Thanks for starting this discussion Kumara.

 

Alongside the many great resources already contributed, there are couple of additional that I point my learners too:

1. The Testing Treatment interactive website is creating a library of resources for helping learners understand fair comparisons and critical thinking skills called the Critical thinking and Appraisal and Resource Library (CARL): http://en.testingtreatments.org/category/learning-resources/

Here are a few related papers:

Describing CARL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0178666

The Key Concepts in TTI: https://ebm.bmj.com/content/23/1/29 

2. We have started a Catalogue of Bias on the back of the 1979 piece by David Sackett where he first introduced the idea. Our catalogue provides a compiled list of biases that affect health research, providing for each bias a definition, examples of its impact in health research and steps for prevention. It currently has 37 biases listed, with a further 100 in preparation: https://catalogofbias.org/biases/admission-rate-bias/

 

I hope you find these resources useful.

 

David

 

David Nunan

 

 

From: "Evidence based health (EBH)" <[log in to unmask]> on behalf of Kumara Mendis <[log in to unmask]>
Reply-To: Kumara Mendis <[log in to unmask]>
Date: Monday, 3 September 2018 at 01:56
To: "[log in to unmask]" <[log in to unmask]>
Subject: Re: How a medical student can learn critical appraisal skills when medical school don't teach??

 

Thank you all for the very useful insights

Would like to ask whether anyone knows any resource that is already available to quantify the knowledge and skills of critical appraisalfor a non-academic clinician in full-time practice?

if not 

Can we try to have some levels including all our suggestions into practice?

Level C - MUST HAVE (to start with for a student/clinicians)

Level B - 

Level A - GOOD TO HAVE (Expert level)

 

Kumara

 

On Mon, Sep 3, 2018 at 5:12 AM Djulbegovic, Benjamin <[log in to unmask]> wrote:

Is anyone aware of a formal study, or has personal experience where critical appraisal of evidence by a practicing physician overturned professional societies’ practice guidelines recommendations (and, thus led to the management that contradicted the guidelines advice)?

Thanks

Ben

 

Ben Djulbegovic

 

 

From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Shaughnessy, Allen
Sent: Sunday, September 02, 2018 3:59 PM
To: [log in to unmask]
Subject: Re: How a medical student can learn critical appraisal skills when medical school don't teach??

 

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These are all great resources. In addition, I suggest (I work with both of these):

 

Essential Evidence Plus -- a group of 7 databases but also daily predigested synopses of "patient-oriented evidence that matters." https://www.essentialevidenceplus.com/

 

For those wanting to learn the basics of critical appraisal, information mastery, and evidence-informed decision-making, we have several series of self-directed online learning modules: http://clinicalinformationsciences.com/

 

Allen

 

Allen F. Shaughnessy, Pharm.D., M.Med.Ed.
Director, Master Teacher Fellowship
Professor of Family Medicine
Tufts University School of Medicine
195 Canal Street
Malden, MA 02148
781-338-0507

 

 

On Sun, Sep 2, 2018 at 1:07 PM McCormack, James <[log in to unmask]> wrote:

Hi Everyone: 

 

Agree with the comments being made by all on this topic

 

We tried for years to help clinicians develop critical appraisal skills and found that they could definitely do it but lacked the time to do it. For that reason, for 95% (I made that number up but I think t is close) of all clinicians they need to identify groups who develop trusted pre-digested information and then learn the skills to translate or transmit that knowledge to patients - that is the skill they need to master.

 

The rest of this is purely self promotion - but I would love to get self promotion from others in this group who also develop this type of material - has anyone created a registry of this sort of information?

 

For primary care we have developed 4 useful (I hope) synopses of information over the years

 

1) I do a weekly medical podcast with a family physician colleague (MIke Allan) called Best Science (BS) Medicine - we just passed our 10th anniversary - we have over 380 30-minute podcasts on a myriad of topics in primary care - all with numbers and approaches as to how to integrate that information into clinical practice - we have even done a number of episodes on critical appraisal. We try very hard to make them fun and easy to listen to and we have become one of the top medical podcasts (according to iTunes) which is really cool - you can find it here therapeuticseducation.org. Most of the podcasts are free but we have a subscription model as well because we have never been able to get unrestricted funding to produce these. If anyone really can’t afford them (students $25 a year) let me know and I’m sure we can help out.

 

2) Tools for Practice - over 200, 300 word synopses of topics relevant to primary care https://www.acfp.ca/tools-for-practice/

 

3) A one-page CVD risk calculator which will give you all the numbers for the benefits and harms of treating blood pressure, cholesterol, and glucose - cvdcalculator.com

 

4) A pain calculator - all the numbers for neuropathic pain treatments http://pain-calculator.com

 

Let’s hear from others on this. 

