- basic template for answering on ‘critically evaluate’ questions in the FCICM exam
- often this is critically evaluate the role of a therapy in a specific condition or patient group
- Rationale – e.g. why was this question important to address?
- Merits (Pros)
- Limits (Cons)
- Evidence – if none or low quality then state that
- My approach – How does all of the above influence how I manage these types of patients, or, in a specific instance, how will this information influence what I do for this particular patient? (ie Tailor to context)
TIPS AND TRAPS
- may need to include key definitions of terms used in the question
- if critically evaluating the role of a therapy (e.g. vasopressin in septic shock), integrate the pathophysiology of the disease with the pharmacology/ features of the therapy. Rationale could also include prevalence of the therapy and/or disease.
- To help generate pros and cons, think about comparisons to alternate therapies and doing nothing. e.g. for vasopressin, consider the specific benefits and adverse effects of the therapy itself, the lack of benefits of alternate therapies, avoidance of adverse effects of other therapies, and avoiding the downsides of no treatment
- There can be overlap between rationale, merits/ limits, and evidence – choose where to put information on a case-by-case basis that is logical and allows the sections to flow. Succinct linking statements may help, e.g. in Limits – “the weight of evidence suggests no benefit for this therapy (see below)” then expand on the evidence in the evidence section below
- There is often no single correct answer to the “My approach” section, however, it should be defensible, be within the range of current practice by your colleagues, and flow logically from the preceding sections
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health, a Clinical Adjunct Associate Professor at Monash University, and the Chair of the Australian and New Zealand Intensive Care Society (ANZICS) Education Committee. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of LITFL.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of two amazing children.
On Twitter, he is @precordialthump.