A Mixed-methods Approach to Teaching Critical Appraisal of Research to Neurology Residents Through Social Cognitive Theory
Katherine Fu1, Joy Chan1, Katelyn Stepanyan2, Ashley Manchada3, Alonso Zea Vera5, Michelle Vermillion 6, Holly Wilhalme4, Adrienne Keener1, Roy Strowd7
1Neurology, 2Hospice and Palliative Medicine, 3Geriatrics, 4Medicine, Statistics Core, UCLA, 5Children's National Hospital, 6Dean's Office, UCLA David Geffen School of Medicine, 7Wake Forest School Of Medicine
Objective:
Using a social cognitive learning theory (SCLT) framework, the aim of the quantitative phase was to compare two different journal club formats for teaching methodology and clinical application. In the qualitative phase, we explored neurology resident experiences with both formats.
Background:
SCLT and its associated four elements of observational learning: attention, retention, reproduction and motivation, have yet to be explored within journal club formats to teach critical appraisal of research to neurology residents.
Design/Methods:
We implemented a sequential, explanatory mixed-methods design. We conducted four journal clubs: two flipped and two traditional, alternating between the two. We designed parallel pre- and post-test forms and analyzed the change in scores using a linear mixed effects model with fixed effects for format and pre-test score. We documented ethnographic observations and conducted semi-structured interviews with residents. The data is mixed during content analysis of interview data.
Results:
Resident participants (n=18 flipped, 17 traditional) of each journal club completed pre-tests (n=16 flipped, 11 traditional) and post-tests (n=8 flipped, 5 traditional). There was no difference in total (Estimate=8.54%, SE=8.21, p=0.33) and methodology (Estimate=12.98%, SE=10.94, p=0.27) scores. There was a statistically significant increase in clinical application pre- and post-test scores with the flipped format (Estimate = 56.37%, SE = 5.68, p < 0.001). Regarding the flipped format, ethnography noted consistent demonstrations of retention, reproduction, and motivation, and interviews noted limited preparation time and possible interpretive bias when designing the discussion guide.
Conclusions:
These results highlight the strengths of a flipped format that emphasizes retention, reproduction, and motivation in SCLT. Further altering the design to a “no-prep” approach and emphasizing individual interpretation of the data and results of the article may further optimize teaching critical appraisal of research.