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Allopathic Medicine: NSU MD Library Guide: EMB & PICO

An instructional pathfinder to researching for Dr. Kiran C. Patel College of Allopathic Medicine

Using PICO to Formulate Clinical Foreground Questions

PICO is a mnemonic used to describe the four elements of a good clinical foreground question:

P = Population/Problem - How would I describe the problem or a group of patients similar to mine?

I = Intervention - What main intervention, prognostic factor or exposure am I considering?

C = Comparison - Is there an alternative to compare with the intervention?

O = Outcome - What do I hope to accomplish, measure, improve or affect?

Different Types of Questions

Fill in the blanks with information from your clinical scenario:
In_______________, what is the effect of ________________on _______________ compared with _________________?

Are ______________ who have _______________ at ______________ risk for/of ____________ compared with _____________ with/without ______________?

Are (Is) ________________ more accurate in diagnosing _______________ compared with ____________?

For ___________ does the use of _________________ reduce the future risk of ____________ compared with ______________?

Does ____________ influence ______________ in patients who have _____________? 

How do _______________ diagnosed with _______________ perceive __________________?

Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.

Examples (PICO):

Constructing a good clinical question in order to use it to seach the literature effectively is challenging, and a fundamental skill that needs to be learnt alongside all other clinical skills.

A useful way to analyse or dissect the topic into its core components is to use parts of PICO, namely the patient (or population), the exposure (or intervention) and the outcome (which may be explicit, or implicit). However, as you have been shown, it is not always necessary to include all  four facets (components) in your PICO search statement, especially if you can find suitable MeSH terms to use in your search. By using the prognosis  filter in your Clinical Query search on binge drinking, for example, you will automatically include the prognosis for long-term mortalilty, as well as other outcomes, so you do not need to add all other possible outcomes to your search strategy initially. Sometimes your search will yield too few results if your search strategy is too specific.

  • An example of an explicit (certain or stated) outcome could be the cost of a particular intervention. 
    • Question: What is the cost of treatment for multidrug resistant tuberculosis?
  • An example of an implicit (uncertain or implied) outcome for binge drinking includes the prognosis for long-term mortalilty, in addition to other outcomes.
    • Question: What is the long term prognosis for teenage binge-drinking?

Here are links for more information.

PICO Examples


PICO Search

PICO Widget.

Below widget is available to do a quick lookup in some of the Ovid databases for your PICO question. Please note this is not a replacement for a precision search finding all results for your query, but it will give you a good indication if you are on the right track formulating your PICO.

Example PICO*: Prevention (O) of Whooping Cough (P) in adults (P) using vaccination (I)

* not all elements are required. In this example the C is not used

Select Ovid Database:
P: Patient, Population, Problem or disease
who are the patients, what is the problem
I: Intervention or Issue
what we do to them, what are they exposed to
Intervention / Issue:
C: Comparison intervention or issue
what do we compare the intervention with
O: Outcome
what happens, what is the outcome

Turning Search Terms into a Search Strategy