Specialised Foundation Programme - Academic Station and Critical Appraisal - Part 2



This on-demand teaching session is perfect for medical professionals looking to build their critical appraisal skills and ace their interviews when applying for specialist or academic foundation programs. The session covers how to tackle both clinical and academic scenarios and includes top tips on how to prepare effectively and structure your answers. Additionally, attendees will learn how to identify common interview questions and how to approach them with confidence. Specific reference to research and specialty areas will be given.
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In this talk we will be looking at the academic station and a brief approach to critical appraisal.

Apologies for the technical issues present in this recording.

Learning objectives

Learning Objectives: 1. Understand and explain the structure of the teaching session and its relevance to the medical audience. 2. Be able to read an abstract critically with respect to the PICO model. 3. Acquire techniques to remember key facts and figures more accurately and effectively during the preparation process. 4. Prepare appropriate responses to possible questions in the interview and identify key motivators for applying to an Academic Foundation Program. 5. Analyze the importance of being able to demonstrate research experience and a comprehensive understanding of the field when preparing for and undertaking the interview.
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The following transcript was generated automatically from the content and has not been checked or corrected manually.

Paige and you're here. Hello. Sorry, guys. I think my door, um, something was playing off. That should be working. Now, can someone just pop in the chart quickly if you can see and hear us, please? Great. Okay, she continued. So you were just talking about the format and the panel. Um, Okay. Thanks, guys. Great. So it's going to the next slide, So just a few quick top tips for us for the preparation time. Um, I would say definitely read through both the abstract, the clinical and the academic, Um, as a whole. Don't make any notes the first time around. Um, yeah. Sorry about the web, cam. I think the quality goes down considerably. Yeah, and it probably like crashes the middle platform. So we're just going to do it without camera, for now. Hopefully run into any more technical issues. Um, but yeah, like I was saying, read through the the academic abstracts and the clinical scenario. First, to get a broad understand of what's going on and then start to kind of go through the abstract with the kind of fine tooth comb and pick out the things that you want to start talking about or critiquing in your critical appraisal. Um, definitely make notes, and I kind of split my paper into half half academic, half a clinical. And bear in mind that you won't be able to see any of these articles during the interview because the interview, um, on your screen it'll be the interview is in you. So you do need to write down all the information that you're going to need because you won't be able to refer to it. And if you're kind of sitting there for two hours between having your 15 minute prep time and doing the interview, you're gonna be very bored and you're gonna have, like, you're going to be stressed out not knowing or not remembering what was in the article. So definitely write as much down as you can. The key points, though, Um, we'll go through the structure we use PICO, and then and then we kind of use ways to critique in terms of an artist, abstract internal extend ability and and how you kind of structure, um, the ethics side of things. We'll go through that later. Um, don't kind of things that you don't shouldn't do. Um, don't write down the entire critique. You only need to note down the important points like the Peko, like important statistics that you might want to refer to. Um and I think it's really important from hindsight. I've realized that at the time, I think I kind of I spent a lot of time writing down the exact status of writing down like the exact wording of how they use of how they phrase things in the academic abstract. But I think it's more important for you actually to understand exactly what they were trying to do, Um, and try to get your head around the research because that will make you a much stronger candidate because having 15 minutes to process um to process an entire academic abstract is not a lot of time because you also have to read the clinical things as well. So just really focus on getting your head around what the message is, what your take on it is, Um, and I think having that approach, you're you're doing really well. Um, and I don't think 50 50 between academic and clinical is needed for sure. I needed a lot more time on on academic probably more like a 75 25% ratio for me. I found academics a lot more difficult just because of the way it was worded. It was very worthy to me. Just took a lot of time to understand exactly what the research or what the research question was. Whereas clinical. I kind of just read through it once noted down what the scenarios were, um, and then just ranked those in order of importance, or which patients should be seen first. Um, so do what works for you, I would say during your interview practice. Um, always practice with a friend if you can, um, and definitely try and get through as many abstract as you can. There are so many online. There's so many good journals like you can just find any random journals like you know, there's so many out there or you can find like quite good ones on BMJ Nature. Um, just pick out any abstract and give yourself, like, 7.5 minutes, 10 minutes to read through the abstract. Make note, and then you can like practice with a friend doing a critical appraisal, or you can even record yourself and then listen back to yourself. Um, but as much practice as you can, I think it's absolutely key. I think Dad's gone again. Uh, okay, I think it's okay. Yeah, I don't think so. No, I completely agree with all the things we said. Um, I think the important things to think about um probably the most important is actually having a structure. So as Alice said, basically the only way you can prepare practice for this is by reading through abstracts against time and, um, making notes and then I think, then walking through them out loud. And that's really important reason that practicing with the friend is helpful because they will be able to explain all they're going to give