Reading habits of practicing physiatrists

Co-creating scholarship through collaborative writing in health professions education: AMEE Guide No. 143

This AMEE guide provides a robust framework and practical strategies for health professions educators to enhance their writing skills and engage in successful scholarship within a collaborative writing team. Whether scholarly output involves peer-reviewed articles, book chapters, blogs and online posts, online educational resources, collaborative writing requires more than the usual core writing skills, it requires teamwork, leadership and followership, negotiation, and conflict resolution, mentoring and more. Whilst educators can attend workshops or courses to enhance their writing skills, there may be fewer opportunities to join a community of scholars and engage in successful collaborative writing. There is very little guidance on how to find, join, position oneself and contribute to a writing group. Once individuals join a group, further questions arise as to how to contribute, when and whom to ask for help, whether their contribution is significant, and how to move from the periphery to the centre of the group. The most important question of all is how to translate disparate ideas into a shared key message and articulate it clearly. In this guide, we describe the value of working within a collaborative writing group; reflect on principles that anchor the concept of writing as a team and guide team behaviours; suggest explicit strategies to overcome challenges and promote successful writing that contributes to and advances the field; and review challenges to starting, maintaining, and completing writing tasks. We approach writing through three lenses: that of the individual writer, the writing team, and the scholarly product, the ultimate goal being meaningful contributions to the field of Health Professions Education.

Educational Resource Utilization by Current Orthopaedic Surgical Residents: A Nation-wide Survey

Background

More than 150 accredited orthopaedic residency programs exist in the United States with more than 3,300 residents. Every year, between 600 and 800 orthopaedic surgeons complete board certification. However, little is known about what residents use and prefer of the many resources available to them. The purpose of this study is to understand how orthopaedic residents across the country prioritize educational resources.

Methods

An 18-question survey with subqueries was compiled on the REDCap (Research Electronic Data Capture) platform. Residents were reached through program coordinators, program directors, and word of mouth. There were 374 total respondents. Responses were summarized for the total population and stratified separately by sex, location, and year of training. P values were adjusted for multiple comparisons using the Bonferroni method.

Results

Respondents were 83.4% male and 16.6% female. Orthobullets was the single most valued resource and general review articles were the single most valued journal resource. The average time spent studying was 10.7 hr/wk (SD = 7.6), with no notable differences by program location or sex. A significantly larger percentage of female residents placed more importance on specialty-specific journals (32.8% rated as very important versus 19.9% from males, P = 0.016) and research-related journals (P = 0.004). VuMedi use significantly increased until postgraduate year-4 (P < 0.001), whereas residents earlier in training used YouTube more often (P = 0.026). There were differences in journal prioritization by program region, with the Midwest, Northeast, and South preferring primary, focused articles and the Northeast, South, and West emphasizing systematic review articles (P = 0.032). Industry-sponsored events were used by 67.4% of residents as an educational adjunct.

Conclusions

Current residents-regardless of sex, location, and year in training-use Orthobullets and other electronic resources. There continues to be utilization of industry-sponsored resources, although they are not the primary focus for those in training.

Comparison of depression prevalence estimates in meta-analyses based on screening tools and rating scales versus diagnostic interviews: a meta-research review

BACKGROUND

Depression symptom questionnaires are commonly used to assess symptom severity and as screening tools to identify patients who may have depression. They are not designed to ascertain diagnostic status and, based on published sensitivity and specificity estimates, would theoretically be expected to overestimate prevalence. Meta-analyses sometimes estimate depression prevalence based on primary studies that used screening tools or rating scales rather than validated diagnostic interviews. Our objectives were to determine classification methods used in primary studies included in depression prevalence meta-analyses, if pooled prevalence differs by primary study classification methods as would be predicted, whether meta-analysis abstracts accurately describe primary study classification methods, and how meta-analyses describe prevalence estimates in abstracts.

METHODS

We searched PubMed (January 2008-December 2017) for meta-analyses that reported pooled depression prevalence in the abstract. For each meta-analysis, we included up to one pooled prevalence for each of three depression classification method categories: (1) diagnostic interviews only, (2) screening or rating tools, and (3) a combination of methods.

RESULTS

In 69 included meta-analyses (81 prevalence estimates), eight prevalence estimates (10%) were based on diagnostic interviews, 36 (44%) on screening or rating tools, and 37 (46%) on combinations. Prevalence was 31% based on screening or rating tools, 22% for combinations, and 17% for diagnostic interviews. Among 2094 primary studies in 81 pooled prevalence estimates, 277 (13%) used validated diagnostic interviews, 1604 (77%) used screening or rating tools, and 213 (10%) used other methods (e.g., unstructured interviews, medical records). Classification methods pooled were accurately described in meta-analysis abstracts for 17 of 81 (21%) prevalence estimates. In 73 meta-analyses based on screening or rating tools or on combined methods, 52 (71%) described the prevalence as being for "depression" or "depressive disorders." Results were similar for meta-analyses in journals with impact factor ≥ 10.

