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Oh, yes. Hi. You could probably stop whistling. Hi. Can I Can everyone here and see us? I'm just going to log in on chrome as well, because last time I couldn't actually see anything on fire. Fox. Oh, yeah. I only really works. Uh, like, none of the chat worked for me. It's okay. I'm here. Oh, yeah, I can see the more current. Yeah, we will give it a minute before we crack on. Hi, everyone. Oh, yeah. I can see that. The audience thing filling up. And, um, for those of you that have joined and you've just submitted your oriole application Congratulations. Um, that's one big headache after the way. And I know this is a really anxious time, but it's also a really big relief because, you know, that type of add minimum is gone out of, you know, out of your life. Now, let's think about Yeah, and it's not no longer in your hands. You can sleep tight, I hope. Um, focus your efforts on something else. Yeah, and it's really good that you guys are here thinking about the next step now, and as always, um, feel free to ask any questions as we go through this. Um, but I think we can get a start. Well, I guess. Yeah. Awesome. Have you got control of the slides? Yes. Yeah, okay. Hello, everyone. My name is Ali. I'm joined tonight by Dr Joseph here, but we'll introduce ourselves more in a moment. Just, uh, just as always, we have to preface these talks about the specialized foundation program by saying that all of the views expressed in this talk and the series overall are solely our own views. They do not reflect the views of the NHS, the trust we work for, or any of the official bodies that were involved with or indeed, the U K F, P O or anyone involved with the specialist Foundation program itself. This is kind of this is our interpretation. What's going on that you're hearing about? It's separate. And we just wanted to give this to you guys, like, you know, like a tip as to help you guys. I think. Yeah. So welcome. And this is the second session there at the same time every week, 7. 30 PM on a Thursday for a minimum of eight sessions, potentially more depending on demand. but we'll certainly be finishing out this series. So in terms of introductions, we'll just take a moment to to introduce ourselves. Um, just unfortunately, our close friend, who is our third colleague, I think he's enjoying, um, a much needed trip with his girlfriend. I think in Spain, So apologies that he's not here. Um, but yeah, he's stuck in an airport. Someone? Yeah, in Spain or something? Yeah. Unable to be here, but actually importantly for this session, Um, both Alex who who were just, uh We're sending his apologies there. And Aqua, as she'll say in a moment, uh, working down as part of the London academic unit, which is which is kind of important for the purposes of this session. Uh, my name is Ali. I am an academic foundation to Doctor. I trained at Warwick doing Graduate Entry Program, So I'm currently for any of you that no new castle I am based between the two big tertiary center. Is there the Royal Victoria in the Freeman, Our local big transplant surgical center? Uh, academically. I'm affiliated with Newcastle University. Where I'm a training fellow within the medical school in my first year is when you do your F one? I did rotations in the possibility and transplant surgery, an academic rotation and then finished up on acute internal medicine. And then I just started F two this past August. I'm currently working as a neurology s h O with an academic block up coming and then finishing in psychiatry. So quite a cerebral second year, and then I'm interested primarily neurosurgery and interventional neuroradiology. And then that's me. I went to med school at Lester, and now I'm based in Sorry. And, um, I'm, I guess associated with three different institutions because that's where I do most of my research. I'm mostly affiliated with U. C L. But because of my sfp now, I'm part of the university of sorry. And alongside Ali, I am doing research with New Castle. So I'm currently on general surgery. I'm an academic f Y one. Then I'll be moving on to stroke rehab, and then I'm on my emergency block with my F two. I'll be starting on academic, and then, oddly, I'm going to have another academic block of endocrinology. And then hopefully, depending on the last person agreeing with the swap, I hope to get on to urology because, crucially, I want to be an academic urologist. I want to do either your oncology or andrology a k I want to do. I want to dedicate my whole life to prostates, penises and testicles. Yeah, somebody has to. So tonight session guys is all about critical appraisal, which is a It's a big, scary phrase that for many of us, I think coming up to the, uh well, the AFP and the SFP is kind of the first time that lots of us will hear about critical appraisal. And think of that sounds technical. Um, what actually is critical appraisal? Well, there are lots of definitions, but I think perhaps the most useful one is it's a systematic process. That means it is a structured and formulaic process and thing that we do. And we'll talk more about that of a piece or a body of research or evidence to judge it's trustworthiness. And overall, it's value within the body of existing evidence. And in short, to think about it very, very simply, how good is it? Um, as a piece of work as a piece of research, and how much should we base our clinical decisions on it because we're taught from day one of medical school that we practice evidence based medicine, and that's kind of the cornerstone of everything we do. But because of that, we're only as good as the evidence that we have if we're doing evidence based medicine with bad evidence that we're doing bad medicine. So we need to be able to appraise critically the value of what we're looking at. So I'm going to take you through the first half of this presentation, talking about the basics of how to analyze the paper, the key questions that you need to ask. And then I was going to take you through the more technical, uh, perhaps important bits that you will need for your interview, which is the next stage. So we're just going to go through it slowly and forgive me because it's a lot of slides. We've split this into lots of subsections, but I think it's the easiest way to approach