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on over to the doctor or bar. She saying over to your pharmacy. Hello, guys. Can you hear me? Gene? This thing comes up, you can perfect. Great. Hi, guys. My name is about she saying I'm in academic foundation, doctor and I work in Manchester. Um, specifically with ensure hospital. So if any of your own with ensure you might see me around, Um, I'm an academic. You're one doctor. I've just started working, Um, and I'm loving it so far. But today I'll be talking you through how I personally, I would critically appraise an abstract which is useful for the SFP interview and beyond as well. Um, this was easily one of the most daunting sections off the F B interview, as it was called last year S F B, as in school this year for me when I was preparing for it on. And everyone has a slightly different way of doing this. But I will talk you through how I do it. There isn't a correct way of doing it. So take what you can from the session and use it when you're particularly appraising an abstract. Um, so, without further ado, let's bit in um, if you have any questions as well, I would appreciate if you can just put them in the chat box and we can go through them towards the end of the talk is well on. I'm sure Gene will help me. Sort of thought through the questions as well towards the end. But we don't have the question for the end of the talk, if that's okay with all of you. All right. So how do I critically appraise on abstract? See my slides Move. Bear with me. Uh, okay. So how I critically Impreza an abstract, So I, firstly, would break it down by reading the abstract and making your notes under the following headaches. Um, so read the abstract carefully on make your notes on the basic information about the journal and the paper that's been given to you, The methods and you know, not any systematic bias, um, statistical analysis conclusion and the clinical relevance off the findings in the study. And then at the end, you summarize your findings. Overall, certain dinner is on doing the critical of present station. This year, I've been made aware, but for those of you who are going to be having the particular place else station. Um, you may either be given an abstract, which you haven't seen before, which is fine. Or you may actually be able to bring your own abstract. Um, and if the latter happens, then bring an abstract that actually ties in with your own interest. Because then you can demonstrate how enthusiastic you have been about your research on area of interest. So something that ties in with your white space questions is great or something you have read is great because then you can demonstrate how interested you are in your particular area of interest. So for the purposes of this talk, I have just chosen, um, an abstract that I found, um, from the New England Journal of Medicine. Um, Andi, I will be critically appraising it while also taking you through the different subheadings that I just talked about, how I would do it. Um and, yeah, I just have your questions ready in the chat box or towards the end, and we will hold Answer them. All right. So, stopping with basic information, Um, so this allows you to basically take stock off the abstract on make note of the obvious things. It's basically like informing the name is data bottom a patient when you know basically talking to them. So you talk. You make a note of things like journal information. What the name of the the Journal is, whether you know about the Impact Factors or New England Journal of Medicine. If you don't know the specific impact factor in just A, it's a high impact journal, a title off the paper. So mention the authors and, when it was published, the type of study. So you're most likely to get randomized controlled trials for your critical appraisal stations and know randomized controlled trials inside out and the main name of the study. So what is the main question that the authors are trying to answer? I particularly like the fecal framework, which you know talks about the population, the intervention, the control and the outcome. So what demographic is being studied in the population that we're studying? What is a specific intervention that they're trying to study? So what's the new technique or the new treatment that they're trying to study? Worse is the control. This could be the gold standard off treatment for that particular disease, for example, or the placebo. And what is the outcome? Meaning what is the intended goal? And what is the patient the paper eventually want to accomplish? So if we go back to that paper that I just shared on the abstract that I just said, this is how I would do it initially. So take stock of the information I've read my paper, the journal. So you're in the Journal of Medicine and I've looked this up, so I know this, but you can just say high impact factor. Sometimes if you mention impact factor, the judges of the panel might even ask you, the Examiner's might ask you, What do you mean by impact factor? Um, so make sure you know how to define impact factor. I know that's slightly outside the scope of the stock, but you know, know how to define it back factor and what you mean by that The title of the paper, Obviously. So it's a randomized controlled trial off year. You're tired for a dollar since with obesity it was published in 2020 and that's the name of the Ortho that published a study type of the study. It's a randomized, double blind controlled trial. And the mainly a move the study is that it compares, you know, retired with Masebo. Most of the placebo in the policy. If we look at the specific people framework. So we're looking at a dollar since that our age, you know, 12 to 18 years old. Um, the intervention is the study of your protide subcutaneous injection. 