Teaching critical appraisal may improve appraisal skills and knowledge but does not change reading behaviour

Abstract

Objective: To assess whether teaching critical appraisal has beneficial effects on health care workers and patients.

Data sources: Ten electronic databases, the internet and references of retrieved papers. Experts and major medical education centres were also contacted.

Study selection: Studies were independently assessed by three reviewers for eligibility. Data extraction and validity assessment were undertaken by one reviewer and double-checked.

Data extraction and synthesis A qualitative approach to data synthesis was used for most outcomes, due to the diversity of outcome measures, interventions, and inadequate reporting.

Results: Sixteen studies met the inclusion criteria, 12 from peer-reviewed journals, and four unpublished studies [one RCT, eight non-randomised between group studies, and seven before-and-after studies]. The strongest impact of critical appraisal teaching was observed on knowledge outcomes: seven of the 12 studies showed a statistically significant positive effect. However, the size of the benefit revealed heterogeneity. Studies showed a consistent increase in skills, with the strength of the effect remaining when self-assessed comparisons were removed. There was a mixed effect on clinicians' behaviour, with most comparisons showing a benefit. There were four comparisons of the impact on attitudes – all were positive, but it was not possible to separate out real effects from a tendency for participants to respond in a ‘desired’ manner.

Conclusions: There is evidence that critical appraisal teaching has positive effects on participants' attitudes, knowledge and skills. However, there are gaps in the evidence as it has an impact on decision-making or patient health, or on satisfaction. It is also unclear whether the benefit is substantial enough to be of practical significance. The evidence supporting all outcomes is weakened by poorly designed, executed and reported studies.

Hyde C, Parkes J, Deeks J, Milne R. Systematic Review of the Effectiveness of Critical Appraisal Teaching August 2000. http://www.bham.ac.uk/arif/SysRevs/TeachCritApp.PDF

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