what to learn and how to teach it: critical appraisal of the literature michele t. pato, md...
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What to learn and How to teach it:
Critical appraisal of the Literature
What to learn and How to teach it:
Critical appraisal of the Literature
Michele T. Pato, MDAAP-9/2011
(no conflicts of interest –funding, data or otherwise)
Michele T. Pato, MDAAP-9/2011
(no conflicts of interest –funding, data or otherwise)
Research Literacy and
Scholarly Activity
Research Literacy and
Scholarly Activity
Research literacy is the ability to critically appraise and understand the
relevant research literature, and to apply research findings to clinical
practice.
Research literacy is the ability to critically appraise and understand the
relevant research literature, and to apply research findings to clinical
practice.
Scholarly Activity = EBM Scholarly Activity = EBM
“In a broader sense, Evidence Based Medicine’s goal is to regulate the way in which physicians gather, analyze, and use clinical information in their treatment of patients”
Fauman MA, Psychiatric Times Feb 2002
“In a broader sense, Evidence Based Medicine’s goal is to regulate the way in which physicians gather, analyze, and use clinical information in their treatment of patients”
Fauman MA, Psychiatric Times Feb 2002
Scholarly activityScholarly activity
What is it- Scholarly Activity is an RRC requirement of residency training programs and includes promoting an environment of scholarship and inquiry within every training program.
What is it- Scholarly Activity is an RRC requirement of residency training programs and includes promoting an environment of scholarship and inquiry within every training program.
“Teaching Scholarly Activity in Residency Training”
“Teaching Scholarly Activity in Residency Training”
IoM in 2003 addresses 3 overarching issues important for the Future of Psychiatric Training.
1. The importance of having better and more data regarding the research workforce and society’s need for psychiatrist-researchers.
2. The need for more outcome data in ongoing and novel patient- oriented research training efforts.
3. The need for a national effort to promote, implement, and monitor the training of psychiatrist-researchers
IoM in 2003 addresses 3 overarching issues important for the Future of Psychiatric Training.
1. The importance of having better and more data regarding the research workforce and society’s need for psychiatrist-researchers.
2. The need for more outcome data in ongoing and novel patient- oriented research training efforts.
3. The need for a national effort to promote, implement, and monitor the training of psychiatrist-researchers
The Endgame- in 5 minutes
The Endgame- in 5 minutes In the end the real issue in any reading
you do will be to judge the applicability to the population YOU are treating.
So at first look judge an articles by:1. Title2. Authors3. References 4. The “Pictures”-(tables and figures)5. The Abstract
If you’re still interested READ ON!
In the end the real issue in any reading you do will be to judge the applicability to the population YOU are treating.
So at first look judge an articles by:1. Title2. Authors3. References 4. The “Pictures”-(tables and figures)5. The Abstract
If you’re still interested READ ON!
DV Cone, EB. Lerner, DM Yealy, Prehospital Emergency
Care 2002
DV Cone, EB. Lerner, DM Yealy, Prehospital Emergency
Care 2002
Critical AppraisalCritical Appraisal
1. Does the INTRO tell me WHY they are doing it?
2. Does the METHODS tell be WHAT they are doing in enough detail for GENERALIZABILITY & REPRODUCABILITY
3. Do I understand the RESULTS?4. ARE their DISCUSSIONS/CONCLUSIONS clear?
And Do I AGREE or DISAGREE? Why?5. Will it change my Practice?-Should this be
the FIRST question?
1. Does the INTRO tell me WHY they are doing it?
2. Does the METHODS tell be WHAT they are doing in enough detail for GENERALIZABILITY & REPRODUCABILITY
3. Do I understand the RESULTS?4. ARE their DISCUSSIONS/CONCLUSIONS clear?
And Do I AGREE or DISAGREE? Why?5. Will it change my Practice?-Should this be
the FIRST question?