it. So it seems a fairly obvious thing, so that you start with the title of your paper because when you're reading anything, the title is the first thing you see. It's the key summary. You've got to get across the key bits of information. So what is the title? Obviously, you've got to be able to read it. That would be a good start. Now, is it purely descriptive of events because you can imagine if you've ever read the paper, you could see, uh, I don't know, incidents of carotid artery aneurysms between 2020 22. A systematic review like that would be a good title for a paper because it tells you literally exactly what was done. Yeah. Um, however, many titles aren't like that, and you'll you'll come across titles that have other things in them. They might have claims they might have puns in them. Sometimes. Like we've published a paper with a with a pin in it, we have so that its goal was to grab attention. Yeah, exactly. Do the authors make any claims in their title? You know, you could imagine a title like, um, ramipril is superior to calcium channel blockers, generally in managing hypertension, for example. That's a specific claim that's being made. Uh, and you would obviously have to read the abstract and the paper to to work out what they've done, unlike the first example. Is it written in such a way as to attract attention or has jargon? Um uh, as as we were just sorry as, uh as we were just talking about often they're designed in such a way to grab attention, but may not be fully descriptive. But coming onto the journal, this is the second important thing to ask. Now a journal is is like the setting in which academic articles and papers live is where they are published. So which journal has your article been published in? Have you ever heard of it before? Um, there's an opportunity for bias to creep in if I start throwing out names like Like The Lancet, like the New England Journal of Medicine. Um, that sort of Holy Grail high impact journal everyone's heard of. Um, And then you start to think about other journals, like the Post Graduate Medical Journal. I don't know if any of you ever heard of that. Um, the point I'm trying to make is it may be a journal with which you are familiar. It may be a journal that you've never heard of, but if you have preexisting views about that journal or that journal has a reputation that can start to color how you interpret an abstract. Is it broadly considered reputable? You know, journals like like The Lancet like New England Journal are broadly considered reputable. If you get Your Lancet paper, that's something that every author wants, or or nature. You know these big journals, However, just because it's a reputable journals, it doesn't mean that all research published within it is good research. The example that you all have heard of is the Andrew Wakefield paper on Was some ileal hyperplasia or something? The paper that I tried to link autism and got disease published in The Lancet, you know, so don't take it as gospel doesn't have a high impact factor now. Impact factor is one of the things that I would encourage you to go away and read about it. It's kind of it's own topic not suitable for here, but those big journals. New England Journal, The Lancet Nature. These journals have very high impact. Yeah, Jama great, great example have a big impact factors, but I think crucially when it comes to London specifically as well and of the Dean Aries like London, Cambridge, Oxford. Um, it's important for you to recognize how BMJ lays out the abstract. How does Lancer lay out the abstracts? Like whenever I see a New England abstract, I know that they always have, like their funding at the very bottom of the conclusions, and they'll be like bracket funded by express it, whereas BMJ will have it in a different format. And usually when it comes to London, they'll copy and paste it and put it on like a They'll show you the screen share and they'll show it to you in this in such a way that you can't recognize it because of the formatting. But if you just know how it's laid out and some of the key words, then you'll be able to be like Oh, yes, it's from that study. Is that Is that from that journal? Um, so I would go home and go through how drama BMJ lancet New England like how they and nature how they are. Exactly. So you'll you'll you'll pick it up. And who knows? You might even get a paper that you've practiced with your mates. Yeah, and they're good for writing your own papers as well. But that's how the abstract should be and the next one is setting, which is the context of your study, Um, where it's taking place, where the authors from where the patients from, Um so your study might be set in North America, like, really commonly might be cities in the United Kingdom again, there's a difference, for example, between Newcastle and London. In terms of its population, it's demographics. Um, so it's a really simple one, But But what is the context? What are we looking at? Um, and then we'll talk later about how that might influence the paper. Authorship is a really kind of easy one to get to grips with, because it's an easy concept to understand. And author is somebody who is listed on the authorship line of a paper, which is usually at the top. Um, who are the authors? How many are there? You know there's a huge difference between what me and Aqua by ourselves could right compared to what a team of 30 people could do if they're all working together. Um, so if the papers got one author of it on it, compared to, you know, hundreds of authors can be on papers now. It gives you an idea about the scope and scale. Who is the first author? That's one of the big questions, because that's the person that's got their name attached to it. Basically, this all rides on them. You could equally make an argument, I think Aqua for senior author as well, Like the person at the end. Um, because if you're, uh, you know, sometimes getting into those high impact factor journals that everyone wants having a big professor as the senior author on your paper might make it easier. Yeah, And I would like, for example, when it comes to authorship as well. If you see like a systematic review and there's one author, I'd be a bit you know, like what that's about, how can you know properly do that? That doesn't sound like