Introduction

Evidence-based practice has become an integral part of routine trauma and orthopaedic practice. You apply evidence of many kinds in your daily practice and this has been reflected in the FRCS (Tr & Orth) exam. In the MCQ part, candidates are given a paper to appraise and answer related questions. Although evidence-based practice may be applied in each exam station, you may be specifically asked about different points of evidence-based practice and be probed to assess the depth of your understanding of these aspects, their strengths or limitations. In the structured oral exam, quoting evidence to support your views is perceived highly and can raise your performance and pass grade. This chapter will cover, in a series of questions, the common scenarios you may face. It has been based on real exam questions that have appeared in the FRCS (Tr & Orth), the EBOT and SICOT exams. The answers are deliberately expanded for comprehension and to help address potential follow-up questions.

Station 1: Level of evidence and grades of recommendations

Q 1: Look at Table 17.1 and fill in the blanks.

1. Systematic review (SR) of randomized controlled trials (RCT) with homogeneous findings.

2. Individual RCT with narrow confidence interval (CI).

3. All-or-none studies.

4. Absolute SpPins and SnNouts.

5. Expert opinion.

6. Analysis based on clinically sensible costs of alternatives; systematic review(s) of the evidence; and including multi-way sensitivity analyses.

Q 2: What is a systematic review and meta-analysis? What is meant by homogeneity or heterogeneity?

For many surgical procedures, there have been a number of clinical studies and it would seem natural to want to combine them to get the most comprehensive overview of the effect of treatment. A review locates and summarizes the findings of studies. A systematic review is a rigorous and pre-structured approach to conducting a review. The researchers decide beforehand on their inclusion and exclusion criteria, how they will search the literature, extract data, synthesize and analyse them. The meta-analysis attempts to combine data from different studies statistically with a view to get a combined and more precise estimate of the intervention effectiveness. This is not always possible due to data limitations.