A Response to “Impact of a National Journal Club and Letter Writing Session on Improving Medical Students’ Confidence with Critical Appraisal” [Letter]

Dear editor

We read with great interest the article by Gokani et al,¹ which provided a unique insight into the potential of a single teaching session in improving medical student’s confidence with critical appraisal. We appreciate the authors’ efforts in conducting this study and would like to offer our comments.

One key aspect of the methodology was that teaching sessions were conducted by doctors in their first or second year of practice after medical school. Although Widyahening et al² found that near-peer tutors were as effective as staff tutors in teaching critical appraisal skills, near-peer tutors in Widyahening et al’s study² had recently passed the same course they were teaching at and had undergone a 3-day “training of teachers” course. Indeed, previous studies have shown that the capability of peer tutors to teach each other and juniors was dependent on their own training as tutors.^3–5 In Gokani et al’s study, the experience and training of near-peer tutors were not reported. Such information is important for implementation in other centres and can affect the effectiveness of the course.

Gokani et al concluded that a single session can improve medical students’ confidence with the critical appraisal process, even in the absence of follow-up sessions. However, the high loss to follow-up (24%) can be problematic as unsatisfied delegates of the course may be less inclined to complete post-course feedback forms, falsely raising the reported confidence post teaching. In order to improve follow-up and reduce bias, we suggest that certificates be provided post completion of feedback forms as a non-financial incentive. In addition to this, the short duration of follow-up in this study may be inadequate to make such a conclusion as confidence may be inflated immediately post-course. Critical appraisal skills need to be developed over time through continued practice, it is important to access the long-term application of such skills and whether confidence remains high over time following the course even in the absence follow-up sessions.

Interestingly, this article demonstrated that an opportunity to write-up a letter under guidance as part of the course is highly valued by students. However, the uptake of this and the number of letters submitted for publication has not been reported. This is likely also due to the short follow-up of the study. Future research can follow-up on this and potentially utilise the number of letters submitted to editors as an objective measure of application of skills learnt from the course.

The findings of this study are important, and the implementation of such courses can help build medical student’s confidence and their application of critical appraisal and letter writing skills. Nevertheless, certain information regarding the tutor’s experience needs to be addressed for other centres to implement this. The conclusion that a single teaching session improves confidence in critical appraisal may be premature and misleading. Future research should focus on application of these skills post-course and confidence level with a longer follow-up period.