you feedback afterwards and say, Well, actually, you talk for five minutes, but I couldn't really understand what you meant for four minutes of it. So you know, or yeah, that was great. It was really clear. I completely understand where you're saying what your thoughts were, but also like practicing with the structure so that when you get to the day and you're sat there with your blank piece of paper and you're 15 minutes of which you're probably going to spend 10 or 11 minutes of that prepping your, um, academic. You don't waste any time writing excess stuff. We'll talk through a structure. I think we both used a bit later on, but just really quickly writing out your kind of little pneumonic or the acronym and then filling out the blanks in between. You have basically bulletproof bombproof, foolproof thing to refer back to. So when you're in the interview a little bit stressed out and you're pushing or you asked the question, you have something that you know exactly where I can look to to get that exact answer. And that's I think a really important thing that helps giving the answer is you're going to give a bit more clear but also helps to keep you calm in that interview situation, knowing that you've kind of got this structure you can rely on, she read the next one. Cool. So, um so yeah, I think we've already said most of these things, but effectively, the I guess the thing that I think it's really important to kind of highlight is that you're applying for a specialist foundation program. The majority of those are academic foundation programs. And so this is the ideal opportunity to show where you're the ideal candidate for an SFP, most likely an academic foundation program job. So expect to talk about things like your motivations and your research background, your experience and research and your understanding about kind of key or obvious research concepts. I don't think you will be asked to, you know, define anything insane or asked any you won't be asked any trick. You got your questions, but you will be asked, um, specific questions about data or definitions. You won't have access to the abstracts you presented. So if you think there is a key point about numbers that you want to make in your presentation and you think people might ask you some follow up questions, make sure that you're also jotting down a few other numbers and things. So you're not just going to say like, Well, it was five and they were, like, five compared to you can't remember what the other number was. Really sorry, but you don't want to do that. You want to throw yourself. Of course. Um, yeah, I think that's absolutely gobbled through most of that exactly. And also, you just reminded me. I think if you're not sure about something, then just don't volunteer it. Um, if you're not sure about what this stat means, then just if you can just don't mention it and if they don't ask them pass because then it would just pass by. Um, don't get yourself in a pickle where you like, try to work out what it means, and it takes you like, five minutes to understand what they're trying to say, and then you can't even justify it properly. And then the interviews will keep asking you about it. And you just give yourself a deeper and deeper hole. So I think just you have to be very confident with what you say and so anything that you're unsure about, if you can avoid it, if they ask about it, you know, just be honest. Try your best. If you don't know what it is, then just tell them I don't know what it is. I would like to read more about it to find out. Um, and that's what academia is. It's constantly learning, um, improving. So, um yeah, that's one of my tips for interview for any kind of interview. To be honest, Cool. Next stage next slide. So how should you approach this station? I think the academic is definitely more difficult than the clinical. Um, they might start off with some questions, like asking you about your background. Why do you want to do a particular SFP? Um, not that I don't think they'll ask you every year, and they don't ask it to everyone, but I would say Just have a few kind of very good answers are very strong answers for the most common kind of questions, like these ones that we're we've written here. Don't make it sound like you've rehearsed it 10 million times, but you need to make sure that while standing fresh and um, very new. It's also encompasses all of the aspects that we've spoken about previously. So, um, the Academic Foundation program caters to allow me to improve clinical, academic kind of my personal and lead the ship rolls. Um, so make sure you include all of those, um, practice as much as you can see whether that's recording yourself like just saying this pill in front of friends, family, any feedback that they have will always be really useful. Um, and I think, try, try and cover like we said. Yet the clinical research education, personal motivations in almost every answer as much as you can. Um, and in London, the interviews won't know which post you've ranked most highly or which post your applying for so And usually the interviewers are not kind of in the specialty area that you've applied for, whereas so I think it's good to make reference as well to saying kind of, Oh, I want to do my research in this area in this institution because I'm interested in this area of medicine and they were leading, um, did some reading research in this particular area of medicine. It just shows that you've done your research and you have very good reasons for why you want to come here personally for Cambridge. Actually, my interview is there were very kind of, um what in the specialty in which I applied to. So there were a lot more questions in the interview about academia, about the research that I've done previously, But for London, I think try to keep it as generic as possible, but do ensure that you. And I'm sure sure you all are very passionate about whichever specialty or subspecialty that you're applying for. Um, done. No, I don't think so. Yeah, I agree with with dementia. Cool. Um, so that was I guess analysis touched on outside of London experience. But I think, in general, my experience and also things I've heard from others who apply two places outside of London found that there's a little bit more conversational, perhaps in the London interviewers. Um, I know in some Dean Aries. Definitely Cambridge. And I believe Oxford and a few. A few others. So we could just say outside of London, you won't be given an abstract to present. So definitely think about preparing an abstract that you've read