Hello all,
The issue of questions that belong to either foreground or background
is a good one because it helps to determine where to look for
information. Finding answers to clinical questions may require searches
for
background information about who, what, where, when or why about a disease. Examples include
What is Down's syndrome? and
What is trisomy 21? Background questions are questions about the
facts of a disease, and point-of-care tools provide excellent context
(background) for these questions. Two tools that are strong in providing
background are
UpToDate and BMJ's
Clinical Evidence. Guyatt et al suggest that background questions
are most often asked by medical students. As medical training continues
through residency and practice, clinical questions get more and more
specific - and these reside in the foreground
of medical evidence. Many research studies indexed in MEDLINE answer specific foreground questions whereas textbooks answer background questions.
see Guyatt et al http://library.med.nyu.edu/library/eresources/student/residencyebm/pdf2005/1A1searching.pdf
Dean Giustini
UBC biomed librarian
Good day to the group,
On the theme of definitions, I'm coming to the conclusion that the
terms "foreground" and "background" questions are not as strictly
defined as I might have thought.
I base this conclusion upon a quick search of online resources to
define the terms (see below). Conceptually, the only strongly agreed
upon aspects is 1) a background question is general & foreground
question is (patient) specific and 2) a background
question is from general references and foreground question is from
primary or secondary research and involves the structured
question. However, those two parameters are silent about the scope and
limitation about the knowledge one is seeking and does not
describe how the two questions interrelate...and then the definitions
vary...
For example, is the diagnosis of celiac disease or autism (spectrum
disorders) may be considered a background question, but those diagnoses
have and continue to evolve over time and they're diagnosis varies by
age; so Nelson's pediatrics from 2005 may differ
from a 2006 review paper in BMJ etc. However, on the flip-side, in
order to craft a well-framed clinical foreground question about a
diagnostic test for autism or celiac disease, it is usually prudent to
first understand how the populations are being defined
and measured.
So - practically speaking - when I'm coaching trainees how to ask
questions (or even improving myself), I'm finding these definitional
concepts helpful but perhaps structurally incomplete.
--Patrick
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Appended:
A list of website and online .pdfs that define the terms: