Specific papers that are directly related to your professional studies have been selected for each group. Details of these papers are provided at the end of this guide. However, regardless of your professional background, the approach you will need to adopt will be similar.
Start by reading through the paper(s) that have been set, and try to write notes about what the authors were trying to do (aim, which should be clearly stated in the introduction), how they designed the study (method), what the main results were (results), and the conclusions they drew from these results (discussion and conclusions). This approach mirrors the IMRAD system which focuses on the main sections of research reports. Even at this early stage in the process you should be able to write brief notes under each of these headings. If you can’t then it is possible that the article is written in an unappealing, overtly-technical, jargonistic manner. A critical appraisal is about making reasoned judgements like this. However, to successfully complete the assignment you will have to use a more formal and detailed system to allow you to systematically examine a series of different features that determine quality.
Formal critical appraisal systems, such as the CONSORT statement for evaluating randomised controlled trials and the Critical Appraisal Skills Programme, focus on the methods section –with good reason. This is the most important section of any research article as it provides details of how data collection was designed and executed. If there are flaws here the results may be corrupted making conclusions meaningless. Whilst the CONSORT statement contains comprehensive guidance for the scrutiny of randomised controlled trials, the CASP tools are perhaps more user friendly for the first-time user, and cover a wider range of research designs. These tools do still focus on important issues and can be confidently used to provide a framework for a critique.
Although CONSORT and CASP are referred to here, many research methods texts will provide a guide to critical appraisal in the form of a series of questions. It is acceptable to use the system you find most appealing. In fact, the best critiques may use a particular tool as a framework, but will bring in elements from alternative tools / texts as appropriate. A formulaic approach, which takes each question in a single tool in turn and offers short, unreferenced, comments will be unlikely to do well.
Although all tools are different, they share an overall focus on three issues:
Is the study valid?
This is perhaps the most difficult question to address. It refers to the method used to gather data, and is asking if it was truly capable of measuring the variables of interest, or if it has been measured in some other way that is flawed.
What are the results?
Purely a descriptive exercise, this question relates to a clear expression of the main findings of the results. It is vital that you can summarise the results succinctly.
Will the results help locally?
Research is always conducted on a sample of subjects, and asking if that sample is similar enough to your population of patients to make the results applicable to you is a vital question. Although you don’t have any clinical experience on which to base this judgement, you should comment on the suitability of the paper to inform practice generally – asking ‘is this good enough to warrant a change in my practice?.
The structure of the critique is also important. An introductory paragraph describing the main focus of the article, and explaining the relevance of the topic area, is a good scene setter. This information should be found in the introduction to the article. When taking your first steps in critical appraisal you are clearly not going to know if the ‘state of the art’ is being provided. However, you should get a clear sense of the authors understanding and knowledge of the subject area by reading this information. If it is unclear then you have to ask if it is jargonistic, lacks clarity, or omits information necessary to understand the thought process behind the research. At the end of the introduction / start of the method, there should be a clear statement of the aim or presentation of a hypothesis, and if you are not sure what is being researched by this stage, then clearly the paper has failed to provide the most fundamental information.
Finally, remember that a critique balances strengths and weaknesses
It is relatively easy to trash a paper, but ‘going for the jugular’ will not assure you of a better grade. True objectivity is the goal, where the strengths and weaknesses are balanced to lead to a justified conclusion. A vast majority of research papers have something to offer, and if you dismiss everything in a paper it is probably because you have failed to balance its strengths and weaknesses. If you haven’t found at least one or two positives in the paper, then you should look more closely.
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