The ability of healthcare professionals to provide their patients with good, evidence based clinical care is vital. This involves seeking out the best available evidence, analysing, critically appraising and applying this to clinical practice. A vast amount of literature is available to the Paediatrician, but many trainees cite time constraints and limited critical appraisal skills as reasons for not keeping abreast with the latest evidence.
We undertook a region-wide, trainee-led, collaborative initiative between medical and nursing staff to promote engagement with important new research and enhance critical appraisal skills amongst Paediatric trainees.
In 2014 we introduced Paediatric Journal Review (PJR), a monthly ‘newsletter’ style production, which incorporated critical reviews of recently published journal articles considered of interest and relevance to trainees and to clinical practice. Each month, members of the editorial team searched for suitable articles through Medline databases, twitter alerts, and a hand trawl of key Paediatric and Neonatal journals. Articles were selected for inclusion based on relevance, interest and quality. Each issue of the PJR had a theme, with issues to date including Neonatal medicine, General Paediatrics, Community Paediatrics and Paediatric Surgery. Articles were summarised in 350 words to include methodology and key findings, with emphasis on key limitations and potential clinical implications. Reviews were drafted by members of the editorial team and ‘guest reviewers’. Reviews were independently scrutinised by another member of the editorial team to ensure consistency and quality. A finalised PDF production was then circulated to all nurses, nurse-practitioners, Paediatric trainees and consultants in the region via email.
After one year of monthly production, an analysis of the effect of this initiative was conducted with a short electronic survey sent out to all potential readers. We received 42 responses from Consultants (29%), trainees (68%), and nurse practitioners (2%), with key results presented in Table 1. All respondents felt that articles were of the right length and were easy to read, with an equal preference for monthly or alternate monthly issues. Additional main comments were that more themed issues should be included, and that there was too much a predominance of neonatal articles. Wider availability of PJR, for example via social media, was also requested.
Whilst there is likely to be some responder bias, this feedback is encouraging. In particular, the reviews seem to be aiding knowledge and clinical practice. In response to the survey, PJR has been converted to an alternate monthly format, with alternation between Paediatric and Neonatal themed issues. Additionally, we have encouraged a broader range of reviewers to increase trainee involvement in the critical appraisal process and encompass a wider selection of review topics. We are also exploring the possibility of social media links to PJR along with discussion forums.
This project has had some limitations. The original editorial board is small and consists of members with a predominantly Neonatal background. This has made the selection of relevant non-neonatal articles more challenging – an aspect that we hope to improve as trainee involvement increases.
The editorial team feel this has been a worthwhile and rewarding project that is achieving measurable improvements in trainee engagement with evidence and critical appraisal. By improving our collective knowledge base and ability to critically appraise, we believe it is possible to positively affect clinical practice and ultimately improve patient care.
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