Teaching residents to read the medical literature: a controlled trial of a curriculum in critical appraisal/clinical epidemiology.

OBJECTIVE

To teach internal medicine residents key principles of clinical epidemiology that are necessary to read critically the medical literature.

DESIGN

Two-phase, non-randomized, controlled educational trial.

SETTING

University-based training program for residents (PGY-l-PGY-3) in internal medicine.

PARTICIPANTS

All 83 residents participated in the trial. Seventy residents completed a test in clinical epidemiology at the end of Phases I and II.

INTERVENTIONS

Residents were assigned to one of eight ambulatory care clinics for half a day each week. A literature-based curriculum in critical appraisal was the subject of a weekly pre-clinic conference for four clinics (Group A). The other four clinics (Group B) had a weekly conference on topics in ambulatory care medicine. At the end of Phase I, both groups were given a test of basic knowledge of clinical epidemiology. The curriculum was then modified with the addition of written questions to emphasize important educational points and to stimulate resident participation. The modified curriculum became the subject of the pre-clinic conference for Group B, while Group A changed to topics in ambulatory medicine. At the end of Phase II both groups were again tested on basic knowledge of clinical epidemiology.

RESULTS

Group B performed significantly better on the second test than on the first, 68.5% vs. 63.3% (p = 0.034), while Group A did not improve (64.5% vs. 65.9%). The differences in test scores for Test II minus Test I were +5.17% in Group B and -1.44% in Group A (p = 0.019). Twenty-one percent of Group B residents vs. 5% of Group A residents improved their scores by 18% or more.

CONCLUSIONS

The residency period is a difficult but important time to teach critical appraisal skills. Educational gains may be small and need to be critically evaluated to stimulate the development of more effective educational programs.