3 mg. In addition, the lifestyle interventions versus the control, which is to study the placebo. Last lifestyle therapy on the outcome. Mr. Study BM i standard deviation at 56 weeks. So this basically is like your main framework. So this is kind of like the bare bones off your critical appraisal. So now that you know all of this, now you can go into a praising the rest of the abstract. It will, um all right, um, so moving on them. So methods and systematic bias um, medicine, the most important section of any people. Um, I would discuss the methods used, and then point out any bias is to embellish you Appraisal. Specifically, look at the inclusion bosses, the exclusion criteria. Um, and, uh, also then think about randomization. So was it how Was it blinded? Was it single, blinded or double blinded? The study we're looking at is double blinded on then. Also think about the sample size in the power calculation. Was this done before hand? And they sort of alluded to that in their method section Or not, um, and examples of systematic bias that you can point out when you are trying to embellish your critical appraisal. Off the metho section, you can mention things like selection, bias to performance, biased observation, bias, attrition, bias and confounding factors. Attrition bias can also come in your results section, but I will explain what I mean by the individual biases. So selection bias eyes when there's improper and, um, ization off participants in the study performance bias happens when one group off subjects in an experiment gets more attention than the invest, then the other group off subjects in an experiment, For example, um, observation bias is when the Examiner's have some conscious or unconscious prejudices that become quite visible in the method section or in the results. Attrition. Bias is lost off participants to follow up, and then you have confounding factors, so a confounding variable basically effects the dependent variable, which is the very well the variable that you are studying and the independent variable on this causes spurious results. So basically, both the variables the depending on the independent variable are sort of affected by this confounding factor. And your EXAMINAL might ask you Well, how do you control for confounding factors in around my schedule on trial? Um, and so you have different strategies to reduce confounding variables. You have randomization, which is two basic. You distribute the confounds equally all across the study restrictions. So you restrict the entry off of, uh off individuals to the study with confounding factors, and this risks bias in itself matching. So you have individuals or groups which, um, are equally distributed amongst the the group that is being treated versus the group that's been getting the placebo treatment to make sure that you have equal amounts of confounding. I guess people in both groups and that sort of cancels out any confounding variables as well. And you can also have multiple, uh, analysis. And this only works if you, um can identify and measure the confounder xyz. Well, so all of these things being considered or not and other things to consider would be was consent taken from the participants that having included in the study and were there any ethical considerations as well? The abstract itself might not have all of this information, but if you mention all of these things that basically shows to the Examiner's that you are thinking about these things when you will eventually lead the paper because you'll only be given the abstract in your critical appraisal station. But it tells the Examiner that these questions are orderly popping up in your head. So they asked, They are what? Mentioning, Even though the abstract would not be big enough for the authors to mention all of this information, Um, so coming back to the paper that we were trying to pick your praise. If we use this particular framework, what are my specific notes about this paper? So this is the method section. So, as I previously mentioned, it's a randomized control child. It's double blinded. It's looking at a daughter, since between the ages of 12 on be under 18 years of age. Um, on these at all since I rub is, But it doesn't make clear how these participants were selected So that's the first thing. And again, what specific inclusion and exclusion criteria was used, So obviously inclusion criteria would be, you know, they're adolescence between that specific age group with obesity on a poor response to the, you know, lifestyle therapy alone. Um, but how do the authors define obesity for the purposes of inclusion in the study and what's consent taken from the A dollar since and if so, how was it taken? Um, how are these participants recruited it recorded in the study, and what was morning was used to consent them. Because it can be we. We cannot underestimate the psychological impact off labeling someone as obese, especially someone that is between the ages of 12 and 18 years, which, um, what parents involved giving consent. Um, you know what these individuals body's Children basically capable of giving consent themselves where their parents involved in the consent process. So you you need to question the ethics off. The study is well, we know that they were given 56 weeks of treatment with 26 week follow up period in which, you know they were given literally retired. Last lifestyle therapy versus placebo and lifestyle therapy so there's a mention of lifestyle therapy, but it's not specific. They're not specific. The old is not specific about what they mean by that and what counts as lifestyle therapy. How is the diet on their lifestyle controlled? Um, in terms of outcomes, the primary outcome is the B. M, my standard