Understanding of research results, evidence summaries and their applicability—not critical appraisal—are core skills of medical curriculum

23 March, 2021

Dear HIFA colleagues,

Below are extracts from a new article in BMJ Evidence-Based Medicine. The full text is freely accessible here: https://ebm.bmj.com/content/early/2021/03/18/bmjebm-2020-111542

'To practice high quality healthcare, clinicians must be able to diagnose correctly, provide preventative and treatment interventions based on the best available evidence, and ensure decisions are consistent with patients’ values and preferences. The educational approaches to teaching evidence-based medicine (EBM) to ensure the clinical decisions reflect both the best evidence and patients’ values are, however, open to question.

'EBM experts devoted to optimising EBM education often suggest that to practice high-value, evidence-based care requires ensuring that clinicians are able to critically appraise original research studies, as well as systematic reviews. Critical appraisal includes addressing risk of bias, and that involves a careful reading of methods and results...

'The notion that most clinicians emerging from professional training will regularly evaluate the risk of bias in methods and results of primary studies is deluded. Most will be uninterested in acquiring the sophisticated skills that such appraisal requires; most of those who are interested will never make obtaining the training to acquire these skills a sufficient priority; and those who do obtain the training and skills will often not have the time to apply them...

'Hence, our educational time should be spent much less on risk of bias in individual studies, and less—depending on how much time we are spending on it now—on quality of a body of evidence, and much more on understanding results.'

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Neil Pakenham-Walsh, HIFA Coordinator, neil@hifa.org www.hifa.org