Journal club critical appraisal — CASC/communication-adjacent teaching station · Psych CASC / OSCE

Prompt

You are the psychiatry registrar leading a 10-minute journal club with a foundation doctor and a nurse. You must structure an appraisal of a short antidepressant trial abstract, explain NNT in plain language, and avoid both uncritical acceptance and nihilism.

Station brief

Format. Teaching/communication station, approximately 8–10 minutes. You facilitate appraisal, not monologue. [1]

Candidate instructions. Lead the team through PICO, validity, results, and applicability for the abstract provided in the station materials (or a stem the examiner reads). Explain NNT in non-technical language. Correct misconceptions calmly. Close with a practice-relevant bottom line. [2][3]

Candidate scenario

Abstract summary (station material): RCT of SSRI X versus placebo, N=240, 12 weeks, double-blind, central randomisation, ITT. Response 48% versus 32%. Authors emphasise a "50% relative improvement in response odds" in the press release. Dropout 22% both arms. Primary outcome pre-specified. [4]

Marking domains

Structures discussion: PICO → validity → results → applicability [1][2]
Correctly computes or explains ARR and NNT from 48% vs 32% (ARR 16%, NNT ≈ 7) [3]
Explains why relative claims can mislead without absolute rates
Names key validity strengths (concealment, blinding, ITT) using accessible language [5]
Invites team questions; avoids jargon pile-on or dismissiveness
Applicability: comorbidities, patient values, monitoring, not automatic protocol change
Time management and collaborative tone

Reveal assessor key

Open. "Let's use a four-part structure so we finish on time: question, trust, numbers, patient." Write PICO on the board. [2]

Validity. Highlight central randomisation/concealment, blinding, ITT, pre-specified outcome as reasons to take the result seriously; still note duration, population exclusions, funding if present. [4][5]

Results. CER 32%, EER 48%, ARR 16%, NNT about 7 — "treat about seven similar patients for 12 weeks for one extra responder." Flag press-release relative framing. [3]

Applicability. Match to local patient; discuss side effects, preference for therapy-first options, and follow-up. EBM includes values. [1]

Close. One-line bottom line + offer to pull the full paper CONSORT diagram next week. Thank the team. [1][4]

References

[1]Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS Evidence based medicine: what it is and what it isn't BMJ, 1996.PMID 8555924
[2]Richardson WS, Wilson MC, Nishikawa J, Hayward RS The well-built clinical question: a key to evidence-based decisions ACP J Club, 1995.PMID 7582737
[3]Laupacis A, Sackett DL, Roberts RS An assessment of clinically useful measures of the consequences of treatment N Engl J Med, 1988.PMID 3374545
[4]Schulz KF, Altman DG, Moher D; CONSORT Group CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials BMJ, 2010.PMID 20332509
[5]Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials BMJ, 2019.PMID 31462531

Station brief

Format. Teaching/communication station, approximately 8–10 minutes. You facilitate appraisal, not monologue. [1]

Marking domains

Structures discussion: PICO → validity → results → applicability [1][2]

Correctly computes or explains ARR and NNT from 48% vs 32% (ARR 16%, NNT ≈ 7) [3]

Explains why relative claims can mislead without absolute rates

Names key validity strengths (concealment, blinding, ITT) using accessible language [5]

Invites team questions; avoids jargon pile-on or dismissiveness

Applicability: comorbidities, patient values, monitoring, not automatic protocol change

Time management and collaborative tone

Reveal assessor key

Open. "Let's use a four-part structure so we finish on time: question, trust, numbers, patient." Write PICO on the board. [2]

Results. CER 32%, EER 48%, ARR 16%, NNT about 7 — "treat about seven similar patients for 12 weeks for one extra responder." Flag press-release relative framing. [3]

Applicability. Match to local patient; discuss side effects, preference for therapy-first options, and follow-up. EBM includes values. [1]

Close. One-line bottom line + offer to pull the full paper CONSORT diagram next week. Thank the team. [1][4]

References

[1]Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS Evidence based medicine: what it is and what it isn't BMJ, 1996.PMID 8555924
[2]Richardson WS, Wilson MC, Nishikawa J, Hayward RS The well-built clinical question: a key to evidence-based decisions ACP J Club, 1995.PMID 7582737
[3]Laupacis A, Sackett DL, Roberts RS An assessment of clinically useful measures of the consequences of treatment N Engl J Med, 1988.PMID 3374545
[4]Schulz KF, Altman DG, Moher D; CONSORT Group CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials BMJ, 2010.PMID 20332509
[5]Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials BMJ, 2019.PMID 31462531