or research one of your own to present and critique. Um, I definitely I would certainly ask. Like, tell me about a paper you've read recently and what you thought about it. So, you know, if you are applying to somewhere else in London, um, we've told you that that's definitely a possibility. So you'd be crazy to not at least read one or two papers enough and that you're interested in That's relevant to you that you can then kind of talk through present and uses a springboard to talk about things you're more interested in or your research background. Or, you know, use it as an opportunity to sell yourself because you have a choice of what paper you may get asked to kind of talk through. I also had a lot more questions about myself and about my motivations and my background, my Cambridge interview than the London one and I was also interviewed by the person who would be my research supervisor. And they had very, very specific questions and asked me some very, um, much less kind of like Tell me what the normal distribution was. It was more like explain to me what magnetic residence spectroscopy is and how What is the physics of that? Because I had a bit of research background associated with it. So I found that the interviews were I was pushed a lot more and ask to give a lot more, um, kind of challenging answers. Just something to be aware of, I guess. Oh, my gosh, they sound like such difficult interviews. Um, yeah, in comparison, I feel like mine was so easy now. Yeah. I mean, I, uh I couldn't really explain the physics of magnetic residence spectroscopy and 45 seconds, so it was a nightmare. Anyway, um, next slide moving. And I guess, um so I guess the other thing to think about the critical appraisal, we'll talk about specific approach and how to formulate your thoughts. But a few more tips. So basically, the point of it is that you can give a short, structured summary of an abstract that they'll present to you. If it's the London one or one that you've read by yourself, it's outside of London. Um, and an appraisal really means that this is really important because I think a lot of people miss this. An appraisal means that you're gonna kind of make touch on some of the things that are present in the abstract. But what you're not going to do is you're not just going to regurgitate the abstract. What you're really doing is you're talking about the stronger and weaker aspects of the study and what your thoughts are on those things. So basically, the things that matter are are you drawing out key strengths and weaknesses of the study And also, what is your overall kind of assessment of a paper and, like, you know, pulling that all together in 10 minutes and then presenting in a way that is coherent and make sense, you're probably going to be talking for about five minutes. Um and so talking for five minutes is very difficult without sounding like you're just, like, rambling on so having structure and how you're talking through is very important. You should expect to be interrupted, so I don't know that Alice was, But I was definitely I kind of mentioned something and someone went Oh, tell me more about that. What is that? And you should expect to kind of defend or justify your interpretation, something that you say is good. So 1 may say, Yeah, but have you thought about it this way? And I think actually, it shows strength to be able to defend. You're working. Did you just go? Oh, no. Yeah, you're right. Uh, you know, you need to kind of come across as you're in control, and you completely understand what you just said, and it makes total sense. And it's crazy that anyone would kind of, uh, challenge the things you're saying. And if they do and they ask, they kind of challenge you may be you may rework your argument, but effectively, you're planning to get a summary of what you think of something over five minutes in a clear and coherent way. It's basically like a little mini oral presentation. Um, so that's what you're kind of aiming for. And we'll go through that a bit more and we'll see hopefully by the end of the session what that should look and feel like. Yeah, exactly. Yeah, exactly what you said. And when I was preparing for these interviews last year, Um, I was, I was told, kind of, When they ask you when they ask you like What did you think of the article, then, just to say, Well, I'm not going to, like, just give an overview. The Peko format of what the abstract was just was describing, and then you just kind of launch into your critical appraisal, and I think if you're super lucky, then your interview is going to interrupt you, and they'll just let you do. You're still for five minutes, seven minutes or whatever, but I think most people that I've spoken to were actually interrupted a lot like I was literally interrupted every two sentences. I said, which is really frustrating, and I think it really interrupts your flow. But on the other, on the other hand, I think the fact that you're able to keep going and still fight your point just shows the interviewers that you really know what you're talking about. Um and that you thought about the abstract Well, so I would say, even if they keep interrupting you and ask you like some really random question sometimes don't let this like, put you off or anything. Just keep going. Keep as much as you can to your structure. Obviously, you won't be able to follow the exact structure that you've written down or that you've practiced at home. But I would still say Try and get all your points in before that station is over because even if they ask kind of an unrelated question, try and tie back into the strengths and weaknesses and what you thought of the paper because that's really important. When I practiced, I did a lot of like recording and, like practicing with friends. Um, just doing a five minute still by myself. But yeah, I think it's useful if someone can continue to interrupt you as that kind of might mimic the real the real thing a bit more. So just to practice of both, I think both monologue in and also being interrupted. Uh, yeah, and I think also it probably sounds like we're really over reading this. And I think probably there is a degree of my personal preference would be prepared for this like it's the worst interview here in your entire life. And then it will go nicely on the day if you prepare for it like you did really well, Great. Thanks, man. You did really well as well. Then you're really struggling the day we I even practiced last year a couple of times with the person being the interviewer, being like intentionally