Elsevier

Surgery

Volume 136, Issue 3, September 2004, Pages 641-646
Surgery

Original Communication
Teaching practicing surgeons critical appraisal skills with an Internet-based journal club: a randomized, controlled trial

https://doi.org/10.1016/j.surg.2004.02.003Get rights and content

Abstract

Background

The effectiveness of interventions for developing critical appraisal skills in practicing physicians has not been studied, despite the documented importance of reading the literature in caring for patients and in continuing professional development. The objective of this study was to evaluate whether an Internet-based intervention would lead to enhanced critical appraisal skills in practicing surgeons.

Methods

General surgeons who agreed to participate were randomized into 2 groups. The intervention was a curriculum in critical appraisal skills that included a clinical and methodologic article, a listserve discussion, and clinical and methodologic critiques. The control group received only the clinical articles. The primary outcome measure was a previously validated 2-hour test of critical appraisal.

Results

Of the 55 surgeons who completed the examination, subjects in the intervention group performed better on the test of critical appraisal skills than those in the control group (mean score: intervention group, 58% ± 8 vs control group, 50% ± 8), with a large effect size of 1.06 standard deviation units (t + 3.92, P < .0001). Training conditions accounted for 22% of the variance in total scores.

Conclusions

A multifaceted, Internet-based intervention resulted in improved critical appraisal skills of practicing general surgeons.

Section snippets

Study population

All 838 active members of the Canadian Association of General Surgeons were contacted by letter and invited to participate in the trial. The requirements for participation outlined in the letter were that the surgeon must have access to the Internet and to E-mail, must agree to being randomized, and must agree to complete a written examination. Surgeons with postgraduate training in clinical epidemiology were excluded from the study. Participants were enrolled by a research assistant (M.M.).

Study design and intervention

Study population

Letters were sent to 838 surgeons on the membership list of the Canadian Association of General Surgeons inviting them to participate in the trial. Of these, 150 surgeons initially expressed interest in participating in the Evidence-based Reviews in Surgery (EBRS) program; after all of the requirements of the study were outlined, only 86 agreed to participate. Three were excluded prior to randomization, and another 2 were excluded after randomization (1 in each group) because they had previous

Discussion

Central to the practice of evidence-based medicine is the ability to critically appraise articles, allowing one to draw conclusions regarding the internal and external validity and generalizability of the study. Despite the importance of critical appraisal to the evaluation and implementation of findings from the medical literature, no studies address how developed these skills are in the practicing community, and no reported studies on how to teach critical appraisal to practicing physicians

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    Planning such meetings to accommodate all schedules can prove difficult leading to poor attendance rates and missed learning opportunities. The recent increased use of online platforms such as twitter and dedicated forums has provided a possible solution to this issue.7,8 There are drawbacks with this method with some studies suggesting low participation in these internet-based clubs compared with the didactic format.9

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Supported by the physicians of Ontario through the Physician's Services Incorporated. The program, Evidence-based Reviews in Surgery, is supported by an unrestricted educational grant from Ethicon and Ethicon Endosurgery.

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