Strategically Reading Randomized Controlled Trials
Topic/Goal of Instruction:
When published guidelines and point-of-care information resources such as UpToDate or DynaMed Plus do not have the answer to clinical questions, healthcare professionals turn to the journal literature. Randomized controlled trials (RCT) are considered the ideal type of study to determine, without bias, the benefit or harm of an intervention and are often sought as evidence-based, authoritative sources of information to answer questions about complicated clinical scenarios. However, healthcare professionals do not have time to read lengthy and complex documents.
The goal of this module is to prepare third-year medical students in their clinical clerkships for the situation laid out above. By the end of the unit, students will be able to look at an RCT, quickly locate key pieces of information about the study design, and use a tool called a critical appraisal worksheet to evaluate the evidence. Twenty minutes is a perfectly reasonable amount of time for this module, considering the goals are more to equip the audience with the tools to perform the task rather than to actually appraise evidence together (since I am not a medical subject expert, but a librarian). This is still an intellectual skill, though, because the information they locate will need to be interpreted and synthesized.
Rationale:
As a medical librarian and liaison to the medical school who already teaches in the curriculum, I am knowledgeable about both the subject and the need for this type of module. One of the primary responsibilities of my job is to help people locate and assess high quality information, and this case is no different. This unit would be immensely useful because, at this point in time, critical appraisal of the literature is not part of the medical school’s curriculum, despite being part of a forthcoming Core Entrustable Professional Activity for Entering Residency laid out by the accrediting body the Association of American Medical Colleges. Since medical students do not receive instruction in this area and the prospect of reading a lengthy and complex document is daunting for them, they end up basing clinical care decisions on less timely, less applicable, and less evidence-based information. The module aims to modify that behavior.
You can view the rest of the documentation for this project here.