Improving Your Critical Appraisal Skills

Introduction to a Series

This post introduces an occasional series, available to our paid subscribers, aimed at helping people improve their ability to read and interpret the medical literature. Improving Your Critical Appraisal Skills will be made up of “chapters” dealing with how to read articles about various study types. These chapters are adapted from my former course, Critical Appraisal of the Landmark Literature. That course was designed for senior medical students and was meant to improve their skills in using the medical literature to solve clinical problems and prepare them to learn from the cases and assimilate new knowledge from journal articles.

Improving Your Critical Appraisal Skills is meant for everyone: people who have just started reading the literature and those who are truly pros; people in the medical field or those currently on the receiving end of healthcare; and, especially, people just interested in understanding medical information. For readers without much experience, I hope the posts serve as a primer. For readers with more advanced skills, I hope they will be a refresher, a resource, and maybe present a new way of looking at a familiar topic. My primary goal is to help people provide and receive better care. A secondary, and more pithy, goal: given a statement, be able to identify the type of evidence that might support it and recognize potential shortcomings. This should enable you to argue with someone about the quality of the evidence given a statement but knowing nothing else. (Use this power cautiously!)

I’d love it if some of you will choose to submit additions to what I post, either to be included in the original post or posted as a supplement. Maybe this will turn into The Martian.

Some of the posts will be a bit longer than usual Sensible Medicine posts. I see them as posts that might be read over multiple settings or bookmarked and returned to.

There are many great resources for learning to read the medical literature. I will draw from many of them. My favorite, and the one that formed the basis of the course handouts 25 years ago is JAMA’s Users’ Guides, collected in the book Users' Guides to the Medical Literature: Essentials of Evidence-Based Clinical Practice. For people with no experience reading medical studies, I’d recommend starting with these.¹ Another JAMA series that is an excellent resource, for those with more advanced knowledge, is the JAMA Guide to Statistics and Methods. I also hope that readers will be inspired to expand on what I present. I’ll be happy to post other people’s takes on the topics.

Evidence based medicine was originally, and most famously, defined as the process of integrating clinical experience and expertise with the best available evidence from systematic research. Practicing evidence-based medicine requires a strong foundation of medical knowledge, the ability to ask well-formulated questions, analyze evidence in the medical literature, and incorporate the answers to your questions into clinical decision making.

Mariana Barosa published this figure to describe EBM in her Sensible Medicine post.

Improving Your Critical Appraisal Skills will not be teaching EBM. It will peel off one aspect, critical appraisal, and aim to improve your skills there. I think this is the easiest aspect of EBM. The synthesis of evidence with biomedical knowledge, clinical experience, and patient preference is the true challenge to practicing good medicine and to making good decisions about your own healthcare.

So, let’s begin. The initial post, The Randomized Control Trial, will be in your inbox tomorrow.

1. If you do this, I would start at the beginning. There is even a podcast that follows some of the original articles.