1. Critical Reading Made Easy:
effectiveness and experience
Clinical Librarian / Deputy Librarian
Education Centre Library
Leicester General Hospital
2. 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
3. CRME: format
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)
Research methods and introduction to CASP
 One : One
4. CRME: content
 Research methods and levels of evidence
 The Checklists
 The questions
 The article
5. Primary Research
For qualitative studies?
No consensus about the relative rigour of different methods
Levels of evidence
Case series and case reports
For quantitative studies
6. Judging the quality of research
 JAMA articles
 Checklists e.g. CASP
A framework for thinking about the quality of research
NHS Critical Appraisal Skills Programme
7. Three questions
Is the methodology appropriate to answer the question.
Is it carried out in a sound way, eliminating bias and confounding?
Are the results real or because of chance?
Introducing / revisiting probability or p-values and confidence
intervals. Interpretation of odds ratio diagrams
Will the results help locally?
8. 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)
 CASP training week
 MSC Health Services Research
9. Who has participated?
 Workshop programme
Approximately 100 staff since 2002, representing a
range of clinical specialties, health professions and
 Overview sessions presented to:
Neonatal postgraduate teaching programme
O&G research and evidence programme
Medical house officer teaching programme
Neonatal Unit multidisciplinary Journal Club
Staff in genetics, family planning, surgery, renal nursing
and mental health pharmacy
10. 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
Generated ideas for qualitative research proposal
Supported staff doing research modules
evaluating RCTs e.g. of escitalopram vs citalopram for major
depression – mental health pharmamcist
11. 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.
12. 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
13. The evidence base
 Systematic review of critical appraisal teaching
Parkes 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
14. 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
15. Opportunities for librarians 2
 Individual email effective but no longer possible
 Posters / flyers
 Word of mouth
 Structured postgraduate teaching
 Journal clubs
16. Opportunities for librarians 3
 Demand for support in other related areas e.g.
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
17. 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