On successful completion of this subject, students should be able to:

1. Generate a critical question leading up from a health scenario
2. Locate, navigate and extract relevant data from important sources of health information
3. Examine critically, synthesise and evaluate the basic principles underlying validity of the results of health care outcome studies
4. Evaluate quantitatively the usefulness of diagnostic and screening tests in health care practice
5. Examine critically, synthesise and evaluate point estimates (effect sizes) used in clinical epidemiology
6. Examine critically, and evaluate principles underlying precision of the effect sizes reported in health care research
7. Understand and apply the principles underlying the translation of research results to health care practice
8. Integrate and apply results (generalise) to specific health care problems

1. Introduction and critical questioning: Knowledge gaps during the course of practice and asking foreground questions to fill these gaps, and focused questions that lead to effective search and appraisal strategies. This would involve development of critical questioning, identifying the specific patient population (P), the type of intervention in question (I), a comparison/control condition (C), and the outcomes for the patient population (O), or PICO. The different study designs used to answer critical questions – descriptive, observational and experimental designs and their strengths and weaknesses.
2. Acquiring the information: The use of citation and synthesised (evidence based) library databases.
3. Are the results valid? - Sources of error in evidence such as random error, systematic error (bias) and confounding. Minimizing sources of error that decrease validity in clinical trial design eg allocation concealment, randomisation, blinding, matching, and ‘loss to follow up’. Effect modification and causality.
4. Quantitative aspects of diagnosis/screening:. Sensitivity, specificity, PPV, NPV and likelihood ratios. Introduction to ROC methods.
5. Effect size: Point estimates (measures of association, effect sizes) used in clinical epidemiology such as ratios, proportions, rates, OR, RR.
6. How precise were the study estimates?: Use of descriptive (data types, measures of central tendency and dispersion, normal distribution) and inferential statistics (hypothesis testing) in clinical research studies including P-values and confidence intervals.
7. Are the valid results important: Principles underlying the translation of research results to health care practice. Clinical as opposed to statistical significance and absolute risk indices such as RD, ARR, NNT.
8. Critical appraisal: Critical appraisal of epidemiological evidence, including assessment of study validity, synthesis of results, and consideration of applicability to a given clinical context
9. Systematic reviews, and meta-analysis: Overview and critical appraisal of systematic reviews. Interpreting findings from meta-analyses
10. Judging applicability: Generalizing results to specific health care problems, the threats to generalizability of research findings and the use of adequate sampling models in this respect. The inter-relationships between patient preferences , the clinical state, research evidence and clinical expertise.