title: Critical Appraisal Skills Among Canadian Obstetrics and Gynaecology Residents: How Do They Fare?
abstract: OBJECTIVE
  Evidence-based medicine has become the standard of care in clinical practice. In this study, our objectives were to (1) determine the type of epidemiology and/or biostatistical training being given in Canadian obstetrics and gynaecology post-graduate programs, (2) determine obstetrics and gynaecology residents' level of confidence with critical appraisal, and (3) assess knowledge of fundamental biostatistical and epidemiological principles among Canadian obstetrics and gynaecology trainees.
  
  
  METHODS
  During a national standardized in-training examination, all Canadian obstetrics and gynaecology residents were invited to complete an anonymous cross-sectional survey to determine their levels of confidence with critical appraisal. Fifteen critical appraisal questions were integrated into the standardized examination to assess critical appraisal skills objectively. Primary outcomes were the residents' level of confidence interpreting biostatistical results and applying research findings to clinical practice, their desire for more biostatistics/epidemiological training in residency, and their performance on knowledge questions.
  
  
  RESULTS
  A total of 301 of 355 residents completed the survey (response rate=84.8%). Most (76.7%) had little/no confidence interpreting research statistics. Confidence was significantly higher in those with increased seniority (OR=1.93), in those who had taken a previous epidemiology/statistics course (OR=2.65), and in those who had prior publications (OR=1.82). Many (68%) had little/no confidence applying research findings to clinical practice. Confidence increased significantly with increasing training year (P<0.001) and with formal epidemiology training during residency (OR=2.01). The mean score of the 355 residents on the knowledge assessment questions was 69.8%. Increasing seniority was associated with improved overall test performance (P=0.02). Poorer performance topics included analytical study method (9.9%), study design (36.9%), and sample size (42.0%). Most (84.4%) wanted more epidemiology teaching.
  
  
  CONCLUSIONS
  Canadian obstetrics and gynaecology residents may have the biostatistical and epidemiological knowledge to interpret results published in the literature, but lack confidence applying these skills in clinical settings. Most residents want additional training in these areas, and residency programs should include training in formal curriculums to improve their confidence and prepare them for a lifelong practice of evidence-based medicine.
authors.affiliation: Department of Obstetrics and Gynecology and Newborn Care, The Ottawa Hospital, University of Ottawa, Ottawa ON.
authors.forename: Olga
authors.initials: O
authors.lastname: Bougie
authors.affiliation: Department of Obstetrics and Gynecology and Newborn Care, The Ottawa Hospital, University of Ottawa, Ottawa ON; Ottawa Hospital Research Institute, Ottawa ON.
authors.forename: Glenn
authors.initials: G
authors.lastname: Posner
authors.affiliation: Department of Obstetrics and Gynecology and Newborn Care, The Ottawa Hospital, University of Ottawa, Ottawa ON; Ottawa Hospital Research Institute, Ottawa ON; Children's Hospital of Eastern Ontario, Ottawa ON.
authors.forename: Amanda Y
authors.initials: AY
authors.lastname: Black
mesh_terms: D056808:Biostatistics; D002170:Canada; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D003627:Data Interpretation, Statistical; D004813:Epidemiology / Q000193:education; D019317:Evidence-Based Medicine; D006176:Gynecology / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D009774:Obstetrics / Q000193:education*; D012107:Research Design / Q000592:standards; D020377:Self Efficacy
keywords: biostatistics; critical appraisal; evidence-based medicine; obstetrics and gynaecology residents; resident education