deviation school, um, which, which they were trying to measure at Week 56. But they're not really mentioned any secondary outcomes. So that's how you would raise the method section off the study on you can then add, You know, your your individual biases and all. They will become more obvious if you read the whole paper, but at the moment I can't really see or comment on any bias is all right, um, so moving on to the next section results. So in terms of the results in the stats analysis, I think this is quite a challenging section as well, because you have to be. You have to understand the results and be able to explain them in a way that is, you know, understandable, just not just you, but also to the examiner's as well. So if you say, um, for example, this you know, this paper states that this study has an order issue or a rental risk of this. They might mean, you know, they might ask you, What do you mean by that? So my point of writing, you know? No. But you know what an order a show means Or know what a relative risk means. There's no how to. Basically, they construct that sentence and be able to explain that. But coming back to what you would be looking at if you're trying to critically appraise the results section so you would ask yourself, Has the primary outcome been achieved? And is there a status taking a significant difference with regard to the primary outcomes? Um, there are different reason which different authors may state that their primary outcomes have been achieved. So look at the values and the confidence intervals. Type one versus type two errors again. This is outside the scope of this particular talk, but know how to define these things. All the ratios in relative risk would be another thing. Know how to talk about them, how to how these a reported and how you would explain it. If you are, ask these questions um and then have any other outcomes been assessed And what these mentioned prior to the study in the method section? So is that all making sense so far? Does everyone understand? Is everyone happy with with that? Do we have any specific questions? I can see? There's about four questions in the chat box. Um, I might just see what they are ginou want at the moment. Yeah, I am. We've got one question which relates toe could cover appraisal for the SFP interview in general. So basically, the question is, if the interviewee is expected to critically appraise a paper before hand would maybe expected to analyzing comment on the whole people, or would they be expected to just comment on the abstract itself? I think they will. They will tell you in, um, their instructions, what they want you to critically appraise. So just I mean, obviously, if you can choose what you want paper, you take for your interview, then you have the option of reading the whole paper as well. But I would try not to do that and just read the abstract and comment specifically on the abstract. Um, I hope that answers the question. Uh, well, if they're any further questions on that fish is put that into the chatter, we will get to them. I'm not sure. Probably understand the question, so maybe we can get to that after the talkers. Well, but yeah, I just saw a few questions, and I thought they might be pertaining to my slides. Um, is the pace of it'll caging? Is that okay at the moment? Oh, yeah. I think it's fine. If our 10 bees few like you're like you to go faster or slower piece again, put them in the chat, and we can adjust. According we can adjust according. Yeah. All right. My happy. Good. Okay, so I'll continue that, um Right. So back to the results section. Um, so right. So has the primary outcome been achieved? Is their staff sticking significant difference with regard to the primary outcomes? Um, so be value and confidence in throws. So is the p value very close to the boundary off the counter confidence into goes, um, be value into So, uh, the confidence interval story. Are they small or the large? Um, on if there are any grafts or any images very rarely would you actually find me? Grab some images in the abstract section off the paper. But if there are any problems or images, then are these represented are the easily understandable um with regard to secondary outcome, so other any outcomes that haven't haven't been previously mentioned in the, you know, aims or the method section on be aware of data fishing or data mining to fulfill second drug outcomes. Basically, this is trying to statically analyze, you know, to variables in in a data spreadsheet to try and get more results on that can often lead to spurious results. So that can be quite obvious in the results section as well. But, um, that will just come with practice. I think when you when you read more and more abstract, you will be you use only become more aware of waters. Ah, what's like a valued result and what isn't? Um so yeah, those are the things you look for when you're trying to particularly praise the results section or an abstract. So if you come back to the paper that we were looking at and yeah, so let's go back to the main name off the study, he wants to assess the difference between the two of you tied on the receiver groups using being my standard deviation which has been discussed. Um, the P value in this study it's significant, assuming that he is less than not going not five on the confidence interval is also seem appropriate. However, I am my standard deviation as a primary outcome measure isn't robust enough. Um, the, um I standard deviation score of the B m I C school is sensitive to transient changes in the adiposity, but it said to be a poor predictor off changes in the total body fat or the overall body fat. So the use of BM I see may not be the most appropriate outcome. Measure off calculation on more over the