Medical College Research Guide

Evidence Based Practice or EBP, allows clinicians to make informed, patient-care decisions by combining the best available research with clinical experience and patient experience.

1) Ask: Formulate a clear, focused clinical question that can be answered. 

2) Find: Gather the most relevant and high-quality evidence to address this question.

3) Appraise: Evaluate the evidence critically for its validity, significant, and applicability.

4) Apply: Use the evidence in conjunction with clinical expertise and the patient's individual values and preferences. 

5) Assess: Review the effectiveness and efficiency of the previous steps and identify opportunities to enhance one's ability to ask, acquire, appraise, and apply. 

The foundation of any research project is a clearly defined question. Understanding your question thoroughly increases the likelihood of finding meaningful and relevant answers. In evidence-based healthcare, this process is referred to as creating a “well-built clinical question.” One effective approach to developing such a question is the PICO framework, which centers around the patient and stands for:

• P – Patient, Population, or Problem
  Who or what is the clinical question focused on? This could include the specific health issue, condition, or situation. Details such as the patient's age, gender, or ethnicity may also be relevant to the context of care.

• I – Intervention, Exposure, or Prognostic Factor
  What is the primary treatment, exposure, or factor being considered? This could include a specific medical procedure, therapy, or variable that might influence the outcome or prognosis.

• C – Comparison or Control (if applicable)
  Is there an alternative intervention or standard of care being compared? This might involve comparing different treatments, diagnostic methods, or exposures. Not every question requires a comparison.

• O – Outcome
  What result are you aiming to achieve or measure? Outcomes might include improvement in symptoms, reduction in disease incidence, faster recovery, or better quality of life.

• T – Timeframe (optional)
  Over what period will outcomes be measured? Time may be a factor in assessing progress or change, such as evaluating the effectiveness of an intervention over six months or one year.

Example: For a person in their 60s with high blood pressure, over the course of 1 year, which approach is more effective for maintaining healthy blood sugar levels: lifestyle changes such as weight loss and exercise, or medication?

P - person in their 60s with heart disease

I - lifestyle changes

C - medication

O - maintaining healthy blood sugar levels

T - one year

Step 1: Using the example above, think about related terms and synonyms for each of the keywords. Creating a concept table can be helpful for this step: 

Step 2: Compose the search string using Boolean Logic. From the chart above, the search would look like this - 

("high blood pressure" OR hypertension) AND ("lifestyle change*" OR exercise OR "weight loss") AND (medic* OR diuretic*) AND ("blood sugar") AND ("one year" OR "12 months")

A few things to keep in mind:

• an * is used as a truncation device and can pick up alternative endings to words
• make sure to use quotes if you are searching two or more words together
• It is recommended to start off with a broad search. So in the case above, begin by searching on P and I of the PICO search string and then add on the C, O, or T to narrow the search. Each time you and an AND to the search string, you are narrowing the results

For a more detailed look at composing a search string, check out the How to Construct a Search Strategy Research Guide. 

The evidence hierarchy pyramid visually illustrates the relative strength of various research study designs. It serves as a useful way to understand that not all types of studies or sources carry the same level of reliability or importance—some provide stronger evidence than others: 

Source: “EBM Pyramid.” Digital Image. Eli M. Oboler Library, 27 May 2016.

Ask yourself how this new information has influenced your previous knowledge

Think about what factors now need to be assessed for implementation - 

• patient experiences and values
• community norms and cultural traditions
• current and reliable research 
• feasibility of implementation within the clinical setting
• clinical expertise

Ask yourself the following questions - 

1) Did you formulate a clear and answerable clinical question?

2) Did you locate the most relevant and high-quality external evidence?

3) Did you critically evaluate the evidence for its validity and usefulness? 

4) Did you apply the evidence and integrate it with your clinical expertise?

5) What were the results or outcomes for your patient(s) after applying the best available evidence?