teaching the art of literature analysis
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DESCRIPTIONTeaching the Art of Literature Analysis. Evan Williams, PharmD, BCPS Assistant Professor of Pharmacy Practice Husson University School of Pharmacy. Overview. Why literature evaluation is important and why people hate it How to make literature less terrible for students and preceptors - PowerPoint PPT Presentation
Making Journal Clubs Work For You
Teaching the Art of Literature AnalysisEvan Williams, PharmD, BCPSAssistant Professor of Pharmacy PracticeHusson University School of PharmacyWhy literature evaluation is important and why people hate it
How to make literature less terrible for students and preceptors
What parts of the study are important and what is beyond essentialOverviewStudents should focus on the statistical methods used as it relates to internal validity of the findings more so than the external validity of the study when discussing journal articles.True or FalsePre Test QuestionsJournal Article Presentations should Focus on an area of practice relevant to the practice siteTie into some other project or problem at the practice siteBe flexible enough to fit into the amount of time a practice site or preceptor can devote to the assignmentAll of the abovePre Test QuestionsThe following study for gorillastatin produced the following results after 5 years of follow up. Based on the results in the table, about how many patients do I need to treat with gorillastatin for 5 years to prevent one CAD event?a) 5b) 8 c) 12d) 16
Pre Test Questions
Discuss reasons literature evaluation is an essential skill for all pharmacistsIdentify components of a quality journal club formatDescribe ways to make student literature review useful to your practiceBriefly distinguish between useful and confounding statistical methods and demonstrate ability to calculate NNT and NNHObjectives
Are your students this last guy?Essential skill for any clinicianEveryone wants to follow evidence-based medicineHow do you know if recommended treatment is evidence based?Needed to keep up with emerging therapiesNew drugsNew guidelinesIf you dont do this, the next generation of pharmacists will be followers instead of leaders regarding drug therapyLiterature Evaluation is Important!Dry, boring reading50 Shades of Primary Literature?
Perceived lack of utilityThis is all summarized in Pharmacists Letter anyway
Fear of statisticsWhat the devil is the difference between a t-test, f-test, and a z-test, anyway?Why People Hate LiteratureThere is nothing clubby about itWe force them to present some random article and belittle them for not knowing stuff we never taught them
It is detached from other learning outcomesPick a recent article that has something to do with your internal medicine rotation.They pick terrible articles because of this
They lack good examples of what we are expectingWhy Students Hate Journal ClubDecide what the desired learning outcome isPresentation skills?A refined, grammatically perfect handout?Identify all of the trials strengths and weaknesses? Distinguish important clinical implications of the trial presented?
Once the outcome is identified, make sure this is communicated to the studentHow to Make This Better Selection of ArticlesStudent vs. Preceptor Selection
Ensure that the article relates to something happening on rotation!This will make it relevant and useful
Type of ArticleOriginal ResearchReview ArticleGuideline EvaluationHow to Make Lit Eval BetterSelection of ArticlesGood vs. Bad ArticlesClinical vs. Surrogate OutcomesSketchy statisticsPrimary outcomes vs. Secondary outcomes
New vs. Old Older articles arent bad or irrelevant!!If the student doesnt know it, it is a learning opportunityHow to Make Lit Eval BetterIdentify what youd like the student to presentBackgroundDo you need this?Needs to be quick
MethodsBriefThese are fairly standardBreeze through the statsHow to Make Lit Eval BetterIdentify what youd like the student to presentResultsBest presented in a table formatIdentify primary vs secondary outcomesDistinguish between clinical and statistical significanceDoes power matter?Calculate NNT and NNHHow to Make Lit Eval BetterIdentify what youd like the student to presentDiscussion should take the most timeIs the outcome valid based on the test used?ConfoundersAre they looking at the right groups of patients?Influence of uncontrolled variables?Statistical vs. clinical significance?Does this change my practice?
ConclusionsDo you agree with the authors conclusion?How to Make Lit Eval BetterPresentation SettingBig time presentation and roast?Conversational?Panel Discussion? CE style?
Do what makes sense for your practice site!Make this useful to youHow to Make Lit Eval BetterGive students enough timeCheck in to make sure progress is being madeSuggest addressing questions prior to the presentation to improve the quality of the presentation
Read the article!
Show the student a clear example of a good handout to followMany are available, so pick one that you likeStudents tend to do better with bullet pointsMake them create their own tablesOther Points For ImprovementIn order to properly evaluate the students critique, you need to have identified the key points that should have pointed out
What are the results?
Are the results valid?
How can I use the results in my practice?What You Need to KnowAny statistically significant differences?
p-value vs confidence intervalsLittle p-values dont make results more significant
Confidence intervals can give an impression of how precise the results areConfidence intervals that cross unity are not significant
Clinical significance?What Are the Results?Number Needed to TreatGood way to quantify clinical significance
1/difference in the event rate between groups25 of 500 people in the placebo group died - (5%) 10 of 550 people in the drug group died (1.8%)The difference between the groups is 3.2%, or 0.0321/0.032 = 31.25 ~ 31If I treat 31 people with the drug, I will prevent one death
Compare this to the Number Needed to HarmWhat Are the Results?Number Needed to HarmSame calculation, but for adverse events10 of 500 people had major bleeding in the placebo group (2%)22 of 550 people had major bleeding in the drug group (4%)The difference between the groups is 2%, or 0.021/0.02 = 50If I give 50 people the drug, I will cause 1 major bleed
Does the risk vs benefit ratio seem reasonable?What Are the Results?Was the primary endpoint clearly stated and reported?Was it relevant? Surrogate vs clinical endpointsComposite endpoints
Was the designed to reveal the primary endpoint?Powered enough to detect a difference if one wasnt found?Does the discussion focus on subgroup analyses? Are the Results Valid?Where the right people included?Intent to Treat (ITT) or Per Protocol Analysis?Inclusion and exclusion criteria Do they control for confounders?Do they limit external validity?
Was bias effectively dealt with?BlindingValid control groupsPlacebo vs active control?Are the Results Valid?NNT vs NNH
Are the patients studied similar to my patients?
How does this evidence jive with other studies regarding the same subject?
Is this study important enough to shift clinical practice? How Can I Apply the Results?New DrugsWhat studies got this approved?Who was looked at?Side effect profiles?
New GuidelinesCheck the referencesThings that have strong/low evidence
Things you dont know/always get questions aboutWhen is aspirin indicated?Evidence that vaccines dont cause autism?Does LDL really correlate with MI?Why do we still use warfarin?Make This Useful to YouPharmacists need to be able to evaluate literature
We should be showing students why this is important
Make sure journal article presentations focus on preparing pharmacists that can critically evaluate literaturePresentation style, format, handouts, length can all vary and should be adapted to the practice site
Focus on the key issues within the studies presentedDont get bogged down in statisticsConsider the clinical impact
Make the exercise beneficial for you and the studentSummary Students should focus on the statistical methods used as it relates to internal validity of the findings more so than the external validity of the study when discussing journal articles.True or FalsePost Test QuestionsJournal Article Presentations should Focus on an area of practice relevant to the practice siteTie into some other project or problem at the practice siteBe flexible enough to fit into the amount of time a practice site or preceptor can devote to the assignmentAll of the abovePost Test QuestionsThe following study for gorillastatin produced the following results after 5 years of follow up. Based on the results in the table, about how many patients do I need to treat with gorillastatin for 5 years to prevent one CAD event?a) 5b) 8 c) 12d) 16Post Test Questions