Evidence-Based Practice (EBP) is the foundational philosophy that guides modern pharmacy and healthcare. It is the “transcending concept” that integrates the best available research evidence with clinical expertise and individual patient values to make informed decisions about patient care. As a PharmD student, developing skills in EBP is not confined to a single class but is woven throughout your curriculum, from the dedicated PHA5244 Principles of Evidence-Based Practice course to the practical application in patient care labs where you must defend therapeutic plans using guidelines and primary literature. This quiz will test your knowledge of the essential components of EBP, from formulating clinical questions and appraising literature to applying statistical concepts and clinical guidelines.
1. Evidence-Based Practice is the integration of clinical expertise, patient values, and what other key component?
- a. Hospital formulary status
- b. The best available research evidence
- c. The cost of the medication
- d. The pharmacist’s personal preference
Answer: b. The best available research evidence
2. The PICO format is used for formulating an effective clinical question. What does the “P” stand for?
- a. Pharmacology
- b. Pharmacy
- c. Patient, Population, or Problem
- d. Plan
Answer: c. Patient, Population, or Problem
3. In the hierarchy of evidence, which study design is typically considered to provide the highest level of evidence?
- a. Case report
- b. Randomized Controlled Trial (RCT)
- c. Systematic Review or Meta-Analysis of RCTs
- d. Cohort Study
Answer: c. Systematic Review or Meta-Analysis of RCTs
4. A study that follows a group of smokers and a group of non-smokers forward in time to see who develops lung cancer is an example of what type of study?
- a. Case-control study
- b. Prospective cohort study
- c. Randomized controlled trial
- d. Cross-sectional study
Answer: b. Prospective cohort study
5. What is the primary advantage of a Randomized Controlled Trial (RCT)?
- a. They are the easiest and cheapest studies to conduct.
- b. The randomization process minimizes selection bias and the influence of confounding variables.
- c. They are always generalizable to all patient populations.
- d. They do not have ethical limitations.
Answer: b. The randomization process minimizes selection bias and the influence of confounding variables.
6. If a study reports a result as “statistically significant” with a p-value of <0.05, what does this mean?
- a. The result is definitely clinically important.
- b. There is less than a 5% probability that the observed result is due to chance alone.
- c. The study had no flaws or bias.
- d. The null hypothesis is proven to be true.
Answer: b. There is less than a 5% probability that the observed result is due to chance alone.
7. A 95% Confidence Interval (CI) is reported as (0.75 – 0.95) for a Relative Risk. What can you conclude from this result?
- a. The result is not statistically significant because the interval is too narrow.
- b. The result is not statistically significant because it includes the number 1.0.
- c. The result is statistically significant because the entire interval is below 1.0.
- d. The study was likely underpowered.
Answer: c. The result is statistically significant because the entire interval is below 1.0.
8. In a clinical trial, the Number Needed to Treat (NNT) is 20. What does this mean?
- a. 20 patients need to be treated with the intervention for one to have a side effect.
- b. The treatment is effective in 20% of patients.
- c. 20 patients need to be treated with the intervention to prevent one additional bad outcome.
- d. The trial enrolled 20 patients.
Answer: c. 20 patients need to be treated with the intervention to prevent one additional bad outcome.
9. The analysis of all subjects in the groups to which they were originally assigned, regardless of whether they completed or received the treatment, is called:
- a. Per-protocol analysis
- b. Subgroup analysis
- c. Intention-to-treat (ITT) analysis
- d. As-treated analysis
Answer: c. Intention-to-treat (ITT) analysis
10. A pharmacist defending a therapeutic plan by citing the latest ACC/AHA guidelines is engaging in:
- a. Guesswork
- b. Evidence-Based Practice
- c. Personal opinion
- d. Cost-minimization analysis
Answer: b. Evidence-Based Practice
11. Which of the following represents the “I” in the PICO format?
- a. Indication
- b. Intervention
- c. Institution
- d. Importance
Answer: b. Intervention
12. The “Methods” section of a published research study is crucial for assessing what?
- a. The clinical importance of the results.
- b. The internal validity of the study.
- c. The authors’ interpretation of the data.
- d. The novelty of the research question.
Answer: b. The internal validity of the study.
13. In a forest plot from a meta-analysis, if the diamond representing the pooled result does not cross the line of no effect (the null line), the result is:
- a. Statistically significant
- b. Not statistically significant
- c. Invalid due to heterogeneity
- d. Clinically insignificant
Answer: a. Statistically significant
14. A study that examines a patient with a very rare disease and retrospectively looks for potential exposures is best described as a:
- a. Case report or case series
- b. Randomized controlled trial
- c. Prospective cohort study
- d. Meta-analysis
Answer: a. Case report or case series
15. Blinding of patients and investigators in an RCT is performed to minimize:
- a. Selection bias
- b. Attrition bias
- c. Performance and detection bias
- d. Publication bias
Answer: c. Performance and detection bias
16. The difference in the rate of an outcome between the placebo group (10%) and the treatment group (8%) is called the:
- a. Relative Risk (RR)
- b. Relative Risk Reduction (RRR)
- c. Absolute Risk Reduction (ARR)
- d. Odds Ratio (OR)
Answer: c. Absolute Risk Reduction (ARR)
17. “External validity” refers to:
- a. The degree to which the statistical analysis was done correctly.
