Clinical Questions Addressed by First-Year Medical Students in Primary Care: A Cross-Sectional Study

In the context of an evidence-based medicine theme, medical students in their first year at McGill University formulate a PICO (population, intervention, comparator, and outcome) question arising from a patient encounter in family medicine. We sought to analyze clinical questions addressed within PICO projects submitted by first-year medical students shadowing a family physician.

A total of 180 student projects were split equally between two reviewers. Questions were then classified according to a three-component classification system: (a) type of question (screening, diagnosis, prognosis, treatment [including preventive treatment], etiology, and harm); (b) Ely's taxonomy; and (c) question topics based on the 105 priority topics of the College of Family Physicians of Canada.

The most frequent question type among the students was treatment/prevention (152, 84.0%), followed by etiology (7, 3.9%), screening (6, 3.3%), prognosis (6, 3.3%), harm (5, 2.8%), and diagnosis (4, 2.2%). Based on Ely's taxonomy, the most frequent question was "How should I treat condition x (not limited to drug treatment)?" (105, 58.3%). Of the 105 priority topics from the College of Family Physicians of Canada, in children (18, 10%), pain (16, 8.9%), pregnancy (12, 6.7%), depression (11, 6.1%), and behavioral problems (10, 5.6%) were most frequently represented.

Clinical questions addressed by first-year medical students, of which the vast majority are about treatment and prevention, can be classified. Students did not commonly address questions related to diagnosis, indicating that additional teaching may be required to use the PICO format to address this question type.