Critical appraisal using the READER method: a workshop-based controlled trial.
(9/726)
BACKGROUND: Critical reading is an important skill for those trying to practice evidence-based medicine. There are a number of recognized structures for critical reading, including the READER model. These methods should be subjected to high-quality studies. OBJECTIVES: We aimed to evaluate the READER method in a practical teaching setting using the highest quality research methodology. METHODS: We carried out a modified randomized controlled trial. Two groups of GP trainers were invited to appraise critically the two articles using either the READER acronym or a semi-structured free appraisal. RESULTS: Of 99 participants in the workshop, 92 completed the study. One-third of participants (33.7%) read more than five articles per month and those who had been in practice the longest read fewer articles (P<0.05). Both groups attributed the lowest score to paper 2. The median total scores were higher using the READER method, although only significant for paper 2 (P<0.05). The median score attributed to the methodology was lower using the READER method than the free appraisal, although this difference was only significant for paper 1 (P<0.05). Overall, 51% (70% of the READER group) believed that taking part in the exercise would encourage them to be more critical of published articles in the future. CONCLUSION: Those using the READER method attributed a higher total score, but were more critical of the methodology than those using a free appraisal. Participants found the study useful and believed that it would be of help in future critical appraisal. The study raises interesting questions about the relative importance to GPs of methodological rigour compared with other factors when evaluating research papers. (+info)
Teaching family practice residents breast cyst aspiration.
(10/726)
OBJECTIVE: To conduct the first study of teaching family practice residents the technique of breast cyst aspiration (BCA) using the Toronto Breast Cyst Aspiration Model (TBCAM) in a workshop. To determine whether this training increases their likelihood of performing the procedure in the future. To discover how residents evaluate the workshop as a teaching method. DESIGN: Prospective parallel-group trial from August to November 1997. Baseline questionnaires were given to both experimental and control groups in August. The experimental group was given a 1.5-hour workshop and a postworkshop questionnaire. Both groups were then given 3-month follow-up questionnaires. SETTING: Family practice residency program at the University of Toronto. PARTICIPANTS: The experimental group consisted of 15 family practice residents from one university-affiliated hospital site. The control group consisted of 54 family practice residents selected from the remaining sites. MAIN OUTCOME MEASURES: Confidence score, likelihood of performing BCA, and effectiveness of the workshop rated on a Likert scale ranging from 1-low to 5-high; and knowledge of BCA rated from 0 to 7. RESULTS: Three months after the workshop, 62% of study subjects and 31% of controls were above the median confidence score of 3.2 (chi 2 3.4, P > .05); 76% of subjects but only 11% of controls were above the median knowledge score of 4 (chi 2 16.67, P < .001); and 75% of subjects and 34% of controls were above the median likelihood to perform score of 3 (chi 2 5.37, P < .05). Most (95%) workshop effectiveness scores were 4s or 5s. CONCLUSIONS: Workshop training resulted in higher confidence, greater knowledge, and more likelihood of performing BCA. The workshop using the TBCAM was evaluated as a highly effective way to teach BCA. (+info)
How can we help people make sense of medical data?
(11/726)
CONTEXT: Information is a basic prerequisite to informed medical decision making. GENERAL QUESTION: How can we help people interpret the quantitative data they need to make informed decisions? SPECIFIC RESEARCH CHALLENGE: To develop and evaluate interventions that will help people make sense of the quantitative data relevant to their health care decisions. STANDARD APPROACH: Traditional patient education interventions focus on providing disease-specific information (e.g., educational brochures about a single disease). POTENTIAL DIFFICULTIES: Interventions that focus on content--the provision of facts--may not be sufficient help for people facing medical decisions. Training that prepares people to make sense of the facts that they are given may be necessary. ALTERNATE APPROACH: We propose developing a generic (i.e., not disease-specific) tutorial to prepare people to better understand and more critically evaluate data on disease risk and the benefits and harms of treatment. This tutorial aims to improve critical reading skills by teaching people about risk (e.g., probability and rates) and showing them what to look for in statements about risk (e.g., time frame), how to put disease risk and treatment benefit in context (e.g., evaluating competing risks), how to interpret changes in risk, and whether to believe the statements about changes in risk. (+info)
Can small group education and peer review improve care for patients with asthma/chronic obstructive pulmonary disease?
