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Guide to Evidence Based Practice: The 6S Pyramid


This guide is intended for use by individuals at The Michener Institute researching academic practice.  It provides a list of reference resources on this topic.  The reference materials consist of relevant journal articles and online resources.   


All images are courtesy of McMaster University Health Sciences Library and we thank them for allowing us to use their resources.

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).

6S Pyramid

The 6S pyramid is arranged in a hierarchy, with the different levels outlined and colour-coded.

Use the concepts identified in your PICO or PS Question (found in the Forming Questions tab) to come up with appropriate 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

  • Visit the Learning Resource Centre to learn how to efficiently and effectively search databases
  • Visit the Background Information tab for answers to more general questions
  • Visit the About EBP tab for a more detailed description of the concepts underlying Evidence-Based Practice

Grey Literature

Grey literature is "... information produced on all levels of government, academia, business and industry in electronic and print formats not controlled by commercial publishing i.e. where publishing is not the primary activity of the producing body." 

Schnopfel J. Towards a Prague definition of grey literature. Presented at: Twelfth International Conference on Grey Literature: Transparency in Grey Literature. Grey Tech Approaches to High Tech Issues. Prague, 6-7 Dec 2010, Czech Republic. pp.11-26. Available from:

Grey Literature Databases

For more information on Grey Literature, here is a video by the University of Guelph.

Additional Information Sources

Consumer Health 

Drug Therapy



Public Health



Integrating information from the lower levels of the hierarchy 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

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 clinical questions.

Article Databases

Clinical Queries

The CINAHL 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:


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

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Michener Institute of Education at UHN, 2018.