changes will only attracted week 56. And they should actually have been both over the 26 week period that the patients or the Children were being for mood up because weight changes quite drastically over a period of time and and the results section, um so that was the first point regarding this results section. The second point that we talked about is the results section should mention how many patients were lost to follow up on whether there's any adverse impacts a zoo. Well, so I remember how I told you guys Attrition, bias, the lost to follow up. Um, they should definitely take that into consideration. And these auto seem to have taken that into consideration. But they don't really elaborate any father in the sense that they talk about the adverse G I am back effects that that the younger side has on patients. But they don't love it on the severity off these, um, adverse impacts or what they are. And the auto state that one off the patients or one of the patients in participants in their trial in the treatment group was lost. Two suicide, um, and the state that this was unrelated to the the the outcome of the trial. Um, and I feel like this underestimates the psychological impact of labeling Children and individuals as of these, as well as the treatment that they are being given a swell. So that is my main take away from this, um, this from the results section, obviously, and everyone might have slightly more, you know, comments that they may have regarding the results sections well, but you can elaborate on that. There's talked about quite a few results here. Um, they have mentioned the primary outcome, but the and they've gone on to elaborate that even for those, um, with with talking about reduction in being my and stuff like that. And you can talk about that when you are being examined. But in the interest of time for this particular talk, we will move on on. You guys can always ask me questions about this. If you have any towards the end of the pocket. That's okay. Um, so moving on. Okay, so, conclusion and clinical relevance. So have you drawn as the reader off this abstract have you draw the same conclusions from the results as the authors of the study? And this comes down to three main things specifically with the third point with regards to randomized controlled trials and number needed to treat. Now, this may not be mentioned in the abstract of the study, but you should be looking out for this If there is a ah, a new treatment or a new intervention that's being studied, Um, when we come back to that in a second, so internal validity. So what is the accuracy of the conclusions that are being drawn in? The study itself? Based off of the results section is people back to the people that we were just reading. And the authors conclude that little blue tide is superior to the placebo therapy. However, it doesn't mean that it's safe to use clinically. Just based off of this one. Study on further research is needed as well as ethical considerations need to be made before this can actually be used in that particular age group of patients. Is there sufficient external bility meaning Can the results off the study be generalized to the wider public? Um, I had sent this abstract beforehand to the organizes. A swell on. I don't know if you guys have had it. Uh, I haven't given it before hand, but on the left hand side, um, off off the abstract, you can see all the different centers that the, um that I've been involved in conducting the study. So the study was conducted in then Mark, Sweden, Mexico and India's for the column on the left side. So yes, based off of that, you can say that Yes, the study the findings of this particular study can be generalized to the wider public is well, and finally you come back the number the the street. So the number of patients that you need to treat to prevent one bad outcome. So, for example, if a drug has an an anti or normally treat of five, that means we need to treat five people with the drug to prevent one bad outcome. So has this been discussed in the abstract? And if not make it, make sure you keep an eye, offer it in the main results section off the main paper, and finally, at the end of all of this, you'd summarize your findings. So in summary, this is a randomized, double blind controlled child that was published in the New England Journal of Medicine in 2020 comparing little blue tide on placebo therapy over a 56 week period. Using be my standard deviation is the primary outcome. While the authors conclude that Leo you Tied is superior to proceed with therapy, they seem to underestimate the ethics of recruiting at all essence as participants and don't fully appear to disclose the severity off the adverse impacts off the treatment that is being studied, which is near your diet in this case, and then you can say, for the research is needed using different Alka measures while being mindful off the headaches and the I've also impacts of this treatment before it can definitely use on this particular group of patients. So that's sort of summarizes everything that you have, you know, bleed from this particular abstract. And, you know, obviously the people will tell you more information. But what the Examiner's want to see from you in that particular Brazel station is Are you asking yourselves the right questions? Are you asking? Um, you know these questions only on when you're reading the abstract, thinking about what you might be looking for in the main paper on. They don't expect you to get every single point because everyone looks at a paper looks at an abstract. It's like looking at a painting and then, you know, getting different meanings from it. Um, I am by no means an expert on your blue tide. This is just a paper have picked up from the Internet, So