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SFP INTERVIEW PART 2 ACADEMIC STATION MARK SCHEME MARK SCHEME Question 1: Why the SFP? 1 DEMONSTRATE AN UNDERSTANDING OF YOURSELF your motivation, interests and career goals 2 DEMONSTRATE AN UNDERSTANDING OF THE SFP how does the AFP map to your interests “EVIDENCE OF INTEREST IN AND UNDERSTANDING OF ACADEMIC MEDICINE IN GENERAL -THE CANDIDTE CAN DEMONSTRATE CLEAR REASON FOR CHOOSING ACADEMIC MEDICINE, UNDERSTANDING OF IT AND MOTIVATION” - SFP SCORESHEET TOP TIPS FOR QUESTION 1 1 BE SPECIFIC! 2 SHOW, DON’T JUST TELL 3 DON’T SOUND TOO REHEARSEDHOW TO CRITICALLY APPRAISE AN ABSTRACT 1 PICK AN ABSTRACT RCTS ARE MOST LIKELY, BUT STILL COHORT STUDIESUDY TYPES E.G. SUMMARY SENTENCE 2 P - POPULATION I -INTERVENTION PICO-K C- CONTROL O - OUTCOME K - KEY FINDINGS (PUT INTO CONTEXT)PUTTING INTO CONTEXT WHY IS THIS RESEARCH IMPORTANT? TARGET POPULATION DISEASE BURDEN? TREATMENT COST? APPLICATIONS TO HIGH AND/OR LOW INCOME COUNTRIES OUTCOMES PRIMARY OUTCOME - VARIABLE BEST SUITED TO ANSWER THE RESERACH QUESTION SECONDARY OUTCOME - AIDS THE INTERPRETATION OF THE PRIMARY OUTCOME SURROGATE OUTCOME -MARKERS THAT ARE SUBSTITUTED FOR THE CLINCIAL OUTCOME COMPOSITE OUTCOME - COMBINATION OF VARIABLES SAFETY OUTCOME - MEASURE OF MORBIDITY AND MORTALITY FROM THE INTERVENTIONS 3 INTERNAL VALIDITY 1. STUDY DESIGN TO WHAT EXTENT DOES THE STUDY MEASURE 2. POPULATION WHAT IT IS TRULY OUT TO 3. RAMBCOS 4. RANDOMISATION MEASURE 5. ALLOCATION HOW GOOD ARE THE 6. MEASUREMENT 7. BLINDING RESEARCH METHODS USED 8. COMPARISON BY THE RESEARCHERS TO 9. OUTCOME ANSWER THE CLINICAL 10. SELECTION QUESTION? 11. ANSLYSIS & RESULTS 3 INTERNAL VALIDITY STUDY DESIGN RCT --> N-OF-1; FACTORIAL; CROSS-OVER; PRAGMATIC; CLUSTER - SUPERIORITY/ EQUIVLENCE/NON- INFERIORITY COHORT STUDIES CASE CONTROL STUDIES SYSTEMATIC REVIEWS + META-ANALYSES POPULATION IS THE SAMPLE REFLECTIVE OF THE TRUE POPULATION WHICH THE CONCLUSIONS DRAWN TO? SAMPLE SIZE + POWER CALCULATION INCLUSION + EXCLUSION CRITERIA (TOO MANY -->DIAGNOSTIC PURITY BIAS) ? CONFOUDERS - WERE THEY ADJUSTED FOR? INTERNAL VALIDITY 3 RANDOMISATION: SIMPLE; BLOCK; STRATIFIED; CLUSTER ALLOCATION - MEASUREMENT DETECTION BIAS (E.G. WHAT MAY BE CONSIDERED AS HEART FAILURE TO ONE CLINICIAN MAY NOT BE BY ANOTHER) FOLLOW UP PROMS? - SUBJECTIVE OUTCOME RAMBCOS: BLINDING - NOT REQUIRED FOR HARD CLINICAL ENDPOINTS EG DEATH RANDOMISATION SINGLE/DOUBLE/TRIPLE BLINDED ALLOCATION OBSERVER BIAS PERFORMANCE BIAS MEASUREMENT OUTCOMES BLINDING TRIAL REGISTRATION NUMBER - A PRIORI → REDUCES DATA DREDGING AND PUBLICATION BIAS DURATION MEASURED COMPARISON OUTCOMES : CLINICAL - SAFETY - PT REPORTED/STAFF REPORTED? OUTCOME CLINICAL? SURROGATE? COMPOSITE? HARD ENDPOINTS → ELIMINATED PERFORMANCE AND OBSERVER BIAS SELECTION COMPOSITE ENDPOINTS MULTIPLE OUTCOMES ASSESSED --> DATA DREDGING (LIMIT BY BONNEFORI CORRECTION) S - SELECTION DIAGNOSTIC PURITY BIAS NEYMAN’S BIAS (SURVIVAL BIAS) MEMBERSHIP BIAS BERKSON’S BIAS RESULTS & ANALYSIS INTENTION-TO-TREAT PER-PROTOCOL ANALYSE PARTICIPANTS IN THE ONLY ANALYSE PARTICIPANTS WHO GROUPS THEY WERE INITIALLY COMPLETED THE TRIAL ASSIGNED TO - ALL RANDOMISED AND ALLOCATED PARTICIPANTS ARE INCLUDED CAN ALSO MENTION: NNT AND NNH SURVIVAL ANALYSIS & KAPLAN MEIER-KEY STATS DEFINITIONS CLINICAL DISEASE COST-BENEFIT ANALYSIS RELEVANCE/IMPORTANCE 4 POPULATION NOT GENERALISABLE TO PATIENT IN EXTERNAL VALIDITY THE EXCLUSION CRITERIA THINK ABOUT IMPLEMENTATION IN LOW SOCIOECONOMIC COUNTRIES THOSE WHO ENROLL ON TRIALS TEND TO BE HEALTHIER THAN THE DISEASE POPULATION→ MEMBERSHIP BIAS INTERVENTION: NNT VS NNH (PHASE IV) PRACTICALITY, RESOURCE BURDEN CESF 5 C - CONSENT/AUTONOMY ETHICS E - EQUIPOISE (NUREMBERG CODE) S - SAFETY OUTCOMES/PLACEBO F - FUNDING & REGISTRATIONWHAT MY CRITICAL APPRAISAL LOOKED LIKE: Summary sentence P I C O K CLINICAL CONTEXT INTERNAL VALIDITY Study design Population RAMBCOS Randomisation Allocation Measurement Blinding Comparison Outcome Selection ETHICS + FUNDING Results + analysis CESF EXTERNAL VALIDITY C - Consent E - Equipoise Clinical disease S - Safety outcomes/placebo Population Intervention F - Funding & registration TOP TIPS 1. PRACTISE PRACTISE PRACTISE 2. Stick to your structures 3. Use the mark scheme WHAT I WISH I’D KNOWN: 1. You don’t need an SFP for a successful academic career 2. It is not a reflection on you as an academic 3. Finals firstRESOURCES