An approach to reading the literature (Facilitator)

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Headshot of Ted Chauvin, PhD · Associate Professor
Ted Chauvin
PhD · Associate Professor
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Headshot of Anne Grossman, MD, FACP · Assistant Professor, Medical Education and Clinical Sciences
Anne Grossman
MD, FACP · Assistant Professor, Medical Education and Clinical Sciences
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Table of Contents
  1. Demonstrate respectful, constructive, adaptive interactions with peers and/or facilitators, including punctual attendance, advanced preparation, professionalism, and giving and receiving feedback
  2. Formulate and critically analyze PICO questions (population/patient/problem, intervention, comparison, outcome)
  3. Describe predatory journals and explain how they can be identified

Activity 1: Application of PICO

The primary purpose of the PICO question is to ask, “Should we change our practice to include this new intervention or continue with our current policy/procedure when caring for this patient population?” The decision to change practice will be based on the measured outcomes of the studies.

The PICO question is a formula applied throughout the Evidence-Based Medicine process.

The PICO framework, in its simplest form, is the following:

P  Problem/Patient/Population
I  Intervention/Indicator
C  Comparison
O  Outcome

Applying PICO

For this activity:

  1. Please break into groups of two.
  2. Define at least one clinical question per student based on a patient you have seen, something related to your CBL case, or any other topic you are interested in.
  3. Outline a search strategy and the answers you find.
  4. After you have located an article, briefly read it and be prepared to give a short presentation on the paper to your small group.

An example:

P  Cancer
I  Phenylalanine
C  Control
O  Mortality

Can phenylalanine be used as a biomarker for patients that have cancer?

Result (using Pubmed): “Tyrosine, phenylalanine, and tryptophan in gastroesophageal malignancy: a systematic review.“

Some things to remember

  • Define the clinical question as precisely as possible (think PICO).
  • If the question concerns something rare, possibly recently changing, or new (think COVID-19), case reports and primary literature are likely the best sources.
  • Books and compiled resources are likely best if something is known and unchanging (anatomy) (examples include UpToDate and Best Evidence).
  • If it is a rapidly moving field with controversies and experimental drivers, look for reviews and meta-analyses; look in PubMed, Cochrane, etc.
  • Google Scholar isn’t the wrong place to start, but it will give you random and “good” information.
  • If using guidelines, they are best from “neutral” guideline sources (e.g., U.S. Preventive Services Task Force (USPSTF), American College of Physicians, WHO, etc.).
  • Validate your sources—is it likely biased based on the origin? How old is it? Is it relevant to this population? Are there limitations or caveats?
  • Research the reputation of sources (e.g., “How good is Wikipedia?”).

Activity 2: Presentation

Present your question and results from at least one of your selected journal articles to your small group. You do not need to present the article you found—this exercise is more about the process than the content.

Be sure to include the following in your presentation:

    • Your question
    • Your search strategy
    • How well your search strategy worked

Predatory journals

Most of your group probably used a database like PubMed to find their results. If you randomly Googled your PICO question, you may have been given results that include predatory journals. How do you know if a journal is legitimate or predatory?

facilitators

There are many ways to do this; ensure the students touch on them:

    1. Check the website thoroughly. Many sites have poor grammar and spelling errors.
    2. Check to see if the journal is indexed in the National Library of Medicine) or, even better, MEDLINE).
    3. If open access, check to see if the journal is a member of the Directory of Open Access Journals (DOAJ), Committee on Publication Ethics (COPE), Open Access Scholarly Publishers Association (OASPA), or International Association of Scientific, Technical and Medical Publishers (STM).
    4. Check the journal’s contact information.
    5. Research who is on the editorial board.
    6. Investigate the journal’s peer-review process and publication times.
    7. Look at past issues.