it's appropriate. And, for example, if it's a big randomized controlled trial and has again 11 author is like that should raise your alarm bells like have been skipped. Yeah, and, you know, talking to like the ethical stuff as well, like when it comes to representation. If you see a study, obviously I'm not talking about old studies where, like you know, 19 eighties, 19 seventies? Fine. But if it was a 2020 paper and you see that it's about women's health and it's all just men, for example, again, that is something that you could if you felt ballsy on the day of your interview, you could raise it because then did they have adequate PPI involvement? You know, like those are just some conscientious points that you can raise. Yeah, lots of these things are based on our perspectives as authors. And like I said, the women's health is a great one where, you know, as a as a heterosexual white man. If I was, for example going to be doing any kind of reflective or qualitative analysis on, um, I don't know perspectives of, uh, female doctors in the N. H. S or something like that. If I'm doing an analysis that relies on my interpretation of something that can be a real limitation because I wouldn't have that lived experience to know, you know, that's not to say my experience wouldn't have value, but it would. Yeah, it would alter the claims that I might be able to make or what I am capable of recognizing when I'm doing that interpretation, um, and as well think about other professionals. So not just doctors, not just surgeons. But you may have, uh, you know, you could have nurses, midwives, dieticians, physiotherapists, occupational therapist. You know, our therapist. Lots of lots of different groups, no languages. A brief point because I think it's fair to say that anything you'll be asked to do as part of your SFP interview will be in English. It would be a a strange curve ball to present you with a non English paper. No, it's more in the sense that, like in systematic reviews, if you see that they've only included English language language as a criteria, then you that's subject to so much bias because there are so many Good, because that could be written in Spanish Russian, like all the other languages. And, um, I think the bias specifically, if you can say this in your, um, interview, they're going to be like, Wow! But the specific bias is called Tower of Babel. I think that's how you pronounce, pronounce the word Yeah, and that's when only English language studies are included, and unfortunately, that has its own, you know, issues. So again, for those of you don't know what that is, I think it's an old biblical story. Or for any Hitchhikers guide to the galaxy, um, fans out there, the babble fish or the Babel fish, whatever it's called, all references to the same thing this idea of language. But and that's what that second bullet point there is about. As Aqua says, a systematic review is a really good example. Or you could think about a randomized controlled trial where you need huge number of patients in order to make them work, especially for bold claims. Um, especially where population health might be different. For example, the if your patient group is in London, that might be very different to Beijing or Nairobi or any of these other places different determinants of health. And if you're uh if you're only including certain populations and certain bodies of evidence, then that will affect your outcome. And this last point is just Oh, sorry, it's just about the general form of what you're looking at, basically, is things like the structure, the form and the grammar correct like, Are they all valid sentences with a subject and a verb. Um, and that's not to suggest, of course, that that good English or, um nice to read English automatically means good evidence or good paper. It doesn't. But if you've got an English language journal and you're reading an English language paper that perhaps doesn't have properly formed sentences or bad spelling or you know things that don't feel right, it just may mean that it's not been through a thorough editing process, which would be very unusual for a high impact factor journal. So it's just something you could bear in mind. But I think for this one, this is most more for papers because there are some deliveries that will give you that will email you the paper like a day before, and you have to, like, read it inside and out. And then London and other theories may just give you an abstract. So obviously figures and diagrams may not be applicable for them, but there are some abstract will that will include it. Um, but that's why I wanted to say before I hand it over to, uh, you know, it's absolutely right, and your this applies obviously much more Two papers themselves Aquasize because abstracts don't have any of these additional elements in. But you may be given a paper. I, for example, in my interviews never had a, uh an abstract or a paper to look at. But my critical appraisal skills were tested in other ways, and one of the really common things was looking at graphs. Actually, um, so the same your your critical thinking skills apply. If you're looking at something like a table or a graph, is this what it says it is? You know, it says a graph showing X y Z do the axis or whatever match that. Is there a funny scale involved? Are the units of measurement appropriate things like that? It's just applying your general critical thinking skills to a, uh, to a piece of evidence. You know, if you ever did GCSE history, you'll assess provenance. Um, it's all about that now detail, a good or appropriate abstract should be written. The goal of an abstract, uh, is is such that either a subject expert, you know, Aqua, for example, knows a lot more about urology than I do. And so her ability to interpret an abstract to a urology paper is much more specialist than mine is. But a good abstract for your urology paper needs to be such that both aqua and I can understand it separately and get the same basic information from it. Um, I say an abstract is kind of useless if you you have to be a professor of urology in order to understand that paper. Because that's not really an abstract, is it? That's just But I think what's important to raise is that your interviews will be a very high stress environment, you know. And