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Edward G. Miner Library

Med Students: Phase 1: Session 1: Ask

This guide will serve as an information resource for first year medical students at the University of Rochester School of Medicine and Dentistry

Ask

Objectives:

  • Understand the difference between background and foreground information. 
  • Become familiar with the EBP LibGuide
  • Be able to identify good evidence
  • Be able to state the 5 steps of Evidence Based Medicine
  • Formulate PICOT questions

EBM Triad

Image source: American Academy of Physical Medicine & Rehabilitation

The Five A's

Evidence Pyramid

Image source: Georgetown University Medical Center

Evidence Resources

What is PICO or PICOTT?

One of the basic skills required for practicing EBP is developing a well-built clinical question. Theses questions need to be directly relevant to the patient or problem at hand and phrased in such a way as to facilitate the search for relevant and precise answers. PICO makes this process easier. It is an acronym/mnemonic for the important elements of a well-built clinical question. It also helps formulate the search strategy by identifying the key concepts that need to be in the article that can answer the question.

PICO or PICOTT:

P = PATIENT OR PROBLEM - How would you describe a group of patients similar to yours?  What are the most important characteristics of the patient?

I =  INTERVENTION, EXPOSURE, PROGNOSTIC FACTOR - What main intervention are you considering?  What do you want to do with this patient?

C =  COMPARISON - What is the main alternative being considered, if any?

O =  OUTCOME - Include patient oriented outcomes (morbidity, mortality, quality of life, etc).

T= 

TYPE OF QUESTION - Identify the question scenario (Therapy / Diagnosis / Etiology / Prognosis)

OR
TYPE OF STUDY - Identify study design to help answer question (Systematic review / RCT / cohort study / case controlled)

Types of Studies

Primary Question Types

  • Therapy: how to select treatments to offer our patients that do more good than harm and that are worth the efforts and costs of using them.
  • Diagnostic tests: how to select and interpret diagnostic tests, in order to confirm or exclude a diagnosis, based on considering their precision, accuracy, acceptability, expense, safety, etc.
  • Prognosis: how to estimate a patient's likely clinical course over time due to factors other than interventions
  • Harm / Etiology: how to identify causes for disease (including its iatrogenic forms).


Other Question Types

  • Clinical findings: how to properly gather and interpret findings from the history and physical examination.
  • Clinical manifestations of disease: knowing how often and when a disease causes its clinical manifestations and how to use this knowledge in classifying our patients' illnesses.
  • Differential diagnosis: when considering the possible causes of our patient’s clinical problem, how to select those that are likely, serious and responsive to treatment.
  • Prevention: how to reduce the chance of disease by identifying and modifying risk factors and how to diagnose disease early by screening.
  • Qualitative: how to empathize with our patients’ situations, appreciate the meaning they find in the experience and >understand how this meaning influences their healing.

From: Sackett, DL. Evidence-based medicine: how to practice and teach EBM.

Articles and Links

Evidence based practice: The practicalities of keeping abreast of clinical evidence while in training. 

Authors: Phillips R, Glasziou P. 

Published in: Postgrad Med J. 2008

Abstract: This paper gives a practical account of why and how to learn to practice evidence based medicine while still in clinical training. It highlights practical benefits to learning the skills (such as passing exams, coping with information overload and helping patients), and explains how to manage each of the four essential steps (asking questions, acquiring information, appraising evidence, and applying the results). Key resources to give the trainee rapid access to evidence based answers are highlighted, as are efficient ways of keeping up to date with the emerging literature.

Resources for Evidence-Based Practice
Miner has a terrific list of resources for Evidence-Based Practice.

See the Evidence-based Practice Guide page

 Videos about Evidence Based Practice

Viva la Evidence

Studies that I Like to Quote

The final days of King Charles II

An interesting YouTube video titled: "Why we need evidence based medicine"

The video isn't terrific, but the audio is worth listening to - it's an historic account of how King Charles II was treated in accordance with the medical knowledge of the time. 

Article: Evidence changes practice

A medical histories article on evidence-based medicine, titled: "From 'trust us, we're doctors' to the rise of evidence-based medicine"

PICO(T) Tutorial