obstructive and intentionally not rude, but kind of very assertive bordering or rude and again like that's not supposed to happen in the interview will be really inappropriate if that did happen. But it does feel you do feel more prepared going into these things, knowing that you've prepped for the absolute worst and when that doesn't happen it feels like things are going quite well. Um, that's the thing. But maybe people shouldn't prepare for that degree. I don't know. That's that's what I did. And that made me feel happier. Yeah, cool. So the most popular structure that we use and probably most people use is PICO uh, pop. So I would say when you first get your critical appraisal, redo the whole thing when you get first, get the abstract, redo the whole abstract and then right down the Peko, it's very important to get this right. And I think this should take, like Max one minute or 1 to 2 minutes just at the beginning. Very clear. Um PICO at the start of your critical appraisal, it just sets the tone right and just shows examiners that you know what you're talking about. Um so PICO population intervention comparison outcome. You should become really familiar with the echo in like any abstract that you read. As soon as you read an abstract, you should be able to kind of regurgitate a peek Oh, in 1 to 2 minutes. So our rough approach to the structure of critical appraisal is to briefly summarize the abstract and then to review the abstract. Also using the pen format. Assessing strengths, weaknesses, um, any other relevant points. So that might so that might include things like funding ethics, um, was informed Consent gained, Um, just lots of other things around. Research that is not necessarily, um, like looking at the study or study design. And I think the most important is how this piece of research, um, impacts or applies to clinical practice, because the whole point of research is that it's going to translate into improving patient outcomes. Um, clearly, no single piece of research can change clinical practice, so I think most of the time your your conclusion will be kind of, Well, this is only one research paper. Um, first of all, I would need to read the whole paper. And second, it's only one piece of research, so it can't change. In clinical practice, you need many. You need bigger studies. You need a lot more studies. You need systematic reviews like a lot goes into modifying or improving clinical outcomes. But I think having an understanding of that is really important. And just show the examiner's that you understand that research is a long process, um, and that it takes a lot of time and research for things to actually impact. Um, um, normal regular clinical practice. Anything to have done? Um, I don't think so. I think anything that I would also just, um, like, highlight is that the Peko for that is really, really good for, uh, randomized controlled trials that that sort of it fits in really well with that population intervention comparison outcome. Um, and you do also need to practice reviewing cohort studies, reviewing case controlled studies, reviewing a meta analysis that potentially a bit mean from to give you that and and thinking about how you can kind of Jimmy PICO those different types of studies into a peek a format. So at least you are kind of remembering it in your in your head in the same way as a template. Um, someone has asked, How does 0.1 and two different? It's a really good question. Uh, will will go through a worked, worked example of a question appraisal a little bit later, and you'll see what we mean by a brief summary of the abstract, followed by a review of the abstract. Um, yeah, Yeah, actually, practice as much as you can. Like other study designed as well, Not just our CTS. I mean, I just practice are CTS And then in my interview, I got some, like, retrospective cohort things like, I literally read the first sentence and I thought, Oh, my goodness. What on earth? I I literally saw that, like the first sentence. I thought Oh, no, I screwed it. There's no point, but just be flexible. Try to work around it and read through the study like that should be the most. I personally, because it was quite difficult. That should take up most of your time understanding and preparing your study. But Chico is very flexible. You can kind of modify it a different study types, but do try and practice as many different types of studies. You can don't make the mistake that I did and then get really stressed on the day. Cool. And so we have an example. Now that we can work through, does the cure codes work? I'm not sure. Uh, annoyingly, uh doesn't. Well, it will send you to a centimeter, but we won't use a centimeter just because everything seems to be crashing this evening. So what I want you to do is post into the chat box. Um, let's make it easy. First of all, so everyone, right? What is the population or as many people feel comfortable and confident, right? What they think the population. And then once you've done that, All right, what is the intervention? What is the comparison? Where's the outcome? Essentially, I want you to write very briefly what you think the Peko is. It'll probably take I don't know, a minute or so. Okay. So one person is written. They think the population is adults within six weeks of elective major upper abdominal surgery in Australia Museum. Did anyone think it's anything different to that and write it? If you think it's different. Good job, right. The interventions. Uh, what the comparison of the outcomes. Okay. Um, so someone said that the intervention is 30 minutes. Video preop? Yeah. Great. Yeah. Comparison booklet. I see. And the and And anyone can identify what the outcome is instance of PPC than 14 days. And what what is a p p c? Mhm? Yeah. Cool. Fine. All right. So yeah, I think you guys are kind of got what I got. Kind of the key things. Um, anyone want to see what they think of strength or a weakness of this study is and there's loads. Uh, if we sit here for 10 minutes, I think you'll be able to probably pick out, like 32 strengths and weaknesses that yeah, absolutely. So, Firstly, first question chipped in. I completely agree that you CPPCC's not fully described in the abstract. Yeah, so their main outcome measure of this PPC thing they're not really clear what that could be. A part from that it could involve. It could include pneumonia, but it could be lots of other things. Strengths got large. Sample size. Um, 400 people? Yeah. I mean, it's a It's a moderate sample size for three for three tertiary hospitals. Yeah, both groups are