CONCLUSIONS

Most meta-analyses combined estimates from studies that used screening tools or rating scales instead of diagnostic interviews, did not disclose this in abstracts, and described the prevalence as being for "depression" or "depressive disorders " even though disorders were not assessed. Users of meta-analyses of depression prevalence should be cautious when interpreting results because reported prevalence may exceed actual prevalence.

Physician characteristics associated with proper assessment of overstated conclusions in research abstracts: A secondary analysis of a randomized controlled trial

OBJECTIVES

Little is known about the physician characteristics associated with appraisal skills of research evidence, especially the assessment of the validity of study methodology. This study aims to explore physician characteristics associated with proper assessment of overstated conclusions in research abstracts.

DESIGN

A secondary analysis of a randomized controlled trial.

SETTING AND PARTICIPANTS

We recruited 567 volunteers from the Japan Primary Care Association.

METHODS

Participants were randomly assigned to read the abstract of a research paper, with or without an overstatement, and to rate its validity. Our primary outcome was proper assessment of the validity of its conclusions. We investigated the association of physician characteristics and proper assessment using logistic regression models and evaluated the interaction between the associated characteristics and overstatement.

RESULTS

We found significant associations between proper assessment and post-graduate year (odds ratio [OR] = 0.67, 95% confidence interval [CI] 0.49 to 0.91, for every 10-year increase) and research experience as a primary investigator (PI; OR = 2.97, 95% CI 1.65 to 5.34). Post-graduate year and PI had significant interaction with overstatement (P = 0.015 and < 0.001, respectively). Among participants who read abstracts without an overstatement, post-graduate year was not associated with proper assessment (OR = 1.04, 95% CI 0.82 to 1.33), and PI experience was associated with lower scores of the validity (OR = 0.58, 95% CI 0.35 to 0.96).

CONCLUSION

Physicians who have been in practice longer should be trained in distinguishing overstatements in abstract conclusions. Physicians with research experience might be informed that they tend to rate the validity of research lower regardless of the presence or absence of overstatements.

TRIAL REGISTRATION

UMIN000026269.

Influence of overstated abstract conclusions on clinicians: a web-based randomised controlled trial

OBJECTIVES

To investigate whether overstatements in abstract conclusions influence primary care physicians' evaluations when they read reports of randomised controlled trials (RCTs) DESIGN: RCT setting: This study was a parallel-group randomised controlled survey, conducted online while masking the study hypothesis.

PARTICIPANTS

Volunteers were recruited from members of the Japan Primary Care Association in January 2017. We sent email invitations to 7040 primary care physicians. Among the 787 individuals who accessed the website, 622 were eligible and automatically randomised into 'without overstatement' (n=307) and 'with overstatement' (n=315) groups.

INTERVENTIONS

We selected five abstracts from published RCTs with at least one non-significant primary outcome and overstatement in the abstract conclusion. To construct a version without overstatement, we rewrote the conclusion sections. The methods and results sections were standardised to provide the necessary information of primary outcome information when it was missing in the original abstract. Participants were randomly assigned to read an abstract either with or without overstatements and asked to evaluate the benefit of the intervention.

OUTCOME MEASURES

The primary outcome was the participants' evaluation of the benefit of the intervention discussed in the abstract, on a scale from 0 to 10. A secondary outcome was the validity of the conclusion.

RESULTS

There was no significant difference between the groups with respect to their evaluation of the benefit of the intervention (mean difference: 0.07, 95% CI -0.28 to 0.42, p=0.69). Participants in the 'without' group considered the study conclusion to be more valid than those in the 'with' group (mean difference: 0.97, 95% CI 0.59 to 1.36, P<0.001).

CONCLUSION

The overstatements in abstract conclusions did not significantly influence the primary care physicians' evaluations of the intervention effect when necessary information about the primary outcomes was distinctly reported.

TRIAL REGISTRATION NUMBER

UMIN000025317; Pre-results.

Overstatements in abstract conclusions claiming effectiveness of interventions in psychiatry: A meta-epidemiological investigation

Objective

Abstracts of scientific reports are sometimes criticized for exaggerating significant results when compared to the corresponding full texts. Such abstracts can mislead the readers. We aimed to conduct a systematic review of overstatements in abstract conclusions in psychiatry trials.

