A Survey Showing the Need to Incorporate the Teaching of Critical Appraisal Skills in the Undergraduate Medical Curriculum.

Aim: Evidence based medicine (EBM) not only increases knowledge but forms the foundations upon which decision making processes are used in medicine. This requires well-conducted research and the ability for doctors to critically appraise literature. The aim of this survey was to gain an insight into the understanding of critical appraisal amongst medical student and trainees, with particular emphasis on the teaching aspect of these skills in the undergraduate curriculum. Methods: Online questionnaires were distributed within the West Midlands Deanery to final year medical students (from the three medical schools) foundation doctors, core surgical trainees and specialist registrars. The questions asked related to levels of confidence in critical appraisal of scientific papers, undergraduate exposure to the process of critical review and opinions on whether these skills should form a more significant component of the undergraduate curriculum. Results: 266 questionnaire responses were received from a range of grades. 127 final year medical students, 62 foundation doctors, 34 core trainees and 43 registrars. Respondents were asked to grade their confidence in critically appraising scientific papers from a choice of no confidence, little confidence, quite confident and very confident. There was a noticeable correlation between level of confidence and grade of respondent. 93% felt critical appraisal teaching was inadequate, with particular emphasis on research methods and paper analysis, with 96% of respondents suggesting this should form a mandatory part of the curriculum. Conclusion: This survey clearly demonstrates the need to ensure that critical appraisal skills are incorporated into the undergraduate curriculum so that newly qualified doctors begin their careers equipped with the essential skills required to practice evidence-based medicine.

The Use of the Prague Classification System in the Reporting of Barrett’s Surveillance Endoscopies.

Aims: The Prague classification for the reporting of Barrett’s oesophagus has been validated in previous studies and is recommended by the British Society of Gastroenterologists (BSG) in their latest guidelines. In this short study we aim to audit the adherence to the use of this system in endoscopy reports produced in a busy teaching hospital in the UK. Methods: We retrospectively audited all the reports for endoscopies performed as surveillance for patients with known Barrett’s oesophagus within a six month period. These reports were examined as to whether or not the Prague classification system was employed. Results: Sixty-seven reports were inspected and six were excluded as Barrett’s was not seen. Twenty-six of the 61 reports studied (43%) used the Prague classification system. The remainder used descriptions and length measurements felt appropriate by the endoscopist. Conclusions: The BSG guidelines emphasise the importance of measuring Barrett’s using a standard methodology. The rationale for this include aiding communication, increasing the level of diagnostic confidence and providing an estimate of the risk of adenocarcinoma development based on segment length. The use of the Prague classification is validated, explicit and consensus driven. However our study demonstrates that only 43% of endoscopy reports use the Prague system. The reason for this lack of adherence is unclear and may benefit from further study.