Critical Appraisal form for Journal Club
Adapted MT Pato from (E. Brooke Lerner 1999-version1.1)
Critical Appraisal form for Journal Club
Adapted MT Pato from (E. Brooke Lerner 1999-version1.1)Name:_________________________Journal Club Date:____________ 1st Author, Title, Pub
Date____________________________________________
Introduction:Hypothesis:______________________
Are objectives clearly stated? No Yes
Methods:Study Design: Correlational Case Report Case Series Cross -Section Cohort
Case control Experimental Meta-Analysis RCT Review –if yes-Where selection criteria specified? Yes/No Other_________Time Frame: Prospective Retrospective Not ApplicableRandomized: Random Nonrandom Not ApplicableBlinded: Unblinded Single Blinded Double Blinded Not
Applicable Enrollment: Convenience Consecutive
Other________________________
Name:_________________________Journal Club Date:____________ 1st Author, Title, Pub Date____________________________________________
Introduction:Hypothesis:______________________
Are objectives clearly stated? No Yes
Methods:Study Design: Correlational Case Report Case Series Cross -Section Cohort
Case control Experimental Meta-Analysis RCT Review –if yes-Where selection criteria specified? Yes/No Other_________Time Frame: Prospective Retrospective Not ApplicableRandomized: Random Nonrandom Not ApplicableBlinded: Unblinded Single Blinded Double Blinded Not
Applicable Enrollment: Convenience Consecutive
Other________________________
Methods continuedMethods continued
SUBJECT+PROCEDURES:Subject Source (population)_________________________________________Inclusion Criteria:_________________________________________________Exclusion Criteria:_______________________________________________How are controls different from cases?__________________Not applicable_____Descriptive Variables:_________________________________________________ _________________________________________________ Outcome Variables: _________________________________________________ _________________________________________________________________Main Dependent Variable______________________ Parametric Non-Parametric Main Independent Variable:_____________________Parametric Non-Parametric
Statistical Test T-test ANOVA Kruskal-Wallis Mann Whitney(check all that Chi Square Fishers Exact Logistic Reg. Linear Reg.apply): Survial Analysis Other_____________ Not applicable CorrelationsIs There a Power Calculation? No Yes Alpha:_____ Beta:_____
Smallest Detectable Difference___________
SUBJECT+PROCEDURES:Subject Source (population)_________________________________________Inclusion Criteria:_________________________________________________Exclusion Criteria:_______________________________________________How are controls different from cases?__________________Not applicable_____Descriptive Variables:_________________________________________________ _________________________________________________ Outcome Variables: _________________________________________________ _________________________________________________________________Main Dependent Variable______________________ Parametric Non-Parametric Main Independent Variable:_____________________Parametric Non-Parametric
Statistical Test T-test ANOVA Kruskal-Wallis Mann Whitney(check all that Chi Square Fishers Exact Logistic Reg. Linear Reg.apply): Survial Analysis Other_____________ Not applicable CorrelationsIs There a Power Calculation? No Yes Alpha:_____ Beta:_____
Smallest Detectable Difference___________
Results+ DiscussionResults+ Discussion
Results:Is there a difference between Groups: No Yes Not applicable Magnitude of the difference between groups?_______ 95%CI________ P Value____List any other relevant findings?____________________________________________
___________________________________________________________________
Percent of subjects lost to follow-up or non-response:_____% Are participants different from non-participants? No Yes If they are different: How are they different?___________________________
Discussion:Was there bias in the study? No Yes
Where:_____________________________________Who can the results be generalized to ?_______________________________________
Conclusion: So What???Did the results support the hypothesis? No YesWill you change you practice from this study? No Yes
Results:Is there a difference between Groups: No Yes Not applicable Magnitude of the difference between groups?_______ 95%CI________ P Value____List any other relevant findings?____________________________________________
___________________________________________________________________
Percent of subjects lost to follow-up or non-response:_____% Are participants different from non-participants? No Yes If they are different: How are they different?___________________________
