Critical Reading Made Easy:effectiveness and experience

Linda Ward

Clinical Librarian / Deputy Librarian

Education Centre Library

Leicester General Hospital

Presentation outline

Format and content of Critical Reading Made Easy (CRME)

Librarian CPD Who has participated Evaluation & Future plans The evidence base Opportunities for librarians

CRME: format Workshops

A series of six workshops introducing research methods and tools to help appraise:Clinical Trials, Systematic Reviews, Qualitative studies, (CASP)Guidelines (AGREE), Patient information (DISCERN)

Overviews Research methods and introduction to CASP

One : One

CRME: content

Research methods and levels of evidence

The Checklists

The questions

The article

Primary Research

 Experimental

 observational

SecondaryResearch

For qualitative studies? No consensus about the relative rigour of different methods

Levels of evidence

Systematic reviews &

Meta-analyses

Randomised controlled trials

Cohort studies

Case control studies

Case series and case reports

For quantitative studies

Judging the quality of research

JAMA articles http://www.cche.net/user

Checklists e.g. CASP

A framework for thinking about the quality of research

NHS Critical Appraisal Skills Programme

http://www.phru.nhs.uk/casp/appraisa.htm

Three questions

Valid?Is the methodology appropriate to answer the question.

Is it carried out in a sound way, eliminating bias and confounding?

Reliable?Are the results real or because of chance?Introducing / revisiting probability or p-values and confidence intervals. Interpretation of odds ratio diagrams

Applicable?Will the results help locally?

Librarian CPD ScHARR training Personal research & interest

leading to pre-2002 sessions (RCTs & Systematic reviews)

CASPfest & CASP workshops e.g. Training the Trainer

Sheffield Evidence Appraisals From ShEBaNg (ShEAFS) http://www.shef.ac.uk/~scharr/ir/sheafs/

CASP training week MSC Health Services Research

Who has participated? Workshop programme

Approximately 100 staff since 2002, representing a range of clinical specialties, health professions and organisations

Overview sessions presented to:Neonatal postgraduate teaching programmeO&G research and evidence programmeMedical house officer teaching programmeNeonatal Unit multidisciplinary Journal Club Staff in genetics, family planning, surgery, renal nursing and mental health pharmacy

Evaluation 1 Evaluation following sessions

has been very positive “Excellent and interesting, even for a beginner like myself”“A very helpful ‘revisiting’”“Came away learning lots”“Now understand confidence intervals”“Made trials understandable”

Supporting workplace research, education and clinical practice

Generated ideas for qualitative research proposalSupported staff doing research modulesevaluating RCTs e.g. of escitalopram vs citalopram for major depression – mental health pharmamcist

Future developments LEicestershire Appraisal Forum (LEAF)

Regular group to evaluate locally relevant research and develop appraisal skills

LEicestershire Appraisal Forum Locally Appraised Topics (LEAFLETs)Appraisal summaries on the Intranet as an educational / EBM tool.

Evaluation 2 Recent questionnaire to workshop attendees

2002-2004: Response rate 15% (12/82)

Overall very positive views of sessions A majority have used CASP or similar checklists since Most report being ‘fairly confident’ in appraisal skills A majority would make time to attend the proposed

LEAF and could see value in LEAFLETs. Of those who couldn’t attend, barriers were time & geography.

Basis to take the LEAF forward

The evidence base

Systematic review of critical appraisal teachingParkes et al. 2001. A cautious “Critical appraisal teaching has a positive affect on participants’ knowledge” Generalisable?

“Highlighted the poor evidence in this area but it is not evidence for stopping critical appraisal teaching”

Skills, attitudes and behaviour?The holy grail: impact on patient care

Opportunities for librarians 1 Start small Work in partnership with clinical staff - sharing

knowledge and skills CASP checklists are new to most Don’t assume participants have high levels of

knowledge. Be adaptable Have a good stats dictionary handy Put statistics in their place

Opportunities for librarians 2 Marketing

Individual email effective but no longer possible Intranet Posters / flyers Word of mouth

Structured postgraduate teaching

Journal clubs

Opportunities for librarians 3

Demand for support in other related areas e.g. SPSS

Endnote / Reference Manager

Care needed not to overstretch ourselves

But librarians need to develop their roles, not least because of national developments e.g. NLH, NCC, e-journals & document delivery

Useful references Critical Appraisal Skills Programme. Evidence-based health care: an open learning resource for

health care practitioners. Oxford. CASP, 2002.

Critical Appraisal Skills Programme. Evidence-based health care workbook: including the Evidence-based Health Care CD-ROM. Oxford. CASP and HCLU, 1999.

Crombie, Iain K. The pocket guide to critical appraisal. London; BMJ Publishing, 1996.

eBMJ. How to read a paper. http://bmj.com/collections/read.shtml. Accessed 08/08/04

Guyatt G. Rennie D. (eds). Users’ guides to the medical literature: a manual for evidence-based clinical practice. sl. American medical Association, 2002.

Pereira-Maxwell, F. A-Z of medical statistics: a companion for critical appraisal. 1998.

Parkes J, Hyde C, Deeks J, Milne R. Teaching critical appraisal skills in health care settings (Cochrane Review). In: The Cochrane Library, Issue 3, 2004. Chichester, UK: John Wiley & Sons Ltd.