During the ASSESS portion of a clinical scenario, clinicians should ask a number of relevant questions. These include several background queries into the patient's history, the condition, and the medical subjects being considered. Questions like these seek to gather information about things, inquiring into the how, what, why, when, and where of the case being presented. Such queries can be more appropriately answered by topical sources like textbooks, clinical monographs, or point-of-care tools like UpToDate or DynaMed.
Asking more foreground questions allows clinicians to arrive at a relevant clinical question targeting a specific patient and problem. This also enables them to incorporate a well-situated intervention and sometimes a comparison that can lead to a specific outcome. For any given case, there will be a single question arrived at that requires clinicians to identify these variables. In EBM, this will generally be done using the PICO research framework. The PICO acronym described below is the most effective method of approaching a clinical scenario by ASKing the right question.
P - Patient, Problem, Population
I - Intervention
C - Comparison
O - Outcome
The PICO designation is important for identifying variables associated with a clinical scenario. The PICO question considers the concepts involved in a case, the terminology of which can be further broken down into synonyms useful for searching relevant literature. Furthermore, the relevant question, how it is framed and what it consists of, help position the question within certain clinical categories--usually therapy/prevention, diagnosis, prognosis, and etiology/harm. These specify the type of approach needed and correlate to study designs to focus the search around.
Therapy/Prevention
P - Patient/Problem/Population
I - Intervention
C - Comparison
O - Outcome
Diagnosis
P - Patient/Problem/Population
I - Test/Type of Screening
C - Gold Standard
O - Outcome
Prognosis
P- Patient/Problem/Population
I - Prognostic Factors/Exposure
C - Absence of Prognostic Factor
O - Outcome
Etiology/Harm
P- Patient/Problem/Population
I - Risk Factor(s)
C - Absence of Risk Factor
O - Outcome
