CRITICAL READING OF MEDICAL PAPERS AT ONSET IN INTERNSHIP

Introduction: Research activities are not developed in undergraduate medical students. Purpose: To evaluate the level of critical reading in medical interns at the onset of the term. Design: Transversal survey. Methodology: A whole group (n: 36) was divided in two groups G1, n=23 (undergraduate interns in a social security general hospital) and G2, n=13 (undergraduate interns in a private medical practical hospital). At the same time we subdivided the whole sample according to the universities they attended (U1, U2, and U3). At the same time we compared a small group (GE, n:4)) that was exposed to a critical appraisal by participating educational methodologies with those with only lecture courses, if any(GNE, n: 32). A previously validated (0.75 consistency) 108-item instrument was applied to the students in one scheduled day. Interpretation, judgments, and proposals were explored. It had 36 items for each indicator and 18 items per design (validation of instruments, surveys, cases and controls, diagnostic tests, clinical trials, and cohorts). The answers were determined as True, False or, Don’t’ Know. Each correct answer (True or False) added one point and each incorrect answer subtracted one point. Questions answered with Do not know did not add or subtract any points. This is how the final grade, which was expressed as group medians, was determined. The grading was performed through an electronic system especially created to minimize data capturing errors and it was carried out blind by staff unrelated to the research. The data were analyzed with version 15 of the SPSS program. Mann-Whitney's U test and Kruskal-Wallis test were used for comparing the groups. Spearman test relating school average and global medians were calculated. The random level was determined as well. Results: The global median obtained in the whole group was low (18 vs 108 total items). The three indicators of critical reading were very low also (6 vs 36 items). The G1 obtained a higher median than G2 (22 vs 11 <=) and in proposal (6 vs 2, <=). No significant differences were found in the six designs. When university groups were compared the U1 developed some student centered educational strategies in critical appraisal; there was no significant difference in school averages and only a slight difference in U1 in interpretation. When the research designs results were compared U1 obtained higher medians in surveys, instruments and clinical trials <=, although very low medians (3 vs 18 items). When the GE and GNE were compared the differences were significant in global medians (55 vs 16), interpretation (17 vs 5) and proposal (20 vs 5). There was also <= in four designs, except for diagnosis tests and instruments. The level of answer random was 39% per G1and 57% for G2. When universities were compared the answer random were 32% U1, 63% U2 and 78% for U3. There was no relationship between school grade and global medians (Spearman 0.16). Comments: The level of critical reading is very low in the students that finished medical school and entering to an intense one year internship in the sample studied. That means that the efforts in considering research as a basic methodological tool in medical school is not sufficient. However there are differences in a small group that has been exposed to critical reading courses centered in the student. A careful study of the curriculum must be done to include this important skill for the evidence based medicine.