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What is the 6S pyramid?

The 6S evidence pyramid above is designed to help health practitioners prioritize evidence. The higher up the pyramid your evidence falls, the more weight you should give it in your clinical decision making process. Not every topic will have evidence at all levels – use the highest level that is available. 

Currently, we do not have access to Systems level evidence at Mount Royal. The resources listed below will help you look for evidence at each of the remaining levels.

The image above is based on levels discussed in the following article:

DiCenso, A., Bayley, L., & Haynes, R. B. (2009). Accessing pre-appraised evidence: Fine-tuning the 5S model into a 6S model. Evidence Based Nursing, 12. 99-101.

Search by Level

DiCenso, Bayley, and Haynes (2009), state "an evidence-based clinical information system integrates and concisely summarises all relevant and important research evidence about a clinical problem, is updated as new research evidence becomes available, and automatically links (through an electronic medical record) a specific patient’s circumstances to the relevant information" (pp. 99-100).

Currently, as students at Mount Royal, you do not have access to information at a systems level.

The National Collaborating Centre for Methods and Tools states:

Summaries provide an outline of management options for a given health issue. Summaries incorporate the highest quality and most synthesized sources of research evidence.

Summaries include clinical and practice guidelines.

A synopsis of a synthesis is an article that summarizes or critically appraises a systematic review or meta-analysis.

Here are some places you may find synopses of syntheses. Please note if the synopsis is summarizing the findings of a single study, it would appear further down the pyramid (see the Synopses of Single Studies tab for more information).

Syntheses are systematic reviews or meta-analyses, which critically evaluate the available research evidence on a topic and attempt to come to a larger truth. These types of studies are associated with quantitative research. Meta-synthesessystematically look at the findings from qualitative studies on a topic.

Please note: Literature reviews, narrative reviews, or articles simply labelled "Review" are not considered rigorous enough to qualify as syntheses in the evidence pyramid. They are reviews that summarize but do not critically evaluate the research or do not provide the process by which the topic was searched and articles selected. They provide great background on a topic, but should not be weighted equally with other evidence in this layer.

A synopsis is a published critique of a single research study. Here is an example. They are published in a number of journals, including those listed below:

Single studies are peer reviewed journal articles reporting the results of original research.

What is PubMed?

PubMed is a freely available database of medical literature. It contains references from over 5000 journals from around the world.

PubMed contains all of the references listed in Medline, which libraries pay to access.

For tips on searching PubMed, check out the following tutorials

Other helpful databases

What about Google Scholar?

Google Scholar can be useful in generating ideas around search terms, but is not a complete replacement for a PubMed search when it comes to health research. It is unclear which journals are included in Google Scholar and how far back it goes.

Google Scholar is very useful in tracking down the full text of articles cited in other works. Search for the title of the article in the search box below, and if Mount Royal subscribes to the journal, a link to the full text will be provided. If full text is not available, you can request the article via Interlibrary Loan below.

Google Scholar Search

It is Asking Me to Pay to Open an Article - What Do I Do?

While you are a student at MRU, you never need to pay to access an article. Sometimes you will come across articles in Google that will not allow you to access the full text - if that happens, here are your options:

- Copy the title of the article and paste it into LibrarySearch. If the article is covered by our subscriptions, a link will be provided to the full text.

- If we don't have the article in our collection, you can request a copy of the article for free using our Interlibrary Loan service.


If you are using Google Scholar at home, you will have to adjust the settings to see which articles are available full text through MRU library.


Choose Settings

settings option on google scholar



Select Library Links. In the search box, search for Mount Royal. Be sure to hit save!

choose library links and search for mount royal


Articles that we paid for access to will be flagged in your search results

Links to full text articles at MRU

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Cari Merkley

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