Abstract
IntroductionCritical appraisal skills are believed to play a central role in an evidence-based approach to health practice. The aim of this study was to evaluate the effectiveness and costs of a critical appraisal skills educational intervention aimed at health care professionals.MethodsThis prospective controlled trial randomized 145 self-selected general practitioners, hospital physicians, professions allied to medicine, and healthcare managers/administrators from the South West of England to a half-day critical appraisal skills training workshop (based on the model of problem-based small group learning) or waiting list control. The following outcomes were assessed at 6-months follow up: knowledge of the principles necessary for appraising evidence; attitudes towards the use of evidence about healthcare; evidence seeking behaviour; perceived confidence in appraising evidence; and ability to critically appraise a systematic review article.ResultsAt follow up overall knowledge score [mean difference: 2.6 (95% CI: 0.6 to 4.6)] and ability to appraise the results of a systematic review [mean difference: 1.2 (95% CI: 0.01 to 2.4)] were higher in the critical skills training group compared to control. No statistical significant differences in overall attitude towards evidence, evidence seeking behaviour, perceived confidence, and other areas of critical appraisal skills ability (methodology or generalizability) were observed between groups. Taking into account the workshop provision costs and costs of participants time and expenses of participants, the average cost of providing the critical appraisal workshops was approximately £250 per person.ConclusionsThe findings of this study challenge the policy of funding 'one-off' educational interventions aimed at enhancing the evidence-based practice of health care professionals. Future evaluations of evidence-based practice interventions need to take in account this trial's negative findings and methodological difficulties.
Highlights
Critical appraisal skills are believed to play a central role in an evidence-based approach to health practice
+ Adjusted for sex, age, attendance at previous educational activity, access to medical library, prior experience of searching literature, formal education in research methods and/or epidemiology and or statistics, prior involvement in research * Statistically significant at P ≤ 0.05 were randomized to the control group and 73 to the intervention group
A total of 61 (85%) and 44 (60%) questionnaires and 43 (60%) and 21 (29%) appraisals were returned by the control and critical appraisal skills (CAS) training participants respectively
Summary
Critical appraisal skills are believed to play a central role in an evidence-based approach to health practice. These reviews observed marked heterogeneity in the nature of education intervention across individual studies, in terms of duration (which varied across studies from 1 hour or less to 10 hours or more) These reviews consistently reported that CAS training results in small improvements in participants' knowledge of methodological and statistical issues in clinical research and enhances their attitudes towards the use of medical literature in clinical decision making. These findings need to be interpreted with considerable caution as most of the studies had poor internal validity. The CASP model of CAS was evaluated in this trial
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