This page presents an overview of the and some examples of learning outcomes used to develop our students research and critical thinking competencies while studying at WCM-Q.
Recognize and fulfill an information need
Exhibit mental flexibility, persistency and creativity when searching
Realize that information sources vary greatly in content and format
Break complex research questions into simple ones
Use various research methods based on need, circumstance and type of inquiry
Decide which information to be used based on need
Value intellectual property, respect original ideas and adhere to academic integrity
Recognize that the tool used to communicate information might impact the value of the information
Keep an open-minded and critical stance when encountering varied or conflicting perspectives and develop awareness of their own biases and worldview
The EBM process begins when a clinician (You) is presented with a scenario that has some uncertain end or unanswered question. You will find that while many of the cases that you face as a clinician are routine and have a known trajectory, some cases have an air of ambiguity to them. In these situations it is critical that you are able to define the major and defining characteristics of the case and organize them in a uniform and meaningful way. This separating the wheat from the chaff, as it were, is the first step of the EBM process.
This process involves examining your cases and asking several important questions:
These, as well as other, questions will help you key in on the most salient points within your case. With this done you can then move on to the first steps in assessment and elucidate answers to your question.
What are background questions? These are questions that assist the clinician in filling in the gaps that they may have on a given subject. These are generally reference-based questions that give either quick or definitional knowledge. Examples include:
Answering these questions will not only give the clinician a fuller view of the case, but also lead them to new understandings and pathways to answering their case question.
Think of PICO as a way to sift out the most relevant concepts from a scenario and organize them in a clear and logical way. PICO stand for:
P: Patient, Population or Problem
This can refer to a specific patient, such as a 24 year-old male with sore throat and fever, or it can also be a more generalized problem, such as Renal Cancer in Vietnam. Them main emphasis is to describe, briefly, who or what is central to the scenario. It is best, especially when dealing with individuals, to be as specific as possible.
Classically, this is any diagnostic, prognostic, therapy or other mediating factor in a scenario. This can often be the intervention that is in question, such as a new drug or diagnostic test.
Your comparison is what is being contrasted to your intervention. In many cases this will be the gold standard. It is important to note that this is not always necessary. So in cases where you may only be examining the effects of a single factor, the comparison can be omitted.
Your outcome is whatever end result is most beneficial to your patient. The two most important points for the outcome are that it should be specific to the clinical outcomes for your patient and that it should be as measurable as possible. Typically most outcomes deal with morbidity, mortality or complications. You should also keep any patient preferences and values in mind here. What are the factors that a patient will want in their outcomes? These can be factors such as, ability to maintain lifestyle, pain management or compliance.
T: Type of Study or Type of Question
In some iterations of PICO you will find a ending T which can represent either the best type of study suited to answering the question. Often this will be a primary level study, as all EBM question can be best answered with either a systematic review or meta-analysis (which are secondary level evidence). Additionally, you may also see the T represented as type of question referring to the four general EBM question types of Diagnosis, Prognosis, Harm/Etiology, and Therapy. Knowing the question type can inform what kind of study is best to select or how you may construct your search.
Using these five factors to make sense of a scenario takes time and effort, but will result in better understanding your scenario and your ability to transfer this knowledge to a searchable entity.
Example of a PICO:
P: A 17 year-old Spanish male diagnosed with narcolepsy with cataplexy and a family history of narcolepsy
I: Low carb / high fat diet and additional daily naps
O: Reduction of daytime sleepiness measured as a 0-10 on the Epworth Sleepiness Scale
T: Type of Question - Therapy / Type of Study - RCT
Your clinical question is the logical construction of your PICO into sentence structure. It should be very redundant from your PICO and follow the same pattern. You can see from the example below that a well-formed PICO will make constructing a Clinical Question very easy.
In A 17 year-old Spanish male diagnosed with narcolepsy with cataplexy and a family history of narcolepsy will adding low carb / high fat diet and additional daily naps versus Venlafaxine lead to a reduction of daytime sleepiness measured as a 0-10 on the Epworth Sleepiness Scale (ESS)?
As you search through databases and information resources, you will find evidence of varying degrees of quality and reliability. While you will need to critically assess your needs in every situation, the pyramid below highlights the general hierarchy of the various levels of evidence.
In addition to the chart below, the Oxford Centre for Evidence-based Medicine has an excellent page on how certain types of evidence relate to certain types of questions.