Rapid Fire Critical Appraisal Top Tips

Dr Annabel Greenwood (ST3), inspired by Dr Ian Morris (Consultant Neonatologist, UHW) 

​This year’s WREN Spring study day featured a fantastic guest lecture from Dr Ian Morris, Consultant Neonatologist at UHW, on top tips for acing the critical appraisal component of the START assessment.   

Although many of you may have tailored your own approach to critical appraisal by now, whether it be for a journal club presentation, or more informally at your leisure whilst critiquing a paper from your journal of choice…perhaps these ‘rapid-fire’ critical appraisal suggestions will help freshen your enthusiasm and approach towards critical appraisal! 
Broadly speaking, there are 3 Key Areas to Appraisal;

1. Relevance
2. Internal Validity 
3. External Validity 

…But what exactly do these mean?!

Relevance– How important is the content of the article to me, my patients, and my practice? The title and the abstract will help you answer these questions.
Internal validity– How sound is the study?  i.e. how accurate is the study? Look at the methods to help ascertain this. 
External validity– How applicableis the article to my practice?  i.e how much can I generalize it? The methods and results sections will help you assess the external validity. 

Now, with those 3 key principles in mind, let us picture the scene…
You’re an ST7 trainee, approaching the end of your paediatric training, years of hard work and dedication behind you, your CCT within touching distance.  You’re at your START assessment, the last hurdle before consultancy, and now for your critical appraisal station.  Twenty minutesto read the article AND then appraise?! How on earth am I going to do this I hear you cry?!

Stay calm, take a deep breath, and burst forth the 9 key questions that will help you ace the station!

Describe the study
What is the type of study (principal method)
What type of question is being asked? (e.g. Diagnostic? Therapeutic? Economic?)
Where was the study carried out? (is it multicentred or single study)
What are the key features?

• These questions should help you form your opening paragraph of the analysis 

Describe the research question

• using the PICO analysis tool (Population, Intervention, Comparison, Outcome)  

What is the relevance of the question?
This is usually described in the introduction.  Is it an important question? Is it worth reading on?  Does it correlate to your clinical practice/scenario?

Describe the methods
Use the PICO template, but expand….
What are the inclusion/exclusion criteria? Is there any masking or blinding?
Are there any secondary outcomes?
 
Comment on the internal validity i.e. how accurate is the study?
Use various checklists e.g. CONSORT, STROBE, PRISMA
Is there a risk of bias?
 
Summarise the primary results 
 
Summarise the key secondary results(briefly)
 
Comment on the External validity– i.e. describe the generalizability of these findings
Were the inclusion/exclusion criteria reflective?
Limitations?
Consider the paper in conjunction with other studies i.e. how does it fit with the evidence out there?
 
Conclusion 
Overall, does this paper help you answer your clinical question? Important to look at the clinical context!

….And just like that, you did it!

​9 logical, concise steps to critical appraisal for the START assessment.  Of course, this is only a suggested approach, but one which I will most certainly be adopting for future critical appraisals. Now, where did I put that journal?.....