 

James McCormack

 

 

 

 

On Sep 2, 2018, at 9:39 AM, Sachin Dave <[log in to unmask]> wrote:

 

Vivek,

 

I advise that you start by digesting book by David Sackett's critical appraisal (CA)  skills and JAMA series on Critical Appraisal skills. That would be a good start. Now if you plan to go to Academia, only sky is the limit if you have time and resources. If you are going to go into busy clinical practice than as many have suggested that you will have to heavily rely on pre-digested (pre-appraised) material by the most reliable sources of health care of developed and developing nations. If pre-digested material still does not make sense, then contact the experts in EBM and get help. 

 

I was a avid student of EBM, till entered a busy private practice of Internal Medicine. Now, I find that the advances in science and therapeutics is advancing at such an enormous pace, not to talk of immense burden of documentations, navigations needs of insurance, hospitals, and government   regulations, that doing CA myself is impossible. 

 

Besides, forum like these are also very helpful for tough ones.

 

Best.

 

Sachin Dave

 

 

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From: "Shaughnessy, Allen" <[log in to unmask]>
To: [log in to unmask]
Sent: Sunday, September 2, 2018 11:54 AM
Subject: Re: How a medical student can learn critical appraisal skills when medical school don't teach??

 

Hi Kumara,

 

Dave Slawson and I have argued that most clinicians need information management skills, of which critical appraisal is only a small part. There are many services now that provide critical appraisal of research articles; most clinicians should know how to evaluate these services, but, more importantly, should use them to stay current with clinical medicine. Clinicians desiring to keep current with medical information by performing their own critical appraisal will likely have the time but, more important, have to stay current with critical appraisal literature as well as their own clinical literature. 

 

See: https://journals.lww.com/academicmedicine/Fulltext/2005/07000/Teaching_Evidence_Based_Medicine__Should_We_Be.14.aspx

 

Allen

Allen F. Shaughnessy, Pharm.D., M.Med.Ed.
Director, Master Teacher Fellowship
Professor of Family Medicine
Tufts University School of Medicine
195 Canal Street
Malden, MA 02148
781-338-0507

 

 

On Sat, Sep 1, 2018 at 11:00 PM Kumara Mendis <[log in to unmask]> wrote:

 

Dear all

 

I have been mostly a silent observer on this list for a long time. Have learnt a lot and continue to learn almost every week.

 

My background is family medicine and medical informatics. I am an academic and a practicing clinician-researcher not only in the academic setting but in my private practice. At the moment I am in Sri Lanka but was in Australia in a academic setting and practicing as a GP for 10 years. 

 

I have a question that I would like to inquire from this forum, related to Vivek's important and timely question

 

My question -

What knowledge and skills should a practicing full-time clinician (not in academic settings) have to practice evidence based medicine

(especially what knowledge and skills in critical appraisal (CA) should s/he have?) 

 

My personal view is very close to the 2002 BMJ editorial from Gordon Guyatt, which was reiterated in the 25 years oral history JAMA/BMJ  https://ebm.jamanetwork.com/ 

 

However, I feel this is not taken notice of and a huge burden of expert knowledge of critical appraisal expertise is being placed on the clinicians and students who are interested in EBP

I am NOT for a moment stating that CA is NOT important. CA is on of the most important aspects that one needs to practice EBM. But how much? what extent?

 

Thank you all in advance

 

Kumara Mendis

https://scholar.google.com/citations?user=SCnisRAAAAAJ&hl=en

 

-----------------------------------------------

There’s no limit to what you can accomplish if you don’t care who gets the credit

Bernard Baruch

 

 

---------- Forwarded message ---------
From: Vivek Podder <[log in to unmask]>
Date: Sat, Sep 1, 2018 at 8:07 PM
Subject: Re: How a medical student can learn critical appraisal skills when medical school don't teach??
To: <[log in to unmask]>

 

Respected teachers,

 

greetings! I am a final-year medical student

from Bangladesh

.

If medical students want to learn critical appraisal skills, particularly, when their medical school doesn't have any official teaching facility for these, how they can learn it? I try to learn as much possible with professor Rakesh Biswas sir in the case-based blended learning system.

 

However, I am pretty sure a lot of students including me is still struggling and if they can not learn how would I practice evidence-based medicine and advocate the prevention of overdiagnosis/overtreatment?

 

 

Respectfully,

Vivek

 

 

 

--

Vivek Podder

Medical Student

Tairunnessa Memorial Medical College

 

 

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