when you're reading this abstract, you're going to have your nerves like, no matter how many you've done. Like, I think I did at least 20 to 30 mark interviews where I literally practice with a mate and abstract reading it in in, like, 10 minutes time and then trying to, like, summarize and stuff, which will go through in a bit, Um, but I think you need to absolutely read, um, abstract that aren't part of your comfort zone, because obviously, with me, um, I had, uh, you know, in urology and men's health on my areas of interest. So when I was given, uh, obstetric paper. I absolutely had, like, a little meltdown because it felt like I was reading jargon, which is, like, that is absolutely not acceptable. Like I need to be able to critically appraise anything and everything, right? So I think you absolutely try to write down different topics, and what they're going to test you on is something that you should know. Like that you can pull out like a like a relevant guideline or relevant rule that you will learn in medical school. Like, for example, bowel cancer screening. Like everybody needs to know that med school, or like, um, triple A screening. You know, like there is something that they will directly pull out of you or they're looking to, uh, you know, they're looking to see if you will say that guideline. Um, so for me, they were looking for something to do with gestational diabetes, and unfortunately, I didn't get to say it. Um, I still, you know, did well, but not as well as I could have because of my anxiety. And how should I was, because it was something that I wasn't 100% comfortable with. So my advice would be. Make sure you read abstract that. Yes, you might be like a high and mighty in your whole area, but be familiar with bits and pieces of everything. Yeah, good advice. Yeah. Um, and then this next one definition. So this is a kind of a a cynical element to all of this. And it's harking back a little bit to what we said earlier about titles that are written to grab attention. Write papers are published for a reason. Um, no one does it. Well, maybe some people do it for fun. Most people don't do it. Um, and given that we will make medical and clinical decisions based on these papers, potentially and often that's what people are trying to sell. Or they might be trying to show that a product or a pill or something is better than another. They When they're describing what they're doing during an article, you need to be you need to be sure that they have been clear with their methodology and their process. So the abstract basically needs to describe everything that they did without going into overbearing detail. And it really doesn't take much because, like I was saying a systematic review. We all kind of know what that is, and we know how it's done. Or at least once you've once you've been in the game a little bit and saying We did a systematic review of X Y Z kind of tells me everything I need to know. But when you get into more, more complex and niche situations, if they're, for example comparing treatments, they have to really specifically layout. We compared X with y. If they said that participants were randomly selected, for example, they should be saying How how do you achieve that? Because actually, true randomness is extremely difficult to impossible in order to achieve. So they need to say how they manage to do that or if they anonymized something how they did it. Um, if they are comparing a treatment to something else, they need to tell you what they were measuring. Or indeed, if they were investigating the efficacy of something, was it being compared to a control? Or are you simply just observing what happens if we give someone a tablet? Yeah, and and just writing down what happened essentially and then conscious of time, though this is not as relevant. I don't think anymore. Yeah, it shouldn't be. It's really simple. Is it an older new paper? When was it published? Yeah, and if you see, like, a big like, we'll go through one of the papers that has changed clinical practice. Um, but obviously, now, thinking about equipoise. Um, if something is now an established gold standard, it wouldn't be right for us to carry out a similar trial. Because now we know that the gold standard has obviously proven beneficial. So just to bear in mind, But basically, now I'd like to expand on PICO. And essentially, this is how when you're asked in your interview to summarize a study, this is what you Well, your first one will be, um, what is the question that they're trying to ascertain? Um, And then you go into the Peko format and with population, If you were looking at who was involved, do they include a pediatric or an adult population, or do they go both? Did they use a whole consensus type thing? Did they specify gender? Did they specify ethnicity? What was their sample size? Um, and did they look at any pre existing health conditions or with a specific about it. And yeah, if you're wondering who they are, then that is a bias that you can't raise. With I intervention, you need to be able to know what was actually done and the most common. Um, I guess study design that you will experience in your critical appraisal is not always. And we will go through it, I think in our third or fourth session, um, there are different. Like in one of our interviews, we were given the end of one study design. Um, whereas we were told that you almost, like, most likely see a cohort or case control or randomized control trial. But, you know, they can throw you a curve ball. But with I intervention, did they receive the treatment? Did they not or did they receive a placebo? That this is the active thing that the study is testing? Whatever. Um, the item of interest is see control. Actually, placebo should be here more than I, um, were arguing about this. Uh, yes. Exactly. Now, C is always control in my in my eyes. That's that's the comparison. Um, the thing that the intervention is compared to uh, when it's and and this is more applicable for like, for example, in our CT, where and our CT is basically the gold standard study design when you're trying to compare or assess a new intervention because you're trying to compare it to something that's existing in practice or placebo and then oh, outcome, what's the main outcome? And here is like a