- b. The degree to which the study results are free from bias and confounding.
- c. The degree to which the results of a study can be generalized to other populations.
- d. The funding source of the study.
Answer: c. The degree to which the results of a study can be generalized to other populations.
18. Clinical Practice Guidelines (CPGs) are valuable because they:
- a. Replace the need for clinical judgment.
- b. Are always up-to-date with the latest research.
- c. Synthesize a large body of evidence into actionable recommendations for clinicians.
- d. Are legally binding documents.
Answer: c. Synthesize a large body of evidence into actionable recommendations for clinicians.
19. A study’s “power” is its ability to:
- a. Influence clinical practice.
- b. Be published in a high-impact journal.
- c. Detect a statistically significant difference between groups if a difference truly exists.
- d. Enroll patients quickly.
Answer: c. Detect a statistically significant difference between groups if a difference truly exists.
20. The curriculum explicitly mentions a “Transcending Concept – Evidence-Based Practice” in which course?
- a. PHA5784C Patient Care 4
- b. PHA5104 Sterile Compounding
- c. PHA5703 Pharmacy Law and Ethics
- d. PHA5439 Medicinal Chemistry
Answer: a. PHA5784C Patient Care 4
21. A statistically significant finding is always clinically significant.
- a. True
- b. False
Answer: b. False
22. Which type of study design is best for determining the effectiveness of an intervention?
- a. Cross-sectional study
- b. Randomized Controlled Trial
- c. Case report
- d. Observational cohort study
Answer: b. Randomized Controlled Trial
23. The purpose of a journal club is to:
- a. Socialize with colleagues.
- b. Practice reading skills.
- c. Critically appraise recent literature and discuss its application to practice.
- d. Fulfill a mandatory meeting requirement.
Answer: c. Critically appraise recent literature and discuss its application to practice.
24. A “surrogate endpoint” is a:
- a. Measure of how a patient feels, functions, or survives.
- b. Laboratory value or physical sign used as a substitute for a clinically meaningful endpoint.
- c. The most important outcome in a trial.
- d. An unexpected adverse event.
Answer: b. A laboratory value or physical sign used as a substitute for a clinically meaningful endpoint.
25. Publication bias refers to the tendency for:
- a. Journals to only publish articles that are easy to read.
- b. Studies with statistically significant or “positive” results to be more likely to be published.
- c. Authors to only cite their own previous work.
- d. Readers to only believe studies from high-impact journals.
Answer: b. Studies with statistically significant or “positive” results to be more likely to be published.
26. The “Discussion” section of a research paper should contain:
- a. A detailed description of the statistical methods.
- b. A neutral presentation of the raw data.
- c. The authors’ interpretation of the results, study limitations, and comparison to other research.
- d. The PICO question.
Answer: c. The authors’ interpretation of the results, study limitations, and comparison to other research.
27. In a meta-analysis, “heterogeneity” refers to:
- a. The quality of the included studies.
- b. The variability or differences in the results of the included studies.
- c. The number of authors on each paper.
- d. The funding sources of the studies.
Answer: b. The variability or differences in the results of the included studies.
28. Which of the following is an example of primary literature?
- a. A review article in a journal.
- b. A clinical practice guideline.
- c. A textbook chapter.
- d. An original research article reporting on an RCT.
Answer: d. An original research article reporting on an RCT.
29. What is a key limitation of a case report?
- a. It is very expensive to conduct.
- b. It cannot establish causality or be generalized.
- c. It requires a very large number of patients.
- d. It always involves a placebo control.
Answer: b. It cannot establish causality or be generalized.
30. The “appraisal of cohort studies” is an EBP topic within which course?
- a. PHA5787C Patient Care 5
- b. PHA5163L Professional Skills Lab 3
- c. PHA5267 Principles of Pharmacoeconomics
- d. PHA5103 Principles of Patient-Centered Care
Answer: a. PHA5787C Patient Care 5
31. Tertiary literature, such as a textbook or a drug information database, is best used for:
- a. Finding the most current, cutting-edge research.
- b. Gaining a general overview of a topic or answering a background question.
- c. Critically appraising study methodology.
- d. Performing a meta-analysis.
Answer: b. Gaining a general overview of a topic or answering a background question.
32. The main difference between an experimental and an observational study is that in an experimental study, the researcher:
- a. Only observes what happens naturally.
- b. Assigns the exposure or intervention.
