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Evidence-Based Medicine: 1. Ask

Developing Clinical Questions

A good clinical question must identify and consider particular pieces of information about the clinical situation.  The PICO Framework is highly recommended for developing clinical questions.  PICO is a mnemonic outlining the information essential for finding strong evidence.    

The PICO Framework 

P Patient or Problem Who is the patient or what is the problem?  What are the important characteristics?  





What intervention will be investigated?  The intervention might be a treatment, therapy, lifestyle change, or prognostic factor.

What potentially harmful factors will be investigated?  

C Comparator What alternative is being investigated?  [This element is optional.  When included, it is often the standard intervention]  
O Outcome What outcome is desired?  The clinician might want to measure or improve a patient's health situation or some other aspect of the clinical situation.  












A T is sometimes included in the framework to indicate that time is significant to the clinical situation, or it can represent Type of Study.   

T Time

Is there a Time frame to consider?  [This element is optional as it may not be an important factor in the investigation]

T Type of Study Which study design is best suited to answer the clinical question.



Clinical Question Tools

The tools and resources linked here are designed to help clinicians define clinical situations and develop focused, answerable clinical questions.  

Clinical Questions



In middle-aged men with common symptoms of heart attack (P), are serial electrocardiograms (I) compared with one electrocardiogram (C) more accurate in diagnosing impending heart attack (O)? 


In white males ages 20-40 years old (P), does consumption of energy drinks 2-3 per week (E) for a period of more than 1 year (T) increase the risk of cardiovascular events (O)?


In adult women with type 2 diabetes living in rural areas (P), how does participation in a diabetes self-management workshop (I) influence the development of serious health complications (O) 1-3 years following workshop participation (T)?  


In preschool aged children with middle ear infection (P), are antibiotics (I) more effective than placebo (C) in reducing duration and recurrence of infection (O)? 


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