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Better is continuous, incremental improvement

The Japanese have a word 'Kaizen' (改善) that captures the concept of continuous improvement, or at a greater level, the philosophy of continuous improvement made in small incremental steps. Kaizen empowers the individual to improve their work in small, but significant ways. Each small improvement compounds upon the last, driving personal and institutional excellence. But this starts with the individual, humanized. Can metajournal lead you to kaizen?

Metajournal: Assessing and applying the evidence

It’s not that Dr. John Ioannidis envisions doctors making all their decisions based solely on solid evidence — there’s simply too much complexity in patient treatment to pin down every situation with a great study. “Doctors need to rely on instinct and judgment to make choices,” he says. “But these choices should be as informed as possible by the evidence. And if the evidence isn’t good, doctors should know that, too. And so should patients.”

— David Freedman on Dr. John Ioannidis, medical meta-researcher.

   Lies, Damned Lies, and Medical Science, The Atlantic, 2010.

Getting better at what you do

Four steps along the journey to getting better at what you do:

  1. You need to be willing to be wrong — and willing to be corrected.
  2. Always be questioning and learning. Be open to learn from others no matter their experience.
  3. You must care about patient outcomes. Empathically.
  4. Finally, you need to contextualize your care for each patient — to their needs and your resources.

"There is only one corner of the universe you can be certain of improving, and that's your own self." — Aldous Huxley

Critically appraising the evidence

It’s hard to keep up with the latest evidence. Not only is the sheer volume of newly published papers overwhelming and the variety of topics broad and wide, but then after finding a paper that piques your interest you are still faced with the tricky task of critically assessing the paper's quality and relevance. Metajournal aims to solve many of these problems, but sometimes you need to just sit down and drag that paper over the keel yourself.

One of the most useful tools I have found are checklists provided by the Critical Appraisal Skills Programme, a UK non-profit based in Oxford. CASP runs workshops that educate healthcare workers and others on how to appraised medical evidence — and they share online the great checklists they use during the workshop under a Creative Commons license.

Find → Appraise → Act

They provide a set of eight critical appraisal tools designed to be used when reading research, covering:

  1. Systematic Reviews
  2. Randomised Controlled Trials
  3. Cohort Studies
  4. Case Control Studies
  5. Economic Evaluations
  6. Diagnostic Studies
  7. Qualitative studies
  8. Clinical Prediction Rule

How to read a journal article

One of the great classic introductions to critical assessment of medical research is Trisha Greenhalgh’s series in the British Medical Journal ‘How to read a paper’. Although the practical aspects of critiquing a paper are better served by newer tools like CASP, Greenhalgh’s work has stood the test of time and is still worth recommending.

The best place to start is with ‘Getting your bearings — deciding what the paper is about’, and then have a look at ‘Assessing the methodological quality’, and ‘Statistics for the non-statistician I’ & ‘II’.

"It usually comes as a surprise ... to learn that some (perhaps most) published articles belong in the bin, and should certainly not be used to inform practice." — Trisha Greenhalgh.

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