nice, like segue into me, saying that there was some conditions that unfortunately are hard to come up with a strict outcome so they can use a composite or surrogate outcomes. And those are some things that we will cover in later session. But as of now, just write them down so you can look them up because that's how you can sound really, really clever. But most of these will be relevant for clinical practice. And when you when it comes to reading an abstract, you really need to think critically and think, will these outcomes change your practice and out outcomes measured, like whatever is being examined in the abstract doesn't match the claims that could be made in the title or the discussion for the results. Yeah, now we will go briefly into how to discuss a paper essentially, basically, how to sound as smart as long as you need to. So, as I said at the beginning, you need to be able to summarize the Peko. So you're going to start off with trying to be like this is, um, a study looking at X y z x y Z that was published, most likely in this journal. Because again, you should be able to make some inferences into which journal it is by going through and reading BMJ Lancet drama Blah blah, blah, blah, blah, blah, blah. You should be able to like, kind of guess what? Show noises. Then you go into your pee is looking at X Y Z patients from X y Z demographic. If they go into you know, that specific detail, it compared whatever the intervention was to whatever the control was, primary outcomes, secondary outcomes. Then you're going to try to summarize the major findings and you are just thinking back to when you have to do your your verbal reasoning in your you can. If you took the you can exam. And now I'd like to talk a little bit about validity because these are like hot buzz words that you need to go back and and read up on. And for the purposes of today, internal validity is looking at the truth of, you know, within the study itself. How sure can we be with this specific research or this specific paper? And, you know, how strong can we make the causation with the methodology to the results and to it's claims with external validity, Truth in reality, which sounds very like like it's biblical, I guess. How generalize herbal is this in the real world? So the way that I split up internal validity and the way that I think I saw, you know, I took, um really, really great interest in looking at I think it was like an imperial group. And, um, I think, uh, what was it called? There's a great YouTube channel, which I will copy and paste a link to later on. But the way that they split up internal validity is something that I, um, have taken, you know, for my critical appraisal you weigh now, the first one I'm going to be looking at is recruitment. And what that is is how did this specific study recruit patients. Was it consecutively? And the scope means more like was an international was a multi center was in the country. And how many centers did include with the title itself or within the first few lines of the abstract, you should be able to gather the scope and how big of a study it is. And in terms of allocation, how did they allocate the groups? Some really, really good abstract will be like. The patients were allocated in a 1 to 1 group, which means that if they have, for example, 60 patients, a 1 to 1 ratio is 32 30. And not only that, but they will go into depth on How did they randomized? How did they did they use cluster randomization? Do they use block randomization? And that is how I segue my mind into allocation. Basically, how do they sort these groups out again? I'm most likely talking about either a cohort or, um and our CT, because that is what you're most likely going to get. Do they talk about nutrition? Did they talk about dropout rates? Um, that's pretty much it. Or did they talk about any intention to treat or per protocol when it comes to blinding. It wasn't single, was it? Double was a triple in the abstract. They should describe what level it was and number five statistics usually again. Unfortunately, in the abstract, they won't really go into depth with, um, the sample size, like, how did they actually power? And was the sample size actually enough to adequately powered the study? And what that means was, um these amazing statisticians will sit down in a group and and really think about the accurate, um, number needed to draw a conclusion to the question that they're trying to answer. And, for example, if they were looking at, uh, noninferiority trial to answer is X better? Sorry is X equivalent or non inferior to why so and so we need 500 patients. But for example, they recruited 400 then that technically could mean that it's an under powered study, unfortunately, but again, they probably might not write that in the abstract. So in your critical appraisal summary, what you would say is I acknowledge that like the sample sizes 400 it was split so that 200 patients were in Group y and 200 patients were in Group X. I would want to read the full paper to, um, see if it met the sample size calculation to see if it was adequately powered. That's just, you know, it's just a job and you need to memorize. So you sound really good on the day itself and PPI Ali and I briefly talked about it when we were talking about, um is an accurate representation. If Ali was doing like a big study on assessing female perceptions, did they have input from patients and the public? This is not really commonly talked talked about, But again, this is something that you can really really um, stand out with if you just want to say that you want to look for the full paper to see if they really, I guess, um took consideration into PPI. Uh, sorry. I don't know why it's doing that. Yeah, and then there are some little extras that we will expand on, um, in another session. But there's external validity and what external reality was. What I said already was how generalize herbal a study is, um, with funding when it's, uh, it's usually mentioned for example, big, big, big drug studies will say it's usually funded by either Pfizer or a big drug company. And what you have to say, then, is during an abstract, you note that it was funded by X Y Z So you'd like to read the full paper to know if they contributed to the study design? Because if they did, then