WHSL Clinical Questions using PubMed: Asking the Clinical Question

There are two kinds of clinical questions:

Background Questions

• • Background questions are about physiology, pathology, epidemiology, and general management
  • They are often asked when still inexperienced
  • Answers to background questions can usually be found in textbooks, narrative review articles (found via PubMed), or encyclopaedias

Foreground Questions

• Foreground questions are more commonly asked by experienced clinicians
• These questions are asked when browsing the literature
  • Eg. what important new information should I know about in order to treat my patient optimally?
• These questions may also be asked when solving specific problems
  • usually in regard to patient care

Evidence-based practice requires you to

• formulate a clear clinical question
• search the literature for relevant clinical articles
• appraise (analyse) the articles retrieved for validity and applicability
  • how will the result benefit my patient/s?
• apply the evidence in practice

Framing the clinical query as a searchable statement is often the most difficult part of evidence-based searching of the literature.  It requires a synthesis of all your previously learnt search skills and knowledge of resources; together with your clinical knowledge and skills, and diagnostic acumen¹.

1. Richardson, S. 1995. The well-built clinical question: a key to evdience-based decisions. ACP Journal Club 123:A12-13.

Background questions are asked when you need basic, general information about a topic (who, what, when, where, how)

• What is hypertension?
• When should an antibiotic be prescribed?
• How should irritable bowel syndrome be treated?

Foreground questions are specific to the particular patient or problem in your clinical scenario

• Can antibiotics be used to treat adult pharyngitis?
• What are the effects of inhaled corticosteroids on asthmatic children?
• Are alternative medicine therapies better than 5-hydroxytryptamine receptor 4 (5-HT(4)) agonist for IBS?

Using knowledge gained from your last PBL trigger, formulate

• Two background questions on the topic
• Two foreground questions on the topic