It is vitally important that physicians -- residents and faculty alike -- be able to incorporate the principles of Evidence-based Medicine (EBM) into their daily practices. Recent healthcare reforms have only underscored the importance of being able to practice efficient, cost-effective medicine. To address this issue, the curriculum of the University of Hawaii's Integrated Medical Residency Program has been modified to incorporate the teaching and learning of EBM.
A prerequisite to practicing EBM, however, is learning how to critically appraise the medical literature. Critical Appraisal skills are being taught to the residents formally during Journal Clubs. To further enhance this learning experience, to preserve the efforts of the residents, and to bring to fruition the results of their toils, the Critically Appraised Topic (CAT) has emerged.
The CAT concept is a relatively new one, and is currently being used in a structured and practical way by few other institutions. The CAT is nothing more than a 1- to 2-paged synopsis of an article in the medical literature that has been critically appraised by a resident or faculty member, much like several currently published journal clubs. The basic elements of the CAT are:
Once entered electronically, the CATS can be retrieved easily while in the clinic, on the wards, or from any Web-accessible terminal, and can be used to answer pertinent clinical questions ON THE SPOT as they relate to REAL patients. A critically appraised topic may be a single paper published in the literature, or may be a compilation of several related papers. In order to avoid any unnecessary confusion, terminology will be kept consistent with other published material.
As with any published material, the reader must judge for him/herself the validity and applicability of any CAT. Through a rigorous and peer-reviewed process, a majority of the anxiety and doubt in this area can be alleviated. In the next phase of development, each CAT will include personal commentary by a local subspecialist.