I do apologize. If there are any experts in the audience, is Well, I do collect me. If I have made any mistakes in appraising this paper or if you've had any different thoughts, then please feel free to share that in the common section as well. Um, but it is important to think and basically demonstrate that to the examiner's. You only have 15 minutes, so you can't wants to be mentioned. Every single point that comes, uh, you know, to you on you may actually find out after appraising the abstract you that your thought of different points and you haven't mentioned the examiner's don't really care about that. They want to see that if you've given something, can you critically a present in that particular movement or no, Um, okay, so that basically concludes my particular prison of this particular abstract. And some of the resource is that I used Oh, sorry. Before we get to that things to know and things you might be asked. So I I do believe that there's a talk after this. If I'm not mistaken, Gene, after my talk in a few weeks' time, which takes you through medical statistics, Um, so that might be a good one to attend a swell, but um, no, the definitions of keaster statistical measures. So things like the value or dress your relative risk confidence interviews know how to define these particular things. Because your interview was might ask you what you mean by this or how you define this over your understanding of these things is different study types. As I said, you're most likely to get a randomized controlled trial for your particular present station. So no, that inside out know the strengths and limitations. In fact, there's a cast, our city checklist a swell that you can use, um, to help you, you know, practice off raising randomized controlled trials. But you have different study times like, Oh, what studies systematic reviews, Stuff like that. And there are different checklists that I used to critically appraised these, um studies and know the strengths and limitations of using different study types. Um, it's interesting, because for one of my interviews, I was asked, how did how I would design around the mice control trials? So definitely think about it. Like the The Examiner's might ask you what? What would you do differently if you were doing the study? Um, so basically your some when you summarize the findings and how I said I would think about the ethical considerations, things like that. So those are important things on you can mention that, You know, I would maybe, you know, if I have a start, assess the impact off this particular treatment. Um, I would maybe not use a dollar since, and maybe I would use people that was slightly older because they're such an impressionable group off. Um, such an impression. Preparation group. And we need to be aware of the ethical considered, uh, minute make ethical considerations for in order since in particular because they are Children at the end of the day. Um, so, yeah, um, think about all of those things. And most importantly, you know, it's easier said than done. I think become when you're trying to do your interview, because I think that helps you think, you know, I think I think probably And think laterally don't get flustered when people are asking you questions because they're trying to see how you walk through, Ah, question that you have been asked, um, so talk through your thoughts, like, you know, speak out loud, you know? Think on then, that will help the examiner's kind. You in the right direction. They're there to help you. Um, in terms of what I use, when I was preparing for this, I would literally speak up a random abstract, you know, from the New England Journal of Medicine, or are going but mint And I would look at I was very interested in breast cancer. So I will go and look at, like, the most recent treatment in breast cancer. Um, you know, chemotherapy and I would actually like, look abstracts and look at trials and try and particularly you praise them. When I was preparing for my interview, if I had to talk about something. Um, because sometimes, you know, they may ask you about what's your area of interest? Have you read any, You know, recent research in your particular area of interest. So make sure you know you're up to date about, um your particular area of interest is Well, because they may ask you questions like that, Um, in terms off the follow geez, resource of critical appraisal. So the disease is, um, links to preparation. How to read the paper. I got this book is so good. I love this book because, um, I was terrible at statistics. I was terribly critical. Appraisal. I hated it on this book. Made it easy for me so I wouldn't read it. It's available in every medical library, hospital, library. Just pick it up, read it. It's very easy, really triggering. How makes you know? So that's very, very easy. And I've I've used this for my FDA interviews. I've used it for my master's degree, and it's been useful throughout. Um, the second book Medical Interview is is quite good. It's quite it's quite a high level book in terms off, like, you know? No. Oh, that's right. So I had a question, Um, in terms off Ah, the, um, with the questions that are available because they're they're mostly am that core trainees, surgical trainees. ST training is ready to start into your stuff like that, but you will be our some of these questions. And I think it is a good book that have, um, you know, for now and for the future as well. Um, on d in terms of basic interview prep what I use for my clinical scenarios. I used, um, the unofficial guy to prescribing. Um, and that basically ran me through all the 80 scenarios on I supplemented that with, like, a nice guy lines and the Oxford Handbook as well. When I was preparing for my interviews, so