that could lead to a bias. And equipoise was that is the equal poised to, um, give a group an intervention that you may know it might not be the best anymore. Then, unfortunately, that trial might not have equal poised. And you really need to think about the four pillars of ethics, Um, which you would have gone through if you know when you were preparing for medical school and we will go through this, I think, in either session three or session for the four pillars. And this is not something that you will commonly see, um, in abstract. But this is something that I think you you might be able to see in a full paper, and that's a data and safety monitoring board. And essentially, what they dictate is that this board basically has the power to stop the trial If, uh, too many side effects or any adverse events are happening essentially and they can perform like interim analyses. Yeah, we'll cover these in our sessions. And I'm trying to, like, be mindful of time, Which is why I'm trying to, like, get through as much as possible as I can, but, um, I think I'm sorry. I just realized that there's so many questions. It's all right. We can. I've been trying to keep up. We can go back to them because you were doing great for time. We're going to finish. Okay, Good, good, good. Right. So I'd like to just now, um, go back to, uh, the crowd. Have they used meta analysis as well? Yes, they have. Um, I know of, uh, not last year. They didn't. I don't think they used the meta analysis, but I know that they have. Definitely. I'm just coming back to questions now. Um, but I guess this is an abstract on the screen right now. Can somebody tell me which journal this is from? Just has it, I guess. Anybody. No, no, it's okay. It's great. It's great. Amanda, I'm sorry for not paying attention. Yeah. Okay, so Amanda's given an answer. Anybody else? Yes, I am. Any more? Any more takers? Yeah, it is. It is New England, very characteristic of them. And as I said, See, it's bracket funded by blah, blah, blah, blah bracket. Um, so during the Peko, if we go into that, can somebody tell me what the P is for this abstract? Not a trick question, but do you want any help? Well, I'll just go. Um, so, p here is there are 46 and a half 1000 participants, and they were 50 to 80 years of age. Yeah, exactly. Good. And I would mention how many participants they actually included. I'm going to challenge you, like or if I may, Because what what we're doing here, guys, obviously is showing you an actual abstract as one exists in the wild. And so it might at any stage, I think, be reasonable for them to fire a question at you. So I'm going to challenge aqua here. Which why is this age group relevant for what the study is testing? Because they are It's fecal occult blood testing. Yeah. This is the patient population that is most at risk. Yeah. You wouldn't do this in. You didn't do this. You know, in kids or 15. Exactly. Yeah. Good job. And then, um can somebody tell me I What is the intervention? This is a good one, because this isn't really I guess somebody was given Drug X and they were compared to a placebo. Close Amanda again? Close. Follow up to be Is that how you pronounce your name? It's actually annual or bi bi annual. I'm not sure how to pronounce that word screening, but that is the intervention. So then what would the control or comparison Group B? Yeah. Yeah, exactly. Usual care. That's the control. And then what about Oh, oh is kind of tricky in this one. And I have to kind of, like, read a bit more into this abstract to kind of get what it was. So not reduction in mortality, just mortality itself, Right? That's what they were looking at for the outcome. Causes of death. Essentially. And that's how I kind of like realized because I was like, Okay, they're looking at colorectal related. Yeah, exactly. Mortality. And in terms of findings, can somebody tell me a key finding that you've read from this abstract. It's not a trick. So it doesn't influence all cause mortality. Yeah, but what can it influence? Gayatri kind of alluded to it. Um And, um, essentially, what it's found was screening did help with colorectal cancer related mortality. But not so much for all cause mortality does that make sense? So it's basically segue. It's separated mortality into two. Yeah, it's what you would expect, isn't it? Like if if I If I go out If I walked outside of my building now and I got struck by lightning, it wouldn't be affected Whether or not I had my bowel screened. One would I would hope so. Yeah. I can't tell that I've not done a study, but it's a big difference in that sense between all course and specifically related. Yeah, looking at So now, um, going into, like the extras, we know that they were there were some randomization, but I'd like to read the full paper to know how they actually randomized the patient groups. And as I said before, we know that there's 46.5000 patients and something that is really, really nice is that 46,000 patients is a huge sample size, so one could assume that it might be adequately powered. But you want to read the full paper to see if they did. You know, what was the sample size calculation? What was the sample size that they needed for the study? And another really, really good thing I saw was that they had a 30 year? No, not necessarily. But it makes you look good. And nowadays, more and more like old papers won't go into depth in the abstract on how they randomized patients. But as the quality of evidence gets higher and higher and higher, Um, and you know, as we scrutinize and critically a phrase papers more and more, you might be able to see they were cluster randomized. Oh, they were blocked. Randomized. You don't need to know specific definitions, but you need to be able to pick them up. Amanda, is that. Answer your question, but I would think that 30 years of follow up is a decent amount of time. To be honest, that's a really, really good followup, Um, time and I think crucially here. What's important is if, for example, again I'm just bringing my area of, like what I want to do. Um, prostate cancer. If we were looking at prostate cancer outcomes, if we're only looking at outcomes for, you know, a year or two and we were trying to see if it was related to mortality 1 to 2 years might not really be appropriate because prostate