Time to think? Questionnaire survey of pre-registration house officers' experiences of critical appraisal in the Mersey Deanery

Abstract

Workload pressures may lead pre-registration house officers (PRHOs) to undervalue critical appraisal and thinking skills. This study aimed to explore Mersey Deanery PRHOs' attitudes, experiences and perceived readiness for practising evidence-based medicine with critical appraisal skills. A cross-sectional survey of 157 PRHOs from 5 postgraduate centres in the UK, using a semistructured questionnaire, at the beginning and end of the pre-registration year. Main outcome measures were level of agreement with closed statements exploring experiences and opinions about critical appraisal skills and evidence-based practice. Open questions explored personal experiences. Most PRHOs (69%) felt medical school prepared them to use critical appraisal skills and perceived such skills as relevant (63%). Fewer felt that their clinical work was based on best available evidence (57%). The busier the PRHOs, the less likely they were to agree that their practice followed best evidence. The PRHOs were more likely to feel supported and that their practice was evidence-based at the end of the year. Responders identified several reasons for their practice not being evidence-based, including workload, lack of skills, deferring to senior colleagues, and non-conducive hospital culture. The nature of PRHO work still mitigates against critical thinking and appraising evidence, with a lack of protected time and perceived inconsistent support from educational supervisors. Many PRHOs rely entirely on evidence-based summaries and guidelines from others. The PRHO year is a period of crucial transition, however, and critical appraisal skills and evidence-based approaches need developing post-qualification, with sufficient protected time for their integration into practice. Foundation year reforms reinforce such requirements.