TEACHING AND TRAINING CRITICAL APPRAISAL OF SCIENTIFIC MEDICAL ARTICLE (CASMA) Pascal Staccini Professor of Biostatistics, Medical Informatics and e-Health School of Medicine of Nice University of Nice-Sophia Antipolis

Context  Since 2004, the second cycle of medical studies in France ends for all students by a national test (national and unique programme)  Decree of 17 January 2004: the national test is a set of four events:  Three trials on clinical records for a period of three hours each. Each file has four to ten questions. Each case is scored from 0 to 100.  A test of critical appraisal of one medical scientific paper lasting three hours. It has two parts: writing of an abstract accounting for 20% of the score of the test and answering 7 to 9 questions accounting for 80% of this score. This test is scored out of 100.  Regarding the specific test of critical appraisal of medical article and in order to ensure that each faculty organizes a fair preparation for this new event, the test has been postponed in June P. STACCINI - Medical Informatics Deparment - School of Medicine - Nice

Steps of local preparation  : seminar of initiation bound for all teachers (juniors and seniors)  : creation of a "task force" LCA (group of volunteers, clinical physicians and methodologists teachers)  Establishment of a preparation program  For students of D2 and D3  For hospital physicians (one session per year of continuing medical education) in order to promote teaching at a « patient’s bed » level 3 P. STACCINI - Medical Informatics Deparment - School of Medicine - Nice

Nowadays  Faculty regular teaching  D2: lectures for the whole class  D3: practical exercices and tutorials with groups of students  Specific slots have been included in the training plan (evening seminars)  D3: 1 conference dedicated to the writing of an abstract 1 conference dedicated to the questions  D4: 1 global conference 1 test per month from september to april (3rd saturday of each month) 4 P. STACCINI - Medical Informatics Deparment - School of Medicine - Nice

Learning objectives  A national programme has been established by the scientific committee of the CNCI  This programme is divided into six parts:  Identitying the type of study  Analysing the methodology: population, methods  Analysing the presentation of the results  Criticising the results and the discussion  Assessing the clinical appliance of the results  Assessing the format of the paper 5 P. STACCINI - Medical Informatics Deparment - School of Medicine - Nice

Local programme  Lectures and tutorials follow a similar plan:  Comments of the CAMSA test of the previous year  Theoretical modules and exercises carried out by type of study: epidemiology, diagnosis, treatment, prognosis 1 session for the abstract A training session to the test  Examinations of D2 and D3 are identical (June and September) in order to compare results 6 P. STACCINI - Medical Informatics Deparment - School of Medicine - Nice

7

8

Curves of two Paris tests - October January 2012 To compare with Nice tests results From normal to asymetric curve shift 9 P. STACCINI - Medical Informatics Deparment - School of Medicine - Nice

10 P. STACCINI - Medical Informatics Deparment - School of Medicine - Nice

What’s new in 2012  First seminar towards junior teachers and assistants  Main learning outcome: how to build the content of a test related to critical appraisal of medical paper (questions and answers)?  Programme Presentation of the national test exam How to choose a « good »article? Description of the materials given to the students Types of questions for an epidemiological study Types of questions for a therapeutic study 11 P. STACCINI - Medical Informatics Deparment - School of Medicine - Nice

English or not english?  Wrong debate  But the first generations of students were reluctant to work on articles in English  Now, training in Medical English is more advanced in L2-L3 (students are "less threaten")  Next year, articles will be in English (except during official tests: French language remains the rule). 12 P. STACCINI - Medical Informatics Deparment - School of Medicine - Nice

Conclusion  Teaching critical reading of medical article combines: Improved teaching sessions focused on theoretical aspects Training sessions orgnised by small groups Testbed exercises with the support of residents or junior physicians – the idea is to select for each discipline articles related to basic facts (basic facts in risk factors, main results about tests, basic facts in therapeutics and main results of prognosis) 13 P. STACCINI - Medical Informatics Deparment - School of Medicine - Nice