similar in sample size, but this is certainly makes life a little bit more simple. Yeah, definitely. It's double blinded. I think someone mentioned that it's in three different tertiary hospital as well. So that's, I would say is A is a strength, so it's a multi center trial, so not just relying on how good one hospital is, you know, if this was if this was the whole study was done at, like a specialist lung hospital or a specialist Upper GI Hospital, then you'd be like, Obviously, you're really good at this because this is what your what your bread and butter is. But it's over different centers. So hopefully seeing a slightly what kind of generalized effect of this weakness? So 14 days postoperatively arbitrary. Yeah, definitely. I completely agree. I can't think of many more complications I can think of one. Actually, that is something that could come up post 14 days. Um, is a control book that usual care, And so, yeah, I mean, that's another good question. What is the gold standard for randomized controlled trial is usual care. Um, as a comparator certainly is within the NHS funded trials, Um, in this country. So yeah, is a is a book. That's usually where I guess the other thing to ask is is a booklet a particularly good blinded measure of blinded control compared to 30 minutes of exercise. Um, like a 30 minute exercise training session, the patients would probably be able to tell the difference between being handed a booklet and doing 30 minutes of training. So can they truly blinded themselves? Or were there other? Where or were they blinded to the possible things that they would be offered? Um, yeah, I guess. Controlling things. So things like controlling ethnicity, gender are there or other demographic things. So this is so we'll go on to kind of population stuff. But it's important to think about are the groups of people who get postoperative pulmonary comp complications, whoever they are. Are they equally distributed across the population of people of all people aged 18 years or older? Or is it that younger people get more of them or older people to get more of them? Could they have done could have stratified their sample or done something slightly better or more interesting with the sampling to mean that you could more easily target? Um, the groups. So I think we've We've shown that there's lots of things you could talk about really with only looking at something for a minute or so. And that's effectively. All you need to do is exactly as you guys have done. You just need to take those points and in structure them more based on country. Yeah, definitely the really nice to get out of jail free card. That we'll talk about a bit more in a minute is that all of these things could be in the main paper. You're just reading an abstract. So for all of the point you're making, you can never be incorrect for just saying. And I want to read the full paper to make sure that they had described the population demographics in further detail. No one no one can criticize you. You're raising it as a really valid point that you're presenting it in a way that so no one can say. Yeah, but obviously it won't be in the abstract. Yeah, you're free and you're good to go. Um, should move on to the next side. Unless there's anything you want to say. This No, you're good. So yeah, we thought that the population of adults greater than 18 years old within six weeks of major abdominal surgery that I completely agree with the person that actually is limited to Australia and New Zealand in three tertiary centers. So 30 minutes of preventative therapy, plus usual perioperative care and then the control is leaflet educational plus usual character there, and then the outcome was this. This postoperative complications and then, um, to this. But I put in quotes. Marks is probably how I would present So when we said earlier around structure. And so the first thing I'd do is I'd give a brief summary of the abstract in the format, I would say exactly as I've putting quote marks. It's a pragmatic, multi center, randomized controlled trial examining reduction of postoperative problems, complications using a preoperative physiotherapy compared to the usual pre active care, including an information booklet in upper abdominal surgery patients. Or, we could say, an elective upper abdominal surgery patients age over 18 years old. The author suggested that Preop physiotherapy was superior to leaflets reducing their PPI PCs, and their data demonstrated a reduction 50% in the incidents of PVCs, including pneumonia. And that's I think hopefully, it shows that you can summarize quite a lot of information there in a few sentences and give someone who's never read the never read this abstract before, a rough idea of what you're talking about and what you're going to go on to talk about. So I guess we've we've really quickly rattling through it and just, you know what are all the strength and stuff? I think it really if you ever feel stuck or you are reading a paper as you will be doing your practicing, there's four key questions that you should ask every paper that aren't in the Peko format but also give you more things to talk about so you never feel kind of stuck and run out of kind of information or content. So I guess the first one is, Where is the study performed? What I mean by that is like, What is the clinical rationale for that? The paper we just looked at is looking at trying to reduce pulmonary postoperative complications in elective surgery. It makes total sense that that was a study that's worthwhile and performed. Electrosurgical care is a thing that affects a lot of patients, and pulmonary complications are very common. Causes are very common etiology of complications, and if there are relatively economic or cheap things that can be done to reduce those complications, then that's benefit patients. It's also cost saving because it reduces the amount of days people spend in the hospital, it possibly reducing mortality depending on what the complications are, and it's really clear, obvious benefit to performing study by that like that and think about what type of study was performed. Primary data is secondary data metal artists, cohort study, randomized controlled trial. All of those things. Then, once you've got your head around, definitely like exactly what the study is, and that can be sometimes quite difficult. A really good abstract. Explicitly say what they've done. But not all abstracts doing some some sort of expect you to make some kind of Oh, right, it's a cohort study. Yes, I completely understand. But hopefully