Art of asking

Patient has a cough, and is prescribed an antibiotic. Single loop learner: Patient returns 5 days later, feeling no better. The physician prescribes a different antibiotic. Double loop learner: Patient returns 5 days later, feeling no better. The physician questions the underlying assumption (“governing variable”) that it was a bacterial lung infection and considers that it may be sinusitis, a viral infection, allergies, or chronic lung disease.

Using the PICO approach to frame questions: 1). Population. 2). Intervention. 3). Comparison. 4). Outcome

Searching the literature

Types of scientific literature: 1). Primary research studies: Studies that gather original data (ideally from humans). 2). Systematic Reviews and Meta-analyses: Rigorous studies that attempt to synthesize all data on a focused clinical or research question. 3). Practice Guidelines: Guidance from organizations about the best way to manage a medical condition. 4). General reviews and summaries: Primarily designed to summarize and educate Textbooks, review articles, book chapters, monographs, critical appraisals, much more.

Finding primary research studies

PubMed / Medline: Millions of studies of every design dating back to early 1960’s

Cochrane Controlled Trials Register: Only clinical trials, over 1.6 million currently (2020). Many not indexed in Medline (smaller, international journals or gray literature)

Embase: European equivalent of Medline

Specialized databases: CancerLit, PsychLit, etc.

Gray literature: Unpublished studies, may available through FDA or other registries