The primary purpose of this course is to teach you the skills to read, understand and critique the medical literature. As future physicians, you are obliged to treat patients according to accepted standards of care and to remain current in your field. To do this well, you will need to read the medical journals that are the most important sources of new information in your field of medicine.
Clinical studies provide the evidence in "evidence-based medicine." The results of clinical studies are published as articles in medical journals. These published studies are used to form opinions issued by specialty societies, such as the American College of Pediatrics. The opinions of these societies will inform your medical practice.
In this course, we will teach you how to read and critique medical journal articles using examples from some of the most widely-read journals including the New England Journal of Medicine (published by the Massachusetts Medical Society), the Journal of the American Medical Association (most often referred to by its acronym,"JAMA"), and the Lancet, the most widely-read British medical journal. Scientific studies that appear in these journals are often covered by the media. The journals actively seek such media coverage since they believe it increases their prestige. No doubt, your patients will hear these media reports and they will likely ask for your opinion. Your responses may, in part, be based on your interpretation of the published studies.
The best medical journals select articles for publication based on a process termed, "peer review." In this process, a manuscript describing the results of a study is sent to outside experts by the journal for evaluation. The decision to accept or reject a manuscript rests with the editor of the journal but it is strongly influenced by the reviewers' comments. For most journals the reviewers know the identity of the authors, but the authors do not know the identity of the reviewers. Some physicians wrongly believe that all studies published in peer-review journals, especially the most prestigious journals, must be of good quality or they would not be published. This course may shake your faith. Indeed, we hope it does. It is important that you acquire the skills to judge the quality of a published study for yourself. Your knowledge in this area will be assessed in Part I of the USMLE, given in the second year of medical school.
If at some point in your medical training you would like to be involved in clinical research and conduct data collection and statistical analyses for yourself we recommend you take additional courses in clinical study design and statistical applications appropriate to clinical research. Preparing you to conduct clinical research and data analyses is beyond the scope of this course.
To critique the medical literature you will need to understand the fundamentals of epidemiologic study design, the sources of bias, and the role of chance. You will need to learn the terminology and how to apply it. The most important concepts are covered in the syllabus. The lectures will be used to reinforce these concepts. The small groups will provide you with an opportunity to apply what you have learned from the syllabus and lectures to medical journal articles. The small group sessions are mandatory because this is the only opportunity you will have to apply the theory taught in lectures. For the small group sessions we have chosen journal articles that illustrate the concepts we want you to learn. They have been chosen to coincide with the six patients/ diseases introduced earlier in this semester including HIV, cardiovascular disease and cancer.
The learning objectives that accompany the lectures are your study guide. After reading the material in the syllabus, you should take the self-assessment quiz for that section. If you are still having difficulty with the concepts, come to lectures prepared with your questions. The self-assessment quiz is not graded and can be taken as many times as you wish. Answers are provided.
The on-line homework quizzes are designed to help you learn to apply the theoretical material given in the lectures and syllabus. The format is multiple choice and open book. The grade you receive on the quiz counts toward your final grade. Students are bound by the honor code to do the quizzes as individual work.
Small Group Preparation
Read the articles to be critiqued in each of the small group sessions before you come to small group. As you read the article, try to apply the concepts taught in the lectures/syllabus. Bring a copy of the assigned articles to small group.
Your final grade will be calculated as follows:
Small Group Evaluation (10%)
Students will be evaluated by their small group instructors on their preparation for the small group and their contribution to the class discussions. Small group attendance is mandatory. Two points will be deducted from the small group participation grade for each small group session missed by a student without prior permission from the small group instructor.
Online Quizzes/Homework (20%)
Students must complete the on-line quizzes by the deadline indicated in the schedule that follows. No credit will be given to students who fail to complete the quiz by the deadline without prior permission of the Course Director.
Paper Critique (30%, 30 points)
Students with an honors grade will receive 30 points; high pass, 28 points; pass, 25 points; and low pass, 20 points. Students who fail will receive 15 points. Students who pass in their paper critique after the deadline will be given a maximum grade of low pass.
Final Exam (40%, 40 points)
You must achieve a final grade of at least 65% to pass the course. However, the final grade for the course will be pass or fail.
How to use the syllabus
All the material required to pass this course is contained in the syllabus, readings and assignments. The syllabus is written in two font sizes: 12 point and 10 point. You are responsible for the material presented in 12 point font. Material presented in 10 point font is supplemental material that you should have a passing acquaintance with, may help you with concepts, or may provide more detail for students who wish in increase their depth of knowledge. Lecturers have variably used bold, underline, italic and text boxes for emphasis.
Recommended Text Books
You do not need to purchase a textbook for this course. We recommend that you use textbooks as supplementary reading if you are having trouble with a particular concept. We have included references to pages in these texts that correspond to the material covered in lecture.
Gordis Leon. Epidemiology. 4th ed. Elsevier/Saunders, Philadelphia, 2009.
This is a good basic text designed for students of epidemiology. It goes into many numeric examples in more detail than will be covered in the course.
Pagano Marcello and Kimberlee Gauvreau. Principles of biostatistics. 2nd ed. Australia; Pacific Grove, CA: Duxbury; 2000.
This is a good text that covers the major concepts in biostatistics needed for students of health sciences with a minimum of math (which we all can appreciate!).
Kramer Michael S. Clinical epidemiology and biostatistics : a primer for clinical investigators and decision-makers. Oxford University Press, London, 1988.
Despite its age, this is an excellent book for its organization, brevity, and clarity - a great book for busy medical students who just want to know the bottom line. It has very good examples of basic calculations using numerically simple examples. Some students love this text, while others find it too brief. The text is out of print, so we have placed two copies on reserve in the library.
There will be optional readings.
Course Director: Janet Forrester is the course director. She is an Associate Professor in the Department of Public Health and Community Medicine at the Tufts University School of Medicine. Dr. Forrester graduated from McGill University with a PhD in Epidemiology and Biostatistics. She has conducted numerous epidemiologic studies in the USA and abroad.
Thank you to graduate student Bradley Moore for his help in preparing some of the content.