they will explicitly say that if they don't explicitly say that, then that's the point you can talk about. So I think this is a cohort study, but I would like the authors to have explicitly stated their research design. And then you can say, Is the research design appropriate to the clinical question? So the study we just looked at they wanted to look at postoperative complications. I think a cohort study is an appropriate and sensible way of doing that. You could, in theory, do randomized controlled trial. That's the other thing you could do. Um, so that is a randomized that is a random. I'm being confusing. But you what? What you're essentially doing is you're just tying it down the same, I think, a randomized controlled trial. It's a sensible where you're comparing these two groups or asking clinical question, Um, as opposed to a different study time, like a case controlled study, for instance would be in in theory would be possible to do it. But it wouldn't make much sense to do that. And then the other thing you can always talk about or should always talk about with all studies is, Is there Has there been ethical approval? So have they stated that they saw ethical approval? They likely will, because it's published in the journal. You know the other, um, but also, you know, what was the procedure of going around that? Have they Are there any, um, you know, was there any funding from a pharmaceutical company or anything like that? There is a quick, easy points to make that highlight that you're aware of these things. It's probably also really important to just mention that pretty much all the papers you're going to read in these journals have been through peer peer review, so they're probably not rubbish papers, Right? So if you sit down on your interview and you say this is a rubbish paper because it doesn't do this and it doesn't do this and it's terrible paper, it's absolute rubbish. I've never read the skin, my life rubbish A. That's probably not going to be the type of paper that you're going to be presented. So if you're prepared to present that sort of paper, you're probably going to come unstuck and be also, most of these papers maybe have a few faults. But in general they've been through fairly rigorous peer review process, and now they're they've been published. So they unlikely to be just a purely terrible paper. So there will be strength and it makes a lot more sense. And I think it shows a lot more kind of understanding about what the purpose of this interview task is to show that you understand how the paper is well rounded than just saying what was the negative bits of the paper are, and it's absolutely terrible because because that's not particularly helpful, and I think it may be difficult in practicality to actually do Yeah, I totally agree. When you say critical appraisal, we will kind of think at least I did as well. Like, what are the negative points? Just trying to pick out things that I would critique. But actually, there's strengths in every single paper, and the papers that they give you are usually, like, good as well. So do you pick up on the strength as well? Really important. Cool. So we're just continuing on this, um, the same abstract which we presented earlier, And I think we can probably skip through to the next slide. So these are again a few of the points that, um we thought, having looked through the paper, these are a few of the points that I think a valid, um, both strengths and kind of weaknesses. And when I when I prepare to talk through an abstract, this is normally how I kind of structure things to write out in PICO and I normally just right words and in a question mark, because that's normally enough of a of a primer to make you think Oh, yeah, that's the thing I wanted to talk about. Um, without having to do plenty of writing. Um and then consent, procedure and stuff we haven't really talked about, but again, really important. Exactly. If someone asked earlier. So the previous slide was PICO. So how you would present? Um, it's just how the how the study is, um, in terms of the Peko outline. And this is more of the Pecos structure helping you to, um, uh, critique the paper. So again, using the same headings population intervention, control outcome, But this time listing the pros and cons in terms of population, you can read through. All of these, um, will release recordings of this session and send the slides as well. If you guys like, so you can take a bit more time to read through. Because I do realize that we're running a bit tight on time today. Um, but yeah, everything will be released to you guys key. I think it's the practice as much as you can. Everyone will have their own way of doing things. Um, structure wise. There's lots of different ways of doing this. There's no right or wrong answer. You just have to do what works for you, um, and what you feel most comfortable with, So just practice as much as you can. I think your technique will change and develop as you practice. Um, but to be honest, like, now is plenty of time before interviews, and so you can really get up to speed. Um, you have plenty of time to prepare now, so just do a little bit a little bit, but quite often, um, by yourself or with others, Um, and you will be super good for an interview. Day comes. We just put this slide in here because these are very common terms which which crop up everywhere in research. I think having a good understanding of what each of these terms means is really useful, especially in the interview, if they ask you. Oh, and you mentioned, um, like a risk ratio, Can you just define that? And personally, I got asked one of these last year. I can't remember which one it was, but it was in the abstract. And then they actually asked me, Can you please define what they mean by this term? Um, so, yeah, this is a really useful list, I think. Just go through it. You know, Google each of the terms, right kind of definition and more importantly, understand how this is applicable in research and in clinical trials. Yeah. Yeah, Basically, I think these are all things that if you're looking at any of these and you think I have no idea what that means, you should go from Google. Read about? Absolutely. Um I think we can get that, uh, get back. Okay, so this is so no to pass definitions just to the work example. Oh, I'm sorry. Here. Yeah. Perfect. So because people have asked a lot of questions and this is something that I think is is sort of asking questions around PICO and about different things. Um, it's probably just easier to hear one done, and then