cancer as we know, if you've got, like, a, you know, a low grade cancer, then they're not really aggressive. So that would be appropriate if it was just for two years. Whereas I think 30 years for colorectal, that's really, really good. But that's pretty much how I've summarized the paper. Yeah, so So really well done, guys in the comments, you know, especially if this is the first time you're trying to do something like this in a room full of of eager people. You know, just by virtue of being here, you're all extremely switched on. So it's a lot of pressure. Um, we're going to do the same thing again. Mine's not presented as nicely, but this is one of my favorite papers to show people when we're thinking about critical appraisal. So I'm going to give you less lead in this time, and we're going to do literally the same thing again, and then we'll just have a few minutes for questions at the end. But rapid fire. I would like everyone or whoever is willing to come forward to do any element of pick. Oh, that they like. So the P, the eye, the C or the oh, just choose one of them and put that in the chat. Or if there is something interesting that you note about the paper or something that you would raise as a discussion point with your examiner, um, put that in. So the idea is that everyone who's willing to chat can choose one thing. So any element of pick Oh, or it can be any discussion point just based on this abstract that you would raise as a thought. So it can be any of the things that, uh either, I said when we were going through the those key questions at the beginning or anything from a couple of sessions. You've got a really wide scope here, things that will be valuable literally say anything particularly appraise this abstract pun very much not intended. Somebody gave me a P. What's the patient population? Give me a P. Yeah. Do you know what that means? Amanda? Yeah, Gloria. Exactly. It's well done. That's a perfect. Yeah. Exactly. Very good. Yeah. Yeah. Um, yeah. So you're basically done both eye and see the Amanda. Yeah, exactly. Yeah. We're getting there. We're filling them all out, so we just need somebody. Oh, this is great. I didn't expect that to work. Yeah, but I think they just have to read it. Yeah, it's a nice abstract. I think it's a Yeah, very, very, very fair. Yeah. And they probably made me itch. So, Oliver, Toby, you're You're saying that when you're reading the abstract. So what do you have to say at the end of your sentence? When it comes to every discussion point with the abstract, you need to read the full paper. Because if it's a good journal, they probably did look into this r t e f p. Yeah, Exactly. I know. Yeah, exactly. Guys were done, and I think I'm going to ask you the same question as they did for the last abstract. Which journal? Is this in again? Not a trick. Yeah, It has the same. It has the same like funded by blah, blah, blah and the brackets. Yeah. Yeah, exactly. Again New England Journal paper. Um, And if you think about you know, if you think about the scale of what this study was trying to achieve because what they're basically saying is, um apixaban, which was then at the time when this paper was published a no ac a novel, oral anticoagulant. Um, what they're basically saying is, we have shown in this huge, huge, huge number of patients in this international trial that apixaban is essentially superior to warfarin. Therefore, thousands and millions of patients around the world need to start being treated with dose packs instead of warfarin. Like think about how huge a claim that is, like, just in terms of, you know, you've knocked to the bottom out of the pharmaceutical industry for any company that makes warfarin, um, the stock price of any company that makes any form of apixaban. Yeah, you know that this is the impact that this has not just on patient care, but on the pharmaceutical industry. The stock market, like huge and but somebody I think Amanda raised noninferiority can somebody tell me the difference between noninferiority and superiority trial study designs. And if you don't know, this is something that you should look up, uh, equivalents versus noninferiority versus superiority because those are Yeah, true. Yeah, exactly. And I think, um, correct me if I'm wrong, but this was designed to test for noninferiority. But what it actually found was that apixaban was actually superior. Not only was a non inferior, which means it's the same clinical benefit, it actually ended up trumping warfarin. So, with noninferiority, you set a little, you know, amount that it needs to meet to be claimed as non inferior. And then if it goes above and beyond a certain number, then you can claim security. But Aqua, who's funding the paper that found? Okay, fine. You know, drug companies. But this was a massive, massive, massive study. So naturally you would I'm just raising it as a discussion for you. You were the drug companies, but what do we have to say when it comes to pretend you're praising? You need to know their involvement. Did they help with study design? You would hope not. You know what exactly? Actually, and another really really good point here is that, um if you guys can notice Aristotle clinical trials dot gov number N C. T. Does anybody know why that's important here? That they've given their clinical trials registration number extra extra brown brownie points, if you can tell me why. Yeah. Transparency. Good. There are some key words that I want to hear from someone. It's the like Latin words, and I don't know how you pronounce them. Yeah, ethical approval. Yeah, keep going. And this is something that will make you sound really, really, really, really small. No takers, no. Okay, fine. So a priority. Essentially, what that means is that when you register your trial on clinical trials dot gov or who, for example, any place that you can see your your protocol or what you set out to do, that means that you're less likely to change your outcomes, which means that there's less bias because everything will set a priority. Which means that things that have already happened beforehand If, for example, there are some sketch studies out there like, really, really old school where, for example, they attempted to do a noninferiority trial. But then also they attempted to do a superiority