Critical appraisal of medical literature in undergraduate and postgraduate medical students
Authors: Mlika Mona , Naceur Abdelmajid , Dziri Chadli , Loueslati Mohamed Hédi , Mezni Faouzi , Zakhama Lilia , Labbene Iheb , Jouini Mohamed 
Published: November 2022

Background

Critical appraisal of medical literature is a challenging competency which is mandatory in the practice of evidence-based medicine. Achieving this competency has been reported to vary according to many factors including the students’ background, gender, or specialty. The majority of the articles published in this field mainly assessed the students’ satisfaction or their cognitive knowledge. The authors aimed to assess the possibility of performing the same training of critical appraisal of medical literature to students with different backgrounds to highlight the link between the critical appraisal practice and the reflexive, cognitive, attitudes and conative profile of the students according to their level.

Methods

Students in the second year (SYME) and third year (TYME) of medical education and students performing continuing medical education (CME) and family doctors (FD) were invited to voluntarily participate in the training. This study occurred from September 2020 to June 2022. Before the workshop, the students were invited to answer a self-assessment questionnaire and a prerequisite test. Two original manuscripts dealing with COVID-19 were analyzed using published checklists. At the end of the workshops, all of the students fulfilled a second self-assessment questionnaire and a Fresno-adapted final test assessing their knowledge. Both self-assessment questionnaires were conceived by an expert committee according to the different steps of questionnaires’ validation. They assessed the cognitive, conative, motivational, and reflexive students’ profile using Likert scale questions. Also, the participants were invited to answer a semi-structured interview.

Results

Ninety-five participants were included with 6 participants in SYME, 54 in TYME, 16 in CME, and 19 FD. The results highlighted the possibility of using the same program independently from the students’ level when using manuscripts dealing with a widely known and confusing disease such as COVID-19. The analysis of the different pre- and postworkshop questionnaire scores highlighted mild or negative scores in the TYME and intermediate or good scores in the other levels. The variation of the mean scores according to the students’ level revealed a significant difference in prerequisite, final test, pre and postworkshop attitudes, postworkshop cognitive, postworkshop conative and satisfaction scores. 11 students from different levels were interviewed. The content analysis highlighted 4 themes including the teaching organization, the institutional assessment, the impact on the research practice and the impact on the patients’ management with the emphasis of the TYME students on the necessity of integrating the teaching and the assessment of the EBM principles in the curriculum.

Conclusion

Our results put emphasis on the necessity of introducing the teaching of critical appraisal of medical literature early in the curriculum in order to avoid negative behaviorism during the clerkship period.