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Clinical Atlas Prestige · Evidence-first

Psych CASC / OSCEFoundations — research methods and study design

Psych CASC / OSCE · Foundations — research methods and study design

Journal club design critique — CASC/teaching station

MRCPsych/FRANZCP-style teaching/communication station: identify true design, map bias, contrast with proper RCT, name STROBE vs CONSORT, collaborative teaching tone.

communication
On this page & tools

Target exams

FRANZCPMRCPsychABPNMD-DNB

Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
You are the psychiatry registrar facilitating a 10-minute teaching station with a foundation doctor and a medical student. The team has a one-page methods abstract for a study claiming 'Drug Z prevents suicide in bipolar disorder'. Methods text (station material): adults with bipolar disorder attending one tertiary clinic; assigned to Drug Z or usual care by the treating psychiatrist; followed for 12 months; primary outcome suicide attempt; analysis among those with complete follow-up; abstract calls the study a 'randomised real-world trial'. Your job is to teach design identification, redesign principles, bias naming, and which reporting checklist should apply — without humiliating the junior team or overselling nihilism.

Station brief

Format. Teaching/communication station, approximately 8–10 minutes. Facilitate, do not monologue. [1]

Candidate instructions. Help the team correctly name the design, list major bias threats, sketch what a true RCT would require, and choose STROBE vs CONSORT. Keep language accessible. Close with a practice-relevant bottom line about not changing suicide-prevention prescribing from this abstract alone. [2][3][4]

Candidate scenario

Methods summary (station material): non-random clinician assignment to Drug Z versus usual care; single tertiary clinic; 12-month suicide attempt outcome; completer analysis; abstract mislabels the study as randomised. [1]

Marking domains

  • Correctly identifies design as observational cohort / non-randomised comparative, not RCT [1]
  • Names confounding by indication, selection into a tertiary clinic, attrition/completer bias, and mislabelling risk [4][5]
  • Outlines true RCT elements: random sequence, allocation concealment, blinding where feasible, ITT, pre-specified outcome [2][5][6]
  • Assigns STROBE to the study as reported; CONSORT only if redesigned as a true RCT [2][3]
  • Collaborative teaching tone; invites questions; avoids jargon pile-on
  • Bottom line: do not change practice from this abstract alone; seek better designs and absolute risks
  • Time management
Reveal assessor key

Open. "Let's not argue about the drug name yet — first, what design is this actually?" Board: assignment method = clinician choice → not randomised. [1]

Threats. Confounding by indication (who gets Drug Z?), single-clinic generalisability, completer analysis loses people who may have attempted suicide or stopped the drug, and the abstract's "randomised" label is a red flag for spin. [4][5]

Redesign sketch. Eligible bipolar adults → concealed random allocation → Drug Z vs usual care or active comparator → blinded outcome adjudication of attempts → analyse all randomised (ITT) → CONSORT flow. [2][5][6]

Reporting. As written: STROBE observational reporting. If redesigned as RCT: CONSORT. [2][3]

Close. "Interesting signal to generate hypotheses — not enough to rewrite suicide-prevention protocols. Next week we can pull a proper RCT or high-quality cohort." Thank the team. [1][4]

References

  1. [1]Grimes DA, Schulz KF An overview of clinical research: the lay of the land Lancet, 2002.PMID 11809203
  2. [2]Schulz KF, Altman DG, Moher D; CONSORT Group CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials BMJ, 2010.PMID 20332509
  3. [3]von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies Lancet, 2007.PMID 18064739
  4. [4]Grimes DA, Schulz KF Bias and causal associations in observational research Lancet, 2002.PMID 11812579
  5. [5]Hollis S, Campbell F What is meant by intention to treat analysis? Survey of published randomised controlled trials BMJ, 1999.PMID 10480822
  6. [6]Schulz KF, Chalmers I, Hayes RJ, Altman DG Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials JAMA, 1995.PMID 7823387