Step 2: Database/Resource Searching
After successfully formulating the clinical question (step 1) you need to find relevant evidence. You may need to consult several types of information resources. These resources generally fall into three categories and are used in sequential order depending on need and applicability. The three categories are:
General Information (Background) Resources
You may often encounter conditions outside your specialty area or that you don’t see often, and need to get a comprehensive overview. Background resources provide excellent detailed information.
This category contains resources that provide background information about various diseases, conditions, and clinical questions. Resources include UptoDate and other E-Books such as DeGowin’s Diagnostic Examination, Current Diagnosis and Treatment, and Merck Manual of Diagnosis and Therapy. These resources are usually in a textbook format and as a result will not always integrate the most current research, but usually include references to journal literature so you can judge the currency of the information.
For example: measles has been nearly eradicated, but there has been a fairly recent outbreak. If you need to refresh your knowledge of the clinical presentation, diagnosis, etc. of measles, a background resource would be the best place to start.
If you're trying to decide on a course of action for a patient (diagnosis, treatment, etc.) and want to base your decision on the best available evidence, consult a filtered resource
In filtered resources, clinical experts and subject specialists pose a question and then synthesize "evidence" to state conclusions based on the available research. These resources are helpful because the literature has been searched and results evaluated to provide an answer to a clinical question. Because of this pre-evaluation, the clinician does not have to do the literature searching and evaluate each study that comes up, saving time and ensuring a level of completeness. This allows the clinician to more quickly make decisions at point of care. The conclusions produced by these resources still need to be evaluated by the clinician for appropriateness to the specific patient, but are very helpful and efficient when an appropriate resource exists.
Examples of filtered resources include the Cochrane Database of Systematic Reviews, InfoPOEMS, ACP's Pier (Physician's Information and Education Resource), National Guideline Clearinghouse, and Natural Standard. Each of the resources above provide a variety of information backed up with links to the literature and references to the resources used to pulled together the conclusions and/or information provided.
If you don’t find an appropriate answer in the filtered resources, you’ll need to search unfiltered resources (the primary literature) to locate studies that answer your question. Additionally, you may choose to search the unfiltered resources to see if any new research has been done since the conclusions reached in the filtered resources were released. Unfiltered resources provide the most recent information, but it’s up to the clinician to evaluate each study found to determine its validity and applicability to the patient. Effectively searching and evaluating the studies found in unfiltered resources takes more time and skill, which is why filtered resources are the first choice for answering clinical questions.
Considered the database of choice for the health sciences, MEDLINE provides primary and secondary literature for medicine, nursing, and allied health professions. Unlike filtered resources, literature searches performed in MEDLINE and other databases provide a first hand look at research and clinical topics. Often referred to as the gold standard, the ideal research consists of Randomized Control Trials (RCT), systematic reviews, and meta analysis. Depending on your topic, you may also consider searching databases such as, BIOSIS, PsycINFO, and CINAHL.
In this tutorial, we refer to databases and other EBP resources accessible from the Bio-Medical Library at the University of Minnesota. Most of these resources are subscription-based—you will need to use a U of MN ID and password to access them. You can access the rest of the tutorial whether or not you have a U of MN ID and password.
Click each resource type to learn more.
After you click each resource type, if you’d like to explore additional information related to searches, click Search References or click the References icon on the tutorial navigation bar at the top of the screen.