Abstract
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 preclinic 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.
Similar content being viewed by others
References
Schwartz JS, Ball JR, Moser RH. Safety, efficacy, and effectiveness of clinical practices: a new initiative. Ann Intern Med. 1982;96:246–7.
Muller S (chairman). Physicians for the twenty-first century. Report of the Project Panel on the General Professional Education of the Physician and College Preparation for Medicine. J Med Educ. 1984;59 (Part 2):11–3, 29–31.
Gehlbach SH, Bobula JA, Dickinson JC. Teaching residents to read the medical literature. J Med Educ. 1980;55:362–5.
Inui TS. Critical reading seminars for medical residents: report of a teaching technique. Med Care. 1981;55:362–5.
Woods JR, Winkle CE. Journal club format emphasizing techniques of critical reading. J Med Educ. 1982;57:799–801.
Linzer M, DeLong ER, Hupart KH. A comparison of two formats for teaching critical reading skills in a medical journal club. J Med Educ. 1987;62:690–2.
Linzer M, Brown JT, Frazier LM, DeLong ER, Siegel WC. Impact of a medical journal club on house-staff reading habits, knowledge, and critical appraisal skills. JAMA. 1988;260:2537–41.
Accreditation Council for Graduate Medical Education. Special requirements for internal medicine programs. Chicago: Accreditation Council for Graduate Medical Education, 1988;13.
Ernster VL. On the teaching of epidemiology to medical students. Am J Epidemiol. 1979;109:617–8.
Cullinan TR. Teaching concepts in epidemiology. J Epidemiol Community Health. 1980;34:201–3.
Vuturo AF. Teaching clinical epidemiology in the family practice office. J Fam Pract. 1978;6:653–4.
Mulvihill MN, Wallman G, Blum S. A seven year retrospective view of a course in epidemiology and biostatistics. J Med Educ. 1980;55:457–9.
Murphy JR. Biometrics in the medical school curriculum; making the necessary relevant. J Med Educ. 1980;55:27–33.
Elford J, Chapman GE, Boothroyd Brooks EM, Shaper AG. Population studies: an integrated course in epidemiology and sociology for medical students. Med Educ. 1985;19:208–13.
Novick LF, Greene C, Vogt RL. Teaching medical students epidemiology: utilizing a state health department. Public Health Rep. 1985;100:401–5.
Knapp RG, Miller MC. Clinical relevance: an issue in biostatistical training of medical students. Med Educ. 1987;21:32–7.
Radack KL, Valanis B. Teaching critical appraisal and application of medical literature to clinical problem-solving. J Med Educ. 1986;61:329–31.
Bennett KJ, Sackett DL, Haynes RB, Neufeld VR, Tugwell P, Roberts R. A controlled trial of teaching critical appraisal of the literature to medical students. JAMA. 1987;257:2451–4.
Barks LR, Burton JR, Zieve PD, eds. Principles of ambulatory medicine. 2nd ed. Baltimore: Williams & Wilks, 1986.
Department of Clinical Epidemiology and Biostatistics, McMaster University Health Science Center. How to read the clinical journals: I. Can Med Assoc J. 1981;124:555–8.
Department of Clinical Epidemiology and Biostatistics, McMaster University Health Science Center. How to read the clinical journals: II. Can Med Assoc J. 1981;124:703–10.
Department of Clinical Epidemiology and Biostatistics, McMaster University Health Science Center. How to read the clinical journals: III. Can Med Assoc J. 1981;124:869–72.
Department of Clinical Epidemiology and Biostatistics, McMaster University Health Science Center. How to read the clinical journals: IV. Can Med Assoc J. 1981;124:985–90.
Department of Clinical Epidemiology and Biostatistics, McMaster University Health Science Center. How to read the clinical journals: V. Can Med Assoc J. 1981;124:1156–62.
Author information
Authors and Affiliations
Additional information
Received from the Division of General Internal Medicine, University of Louisville School of Medicine, Louisville, Kentucky.
Rights and permissions
About this article
Cite this article
Kitchens, J.M., Pfeifer, M.P. Teaching residents to read the medical literature. J Gen Intern Med 4, 384–387 (1989). https://doi.org/10.1007/BF02599686
Issue Date:
DOI: https://doi.org/10.1007/BF02599686