you have a rough idea of what you're aiming towards. So this is a paper that's on the BMJ. What I'm going to do is I'm going to talk through very briefly how I would kind of present. This is a critical appraisal. I'll definitely caveat by caveat this by saying I haven't prepped for AFP interviews for over a year now because I haven't needed to, uh and I'm definitely if you really, really depressed me, quiz me. I'm sure you'll be able to point out things I've got wrong. But hopefully it will be useful to hear me talk through how I present a critical appraisal, Um, for the structure and then kind of going through the different bits of it, and we'll tie it together in your heads. So if I was so this is This is the paper I'm going to talk through. So it's an acute urinary retention risk of cancer. Population based Danish cohort study. Um, and we'll set like a rough time for five minutes or so. So I'm not just talking forever. So what I would do? I would start by saying, This paper is a nationwide study exploring the risk of a number of different cancers in patients. Presenting the first episode of urinary retention and what I'd like to do is I'm going to present this in a peek a format. So I'm going to talk through population intervention comparison and outcome. So the population was nationwide based in Denmark, and they involved all hospitals in Denmark, patients 50 years old or over, and I think that shows that they're able If you look at the number of patients recruited, 75,983 they were able to achieve a really large sample size, and that appears to be a reasonable population for this study. Given that it's looking into cancer, I'd assume that cancer incidence increases with age. But I'd like to know why only patients age 50 years older over identified where there was a specific reason. And I also want to know if Denmark and the UK have similar cancer risks. So whether this the findings of this paper could be applied to the population where I work in. So this is a cohort study, and as a result, there's kind of no intervention. But I suppose you could argue the thing they are looking at, uh, in the sense of intervention is whether there is urinary retention. And the thing I'd be interested to know in in the main paper is How was the urinary retention diagnosed and and and how that was recorded and how people that went back to look through that data to record it? Um so the comparison was patient. Who's presenting with the first episode of urinary retention and their cancer rate cancer risk compared to a normal population so I didn't expect that the paper would talk about and discuss rates of cancer in general population. And again I'd be wanting to make sure that that is comparable to what? To the So basically, the clinical context I working is already said, and in terms of the outcome, I think there is looking at it very briefly from the abstract they present. The outcome measure is absolute risk of cancer, and they present this appropriately. And I think that the the absolute appears to be presented an absolute risk increase. Um, and they presented that as a percentage, and I think that's appropriate. I'd like to know what the statistical analysis was done, and I'd like to know if they did any, Um, if they did any, uh, kind of other types of analysis or assessment of outcome. I'd also like to know if there were any other endpoints analyzed, so cancer is obviously one endpoint. But I'd like to know if there are any others such as, um, mortality, because I think those are important outcomes as well. Um, and I think the other thing that is interesting. They treated all these, so they looked at a lot of different cancers, Um, but just as kind of what the risk of these cancers. But we know that all of the cancers they're talking about prostate cancer, for instance, has a very good prognosis compared to some of the other cancers, like neurological cancers often do, and colorectal cancer can have. So I think that's a very interesting way in which they presented these. Cancer is almost like they're so anonymous, but they're not. And we know that many of these cancers have slightly different presentations for patients, and we know that anatomically many of these cancers, depending on where they're from, urinary retention, may present a different stage and that cancer process. So we're not just seeing the diagnosis of cancer, but also I want to know whether they did any analysis looking at the different stages of cancer when they were diagnosed. So that's kind of going through Petco structure. I think other possible sources of bias I'd like to think about is potentially confounding. So something they're talking about here is the first time necessarily very attention. We know that there are lots of reasons for someone to be catheterized when they present a hospital but they don't. They may not necessarily be in urinary retention because of the because of the cancer they may be harboring. For instance, someone with the urinary sepsis secondary to immune compromise may present in your in your attention, but it wouldn't be the cancer that would be driving that, for instance. And it was, Do you like to look at how they consented patients into this? Whether patients bought any patient interest groups were, uh, kind of approached to discuss this. Given this is a nationwide study, I'm not sure whether patients individually were consenting for this, but I'll be able to read more about that in the main Patriot, I think, just in conclusion, um, other other things so essentially shown that they found an increased risk of cancer, and they're presenting with the first episode of urinary retention. I think it's a really I think the conclusion matches those results, Um, but it also suggests it's probably something we already know that people presenting with the urinary retention that may be the first presentation of many types of cancer for instance, your genital cancer. So I'm not sure whether this in itself is brand new information for me anyway. Um, I think it is a worthwhile study, though. Urinary retention is a very common problem. And obviously, neurological, colorectal neurological cancers have very poor outcomes that later they found two. Any obvious or any easily accessible flag for an early presentation for cancer is definitely something that's worthwhile looking into. So that's so overall, I think this is a worthwhile paper. I think it matches to a population which I work, and hopefully, um, I think it's a I think it's a valid, interesting findings. Um, but I'm not sure it necessarily would change