- c. Looks back in time.
- d. Does not enroll human subjects.
Answer: b. Assigns the exposure or intervention.
33. What does it mean if an RCT is “double-blind”?
- a. The study results were not published.
- b. The study enrolled patients with vision problems.
- c. Both the study participants and the investigators/clinicians are unaware of the treatment assignments.
- d. The statisticians are unaware of the treatment assignments.
Answer: c. Both the study participants and the investigators/clinicians are unaware of the treatment assignments.
34. The “Results” section of a research paper should be:
- a. A subjective interpretation of the data.
- b. A neutral, objective presentation of the study’s findings.
- c. A review of prior studies.
- d. A list of study limitations.
Answer: b. A neutral, objective presentation of the study’s findings.
35. A confounding variable is a factor that:
- a. Is the outcome of interest.
- b. Is associated with the exposure and the outcome, and can distort the true relationship between them.
- c. Is only present in the treatment group.
- d. Makes the results more statistically significant.
Answer: b. Is associated with the exposure and the outcome, and can distort the true relationship between them.
36. A Relative Risk (RR) of 1.0 indicates:
- a. The treatment doubles the risk of the outcome.
- b. The treatment halves the risk of the outcome.
- c. There is no difference in risk between the treatment and control groups.
- d. The study was flawed.
Answer: c. There is no difference in risk between the treatment and control groups.
37. Which database is a primary tool for searching biomedical literature?
- a. Wikipedia
- b. Google
- c. PubMed/MEDLINE
- d. Facebook
Answer: c. PubMed/MEDLINE
38. Attrition bias occurs when:
- a. The study methods are not valid.
- b. Patients who drop out of the study are systematically different from those who remain.
- c. The wrong statistical test is used.
- d. The sample size is too small.
Answer: b. Patients who drop out of the study are systematically different from those who remain.
39. The most important factor to consider when evaluating a clinical practice guideline is:
- a. The length of the document.
- b. The reputation of the authors.
- c. The rigor of the evidence-based process used to create it.
- d. The cost of the treatments it recommends.
Answer: c. The rigor of the evidence-based process used to create it.
40. The ultimate purpose of EBP is to:
- a. Make healthcare more complicated.
- b. Improve patient outcomes.
- c. Save money.
- d. Publish research papers.
Answer: b. Improve patient outcomes.
41. An “active control” in an RCT means the control group receives:
- a. A placebo
- b. No treatment
- c. The current standard of care
- d. A lower dose of the investigational drug
Answer: c. The current standard of care
42. The “Introduction” section of a research paper should end with:
- a. A summary of the results.
- b. A statement of the study’s specific objective or research question.
- c. A list of the authors’ conflicts of interest.
- d. The conclusion of the study.
Answer: b. A statement of the study’s specific objective or research question.
43. A key strength of a meta-analysis is its ability to:
- a. Eliminate all bias from individual studies.
- b. Increase the statistical power by combining results from multiple studies.
- c. Include unpublished data.
- d. Prove causality with certainty.
Answer: b. Increase the statistical power by combining results from multiple studies.
44. Which factor is NOT part of the three core principles of Evidence-Based Practice?
- a. Best research evidence
- b. Clinical expertise
- c. Patient values and preferences
- d. Manufacturer’s recommendations
Answer: d. Manufacturer’s recommendations
45. Selection bias is primarily controlled for in a clinical trial by:
- a. Blinding
- b. Using a placebo
- c. Proper randomization
- d. Intention-to-treat analysis
Answer: c. Proper randomization
46. A case-control study is retrospective, meaning it:
- a. Follows patients into the future.
- b. Looks back in time from outcome to exposure.
- c. Happens at a single point in time.
- d. Involves an intervention.
Answer: b. Looks back in time from outcome to exposure.
47. When a pharmacist evaluates primary literature to answer a drug information question, they are performing a key step in EBP.
- a. True
- b. False
Answer: a. True
48. Why is it important for a pharmacist to be able to appraise literature?
- a. To be able to make informed decisions when guidelines are old, conflicting, or do not exist for a specific patient.
- b. Only if they work in academia.
- c. To find errors in every published study.
- d. To impress physicians.
Answer: a. To be able to make informed decisions when guidelines are old, conflicting, or do not exist for a specific patient.
49. The “gold standard” study design for determining the efficacy of a new drug is the:
- a. Case-control study
- b. Prospective cohort study
- c. Double-blind, randomized, placebo-controlled trial
- d. Meta-analysis of observational studies
Answer: c. Double-blind, randomized, placebo-controlled trial
50. The principles of EBP are intended to be applied:
- a. Only in academic medical centers.
- b. Only for inpatient care.
- c. Across all pharmacy practice settings to improve the quality of patient care.
- d. Only when a new drug is released.
Answer: c. Across all pharmacy practice settings to improve the quality of patient care.