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Evidence-Based Medicine

A guide to evidence-based medicine (EBM) resources and information

PICO and Well-Designed Clinical Questions

The PICO model is a helpful tool that assists you in organizing and focusing your foreground question into a searchable query. Dividing into the PICO elements helps identify search terms/concepts to use in your search of the literature.

PICO is an acronym that can be used to create well-designed clinical questions.

P = Patient,population,predicament or problem

I  = Intervension, exposure, test, etc

C = Comparison intervention, exposure, test, control, if relevant

O = Outcome of clinical importance, effects, including time when relevant


What is the condition or disease you are interested in?


What intervention are you considering?
What do you want to do with this patient?


Is there an alternative to compare with the intervention? (Can be none or placebo).


What is the clinical outcome of interest to you and your patient?

Background Questions

Before forming a clinical question you may need to answer background questions. Background questions ask for general knowledge about an illness, disease, condition, process or thing.

Sources of information for background questions include:

  • reference books
  • textbooks
  • drug monographs
  • other sources which provide an overview of a topic.

Foreground Questions

Foreground questions ask for specific knowledge about a Patient or problem, an Intervention, Comparison, and Outcome (commonly referred to as PICO).

Information sources for foreground questions include:

  • systematic reviews
  • practice guidelines
  • meta-analyses.

Types of Clinical Questions

Clinical questions usually fall into the following categories:

  • diagnosis
  • therapy
  • harm or etiology
  • prognosis
  • prevention
  • qualitative

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