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Resources for Evidence-Based Practice: The 6S Pyramid

Learn about the core concepts of evidence-based practice and discover resources for developing your skills in EBP.

About This Page

The resources found in the 6S Pyramid contain evidence that will help you answer foreground questions (queries that bring together multiple concepts related to a specific clinical situation or research topic).

Six S Pyramid hierarchy of evidence

[Adapted from DiCenso, Bayley and Haynes (2009). ACP Journal Club. Editorial: Accessing pre-appraised evidence: Fine-tuning the 5S model into a 6S model. Annals of Internal Medicine, 151(6):JC3-2, JC3-3.]

The 6S pyramid is arranged in a hierarchy, with the different levels outlined and colour-coded to the right of this page

Use the concepts identified in your PICO or PS Question (found in the Forming Questions tab) to come up with approriate search terms, remembering:

  • A piece of evidence's ability to guide clinical action increases as you move up the pyramid.
  • Topics become more specific as you move down the pyramid.

More Tips

  • Watch HSL's Database Fundamentals Tutorial to learn the basics of effective and efficient searching.
  • Visit the Background Information tab for answers to more general questions (e.g. Terminology, Drug Info, etc.) 
  • Visit the About EBP tab for a more detailed description of the concepts underlying Evidence-Based Practice

Off-Campus Access

The small lock icon office campus lock icon beside a link indicates this is an online library resource.  When you click on the resource link from off-campus you'll be redirected to a login page. Login using your MacID and password to access the content.

Grey Literature

Additional Information Sources


Consumer Health

Drug Therapy



Public Health


Citing Sources

American Psychological Associations (APA) Style Guides

Vancouver Style Guides

Citing Evidence-Based Texts


Rainbow - all levels of the pyramid can be found in these sources.

Meta-Searches search for evidence across multiple resources.  These tools return information from all levels of the pyramid:


Integrating information from the lower levels of the hiearchy with individual patient records, systems represent the ideal source of evidence for clinical decision-making. 


Summaries are regularly updated clinical guidelines or textbooks that integrate evidence-based information about specific clinical problems.

Clinical Practice Guidelines

Evidence-Based Texts

Synopses of Syntheses

Synopses of syntheses, summarize the information found in systematic reviews.  By drawing conclusions from evidence at lower levels of the pyramid, these synopses often provide sufficient information to support clinical action.

Evidence-Based Abstract Journals 


Commonly referred to as a systematic review, a synthesis is a comprehensive summary of all the evidence surrounding a specific research question.    

Synopses of Single Studies

Synopses of single studies summarize evidence from high-quality studies.   The following evidence-based abstract journals are the best place to find this type of information:

Single Studies

Studies represent unique research conducted to answer specific clincial questions.

Article Databases

Clinical Queries

The CINAHL, OVID (Medline, EMBASE, PsychINFO), and Pubmed databases can be searched using the Clinical Queries filter, limiting your results to specific clinical research areas: Therapy, Prognosis, Review, Qualitative, and Causation (Etiology)

For further information and tips on using the Clinical Queries filter, please visit the following links: