Session 7: Academic Station - part 3 (common graphs & extras)



This on-demand teaching session is focused on helping medical professionals prepare for the academic station of the Specialized Foundation Program (SFP) interview. The session will cover some extra topics such as common questions, graphs, flowcharts, and diagrams. It will also include a Q&A session covering the academic station, the SFP, and doctor roles and responsibilities. Current SFP doctors will be hosting the session and will cover topics such as critical appraisal of papers, statistics, and ethics. The session is part of a free national initiative to support applicants of the SFP. Don't miss out on this comprehensive and informative on-demand teaching session before you apply for the SFP!
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This is the last of our sessions focussed on academic station where we will wrapping up with some key extra bits of information including common graph analysis and other common general questions!

Learning objectives

Learning Objectives: 1. Understand the purpose of the Kaplan-Meier survival curve. 2. Interpret the Kaplan-Meier survival curve and how it relates to hazard ratios. 3. Comprehend the different types of analyses used to calculate survival. 4. Be aware of different types of questions that may be asked in the academic station of the SFP interview. 5. Recognize how to structure and prepare for interviews for SFP, including time management and different tracks.
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Computer generated transcript

The following transcript was generated automatically from the content and has not been checked or corrected manually.

Hello, everyone. Thank you all for joining uh today's session. Um So today's session is going to be the last uh as part of our series on the academic uh station. We're gonna cover some extra things that you can be asked in your academic station, including some common graphs, some diagrams and other common uh questions as well. Uh So, as I said, this is going to be our outline. We're gonna cover some, some, some graphs uh and some flow charts and some diagrams. Uh So the session is gonna be uh shot one. And we're gonna have uh uh an elaborate Q and A session uh at the end of this uh so that you can ans so that we can answer any questions that you may have regarding the academic station uh or the interview uh for the SSP in general or if you just want to ask a bit more about um what it's like being an S FP uh doctor as well and what your roles and responsibilities are as well. We can cover some of that any questions regarding the S FP we're happy to take towards the end. Um Firstly, I'm not monitoring the uh chart section over here. Um So if there are any questions, uh we can wait until the end and then we can uh try and go through them together. Um So just to recap on who we are, we're a free national initiative to support applicants for the specialized foundation program with the S FP and it led by current S FP doctors across the UK working in different tracks including um research education and leadership. Uh And we be, we, we try to aim, we aim to provide uh in webinars as well as personalized application uh support as well. So far, we've complete, completed uh the overview um session, highlighting some personal motivation uh questions that you can be uh asked during the interview. We've covered a bit of the academic uh station as well today being the last one. And we're gonna have um the, we're gonna cover the clinical uh station uh next week onwards, right? Um So my name is Nero Ravi Kumar. I am one of the S FP doctors in the research track tract uh covering um in the East Midlands uh dry at the minute. Uh I will also be joined by uh Doctor Yussef uh and Doctor Julia has ha has given her inputs for this um session is good. So just a quick recap as to how your interview is structured. So, again, it depends on different deaneries and I would suggest to uh I would highly suggest to have a look at the deaneries that you're applying their websites to see what exactly the structure of the interview is. But broadly speaking, you will have um a personal motivation statement station which would be very similar to your whitespace questions. So you need to know your white space, so you need to know what you've written in your whitespace questions like the um back of your hand. Um And this is th this station really has uh is, is where you can actually demo demonstrate that why you want to, why you want to do the S FP and what motivates you and what are your personal reasons for doing this and how you're gonna utilize that protected time that you're going to get uh in improving yourself as a clinician and as an academic uh as an academic uh the second station, this you may or may not have depending on whether you choose to do the research track or whether you choose to do the medical education or leadership track. Uh I don't know about um all the deaneries, but I know some deaneries still include the academic station if you're doing one of the other tracks. So that's why um please uh speak to SF PS that have done um that particular track uh in that particular denary uh to get a bit more idea. But also look at the websites for the different dries to see whether they actually include this or not. Uh And in the academic station we've covered how to critically appraise uh an abstract or a paper. Uh We've gone through some statistics, we've gone through some ethics uh as well. And, um, and that's what we've done so far and we're gonna complete the session today by going through some other common questions and graphs and flow charts. And then finally you'll have a clinical station, these are most likely going to be a or E scenarios which you, which should have come across uh in med school as well along with some ethics um along with some ethics, uh ethics based questions as well. Um But these are very similar to, to the ones that you would have uh had in medical school. Um And we will cover this in our upcoming sessions as well. So most of your interviews are going to be uh online. Um And the so most of the most few interviews are gonna be online either by, by teams assume, but I think most, most, most places would use teams. Um Some, some denies offer um offer you offer you to book slots. Uh And this, this can be done by oral or they will send you an email as to how this needs to be done. Uh try to book early uh in order in order for you to get uh your preferred slot. Some people like it early in the morning, some people like it late late in the evening or some people just like it uh midday so that they have enough time for preparation but not um too much as well. Um It usually lasts between 15 to 30 minutes. Uh And N II haven't heard of any gene that does it for more than that time. And it often is a panel interview where you have 2 to 3 clinical uh and academic doctors who would ask you questions about various things. In most interviews, it's going to be one person asking you questions and 2 O2 other silent people just taking notes in the background and some, some places also have admin people just in the background. Um It when so in terms of your dates for interviews, um the UK FP O website has a clear um uh outline for when these are going to take place for each of the tries. But if you want, you can have a look over here as well mostly but mostly uh from mid November to um uh early December is when your interviews are going to take place. Um know, you know, you know, the expected dates and be prepared uh for them because it does come around quicker than you think and you need to balance your preparation. Keep on top of your usual studies as well and placements and all of that. Uh and sometimes it can be very uh and sometimes it can be very late that you get the email that you've been selected for the interview. So just be, be be aware that this can be um and sudden notice and it can come around quicker than you than you than you'd expect. Right? So going in today, going into today's uh session, I'm gonna start off by talking about uh some common graphs that you can come across. Um So the first one is the Kaplan Mayer curve, but before we go into how to interpret this curve and what it actually means you need to know what a survival analysis is. So, survival analysis is the study of time between entry to a trial and a subsequent event event. Although the name does suggest that it is um survival that means mortality. It uh the event is mostly mortality. It does not necessarily mean mortality. It can be used um for any, any uh event. But because it was first uh introduced in, in the, in this context, that's why the name. So just keep that in mind. Um When you're trying to interpret uh these grafts, the next is a Captain Mayor analysis. So what is the statistical test done to calculate the survival analysis? And that is going to be your captain May analysis. It is the probability of surviving in a given length of time while considering time in many small intervals. So what is the probability of, of survival in the next five days? What is the probability of survival in the next 10 days and then so on and so forth. And then that gives the shape of the curve. And there have been various types of analysis as well to calculate survival. But uh based on uh research, this is the best method to calculate the fraction of subjects living for a certain amount of time after treatment. And this is mainly because it takes into account those patients that have, that have been lost to follow up. Um And it's, it, it uh satisfies all the assumptions that we take into consideration. Uh when we take that, oh when, when we take that into account as well, and then finally, hazard issue. Um So we went through the definition of hazard ratio purely in terms of statistical term um term as the uh relative difference between uh two groups. So the relative uh difference of the event occurring between two groups over a period of time. But in this, in this context as well, it can, you can have another definition which is the slope of the curve is defined as a hazard. And this is a measure of how rapidly the event is occurring in the subjects. And then the, the, the difference between the two, the relative difference between the two groups will be called your hazard ratio. So if you take this example, for instance, so this gives you survival time in months on your X axis and your over overall survival as a proportion in your Y axis. So the way to interpret this is from left to right and just going through your, through the basics as to what is your X axis? What are, what is your Y axis? What are the different, what are the different lines suggest and so on and so forth. So your blue line is going to be surgery whereas your red line is going to be nonsurgery. Um, so, I don't know. Uh, So this uh is a study that was done based on a pen. Um the outcomes after some form of surgery, I can't remember what exactly. But it is comparing the surgical procedure was a versus a non surgical procedure and how many people actually survive um in the study. So if we look at zero months, so when uh everyone was enrolled, they're all alive. And that's why your overall survival or the proportion of patients that survive is gonna be 100% or one. And then as time progresses, the number of patients um that do not survive increase and therefore the overall uh survival, the proportion of patients that actually survive decreases as we go along. And that's why you have the downward slope. Now, depending on how steep the slope is the uh proportion of survival changes. So in this case, your non surgical group or the red line is more steep when compared to the surgical line, which is your blue line. And that means that the um proportion of people that survive is lesser in the non surgical group compared to the surgical group. And then this can further be confirmed using the hazard ratio which actually takes into which, which is the mathematical representation of the of the slope. So in this case, your hazard ratio is 0.57 which means that the um the ratio of people surviving in the non surgical group is greater uh is lesser than that in the uh survival in the surgical group. Sorry. And this difference is statistically significant because the p value is less than point naught one and the 95% confidence interval is between 0.49 and 0.62. Uh And it does not include one. I hope that makes sense. If, if you have any questions, we'll come, come back to it at the end. And I can uh explain it a bit more in detail. You have to take, you have to keep in mind that not all survival curves are going to be in the downward trajectory. Sometimes you're gonna get survival curve in the upward trajectory and how you distinguish between the two depends on what the Y axis is. So, in this case, this is part of the recovery trial where you can be where you are uh comparing usual care versus dexamethasone in um in CO in patients with COVID and the long term and the outcome. Um So, in this case, if you're looking at the Y DX axis, it stays since randomization, which is the same, which is the time and your Y axis is gonna be mortality. So in this case, you're looking at how many patients are dying. Whereas in the previous case, you're looking at how many people are surviving. And therefore you have a downward slope in the previous one and an upward slope in this one. So again, if we go through this, uh the um the, the, the orange line is dexamethasone and the black line is usual care uh at day zero, you can have zero patients that are dying uh and therefore gonna start at zero. And then as um time progresses, you see uh the different uh the the difference between the two groups uh graphically, we can see that usual care has a higher percentage of mortality compared to dexamethasone. And this can be confirmed using the rate ratio or the hazard ratio, which is 0.83. Um which a which again shows that usual care has a higher mortality compared to dexamethasone. And then the confidence interval also shows that this confidence interval P value also shows that this is a significant result. So when you asked to analyze the Kaplan Mir curve, the the main thing that you have to do is state what the X axis is what the y axis is, what the graph is actually trying to depict. And what are your inferences from uh the graph? The next type of graph that you can be asked are forest plots. So forest plots um are a graphic representation of meta analysis that visualizes the association of all studies within the meta analysis in relation to each other and then demonstrates a pooled effect estimate. So if we take this um forest plot into, into consideration, you're comparing two different surgical um options. So you have mini thoracotomy and sternotomy and this is for and this study was done to look at the differences in outcomes between the two groups in ReNu mitral valve surgery. So you have the different studies uh or subgroups on your left so that you have your different studies on the left over here. Um You have the mean, the standard, the standard deviation, total number of patients for both groups. Um then the mean difference. So with forest plots, you can have either mean difference or you can have an odds ratio. Um This one depicts mean difference uh because of the type of outcomes that you have. Um if you, if you look at the plot on, on the right hand side over here, you can see different green boxes and that is the the main difference of that particular study and the size of the box depends on the weight of the um of the study. So if you have more number of patients or higher quality of patient, uh the how if the standard of the paper is quite high, then your weight increases and if the number of patients are lower, uh or the difference is not as um significant. Oh, sorry, not the difference. If the paper is not as significant, then your weight becomes uh lesser. The exact calculation uh goes over my head and I won't be the best person to explain that. But if you want, you can have a read about that, but you're not gonna be asked how to calculate your weight for uh in your interviews. So that's what, that's what's um represented by the, the green boxes. And then you have the lines that accompanied and that shows you your 95% confidence interval uh of for that particular study. And then at the bottom of the tape of the, of the, of the chart, you have this diamond. Now this diamond represents the pooled estimate from all of these studies and gives you a mean difference. So in this case, the mean difference is gonna be minus 3.71 which is in favor of the mini thoracotomy group. And then, so the lo the lo the horizontal points of the diamond represents the 95% confidence interval. Um and the vertical points of the, the diamond represents the actual mean difference. Now, an easy way of looking at whether this is significant or not is whether it crosses zero or the midline. If it does mean difference, it's gonna be zero. If it's an O ratio, it's gonna be one. And then you can also confirm this by looking at the P value which is very significant for here as well. And this is all that you need to know for a forest plot is to see what the two groups are, how many studies are included, what the outcome is. And, um, what is the pooled estimate, whether it is significant or not? And what is it favoring? Hope that makes sense. If you have any questions, we'll come back to it uh at a later stage as well. The next um section are gonna be is gonna be on uh flow charts. So the first type of flow chart that you can expect is a prisma flow chart that this represents the flow of information through the different phases of a systematic review and all systematic reviews. Um whether it be metasis or not needs to have a prisma flow term. The main idea for this is to see how many, how many records were identified. So how many studies did you actually look through? How many were were actually relevant to your study and how many we were actually included within your study? And you need to provide reasons for why each study was or why this with these studies were excluded. And this improves the quality of your research to show that the search that you have done is comprehensive and you had valid reasons for removing uh said articles. Um So basically if you run from the top the records identified through database searching additional records identified to other sources, and that gives you your total number of records identified and then you remove your duplicates and then you get your actual number of um studies that you, that you can use. And then you have your abstract screening title, uh title and abstract screening which um screening where you exclude a few studies based on your search criteria or based on your inclusion criteria. And then go and then you, the next step is going to be assessing the full text to see if it matches your inc inclusion criteria. And then finally, you're going to include studies in your qualitative analysis and quantitative analysis, which is your meta analysis. The main thing to look out for is what exactly were the reasons why studies were excluded and whether they are reasonable or not when it comes to critically appraising a paper, this uh comes handy comes in handy when you're actually looking at the quality of the paper and the um internal validity of the paper. Uh to say uh because if a study is excluding certain papers for the sake of it, because they don't want be the big um for whatever reason, which may not be actually um meaningful or does not match the inclusion criteria, then you can say that there is some form of data touching or uh pointing the um results in one direction. Uh rather than being more holistic if that makes sense. The next thing is uh consult diagram, uh this is essentially the same as the Prisma flow chart just that it is used in um randomized uh trials of 22 groups. So how many patients um are assessed for eligibility? What is the inclusion exclusion criteria? And how many are excluded? How many were randomized and how many were in each groups? And then finally, um how many patients uh were lost to follow up? And then how many were included in the analysis? Again, in this diagram, you need to look at what the reasons were for excluding patients. And again, this comes in handy when you're assessing the internal validity of the paper and to see that there is no uh of uh any salts and that is basically it uh for today's uh session. Um We have AQ name lined up. Um So you can ask your questions. No, Yusuf. Um If you have any questions regarding this session, if you have any questions with regards to the interview process in general, you can fire away and we'll try our best to answer them. And if you guys could fill out the feedback, please, we'd really appreciate it as well, right. So we have a question of you. How long did it get to appraise your paper before the interview? I guess this depends on which Deanery you're applying to. Um So in the East Midlands, uh you got sent the paper one day before and you had 24 hours to uh appraise that paper and present be fine and, and present your uh findings at the interview. And then they asked further questions on top of that. But in my other interview, we got sent the pa we got sent an abstract 15 minutes before the interview and we had to critically appraise the abstract along with answer uh any questions the interviewers had um from, from the material that were, that was given to us. So again, I guess it depends on, on which uh Deaner you're applying two. But if, if you're getting sent uh uh um a paper, this would be done at least 24 hours prior because you need time to actually go through it. Uh If you're not, if you're expected to do uh if they are giving it to you 10, 15 minutes before your actual interview, this is going to be an abstract which is going to going to be much shorter and your uh appraisal may not be as comprehensive as that for when you do uh a whole study. Any other questions guys? OK. I don't think so. I think if there's nothing else we're happy to end this session. Yeah. Sounds good. Thank you, everybody for joining. Thank you, everyone in the feedback as well. Be really helpful. That was good. Smashed it