1. THE RESEARCH UNIT FOR GENERAL PRACTICE IN COPENHAGEN Anni B.S. Nielsen Charlotte Tulinius Christian Hermann Lars J. Hansen 1 “Forskningstræning” Systematic training in Critical Appraisal as a Mandatory Element of GP Specialist Training in Denmark

2. THE RESEARCH UNIT FOR GENERAL PRACTICE IN COPENHAGEN Anni B.S. Nielsen Charlotte Tulinius Christian Hermann Lars J. Hansen 2 Aims and rationale of the systematic critical appraisal training module Aims: To develop the skills to seek out and evaluate new knowledge as well as to transfer this knowledge into practical clinical use Rationale: To ensure the learning of an approach that can provide the foundation for life-long learning

3. THE RESEARCH UNIT FOR GENERAL PRACTICE IN COPENHAGEN Anni B.S. Nielsen Charlotte Tulinius Christian Hermann Lars J. Hansen Systematic training in critical appraisal since 2004 The 20 days’ “systematic training in critical appraisal” was designed specifically for all medical specialties Guidelines introduced by the Danish National Board of Health The three regional postgraduate medical educational councils were left to interpret the guidelines and assume responsibility for the delivery The practical implementation has involved different institutions, e.g. the general practice research units and institutions in Aarhus, Odense and Copenhagen

4. THE RESEARCH UNIT FOR GENERAL PRACTICE IN COPENHAGEN Anni B.S. Nielsen Charlotte Tulinius Christian Hermann Lars J. Hansen 4 When completing the course the trainee should be able to… Describe an issue in the context of current clinical practice and illustrate existing knowledge – and gaps Review current knowledge by way of a systematic search in the research literature Critically interpret results from the literature – proposing solutions for the problem Summarize the results, communicate these to colleagues Use research results to evaluate the organizational, economic and ethical consequences of changing practice

5. THE RESEARCH UNIT FOR GENERAL PRACTICE IN COPENHAGEN Anni B.S. Nielsen Charlotte Tulinius Christian Hermann Lars J. Hansen How do we teach systematic training in critical appraisal? Systematic critical appraisal of the literature. Learning how to read a paper about prognosis, diagnostics etc. How to handle knowledge and to find relevant literature. Introduction to relevant databases Course in basic research methods including design, methodology ethics Discussion of own project with supervisor

6. THE RESEARCH UNIT FOR GENERAL PRACTICE IN COPENHAGEN Anni B.S. Nielsen Charlotte Tulinius Christian Hermann Lars J. Hansen 6 The phases in the 20 days’ systematic critical appraisal training module Preparation of a question/problem of clinical relevance A written presentation of background of the research questions and plan for the literature search Collection of knowledge through searching in relevant databases Critical analysis of the collected literature. Could the literature answer the question? Is the literature relevant? Are the methods used appropriate? Oral presentation based on written report

7. THE RESEARCH UNIT FOR GENERAL PRACTICE IN COPENHAGEN Anni B.S. Nielsen Charlotte Tulinius Christian Hermann Lars J. Hansen 7 3 regional postgraduate medical educational councils are responsible for the GP systematic training in critical appraisal 2006-2009: 90 trainees 2006-2009: 95 trainees 2006-2009: 58 trainees

8. THE RESEARCH UNIT FOR GENERAL PRACTICE IN COPENHAGEN Anni B.S. Nielsen Charlotte Tulinius Christian Hermann Lars J. Hansen Evaluations - differences and similarities Differences Evaluation strategies Residential course vs. non- residential course E-learning module vs. lectures Similarities Good evaluations of the course – especially critical appraisal of the literature The trainees’ topics has GP-relevance –The evidence for vitamin D treatment –Best practice for treating CPOD patients in general practice –Best treatment of children suffering from otitis media Some trainees have previously had negative experiences with research. They are surprised: They now know how to find the evidence

9. THE RESEARCH UNIT FOR GENERAL PRACTICE IN COPENHAGEN Anni B.S. Nielsen Charlotte Tulinius Christian Hermann Lars J. Hansen 9 Systematic training in critical appraisal - Forskningstræning = Makes a happy and Skilled doctor

10. THE RESEARCH UNIT FOR GENERAL PRACTICE IN COPENHAGEN Anni B.S. Nielsen Charlotte Tulinius Christian Hermann Lars J. Hansen 10 Time scale The time scale for the training in critical appraisal is set at 20 days (it started with 60 days -> 20 days). A literature project should be designed and undertaken. Both a written and an oral report must be completed. The trainee must also participate in the educational programmes that are relevant to the project (participate at least 90%).

11. THE RESEARCH UNIT FOR GENERAL PRACTICE IN COPENHAGEN Anni B.S. Nielsen Charlotte Tulinius Christian Hermann Lars J. Hansen 11 Introduction. Within the last 6 months of the hospital phase = Seminar-days Groups including max 10 trainees with a seminarleader. Discussions and presentations of project including feedback. = Course-daysCritical appraisal of the literature in small groups and search of literature in Relevant databases. = Work in groups = Home-working-day udHow are the days? The CAT module in Region East Academic advisors (3 hours) Head course. In phase 2 (general practice)

12. THE RESEARCH UNIT FOR GENERAL PRACTICE IN COPENHAGEN Anni B.S. Nielsen Charlotte Tulinius Christian Hermann Lars J. Hansen 12 Paedagogic frame and teaching frame Based on the trainees own experiences – and starting to build on where they are standing… –Relevant to the doctors clinical reality –Problem-based learning –Applicable to daily clinical work Activating the participants Critical reflexion as a learning strategy Formative evaluation Summative evaluation on oral and written products

13. THE RESEARCH UNIT FOR GENERAL PRACTICE IN COPENHAGEN Anni B.S. Nielsen Charlotte Tulinius Christian Hermann Lars J. Hansen 13 Training today (reform 2004): 5 years 12 30 6 6 Introduction to General Practice General Practice – phase 1 6 Hospital General Practice – phase 2 General Practice – phase 3 Months 20 days Critical appraisal training