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Critical reading made easy: effectiveness and experience

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    Critical reading made easy: effectiveness and experience Critical reading made easy: effectiveness and experience Presentation Transcript

    • 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 Secondary Research For qualitative studies? No consensus about the relative rigour of different methods Levels of evidence 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 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
    • 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 proposal
        • Supported staff doing research modules
        • evaluating 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 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
    • 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.