Critical Reading Made Easy: effectiveness and experience

1
Critical Reading Made Easyeffectiveness and
experience

• Linda Ward
• Clinical Librarian / Deputy Librarian
• Education Centre Library
• Leicester General Hospital

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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

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CRME format

• WorkshopsA series of six workshops introducing
  research methods and tools to help
  appraiseClinical Trials, Systematic Reviews,
  Qualitative studies, (CASP)Guidelines (AGREE),
  Patient information (DISCERN)
• Overviews Research methods and introduction to
  CASP
• One One

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CRME content

• Research methods and levels of evidence
• The Checklists
• The questions
• The article

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Levels of evidence
For quantitative studies
Secondary Research
Primary Research   Experimental   observational
For qualitative studies? No consensus about the
relative rigour of different methods
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Judging the quality of research

• JAMA articles
• http//www.cche.net/user
• Checklists e.g. CASP

NHS Critical Appraisal Skills Programme
http//www.phru.nhs.uk/casp/appraisa.htm
A framework for thinking about the quality of
research
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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?

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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

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Who has participated?

• Workshop programmeApproximately 100 staff since
  2002, representing a range of clinical
  specialties, health professions and organisations
• Overview sessions presented toNeonatal
  postgraduate teaching programmeOG research and
  evidence programmeMedical house officer teaching
  programmeNeonatal Unit multidisciplinary Journal
  Club Staff in genetics, family planning,
  surgery, renal nursing and mental health pharmacy

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Evaluation 1

• Evaluation following sessionshas 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

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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.

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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 couldnt attend, barriers were time
  geography.
• Basis to take the LEAF forward

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The evidence base

• Systematic review of critical appraisal
  teachingParkes 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

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Opportunities for librarians 1

• Start small
• Work in partnership with clinical staff - sharing
  knowledge and skills
• CASP checklists are new to most
• Dont assume participants have high levels of
  knowledge. Be adaptable
• Have a good stats dictionary handy
• Put statistics in their place

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Opportunities for librarians 2

• Marketing
• Individual email effective but no longer possible
• Intranet
• Posters / flyers
• Word of mouth
• Structured postgraduate teaching
• Journal clubs

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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

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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/collect
  ions/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.