(12/726)
OBJECTIVE: To study the effectiveness of an intensive small group education and peer review programme aimed at implementing national guidelines on asthma/chronic obstructive pulmonary disease (COPD) on care provision by general practitioners (GPs) and on patient outcomes. DESIGN: A randomised experimental study with pre-measurement and post-measurement (after one year) in an experimental group and a control group in Dutch general practice. SUBJECTS AND INTERVENTION: Two groups of GPs were formed and randomised. The education and peer review group (17 GPs with 210 patients) had an intervention consisting of an interactive group education and peer review programme (four sessions each lasting two hours). The control group consisted of 17 GPs with 223 patients (no intervention). MAIN OUTCOME MEASURES: Knowledge, skills, opinion about asthma and COPD care, presence of equipment in practice; actual performance about peakflow measurement, non-pharmacological and pharmacological treatment; asthma symptoms (Dutch Medical Research Council), smoking habits, exacerbation ratio, and disease specific quality of life (QOL-RIQ). Data were collected by a written questionnaire for GPs, by self recording of consultations by GPs, and by a written self administered questionnaire for adult patients with asthma/COPD. RESULTS: Data from 34 GP questionnaires, 433 patient questionnaires, and recordings from 934 consultations/visits and 350 repeat prescriptions were available. Compared with the control group there were only significant changes for self estimated skills (+16%, 95% confidence interval 4% to 26%) and presence of peakflow meters in practice (+18%, p < 0.05). No significant changes were found for provided care and patient outcomes compared with the control group. In the subgroup of more severe patients, the group of older patients, and in the group of patients not using anti-inflammatory medication at baseline, no significant changes compared with the control group were seen in patient outcomes. CONCLUSION: Except for two aspects, intensive small group education and peer review in asthma and COPD care do not seem to be effective in changing relevant aspects of the provided care by GPs in accordance with guidelines, nor in changing patients' health status. (+info)
Physiology teaching in the developing world: models for quality learning.
(13/726)
An important initiative to develop higher education and physiology teaching was launched when recommendations were deliberated at the concluding session of a four-day international workshop, Physiology Teaching in the Developing World: Models for Quality Learning, held April 5-8, 1999, at the Aga Khan University, Karachi, Pakistan. The event was organized under the auspices of the International Union of Physiological Sciences (IUPS), Pakistan Physiological Society, and Aga Khan University. Among other major sponsors, the Islamic Development Bank, Islamic Educational Science and Cultural Organization. Third World Academy of Sciences, and Pakistan Science Foundation were prominent. (+info)
Construction of a model demonstrating cardiovascular principles.
(14/726)
We developed a laboratory exercise that involves the construction and subsequent manipulation of a model of the cardiovascular system. The laboratory was designed to engage students in interactive, inquiry-based learning and to stimulate interest for future science study. The model presents a concrete means by which cardiovascular mechanics can be understood as well as a focal point for student interaction and discussion of cardiovascular principles. The laboratory contains directions for the construction of an inexpensive, easy-to-build model as well as an experimental protocol. From this experience students may gain an appreciation fo science that cannot be obtained by reading a book or interacting with a computer. Students not only learn the significant physiological concepts but also appreciate the importance of laboratory experimentation for understanding complex concepts. Model construction provides a hands-on experience that may substantially improve performance in science processes. We believe that model construction is an appropriate method for teaching advanced concepts. (+info)
A model circulatory system for use in undergraduate physiology laboratories.
(15/726)
The cardiovascular system is a central topic in physiology classes, yet it is difficult to provide undergraduates with quality laboratory experiences in this area. Thus a model circulatory system was developed to give students hands-on experience with cardiovascular fluid dynamics. This model system can be constructed from readily available materials at a reasonable cost. It has a realistic pressure drop across the different vessels. Using this system, students can investigate the effect that blood volume, vessel compliance, vessel construction, and heart activity have on blood pressure and flow. The system also demonstrates the effect of vessel diameter on resistance and fluid velocity. This model may give students a more concrete, intuitive feel for cardiovascular physiology. Another advantage is that it allows dramatic and easily controlled manipulations with quantitative results. Finally, its simple construction allows students to interchange components, giving them greater flexibility in experimentation. (+info)
From psycho-social theory to sustainable classroom practice: developing a research-based teacher-delivered sex education programme.
(16/726)
This paper describes the development of a theoretically based sex education programme currently undergoing a randomized controlled trial in the UK. It considers some of the practical difficulties involved in translating research-based conclusions into acceptable, replicable and potentially effective classroom lessons. The discussion acknowledges that the implications of social psychological research and the requirements of rigorous evaluation may conflict with accepted principles inherent in current sex education practice. It also emphasizes that theoretical ideas must be carefully embedded in lessons which are informed by an awareness of classroom culture, and the needs and skills of teachers. For example, the use of same-sex student groups to reflect on the gendered construction of sexuality may be problematic. Materials must be tailored to recipients' circumstances, which may require substituting for limited experience with the use of detailed scripts and scenarios. Furthermore, role-play techniques for sexual negotiation that work elsewhere may not be effective in the UK. The use of trigger video sessions and other techniques are recommended. Finally, the problems involved in promoting condom-related skills are discussed. The paper concludes that, if an intervention is to be sustainable beyond the research stage, it must be designed to overcome such problems while remaining theoretically informed. (+info)