Evidence-based Health Care: the Open Learning ResourceBMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7228.193 (Published 15 January 2000) Cite this as: BMJ 2000;320:193
Critical Appraisal Skills Programme, £90
ISBN 1 901 868 01 x
This is not a standard text by one author or even a team of experts. This is a critical appraisal skills programme, an open learning resource for healthcare practitioners, developed through advice from and consultation with over 60 people. The advisers' breadth of practical experience and wisdom are reflected in the content. An enormous range of work is cited—including many of the now standard papers on evidence based health care and critical appraisal skills, papers on management of clinical problems such as the use of antibiotics in general practice and treatment of schizophrenia, Roy Porter's medical history of humanity, Donald Schon's reflective practitioner, as well as literature on organisational change.
There is a self effacing tone to the programme: space is given to voices critical of the “evidence based movement,” and there is a clear acknowledgement that “decisions cannot be made on the basis of evidence alone.” Connections are made between evidence and the need for transparency in order to meet patients' expectations, and the programme links to the swampy world of routine practice. A dry, didactic exposition of the case for evidence based health care this is not.
The package consists of five books, each covering a unit of the programme; a hefty volume of offprints, providing instant access to original papers; an interactive CD Rom that takes the learner through the processes of searching for and appraising systematic reviews and randomised controlled trials; a glossary of important terms; and an evidence based health care workbook. All in a plastic box. Through the programme the learner is encouraged to relate text and sources to his or her own practice or situation in the healthcare system. And the CD encourages the learner to explore beyond the programme by signposting the way to information available on the internet. This is great stuff. Committees do not have a good track record of designing things that function, and so to have synthesised advice from so many without producing an obvious dromedary is a major achievement.
Of course, there are glitches and things that could be improved. The programme is not designed for a particular group but “is a multidisciplinary programme aimed at all those who make health care decisions and those who seek to influence the decision making process.” To achieve this, better mapping of contents is needed to help individual learners find their own way through the enormous amount of material. The glossary could be improved. The CD is associated with, but not linked to, the five main units. This makes the whole package feel a little disjointed. It would be great if all units could have an interactive component. But perhaps that is to come. Keeping up to date is something that the authors reflect on in their introduction. To remain topical and dependable, the programme will need regular updating.
This idea from the NHS Executive Anglia and Oxford Research Advisory Group, funded by the NHS Executive's Regional R and D Committee, seems to be a unique product. A search of the websites bmjbookshop.com and amazon.co.uk did not reveal any other similar programme or interactive CD on critical appraisal skills. But then neither was this programme revealed, neither by searches of the websites nor by two telephone inquiries to medical bookshops. The publishers perhaps need to be a tad more proactive about marketing their programme.