Critical Appraisal of the Medical Critical Appraisal of the Medical LiteratureLiterature

CABS Module Spring 2004CABS Module Spring 2004

John Coverdale MD, FRANZCPJohn Coverdale MD, FRANZCP

Paul Haidet MD, MPHPaul Haidet MD, MPH

Daniel Hunt MDDaniel Hunt MD

GoalsGoals

• Promote evidence-based practice on Promote evidence-based practice on rotations and in clinical practicerotations and in clinical practice

• Set a pattern for life-long learningSet a pattern for life-long learning

• Develop skill in applying the medical Develop skill in applying the medical literature to patient careliterature to patient care

TodayToday

Deciding on What You’re Looking For: Deciding on What You’re Looking For: The 4-Part Clinical QuestionThe 4-Part Clinical Question

Team LearningTeam Learning

• Individual PreparationIndividual Preparation

• Readiness AssuranceReadiness Assurance– IndividualIndividual– TeamTeam

• Application ActivitiesApplication Activities

Individual PreparationIndividual Preparation

• Please read the article on asking clinical Please read the article on asking clinical questions now ( approx. 10 minutes)questions now ( approx. 10 minutes)

Individual Readiness AssuranceIndividual Readiness Assurance

• Take the Readiness Assurance Test in your Take the Readiness Assurance Test in your folders; record your answers on the answer folders; record your answers on the answer sheetsheet

• Closed BookClosed Book

Team Readiness AssuranceTeam Readiness Assurance

• Now, take the SAME TEST again as a teamNow, take the SAME TEST again as a team

• Use the ‘IF-AT’ forms to record your Use the ‘IF-AT’ forms to record your team’s answersteam’s answers

Using the ‘IF-AT’ formUsing the ‘IF-AT’ form• Decide with your group which is the correct answer Decide with your group which is the correct answer

and scratch that answer on the formand scratch that answer on the form• If there is a ‘*’ beneath the answer you scratched, If there is a ‘*’ beneath the answer you scratched,

you got the question correct; move on to the next you got the question correct; move on to the next questionquestion

• If there is not a ‘*’, keep scratching until you find If there is not a ‘*’, keep scratching until you find the answer with the ‘*’the answer with the ‘*’

• Points will be scored as follows:Points will be scored as follows:– Correct answer on the first scratch: 4 pointsCorrect answer on the first scratch: 4 points– Correct answer on the second scratch: 3 pointsCorrect answer on the second scratch: 3 points– Correct answer on the third scratch: 1 pointCorrect answer on the third scratch: 1 point– Correct answer on the fourth scratch: 0 pointsCorrect answer on the fourth scratch: 0 points

Application:Application: Decide with your group which of the Decide with your group which of the following questions would be best.following questions would be best.

A.A. What are the guidelines for management of diabetic What are the guidelines for management of diabetic ketoacidosis in pediatric patients?ketoacidosis in pediatric patients?

B.B. Does addition of bicarbonate to standard therapy improve the Does addition of bicarbonate to standard therapy improve the serum pH in pediatric patients with DKA?serum pH in pediatric patients with DKA?

C.C. In a pediatric patient with diabetic ketoacidosis, does the In a pediatric patient with diabetic ketoacidosis, does the addition of bicarbonate to standard therapy improve addition of bicarbonate to standard therapy improve mortality?mortality?

D.D. In a pediatric patient with newly-diagnosed diabetes mellitus In a pediatric patient with newly-diagnosed diabetes mellitus presenting as DKA, is there a physiological rationale for the presenting as DKA, is there a physiological rationale for the use of bicarbonate?use of bicarbonate?

E.E. What are the adverse pathophysiological consequences of What are the adverse pathophysiological consequences of bicarbonate in diabetic ketoacidosis?bicarbonate in diabetic ketoacidosis?

The Four-Part QuestionThe Four-Part Question

• PopulationPopulation

• Intervention (or risk factor)Intervention (or risk factor)

• Comparison GroupComparison Group

• Outcome (‘final’ outcomes better)Outcome (‘final’ outcomes better)

Team LearningTeam Learning

• Individual Preparation (see one)Individual Preparation (see one)

• Individual Readiness Assurance (do one)Individual Readiness Assurance (do one)

• Team Readiness Assurance (teach one)Team Readiness Assurance (teach one)

• Application Activities (collaborate and Application Activities (collaborate and debate one)debate one)

Team Learning PrinciplesTeam Learning Principles

• There is Strength in numbersThere is Strength in numbers

• Well-functioning teams do better than their Well-functioning teams do better than their best (smartest) individualbest (smartest) individual

• Grades to both individual Grades to both individual andand team team

Grade WeightsGrade Weights

• Individual Grade – 40%Individual Grade – 40%– Readiness AssuranceReadiness Assurance– HomeworkHomework– Final ExamFinal Exam

• Team Grade – 60%Team Grade – 60%– Readiness AssuranceReadiness Assurance– Final ExamFinal Exam

Next SessionNext Session

Finding What You’re Looking For:Finding What You’re Looking For:

Efficient Searching of the Medical LiteratureEfficient Searching of the Medical Literature

Dan Hunt, MDDan Hunt, MD