Lesson 1: Teaching Critical Appraisal for Medicos and Non-Medicos

The gap between a medico and a non-medico is mostly a matter of knowledge base — not capability. A self-taught, empowered patient can out-reason a specialist on their own condition. That's the spirit in which this course begins: everyone in this room, technical background or not, is capable of learning critical appraisal and, eventually, evidence-based medicine (EBM).

Every patient who comes to us sick is, in effect, a teacher — handing the medical fraternity a lifelong learning opportunity. Before any data collection, the job is to make that person feel comfortable, treated with empathy and respect, and genuinely supported.

Step 1 — Taking Patient History

History is the patient's story. It can be recorded in the structured way taught in medical school, or in a narrative format that's easier for non-medicos and newcomers. A good history is detailed, timelined, and drawn from reliable sources. Patient problems can be captured:

• Qualitatively — e.g. "shooting pain"
• Quantitatively — e.g. "100°F temperature"
• Narratively — e.g. "pain so bad since morning they couldn't do housework"

Updating the history over time matters — good data capture is one of the most valuable things you can do.

Step 2 — Clinical Examination

Look, feel, touch. Photographs, audio, and video can supplement this. Between history and examination alone, most diseases affecting humankind can already be identified.

Investigations come next — they confirm the provisional diagnosis and let us look more deeply into the body. Together, history and examination answer two core questions:

• What is the problem (listen)
• Where is the problem (examine)

Note: history-taking and examination are already EBM in action — examinations carry their own sensitivity and specificity, and history-taking reveals patient priorities.

Step 3 — What Can Be Done About It

This is where we get our hands into the treatment plan, and into the questions that arise — from the patient or from ourselves — while building a robust plan. But first, three tools worth knowing:

SOAP Notes

Subjective, Objective, Assessment, Plan — a documentation format used by care teams to communicate clearly:

• S — the patient's concern today, in narrative form
• O — objective values: temperature readings, investigation results, etc.
• A — your assessment/examination of the patient now
• P — the treatment plan

Anyone — medico, non-medico, patient, or caretaker — can use this template for daily data.

PaJR — Patient Journey Record

Document the patient's ongoing journey: daily updates, a photo of their food plate, sleep routine, exercise routine, and any other clinically meaningful parameter relevant to the patient. Keeping it focused tends to improve adherence to regular updates.

Identifying Fake News

Fake news is common enough to have its own term — infodemic. You likely already guard against it by:

1. Checking whether a headline is a clickbait
2. Cross-checking the same news across multiple sources
3. Checking sources that are authentic and reliable

Doing any of this means you kept your skepticism and critically analysed the information rather than accepting it at face value. That's critical appraisal — and we're about to apply the same discipline to medical evidence in research papers.

What the Evidence Pyramid Tells Us

Clinical research comes in several types, and it's worth seeing them laid out visually before diving in:

In-vitro and in-vivo pre-clinical studies sit below this pyramid. The pyramid gives a sense of clinical usefulness by level — but it shouldn't create the illusion that lower-level evidence is useless compared to higher-level evidence. Every study type has its own pros and cons, and the ranking blurs in practice.

These three images are enough to get anyone started. Dive deeper as you begin practicing critical appraisal on evidence tied to real clinical questions.

The Easy Way vs. the Hard Way

There are two speeds for critical appraisal. The easy way is quick and gives you the important details. The hard way is slow and gives you deeper understanding.

The hard way means reading the paper in full detail — the data, the statistical analysis, individual patient data where available, possible biases, and funding sources. It can be overkill for a quick clinical question, but it builds real understanding over time.

Pro tip: various CDSS (clinical decision support system) apps offer pre-appraised evidence summaries for common clinical questions — useful shortcuts once you understand what's behind them.

Wait — Are We Missing Something?

Yes: the clinical question. Or, really, the patient. This is exactly what happens too often in medical education — the key beneficiary quietly drops out of the picture. That's not acceptable here.