the metablog

Thoughts, news and musings from the metajournal team.

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’ in the UK. These have been reproduced on gasexchange covering four common research types: Randomized Controlled Trials, Systematic Reviews, Cohort Studies and Case Control Studies. Use these useful checklists now, or at the very least bookmark them for future reference.

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.

Feeling more informed?

My goal with metajournal is that with each issue you will not only feel more informed, but actually be more informed — and with that greater level of knowledge and awareness, then apply your understanding of the medical evidence to the people in your care everyday.

Many issues of your personal metajournal will be filled with actionable articles that immediately change what you do in important ways. Sometimes though issues may only contain a mere sprinkling of interest for you and your practice. With metajournal I aim to search out the most relevant and actionable evidence for you, but even these 'lesser' articles are equally important in contextualizing your knowledge and highlighting the important place your practice has within the greater world of your and other specialties.

Highly personalized and relevant evidence targeted to your interests and professional needs is very valuable — in fact it's one of metajournal's core goals — but there is a real cost to only being exposed to research that confirms your interests. Articles that metajournal suggests primarily because of their quality and broader signficance are important for this reason, even if they fall outside ares of your normal clinical interests.

Okay, let's jump in!

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