my practice in any way. So that's me talking through it. I think that's about five minutes to say, uh, there's definitely loads of stuff that I didn't talk about. And there's definitely, you know, uh, other things and other ways of talking about that. But hopefully that gives an idea of how you can talk through the critical appraisal. Nice one. Done. It just reminds me. Yeah, this time last year, I was practicing these kind of things as well. I still sit out of practice and that Yeah, it's very difficult. I I found this quite difficult personally, so yeah, just practice as much as you guys can cool any questions? Let us know. Um, so never give generic answers to open questions. Um, you know, I think try and be as specific as you can use the article to back up what you're saying. Um and don't just regurgitate and describe the facts in what they are in the abstract. Do try and put a cross your own take on things, and what they want to know is what you think what your opinions are. Um, don't get really stressed out by the by the like, complicated stats. Um, don't focus on the minutia. It's just not important. Try and get the bigger picture and how these things can apply to clinical practice. Um, like I said before, don't try and like, do any complicated math. It's just not worth the time and the effort. You just want the bigger picture of what's going on. And, yeah, like we've been saying throughout, I think this station just requires a lot of practice, Um, reading as much as reading as many abstracts as you can, Um, and just practicing as much as you can as well. I think it's definitely harder than the clinical station. Um, just that just because we don't have as much practice on critical appraisal, um, compared to clinical things at med school. So this is really something that I at least for me, I felt like I was learning it as I was preparing for the interview. So just yeah, you can only try your best, but you have plenty of time now until the interviews. So, um yeah, so that should give you enough time to practice anything to add? No, I completely agree that this is the hardest station to excel on this. Doing well in this station will get you the job. Doing badly in the clinical station will lose you the job so everyone will be able to do most people be able to do the clinical station quite well. But to do this station really well is difficult. Um, so just a few kind of resources how to read a paper by, uh, Green. How is an excellent paper is excellent book. Sorry is excellent kind of introduction to reading through papers. Lots of the things that we've talked about today, at least to a degree, are touched on in way more detail and much more eloquently in that book, Um, doctors kind of critical appraisal I haven't used, but I've had very good things about it. Um, and there's a load of stuff on so statistics to get your head around some. Really? You know, things like sensitivity, specificity, nominee to treat. And there's loads of BMJ endgame. So you go into the BMJ website and search for end games, and they're all by Dr Phil Cedric and they're very good. They're very short. Probably 2 to 3 minute reads. Um, and Allison, I both said multiple times now just read articles and just get into a process of doing, um I definitely red abstracts daily. Not lots, but maybe one or two just to kind of try and keep it in my head. Um and yeah, I think that's probably about it. Anything you want to add? A little, uh, no, Nothing to add. So I just posted in the chat link for feedback form. Um, and any questions that you guys have please pop in the chat. I think someone asked for the one for the London interview. Is it generally presentation and four questions or is the first question to present, I think they at least for me, they opened it like it was a very general question. Like, what did you think of the paper? And I mean, if you hadn't prepared, then maybe you would have kind of just given a general overview. But I think if you practice critical paid, and then they can tell very quickly that you go straight in with your peak. Oh, and then you just say, now I'm going to critically plays waking up the strengths and weaknesses of the paper. Um, and then they'll interrupt you whenever they like. So just, um, yeah, my my opinion, My advice is just to go in and to see as much as you can from what you've read and prepared. Yeah. I had a very similar experience. I was actually first asked, Tell me a bit about yourself and and I talked about myself a little bit. And then they said, Okay, great. And now talking through the abstract, it was very clearly signs posted what they wanted me to do. And then once I talked through the abstract, uh, and got through most of it, they started kind of asking me a few questions about what I thought of different things. Um, and then it kind of goes from that. It's only 10 minutes, so it does really go very, very fast. Um, so you you won't feel like you're you're stuck in there for ages. Um, cool. I think there were no other questions. Um, if we've missed, then you can You can just be posted, but I think we went through them as we're going along. Um, Yep. So join the Facebook group. Minor bleed and the SFP group. Any questions? Email us sfp at my nose bleed dot com. And we're also in the process of organizers a mock interview for you guys. Um, it's been, as you can imagine, challenging to two pair. Two pair you guys up with mentors, but hopefully we'll get the mock interview, um, scheme up and running within the next few weeks. Let me now post a link. So just posted Google form. If you guys are interested in taking part in the market interviews, um, where we will send out more information in due course. Um, but obviously no guarantees for having a mock interview just because of the sheer number of, um you guys applying and and the ratio of mentors. Um, but yeah, I have to Google form in the chat now, so do put your details in their interested Cool. Please make sure to leave us feedback. It's really useful for us. So we can evidence that we've done this teaching and and also we can act on the feedback to improve things. Um, and if anyone has no further questions, then we'll let you get back to your evening. Yeah. Last talk tomorrow, clinical scenarios will be seven o'clock again. Do you make sure to tune into that one and then, yeah, that will be the last of hours for Webinars covering sfp. But any questions, As always, do contact us. We'll do our best to apply. Okay, Hope you guys have a nice evening. Thanks for joining us. And sorry for the technical problems. Cool. Bye. Hi.