Methods

We searched for randomized controlled trials published in 2014 that explicitly claimed effectiveness of any intervention for mental disorders in their abstract conclusion, using the Cochrane Register of Controlled Trials. Claims of effectiveness in abstract conclusion were categorized into three types: superiority (stating superiority of intervention to control), limited superiority (intervention has limited superiority), and equal efficactiveness (claiming equal effectiveness of intervention with standard treatment control), and full text results into three types: significant (all primary outcomes were statistically significant in favor of the intervention), mixed (primary outcomes included both significant and non-significant results), or all results non-significant. By comparing these classifications, we assessed whether each abstract was overstated. Our primary outcome was the proportion of overstated abstract conclusions.

Results

We identified and included 60 relevant trials. 20 out of 60 studies (33.3%) showed overstatements. Nine reports reported only significant results although none of their primary outcomes were significant. Large sample size (>300) and publication in high impact factor (IF>10) journals were associated with low occurrence of overstatements.

Conclusions

We found that one in three psychiatry studies claiming effectiveness in their abstract conclusion, either superior to control or equal to standard treatment, for any mental disorders were overstated in comparison with the full text results. Readers of the psychiatry literature are advised to scrutinize the full text results regardless of the claims in the abstract.

Trial registration

University hospital Medical Information Network (UMIN) Clinical Trials Registry (UMIN000018668)

Overstatements in abstract conclusions claiming effectiveness of interventions in psychiatry: a study protocol for a meta-epidemiological investigation

INTRODUCTION

Abstracts are the major and often the most important source of information for readers of the medical literature. However, there is mounting criticism that abstracts often exaggerate the positive findings and emphasise the beneficial effects of intervention beyond the actual findings mentioned in the corresponding full texts. In order to examine the magnitude of this problem, we will introduce a systematic approach to detect overstated abstracts and to quantify the extent of their prevalence in published randomised controlled trials (RCTs) in the field of psychiatry.

METHODS AND ANALYSIS

We will source RCTs published in 2014 from the Cochrane Register of Controlled Trials (CENTRAL) that claim effectiveness of any intervention for mental disorders. The abstract conclusions will be categorised into three types: superior (only stating significant superiority of intervention to control), limited (suggesting that intervention has limited superiority to control) and equal (claiming equal effectiveness of intervention as control). The full texts will also be classified as one of the following based on the primary outcome results: significant (all primary outcomes were statistically significant in favour of the intervention), mixed (primary outcomes included both significant and non-significant results) or all non-significant results. By comparing the abstract conclusion classification and that of the corresponding full text, we will assess whether each study exhibited overstatements in its abstract conclusion.

ETHICS AND DISSEMINATION

This trial requires no ethical approval. We will publish our findings in a peer-reviewed journal.

TRIAL REGISTRATION NUMBER

UMIN000018668; Pre-results.

What to call spinal cord damage not due to trauma? Implications for literature searching

OBJECTIVES

To illustrate the importance of multiple search terms and databases when searching publications on spinal cord damage not due to trauma. To develop comprehensive search filter for this subject, compare the results for 2000-2009 with the Medical Subject Headings (MeSH) and Emtree term 'spinal cord diseases' and determine changes in the number of articles over this period.

DESIGN

Literature searches and search filter development.

SETTING

Australia.

INTERVENTIONS

Titles and abstracts searched in MEDLINE and EMBASE (2000-2009) for articles involving humans using search terms 'non-traumatic spinal cord injury' and 'nontraumatic spinal cord injury' (concise search). Develop comprehensive search filter for 'spinal cord damage not due to trauma' and compare the results with the MeSH term 'spinal cord diseases.'

OUTCOME MEASURES

Annual publications (2000-2009) identified in MEDLINE and EMBASE literature searches.

RESULTS

Concise search identified 35 articles published during 2000-2009. More publications were identified using the term 'nontraumatic spinal cord injury' (n = 20) than 'non-traumatic spinal cord injury' (n = 16). Publications increased for both terms 'spinal cord diseases' (2000 = 279; 2009 = 415) and 'spinal cord damage not due to trauma' identified by the comprehensive search filter (2000 = 1251; 2009 = 1921).

CONCLUSIONS

Concise searches using terms 'non-traumatic spinal cord injury' and 'nontraumatic spinal cord injury' fail to identify relevant articles unless combinations of terms and databases are used. These are inadequate search terms for a comprehensive search. Further research is needed to validate our comprehensive search filter. An international consensus process is required to establish an agreed term for 'spinal cord damage not due to trauma.'

