10 The Critically Appraised Topic appraised
Teunissen, C.M.W., Mijnhout, G.S., Groeneveld, P.H.P.
Locatie(s): Zaal 0.11
Categorie(ën): Parallelsessie
Introduction: A common tool to teach residents how to find evidence for questions about treatment or diagnosis arising in their daily practice, is the Critically Appraised Topic (CAT). The CAT is performed by formulating a structured question, using the Patient Intervention Control Outcome (PICO) format. To find the best available evidence, aggregated evidence is searched first using a top-down-approach. First, the National Guideline Clearinghouse and CBO guidelines are searched for evidence-based guidelines, followed by the TRIP database and Cochrane Library for systematic reviews. Only when no clear answer is found yet, PubMed is searched for primary studies as the final resort.
Aim of the study: To assess the yield, benefit and influence on daily clinical practice of the CAT performed by internal medicine residents.
Methods: From July to December 2012, both the presenting resident (a different one each week) and two staff members (the same two if present, or only one if the other was absent) completed a questionnaire consisting of standard list of previously defined questions about the yield, benefit and influence on daily clinical practice of each consecutive CAT and the resident was asked his/her opinion about the benefit of the CAT in general.
Results: A total of 17 CATs were appraised. All residents found the CAT a useful part of their medical specialist training and an important competency for their future work as a medical specialist. However, only 22% stated that they regularly use the CAT method outside the weekly CAT. In 55% of CATs, a clear answer was found. The staff members judged the PICO format was applied well in all CATs. The search strategy was adequate in 79%. However, in only 46% of CATs there was enough evidence available to properly answer the question. Aggregated evidence was available in only 53% of CATs. The answer to the CAT rarely influenced medical practice (11%) or our medical protocols (6%).
Conclusion: The CAT seems to be a useful tool to search medical evidence and a valued part of the internal medicine specialist training, but questions frequently cannot be answered due to lack of (aggregated) evidence and the results rarely influence our daily practice. Has the time come to change our CAT education?