trial, so they needed to meet like a higher number. But then, unfortunately, because patients weren't recruited, well, they've now changed the outcome to noninferiority or something, or they've changed. Like, uh, actually, a group is dying more. Maybe we shouldn't have mortality. Maybe we should look at side effects as outcome. That's not good, because that's changing the study, isn't it? So when you see a clinical dot clinical trials or government, but you know that everything was set prior, so they have, like a set protocol to follow, essentially. So when it comes to critically appraising it, you'll be like, I noticed that the Aristotle trial had an N C. T. Number, which means that outcomes and the protocol was set a priority. That's all we say. Boom. Another key word. Second story. Wow, I think. Does that bring us to questions then? Yeah, I think so. Um, you guys have any questions at all? Because one of our comments from the previous lecture we went on and on and on, and I think we hit like, nine, and somebody said this should strictly just stick to an hour. So we wanted to just be mindful of that. And you know your time. Yes, they will. Um, but we have a dedicated session to that. Yeah, uh, do you have any particular facts? Okay, so we've seen New England a couple of times, so let's just say, um, onset to the let's see onset BMJ. What else? Oh, another, um good. Yeah. Drama as well, Because they will most likely just copy and paste. They unfortunately will not give you a screenshot from the journal itself. The logo in the corner. Yeah. The Logan is like, you know, it's from this. Uh huh. Uh, so I don't think lawns that have, um the funding like that the way that, uh and any jam does it. I think Lancet have a separate little section called Funding. Yeah, I think like a declaration thing. Yeah, literally. Just like funding. And then, um BMJ You're not being lazy. I think genuinely you need to look. Uh huh. They will only pretty much give you the abstract or they'll give you, um, like if, for example, they have, like, a funding statement. They'll give you that. And if they have given you a bit more than the abstract they are most likely wanting you to comment on it. Otherwise they wouldn't have given it to you. Amanda. Yeah, again, trying to To to come back to what some people have said it, although like, these skills are important and they're important for all academics, especially for you guys that that will be going into your specialized foundation program. Now it's you that's going to be responsible for a lot of these things, regardless of whether you are asked to critically appraise an abstract in your interview or not A you will need the skills anyway. So they're worth learning, especially if you start going to journal clubs and things, which is a great thing to do and be you. Even though you may not be given an abstract, you can be asked about any of the things that we've talked about because they are all important skills for a young academic, Um, or, you know, you could even be asked to design something like, How would you design a study that capture X Y Z Yeah, like they'll give you something, they'll give you a trial and, for example, we'll go into depth on our study design session But they might ask you, Do you think that this study design is appropriate for answering this question? And that's when you really need to become familiar with what have they What have they asked me That? Um, but Oliveto be I don't again. I don't know if that's how you say your name. Um, so for London, I think we got 15 minutes to read it. It was just shown on the screen. And then you only have 10 minutes, and I think, like some interviewers will be like, Okay, summarize the paper and then I won't give you any que You just keep talking for 10 whole minutes and they don't prompt you. They don't stop you where some examiners will be nice and they'll ask you questions along the way. Or some examiners made grill you like There isn't there is a standardized mark scheme, but there's no I guess, standardized way of asking questions, if that makes sense. Yeah, it's usually all about probing your knowledge. Yeah, Yeah, exactly. And, general, I think generally they want you to do well and they will try to suck up or ask you the right questions so that you can say the buzzword. So the key words that, you know, we went through today and I know some degrees will email you out the paper one day beforehand, so that naturally means you won't sleep. You will read the inside out. I mean, Google it. Yeah, exactly. Um, we'll give it a couple more minutes, guys. And then in response to our feedback from last time, we'll we'll can the session at 25 too. Yeah, but just as a as an in general, uh, as we move towards the clothes, Thank you all for coming. Um, it's really lovely that that, you know, so many of you are giving up your time because that's what this is to basically try and come and be better at something, and that's that's very meaningful. Yeah. Um, do you have any more questions, guys? Um, and as ever, there's a link just gone out in the middle chat. But please do fill out the feedback for me if you have the time and or inclination to do so because it really does help us. It's It's basically the mechanism that allows us to do this for free. Um, as well as medal, obviously being the amazing platform. Yeah, and under equally when it's when it's you guys that are on the other side of this in in a year in two years, we hope that you were also doing doing these webinars to help to help the next generation through. So it's a difficult process. Yeah, but I think that might not. There aren't any other questions. Cool. Well, that's it. 25 to thank you all for coming. Thank you so much. And thank you for the interaction, guys, because you're going to be doing this. And I know it's super, super super early on and you might not be thinking about, you know, interviews just yet. But it's always better to get started early. No problem. And we will go more into depth. And we just We were aware of the time constraints and we really wanted to go through the examples first. And we will go more into depth with the different terms and the study designs because I think that's where the nitty gritty, you know, the the hot topics are Yeah. Yeah. Thank you, guys. Bye bye.