I would know, know like, if you do that book, if you do one official guide to prescribing, you know, for your clinical station if you practice one abstract every few days, you're feeling up to your interview on Make sure you know your white space questions inside out for your interview as well. Um, I don't see how you can get any of the place. Um, so that concludes my talk. I'm happy to take any questions. Um, and let's see what questions we have. Gene, are you on? Yes, I am. So, So far, I've seen two questions for first question is from new See who is basically asking about the structure that your advice people to use when you're critically appraising an abstract during the secretary interview. Okay, um, so when I talked about the headings that we have just critically so basically, these are the questions that you should be asking yourself when you are reading the paper. So go through the basic information on I would make notes on the abstract itself. So if you have an abstract that looks like this, if you have space in the colon's or at the back, I will basically right, people. Population intervention control outcome on the top. Uh, make a note off the the journal, The name off the study on, then, right, Your thoughts under the following heading. So methods. What thoughts do you have for metas results considerations for the future, and then finally summarize at the end. And basically, if you just have that at the back off your you know, if you you will probably get a paper if you have not been, uh, given the given the opportunity to bring your own abstract. Basically, if you use that as a structure, then I don't see how you can miss anything. I hope that answers the question, Lucy. Okay, good to this. Yeah, and all the final questions. So far, I haven't used someone answered this. So the question is, do you have or know of any resource is they they find these homes in medical statistics? Yeah. So the how to read the paper book is quite good for that. Also, the the link I shared for there's a link in the previous slide of the, um back. Oh, I warned. Well, you guys okay? This one? Yeah. Oh, body is not my friend today. Um, Okay, this one. So this this library off predicted appraisal. Resource is that is quite useful. I use this, um, for my for my interview as well, because it takes you through papers and definitions and stuff like that on gum, don't you, Gene? Don't you also have medical statistics into the talk coming up Well, later? Yep. That's right. It's happening next Monday, so she must plug here, Come along. If you like to learn about that, we have a sneaking in calculator in a degree that if you just statistics really heavily so I think it will be very beneficial for anyone Would like to learn more about these. Yeah, apologies. We couldn't go any further in the statistics because this was just the structure of how you were politically appraised something. Um So I hope this was helpful. If you have any other questions and talk or someone wants to a new themselves and checked as well I'm happy. If you have any basic questions about F B in a while, I'm happy to answer them. Know you can email me any questions about the interview itself. Any burning questions at all At the moment, while we're waiting for me questions to come in, I put in the length of the feedback form in the chat. So if you fell in the feet, but you get a certificate, and on top of that, you also receive the slides and the recording off the session today. So if you like access to that, please make sure that you feeling awfully that form. And it helps us learn about what we can try and do better for future sessions. So thank you very much. Um, I don't see any questions in the chart of the moment of our she Okay, that's fine. Um, yeah. I hope this has been useful for all of you guys. Um, it's been lovely. Thank you for having me, Gene. Um and I hope this was this this on Saudi? Oh, you know, questions about doing critical appraisal. Um, if you use this structure, you will not miss miss anything in in a critical appraisal. Try and be as cool, calm and collected. It can be very daunting to do our critical appraisal in 15 minutes. You would basically get 10 minutes beforehand to read the abstract, make your notes and then 15 minutes to present your findings. So I would initially, like, read as many abstract as possible, and then start timing yourself because you will become quickly read it. And you don't know what the scan for exactly. So this is the structure I use for my my interviews, and it really did help me. One of my interviews didn't have the particular Brazel station. Um, and the other one did. So, um, yeah, I used this particular this particular format to make my notes, Um, on, I think disturbed I I think when you see ask me about this particular structure to use, I would just use the back off your paper. If you're allowed to write at the back of your abstract that you've been provided or if you've been given a separate piece of paper, just use that right peek on the top. The name the journal. Anyone's joining the name off the paper, and then the basic information the meth critical appraisal about the metals, the results of the conclusions, your conclusions and then obviously summarize your findings of the very end. Um, yeah. I hope that was helpful for all of you. Thank you very much for having me Gene again. Thank you very much for speaking of Marshall were going quite a few. Thank you, sir. And the chart. So I would say, Are these found it very, really useful. The main people coming today, everyone And of course, thank you again to a bar. She for speaking to all of us today. All right, great. Thank you, guys. I think everyone, we're gonna end it here now. But look, if you've got any SFP interviews coming up,