Validation of a formula for assigning continuing education credit to printed home study courses

OBJECTIVES

To reevaluate and validate the use of a formula for calculating the amount of continuing education credit to be awarded for printed home study courses.

METHODS

Ten home study courses were selected for inclusion in a study to validate the formula, which is based on the number of words, number of final examination questions, and estimated difficulty level of the course. The amount of estimated credit calculated using the a priori formula was compared to the average amount of time required to complete each article based on pharmacists' self-reporting.

RESULTS

A strong positive relationship between the amount of time required to complete the home study courses based on the a priori calculation and the times reported by pharmacists completing the 10 courses was found (p < 0.001). The correlation accounted for 86.2% of the total variability in the average pharmacist reported completion times (p < 0.001).

CONCLUSIONS

The formula offers an efficient and accurate means of determining the amount of continuing education credit that should be assigned to printed home study courses.

Evidence-based practice: an examination of its ramifications for the practice of speech-language pathology

PURPOSE

The purpose of this article is to consider some of the ramifications that arise when a discipline newly endorses evidence-based practice (EBP) as a primary guiding principle. Although EBP may appear straightforward, events experienced by peer disciplines that have preceded us in the implementation of EBP raise questions about defining acceptable forms of evidence for treatment effectiveness and efficacy, the potential roles of nonspecific or common factors, therapist quality in achieving therapy outcomes, and eventual applications of EBP that may overly confine which treatments are considered acceptable and reimbursable.

METHOD

Through narrative review of the literature, the article examines valuable as well as controversial features of EBP in addition to obstacles that may impede the transition of evidence (research findings) to clinical practice.

CONCLUSION

EBP is a valuable construct in ensuring quality of care. However, bridging between research evidence and clinical practice may require us to confront potentially difficult issues and establish thoughtful dialogue about best practices in fostering EBP itself.

Using facsimile cascade to assist case searching during a Q fever outbreak

In September 2002, facsimiles were sent to 360 primary-care physicians alerting them to a local outbreak of Q fever. The physicians subsequently submitted serology samples on significantly more patients than in a previously comparable period in 2001. Facsimile cascade assists effective communication with primary-care physicians in an outbreak investigation.

Information Literacy for Speech-Language Pathologists: A Key to Evidence-Based Practice

Purpose

In this tutorial, we review the tenets of information literacy (IL) that parallel and intersect with new American Speech-Language-Hearing Association (ASHA) certification standards requiring clinicians to engage in evidence-based practice (EBP).

Method

A review of the literature on EBP in medical and allied health areas was conducted through an online database search. The Information Literacy Competency Standards for Higher Education (American Library Association, 2004) are used as a framework for outlining IL practices that will aid in EBP.

Results

Current strategies are contrasted with more desirable strategies. Potential barriers to the utilization of information-literate procedures in locating sources of reliable clinical evidence are discussed together with potential solutions.

Conclusion

Suggestions for more efficient information searches by clinicians, as well as a proposed discipline-wide agenda for increasing clinicians' IL skills during and after entry-level graduate training, are provided.

Reading habits of physical medicine and rehabilitation resident physicians

OBJECTIVE

To investigate the focus and extent of the resident physician reading habits, to compare how these change over the years of their training, and to compare these habits with those of physiatrists in practice.

DESIGN

A total of 1,076 surveys were sent to 80 physical medicine and rehabilitation residency programs accredited by the Accreditation Council for Graduate Medical Education. The questionnaire contained a list of 36 journals pertinent to the field of Physical Medicine and Rehabilitation. Resident physicians were asked to indicate which journals they read during the past year and how extensively they read them. Respondents were also asked whether they participated in a journal club and if they read as much as they would like.

RESULTS

A total of 324 surveys (30.1%) were completed correctly. At least half of the surveyed resident physicians scanned or read six journals:Archives of Physical Medicine and Rehabilitation (85.2%), American Journal of Physical Medicine and Rehabilitation (80.6%), Journal of the American Medical Association (68.8%), New England Journal of Medicine (60.5%), American Journal of Sports Medicine (50.9%), and Rehab in Review (49.7%). Most resident physicians (93.9%) responded that they do not read as much as they would like, and 90.1% of resident physicians participate in some form of journal club.

CONCLUSION

Most resident physicians in the field of physical medicine and rehabilitation tend to scan for important articles within one of six journals, with most of these physicians noting that they do not read as much as they would like. As the resident physicians advance in postgraduate-year level, the number of journals that they scan increases. The reading habits of the resident physicians were quite similar to those noted in our previous study of the reading habits of practicing physiatrists.