This blog, by Emily Sanger, was originally posted on the Cochrane Common Mental Disorders (CCMD) website. Emily is about to start her first year as a foundation doctor after graduating from the Hull York Medical School. Her main interest is studying mental health, specifically global and child and adolescent mental health. Before starting her training she spent some time working with CCMD. You can view more posts from Emily here on Students 4 Best Evidence, a blogging site by - and for - students.
While I was working with Cochrane Common Mental Disorders I completed the Cochrane Interactive Learning: Conducting an Intervention Review online course. This consists of 10 training modules which teach you about how a systematic review is performed and goes through critical appraisal. At the end of each module are questions and once you pass these you are given a certificate to download.
Understanding systematic reviews, and in particular how to critically appraise a paper, is an important skill for medical students to have; not only to pass exams but also to be able to review evidence, helping make decisions about care in the future.
Starting at the basics, the first module gives you an overview of a systematic review and how to structure your research questions. This was something I felt comfortable with but it is useful if you want more of an understanding on how to form your questions, as well as getting an idea of who should be involved in a review.
The second module takes you through what a systematic review protocol is and how to conduct one. Protocols are important for reducing bias in a review, providing transparency and accountability from the authors. The process of publishing a protocol, as well as the importance in reducing bias, was not something I was too familiar with before this. I found it interesting to learn what goes on before data collection starts. After this, modules three and four go through conducting a literature search, selecting studies to include and important data to collect from these papers.
I found the next three modules focusing on bias, analysing results and interpreting findings, particularly useful for developing critical appraisal skills. Module 5 on bias helps you identify where bias may arise in different types of research studies. It also goes through the different ways that studies could reduce bias which has helped me when using Cochrane’s ‘Risk of bias’ tool. Module 6 then goes through key aspects of analysis. I found this particularly useful for getting my head around different definitions like odds ratio and standard mean difference (some of which tend to come up in exams). Finally, the 7th module on interpreting results helped me to understand what to focus on when deciding how certain the results are, as well as reminding me of how to interpret a funnel plot. Module 8 then draws on this and helps you to understand how these results should be written up and the importance of summarising the review.
I then completed Module 9: ‘Introduction to health economics’ and Module 10: ‘Network meta-analysis’. These modules are helpful if you want a broader understanding of what goes on in an economic evaluation, as well as developing your skills to perform a network meta-analysis. However, I would say that the other modules were more useful as a student developing appraisal skills.
There was a lot of information included in the modules, and the modules took on average an hour each to complete for me, depending on how long it took to do the questions. With all the information the questions at the end were useful for checking understanding – you have to get full marks to pass so some may take more than one attempt!
Overall, I feel much more comfortable with the process of conducting a systematic review and how to interpret the results and risk of bias since completing these modules.
Cochrane Interactive Learning modules provide over 10 hours of self-directed learning on the complete systematic review process for both new and experienced review authors. The first module is free for anyone to access. Details regarding access to the remaining modules can be found here.