1. Authors of this presentation have the following to
Background
Objectives
Results
Discussion
Outlining a Well-Constructed Clinical Question Using PICO
Performance on PICO Questions: All Questions Combined n (%)
Performance on PICO Questions According to Topic of Question
Implications
Although students were successful at some components of constructing a
PICO and using criteria to select an information resource, additional
interventions need to be incorporated into the classroom to improve students’
abilities.
.
Shannon Reidt, Pharm.D., MPH, Franklin Sayre, MLIS, Jennifer Chen, Pharm.D., Karen Bastianelli, Pharm.D.,
Sara Sobota
Instilling a Rational and Methodical Approach to Acquiring Information to
Answer Well-Constructed Questions
Excellent Strong Limited Not evident
Population 214 (43.5) 37 (7.5) 4 (0.8) 237 (48.2)
Intervention 238 (48.3) 0 (0) 6 (1.2) 248 (50.4)
Comparison 196 (39.8) 0 (0) 20 (4.1) 276 (56.1)
Outcome 193 (39.2) 19 (3.9) 15 (3.0) 265 (53.9)
Justifying Choice of Information Source Using Criteria
Performance on Using Criteria to Justify Selection of Information Source:
All Questions Combined, n( %)
Evidence based medicine (EBM) is a systematic approach to clinical problem
solving that involves the integration of the best available research evidence
with clinical expertise and patient values. EBM requires the ability to ask well-
constructed questions; acquire, appraise, and apply information; and assess
one’s ability to execute these steps. First year students develop a foundation
for practicing these skills in the Pharmaceutical Care Skills Laboratory. The
focus of EBM instruction in the Pharmaceutical Care Skills Laboratory is often
on constructing questions and acquiring information.
Performance on Using Criteria to Justify Selection of Information Source
According to Topic of Question
Results (continued)
Methods
To instill a rational and methodical approach by which first year pharmacy
students evaluate and select information resources based on relevance,
validity, and convenience to answer well-constructed clinical questions.
A team consisting of clinical faculty, laboratory faculty, and a librarian
redesigned instruction to focus on instilling a rational and methodical criteria for
selecting drug information resources based on relevance, validity, and
convenience instead of teaching characteristics of specific resources.
Constructing a clinical question using PICO (population, intervention,
comparison, outcome) was also taught. Previous instruction did not focus on
outlining a well-constructed question and did not require students to provide a
rationale for selecting an appropriate information source to answer questions.
After five hours of instruction, students completed an assignment requiring
them to formulate clinical questions using PICO and justify their choice of
information resource using the criteria of relevance, validity, and convenience.
The assignment included one clinical case asking students to resolve three
issues:
1. Indication of inhaled corticosteroids in the treatment of asthma in children
2. Lifestyle modifications and pharmacological intervention in asthma
management
3. Correlation between use of inhaled corticosteroid in children and stunted
growth
Students were to provide information on these issues while focusing their
efforts on outlining a question and justifying their choice of information source
to answer the question. It was expected that each of the 167 students would
submit three PICO questions and three rationales explaining their choice of
information source.
Student responses were evaluated by a rubric that classified work as not
evident, limited, strong, or excellent. The rubric evaluating the PICO question
was worth 24 points with 6 points allocated for each of the four PICO
components. The rubric evaluating information source was worth 18 points
with 6 points allocated for criteria related to convenience, relevance, and
validity.
Clinical Issue Average Total Score, n=24 points
Indication of inhaled corticosteroids in
treatment of asthma in children
12.5
Lifestyle modifications and
pharmacological intervention in asthma
management
10.9
Correlation between use of inhaled
corticosteroid in children and stunted
growth
9.3
Average of all cases combined 10.9
Excellent Strong Limited Not Evident
Convenience 45 (9.1) 90 (18.3) 122 (24.8) 235 (47.8)
Relevance 69 (14.0) 108 (22.0) 164 (33.3) 151 (30.7)
Validity 27 (5.5) 50 (10.2) 59 (12.0) 356 (72.4)
Clinical Issue Average Total Score, n=18 points
Indication of inhaled corticosteroids in
treatment of asthma in children
5.6
Lifestyle modifications and
pharmacological intervention in asthma
management
4.9
Correlation between use of inhaled
corticosteroid in children and stunted
growth
4.9
Average of all cases combined 15.4
• 164 of 167 students submitted assignments
• 56 submissions did not follow directions but were included in analysis
• Student performance may be underestimated as 56/167 (33.5%) did not
follow directions.
• Performance related to outlining specific components of a PICO are similar
although student performance was highest related to outlining the Population
and lowest when outlining the Comparison.
• Student performance was highest when using relevance criteria with 36% of
responses graded as “strong” or “excellent” and lowest when using validity
criteria with 84.4% of responses were graded as “limited” or “not evident.”
• Student performance related to outlining a PICO varied across cases
although ability to use criteria to justify selection of information source did
not.
• Rational selection of an information source may be challenging to students
in their first semester of pharmacy education given their lack of
pharmacotherapy knowledge and clinical experience.
• Completing process-based assignments can be challenging for students
who are focused on product of an assignment. In other words, students may
be more focused on “answering the question” rather than justifying their
process to answer the question.
Authors of this presentation have the following to disclose concerning possible financial or personal relationships with commercial entities that have
a direct or indirect interest in the subject matter of this presentation.: Shannon Reidt, Franklin Sayre, Jennifer Chen, Karen Bastianelli, Sara Sobata:
Nothing to disclose.
For more information, contact: Shannon Reidt (reid0113@umn.edu)