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The practice of EBHC starts with formulating a question. A well-built question is a key to EBM [R].
Resources for structuring clinical stories into answerable questions
1) Centre of EBM (CEBM) Oxford, UK
2) More practise clinical scenarios from CEBM
3) Monash Institute of Health Services Research. Evidence-Based Answers - to Clinical Questions for Busy Clinicians. 2006
4) Glasziou P, Del Mar C, Salisbury J. Evidence based practice workbook. Second edition. BlackwellPublishing. P 21 -38
Why do you need to structure the question?
To get the question clear in your mind
To identify the information you need to answer the question
To translate the question into searchable terms
To develop and refine your search approach
To evaluate articles that we retrieve from the search
Types of clinical questions
The questions can be broadly divided into 'Background' or 'Foreground' types
Background questions are about general knowledge and have two components;
a) A question root (who, what, when, where, how, why) with a verb
b) A disorder, test, treatment or other aspects of health care
Foreground questions
Ask specific knowledge to inform clinical decisions or actions
Four essential components
(a) Patient / Problem
(b) Intervention (or exposure)
(c) Comparison if relevant
(d) clinical outcomes, including time (if relevant)
Clinicians need both background and foreground knowledge. The proportion of background and foreground knowledge varies with the experience. For e.g. student who starts clinical work in a hospital (A) will have lots of background questions whereas a consultant will have an increasing proportions of foreground questions (B).
Answers to background questions can be normally found in textbooks and we use the PICO format to obtain answers to foreground questions
Figure - insert here
PICO
We use a framework called “PICO” to make the process of asking an answerable question easier (but it is still tricky and takes practice). PICO stands for:
• Patient or Population
• Intervention or Indicator
• Comparison or Control
• Outcome.
Minutes spent properly formulating your question will save you hours in search time.
How would you describe your Patient / Problem?
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EBM 
