Teaching critical appraisal skill in health care settings

Health Care Research Unit South Academic Block, Southampton General Hospital, Tremona Road, Southampton, Hampshire, UK, SO16 6YD.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2001; 3(3):CD001270. DOI: 10.1002/14651858.CD001270
Source: PubMed

ABSTRACT Critical appraisal is the process of assessing and interpreting evidence by systematically considering its validity, results and relevance to an individual's work. Within the last decade critical appraisal has been added as a topic to many medical school and UK Royal College curricula, and several continuing professional development ventures have been funded to provide further training.
To assess the effects of teaching critical appraisal skills to health professionals, on the process of care, patient outcomes and knowledge of health professionals.
We searched The Cochrane Library (to Issue 2 2000), MEDLINE (1966 to 1997), EMBASE (1980 to 1997), Eric (1966 to 1997), Cinahl (1982 to 1997), Lisa (1976 to 1997), Sigle (1980 to 1997), Science Citation Index (1981 to 1997), PsycLit (1974 to 1997), the world-wide-web, and reference lists of articles. We also contacted major medical education centres.
Randomised trials, controlled clinical trials, controlled before and after studies and interrupted time series analyses of educational interventions teaching critical appraisal to health professionals. The outcomes were: process of care; patient mortality, quality of life, and satisfaction; and health professional knowledge/awareness based upon objective, standardised, validated instruments.
Two reviewers independently extracted data and three reviewers independently assessed study quality.
One USA hospital-based randomised trial was included involving 44 doctors. The outcome assessed was critical appraisal knowledge. Process of care, patient health or attitude/awareness outcomes were not assessed. Critical appraisal teaching was reported to have resulted in a 25% improvement (adjusted figure) in critical appraisal knowledge in the intervention group compared to a 6% improvement in the control group, which was statistically significant (p=0.02).
There is evidence that critical appraisal teaching has positive effects on participants' knowledge, but as only one study met the inclusion criteria the validity of drawing general conclusions about the effects of teaching critical appraisal is debatable. There are large gaps in the evidence as to whether teaching critical appraisal impacts on decision-making or patient outcomes. It is also unclear whether the size of benefit seen is large enough to be of practical significance, or whether this varies according to participant background or teaching method. The evidence supporting all outcomes is weakened by the generally poorly designed, executed and reported studies that we found.

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    • "There was unclear or weak evidence for the effects of tailored interventions that addressed barriers to change [10], teaching critical appraisal skills [11] and printed educational materials compared to other interventions [12]. Educational outreach visits (EOVs) [13] and audit and feedback [14] resulted in small to moderate behaviour changes with those that included EOVs being slightly more effective than audit and feedback alone [13]. "
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    • "A Cochrane review of the research evaluating the effect of teaching critical thinking skills to healthcare professionals already caring for patients found a remarkable 25% improvement in clinical accuracy.8 However, the Cochrane review also said there were too few properly designed and conducted studies to be confident in the size of the improvement or its actual clinical significance. "
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