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Kinds of Clinical Questions
There are two kinds of clinical 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 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
The Clinical Question
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?
Foreground questions are typically posed using the PICO framework to formulate the clinical question.
Using knowledge gained from your last PBL trigger, formulate
- Two background questions on the topic
- Two foreground questions on the topic
Use the examples provided in the boxes above to guide you in formulating these kinds of clinical questions.