the effect of _______(I) on ______(O) compared with _______(C)?

In _______(P), what is the effect of _______(I) on ______(O) compared with _______(C) within (T)?

Examples:

What is the duration of recovery (O) for patients with total hip replacement (P) who developed a post-operative infection (I) as opposed to those who did not (C) within the first six weeks of recovery (T)?

For patients 65 years and older (P), how does the use of an influenza vaccine (I) compared to not received the vaccine (C) influence the risk of developing pneumonia (O) during flu season (T)?

Adapted from Ask: Write a Focused Clinical Question. Created by librarians from Cline Library, Northern Arizona University.

Question Type: Prognosis

Librarian note: questions that relate to prognosis may occasionally include an element that corresponds to time or timeframe (T). The inclusion of time in your question statement may be prudent if the original prompt has a time or time-sensitive component. 

Does __________ (I) influence ________ (O) in patients who have _______ (P) over ______ (T)?
In _______ (P), how does ________ (I) compared to ________ (C) influence _________ (O) over _________ (T)?

Examples:

Does tele-monitoring blood pressure (I) in urban African Americans with hypertension (P) improve blood pressure control (O) within the six months of initiation of the medication (T)?

For patients 65 years and older (P), how does the use of an influenza vaccine (I) compared to not received the vaccine (C) influence the risk of developing pneumonia (O) during flu season (T)?

Adapted from Ask: Write a Focused Clinical Question. Created by librarians from Cline Library, Northern Arizona University.

Question Type: Diagnosis

Are (is) _________ (I) more accurate in diagnosing ________ (P) compared with ______ (C) for _______ (O)?

In ________ (P) are/is ________(I) compared with ________(C) more accurate in diagnosing ________(O)?

Examples:

In middle-aged men with suspected myocardial infarction (P), are serial 12-lead ECGs (I) compared with one initial 12-lead ECG (C) more accurate in diagnosing an acute myocardial infarction (O)?

Is a PKU test (I) done on two week old infants (P) more accurate in diagnosis inborn errors in metabolism (O) compared with PKU tests done at 24 hours of age (C)? 

Adapted from Ask: Write a Focused Clinical Question. Created by librarians from Cline Library, Northern Arizona University.

Question Type: Etiology/Harm

Librarian note: questions that relate to etiology/harm may occasionally include an element that corresponds to time or timeframe (T). The inclusion of time in your question statement may be prudent if the original prompt has a time or time-sensitive component. 

Are ____ (P) who have _______ (I) at ___ (Increased/decreased) risk for/of_______ (O) compared with ______ (P) with/without ______ (C) over _____ (T)?

Are ______(P) who have ______(I) compared with those without _______(C) at ________ risk for/of _______ (O) over ________(T)?

Examples:

Are kids (P) who have obese adoptive parents (I) at Increased risk for obesity (O) compared with kids (P) without obese adoptive parents (C) during the ages of five and 18 (T)?

Are 30- to 50- year old women (P) who have high blood pressure (I) compared with those without high blood pressure (C)at increased risk for an acute myocardial infarction (O) during the first year after hysterectomy (T)?

Adapted from Ask: Write a Focused Clinical Question. Created by librarians from Cline Library, Northern Arizona University.