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PICO: The Secret Ingredient to Clinical Research: Putting PICO to Action During Clerkship

An Effective and Efficient Tool in Organizing Your Research

How is PICO helpful when serving patients?

Taking the Big Picture & Developing Four Bite-Sized Components

Focused Answerable Question

Forming an answerable clinical question using the PICO method is rather simple.

You simply bring the four PICO components together in a question form. 

 

I am going to use the consumption of  dark chocolate in regards to improving the cardiovascular system in healthy young adults as an example:
In healthy young adults (P), does the consumption of dark chocolate (I) improve an individual's cardiovascular system (O) in comparison to those who do not consume dark chocolate (C)?
In this example, the four parts of PICO are stated ensuring the research is focused and clear. Notice, the components do not have to go in the exact PICO order, but all of the relevant factors are necessary.

 

I want to provide an example that does not use a comparison as well since a comparison is not always necessary like the following example:
Is healthy diet and exercise (I) effective in the management of blood glucose levels (O) in patients with gestational diabetes (P)? 
As you can see, this example isn't comparing the intervention to an alternative method of managing gestational diabetes.

 

Now, if you wanted to add a comparison, you could compare two age groups in which the question would go like this:
Is healthy diet and exercise (I) as effective in the management of blood glucose levels (O) for patients aged 40 years or older with gestational diabetes (P) in comparison to patients under 40 years of age with the same condition (C)?

You could also compare treatment options:
Is healthy diet and exercise (I) more or less effective in the management of blood glucose levels (O) for patients with gestational diabetes (P) than insulin (C)?

Establishing Focused Searching Terms

Forming search terms is made easier with PICO. 

Using the chart below, I have taken the main concepts of our PICO example involving gestational diabetes and developed the primary keywords as well as some alternative terms. 
I have added columns to the table in order to separate the description of the patient/problem and the two medical interventions. This is done to provide alternative terms for each individual concept.
Also, you do not need to use all of the concepts in your initial search. You want to, first, focus on your primary keywords and add in additional terms if you need to filter out results. I have the primary keywords marked with *.
Population/Problem/Patient Descriptors for Population/Problem/Patient Intervention (1) Intervention (2) Comparison Outcome
Gestational Diabetes* 40 Years Old Diet* Exercise* Insulin* Management*
Pregnancy-Induced Diabetes Middle-Aged Healthy Diet Physical Activity Hypoglycemic Agent Disease Management
Now, you might be wondering how I found alternative search terms. There are a few methods to help you find additional ways of saying the same thing:
  1. MeSH Database - Use the MeSH database within PubMed to find additional entry terms as well as the appropriate Medical Subject Heading or MeSH term. In most cases, knowing the exact MeSH term isn't necessary, but it can be helpful. When you search a keyword in the MeSH Database, you will find a brief description. In this description, you may also find relevant search terms.
  2. Subject Tracing - If you run a search using your basic and initial PICO keywords, you may be able to find alternative terms through reading the subject terms and keywords highlighted in relevant and applicable resources as long as the search was fruitful. 
  3. Personal Knowledge - You may know additional appropriate medical terms simply from your learning. 
  4. Acronyms - If you are using a keyword that has an acronym this is an appropriate alternative term and vice versa. For example: COPD and Chronic Obstructive Pulmonary Disease are both interchangeable search terms.