Psychiatry: practice, law & professional skills
Critical appraisal & evidence-based psychiatry
Critical appraisal is the skill of reading research and judging whether it is trustworthy, important and relevant to the patient in front of you. It is the foundation of evidence-based psychiatry and is examined heavily in specialist exams.
Depth by stage, Pre-U → Consultant (details)
What is it?
New studies about psychiatric treatments appear every week, and some are misleading. Critical appraisal is a structured way of asking: is this study well designed, are the results real, how big is the effect, and does it apply to my patient?
Evidence-based psychiatry combines the best research evidence with clinical experience and the patient's values and circumstances. It underlies clinical practice guidelines, such as Malaysia's MOH Clinical Practice Guidelines and NICE guidance from the UK.
Psychiatrists use appraisal checklists, understand concepts such as bias, confounding, number needed to treat and confidence intervals, and can explain evidence to patients in plain language.
Why does a psychiatrist need it?
Without appraisal skills, psychiatrists can be swayed by marketing, weak studies or headlines. Good appraisal leads to safer, more effective treatment decisions and to honest conversations with patients about benefits and risks.
What level is expected at each stage?
Scale: 1. Aware → 2. Understands → 3. Applies → 4. Masters / Teaches. What the levels mean.
- Pre-UNot expected
- Pre-clinicalAwareLearns basic study designs and biostatistics terms.
- ClinicalUnderstandsAppraises simple papers in journal clubs and evidence-based medicine sessions.
- HousemanshipAwareUses guidelines; little formal appraisal time.
- Medical officerUnderstandsJoins journal clubs and appraises papers relevant to practice.
- Psych traineeAppliesAppraises all major study types and passes exam-level appraisal questions.
- Specialist / consultantMasters / TeachesLeads journal clubs, contributes to guidelines and teaches appraisal.
What are the key topics?
Evidence-based practice
- Asking answerable questions (PICO)
- Searching databases such as PubMed and the Cochrane Library
- Hierarchy of evidence and its limits
- Clinical practice guidelines and GRADE ratings
- Applying evidence with patient values
Appraising studies
- Randomised controlled trials: randomisation, allocation concealment, blinding, intention-to-treat
- Cohort and case-control studies: confounding and bias
- Diagnostic test studies: sensitivity, specificity, predictive values, likelihood ratios
- Systematic reviews and meta-analyses: heterogeneity, publication bias, forest and funnel plots
- Qualitative studies: credibility and transferability
- Economic evaluations (overview)
Numbers that matter
- Relative risk, odds ratio, absolute risk reduction
- Number needed to treat and to harm
- Effect sizes such as standardised mean difference
- Confidence intervals and statistical versus clinical significance
- Survival analysis and hazard ratios (overview)
Tools and checklists
- CASP checklists
- CONSORT, STROBE and PRISMA reporting guidelines
- Risk of bias tools
- Recognising spin and conflicts of interest
How is it learned and assessed?
- Evidence-based medicine sessions and journal clubs in medical school
- Regular journal clubs during MO and trainee years
- MRCPsych Paper B includes a substantial critical review section; MMed (Psychiatry) examinations and dissertation work also test these skills
- Consultants maintain skills through CPD and guideline work
Typical textbooks and resources
- How to Read a Paper — Trisha Greenhalgh
- Evidence-Based Medicine: How to Practice and Teach EBM — Straus and colleagues
- Critical Appraisal for Psychiatry — practical revision guides for MRCPsych candidates
- CASP (Critical Appraisal Skills Programme) checklists
Titles are widely used examples; editions change. Use university libraries or legitimate purchases.
Common questions
What does 'number needed to treat' mean?
It is how many patients need to receive a treatment for one extra person to benefit compared with the alternative. A smaller number means a more effective treatment.
Is critical appraisal tested in psychiatry exams?
Yes. The MRCPsych Paper B has a large critical review component, and Malaysian specialist examinations also test the ability to interpret research.