Discussion:Was there bias in the study? No Yes
Where:_____________________________________Who can the results be generalized to ?_______________________________________
Conclusion: So What???Did the results support the hypothesis? No YesWill you change you practice from this study? No Yes
Statistics to Define (So they aren’t afraid to read the
methods section)
Statistics to Define (So they aren’t afraid to read the
methods section)
1) Reliability = Reproducability2) Validity= truly measuring the concept3) Power= will you detect the difference if it exists4) Kappa- can two people agree: >.75) T-tests-as simple 2 group ANOVA6) Correlations- If one changes does another: same
direction (+) or different direction(-)7) ANOVA-Analysis of Variance- Is the change due to
what I did or just do to randomness of population? 8) Parametric vs Non-parametric- Nominal vs
Ordinal/categorical9) Chi squared- expected versus observed10) Relative Risk and Odds Ratios- predictor to outcome
1) Reliability = Reproducability2) Validity= truly measuring the concept3) Power= will you detect the difference if it exists4) Kappa- can two people agree: >.75) T-tests-as simple 2 group ANOVA6) Correlations- If one changes does another: same
direction (+) or different direction(-)7) ANOVA-Analysis of Variance- Is the change due to
what I did or just do to randomness of population? 8) Parametric vs Non-parametric- Nominal vs
Ordinal/categorical9) Chi squared- expected versus observed10) Relative Risk and Odds Ratios- predictor to outcome
Looking at any type of Article
Looking at any type of Article
Sackett et al,Clinical Epidemiology: 1991, Little Brown and Co
Keeping Track-Know your Gaps
Keeping Track-Know your Gaps
1. Keep it simple2. Decide ahead what types of articles and
statistical methods you want covered3. Use Critical Review Forms to ID
Types of research and Types of statistics4. Review what has been covered periodically
Biannually, Annually, Quarterly Pick articles accordingly
1. Keep it simple2. Decide ahead what types of articles and
statistical methods you want covered3. Use Critical Review Forms to ID
Types of research and Types of statistics4. Review what has been covered periodically
Biannually, Annually, Quarterly Pick articles accordingly
Tracking articles week to weekTracking articles week to week
PGY-32002-03Discussant
Article Date read
Research design used
Statistics Used
1)Pato Faculty +PT-pgy-3
Pato-CMI and Buspar in OCD 1991
3/5/03 RCT Anova,T-test, ICCorr
2) Course DirectorSA-pgy2
Fairburn- Risk factors Bulimia Nervosa1997
3/12/03 Case-control
Logistic regression and chi-sq
3) Training Director-CP-pgy-4
Nurenberger-DIGS-1994
3/19/03 Diagnosis-Experi-mental
Chi sq,Kappa(corr coeff)
Journal Club Master Sheet(topics you want covered-YEARLY)Journal Club Master Sheet(topics you want covered-YEARLY)
Article Types # read
1. Case report2. Case series3. RCT I4. Experimental I5. Cohort 6. Case-control I7. Cross Sectional8. Correlational9. Meta-Analysis
Article Types # read
1. Case report2. Case series3. RCT I4. Experimental I5. Cohort 6. Case-control I7. Cross Sectional8. Correlational9. Meta-Analysis
Statistical Methods #noted 1. T-test I2. ANOVA I3. Chi-squared II4. Linear regression5. Logistic regression I6. Kruskal-Wallis7. Mann-Whitney8. Fishers-exact9. Survival Analysis10. Correlation coeff II
Statistical Methods #noted 1. T-test I2. ANOVA I3. Chi-squared II4. Linear regression5. Logistic regression I6. Kruskal-Wallis7. Mann-Whitney8. Fishers-exact9. Survival Analysis10. Correlation coeff II
You can promote reading the literature as a life-long Pursuit
rather than a chore.
You can promote reading the literature as a life-long Pursuit
rather than a chore.
But REMEMBER:YOU CAN’T WIN THE LOTTERY
IF YOU DON’T BUY A TICKET!!!
But REMEMBER:YOU CAN’T WIN THE LOTTERY
IF YOU DON’T BUY A TICKET!!!
Scholarly activityScholarly activity
What is it- Scholarly Activity is an RRC requirement of residency training programs and includes promoting an environment of scholarship and inquiry within every training program.
Scholarly Activity includes a broad range of activities from being able to critically appraise the scientific literature to participating in research that actually contributes to the literature.
What is it- Scholarly Activity is an RRC requirement of residency training programs and includes promoting an environment of scholarship and inquiry within every training program.
Scholarly Activity includes a broad range of activities from being able to critically appraise the scientific literature to participating in research that actually contributes to the literature.