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WHSL Clinical Questions using PubMed: Asking the Clinical Question

The first in a series of evidence-based medicine guides

Kinds of Clinical Questions

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

 

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

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

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.

Exercises

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.