Sir: Dhar and O'Brien (Psychiatric Bulletin, February 2001, 25, 67-68) present a trainees'-eye view of the Critical Review Paper of the Membership examination. They advise setting up evidence-based journal clubs (EBJC) to teach critical appraisal skills, but what is an EBJC?
The practice of evidence-based medicine (EBM) involves conscientious, explicit and judicious use of current best evidence in making decisions about individual patients' care (Sackett et al, 1996). This requires formal assessment of the quality and implications of available evidence to maximise the quality of clinical decision-making. It is unlikely that an EBJC can truly emulate EBM without considerable work (Walker et al, 1998). How then do trainees prepare for the Critical Review Paper?
In Inverclyde, we hold a weekly journal club attended by all grades of medical staff, which alternates between an EBJC and a ‘critical appraisal journal club’ (CAJC) format. In EBJCs, presenters address a clinical question with reference to the wider literature. Summaries of relevant papers lead to an overall awareness of the current evidence base and a ‘clinical bottom line’ is established. The CAJC aims to teach the skills examined in the Critical Review Paper. A single article is chosen and introduced with reference to critical questions such as those proposed by Greenhalgh (1997). The audience participates in the appraisal process. The strengths and limitations of the research inform result interpretation, and the participants derive conclusions on that basis.
Trainees find the CAJC format beneficial in their preparation for the Membership examination. We commend this format to training schemes throughout the British Isles.