Whether a graduate of a pharmacy school with a strong evidence-based medicine curriculum or not, many New Practitioners struggle with literature evaluation skills throughout their career. It may be easy to recognize selection bias, but much harder to remember what to do after it has been recognized. Brushing up on critical appraisal of literature skills is an important part of lifelong learning, especially for preceptors who incorporate evidence-based medicine tasks into their rotations. This need not be a time-consuming process, as basic skills can be easily acquired in a short period of time.
The Delfini Group, a public service entrepreneurship, is committed to helping individuals and organizations learn and apply evidence- and value-based clinical improvement tools. Their website, www.delfini.org, has many free online resources that can help with this endeavor. From searching the medical literature to appraising results and everything in between, this website has materials that have been designed to help develop literature evaluation skills.
Useful tools for preceptors
Materials are available as 1-page fact sheets or checklists to focus on specific tasks. One-pagers and other tools can be found by clicking on “Free Online Tools” on the left navigation panel of the site. Resources that are important foundation reading are marked with stars. This a good place to start for someone with a large knowledge deficit.
If improving specific areas is necessary, focusing on applicable topics is easy. Preceptors can introduce or help to develop these skills reinforced during both IPPEs and APPEs. During IPPEs, topic discussions can be held throughout the year and 1-pagers can be used to help facilitate these discussions. Introducing the website and letting students explore their own knowledge deficits is useful during APPEs, where students may put together many different areas for a project.
Many final-year students need practice evaluating literature and benefit from opportunities to do so. When done well, journal clubs or other evidence-based discussions benefit both the student and clinicians at the rotation site. Students who aren’t confident in their literature evaluation skills can be intimidated or apprehensive when given an assignment that has them using these skills. Preceptors may find it useful to talk through an article with a student to identify areas of critical appraisal that they may be weak in, then use the tools on delfini.org to help fill in the gaps. Giving students a copy of tools that help shore up areas of weakness helps them develop those areas and become more competent.
Help students master the concepts
Analyzing results is probably one of the tougher areas for students to learn. There are many hard concepts that come up during the analysis of results, including alpha and beta errors, interpreting time-to-event analysis, and composite endpoints. Many students and even many practicing pharmacists need to brush up on these concepts. There are four tools available on the site that provide great tips on assessing results and determining whether the results are true and useable.
The tools and educational materials offered help develop competency in critical appraisal of the literature. It is vital for patients that pharmacists are able to evaluate and interpret the information that comes out, and these skills are important to cement before students graduate. When working with students, I use many of the 1-pagers provided by Deflini to help with understanding of concepts like p-values, the impact of internal and external validity, and Type I and Type II errors. While talking through these concepts is helpful, providing a reference back to material will help them master these concepts. Because I don’t run into them often, I use the Time-to-Event Analysis 1-pager when looking at studies with Kaplan-Meier curves to make sure I analyze them correctly and to help me be confident in my interpretation of the study.
This site provides unbiased and comprehensive tools—including video tutorials, sample projects, and a blog—to reinforce literature evaluation skills during a pharmacist’s or student pharmacist’s career, and should be a regular go-to site when shoring up skills.