Teaching critical appraisal during critical care fellowship training: A foundation for evidence-based critical cave medicine

Objective: To determine whether fellowship training in critical care medicine with critical appraisal exercises improves the ability and confidence of fellows to evaluate the medical literature. Design: Prospective, interventional pilot study. Setting: Multidisciplinary critical care medicine training program at a large university hospital. Intervention: Fellows were given three didactic sessions covering study design, analysis, and critical appraisal techniques. During the course of the year, each fellow was required to review one article from the literature and present a critique of this article to the group and faculty (Journal Club). Fellows were guided in the preparation of this presentation by one of the critical care medicine faculty. Finally, a written analysis and critique of the article was performed by each fellow. Measurements and Main Results: A test was given to each fellow at the beginning and end of the academic year. This test consisted of two pairs of articles on therapy for acute lung injury. For the pretest, each fellow was assigned, at random, one pair of articles. Fellows were given 1 hr to review both articles and to fill out a six-point test to assess their ability and confidence to appraise each article. At the end of the year, each fellow was tested on the opposite pair, the tests were graded in a blinded fashion and the results of each test were compared. Six fellows completed both pre- and posttests. These paired results were analyzed separately, whereas results for another six fellows were conducted as an unpaired analysis. Mean scores increased both for the paired analysis (4.1 +/- 0.7 vs. 5.1 +/- 0.5; p = .015) and for the unpaired analysis (4.3 +/- 0.6 vs. 5.0 +/- 0.5; p = .012). Self-reported confidence in critical appraisal also increased (2.5 +/- 0.5 vs. 3.9 +/- 0.7; p = .004 and 2.6 +/- 0.5 vs. 3.9 +/- 0.6; p < .001, respectively). Conclusion: Critical appraisal exercises used in the training of critical care medicine fellows appear to improve both ability and confidence to appraise relevant medical literature.