Commissioned training might range from one-day workshops (introducing evidence-based healthcare and types of research) to one-week intensive trainer-training programmes (enabling organisations to intensively train key individuals who can then cascade training within their organisation). Alternatively, we can work with health/social care and educational groups or teams who may wish to retrieve and review the evidence around a particular issue, such as health inequality or cancer care. As a consequence, the cost of the training depends on the type and quantity of workshops requested.

If your organisation already understands why evidence-based healthcare is such a powerful principle, on-site workshops can be designed to focus on specific programmes you may need to evaluate or implement from an evidence base. For example, we worked with one Health Authority guiding them through a series of workshops, to identify a cost-effective screening programme for diabetic retinopathy. Our workshops resulted in the decision to fund a direct-access screening clinic at a major hospital.

It is not essential that participants have previous experience of critical appraisal skills or any knowledge of the topic area under consideration.

Workshops are available either as a series of core workshops or can be delivered as a flexible programme of on-site or commissioned workshops. These enable training to be delivered on-site or at a venue of your choice, with the opportunity to have it linked to local patient and service-delivery priorities. This means that questions that are important to your team or organisation can be addressed via the critical appraisal of related evidence. Please contact the project office for further details. The following topics are currently available on-site.

1. INTRODUCTION TO EVIDENCE-BASED HEALTHCARE (1 session) This workshop is most suited to participants who have little or no experience of evidence-based healthcare (EBH) or critical appraisal skills. The basic concepts of EBH are introduced and a range of research methods is overviewed (study designs, statistical terms, interpretation of results).
   
   
2. RESEARCH GOVERNANCE. This interactive workshop explores the practical implications of the Department of Health Research Governance Framework. Ethical issues are considered in a broad context, focusing on some of the indirect and frequently unacknowledged causes of adverse outcomes. These include the harmful consequences of continuing an established practice without questioning its validity, or the equally unethical prolonging of a clinical trial beyond the stage at which there is clear evidence for the efficacy, or otherwise, of a particular intervention. The importance of adhering to relevant good practice guidelines is stressed, with reference to the widespread negative impact of poor research in terms of funding, recruitment and the subsequent dissemination of unsound inferences. The need for critical appraisal skills is emphasised, both as a protection against the acceptance of invalid findings and as an essential precursor to carrying out research that meets the highest scientific and ethical standards.
   
   
3. RANDOMISED CONTROLLED TRIALS (1 session) The evidence that can be derived from one particular type of research - the randomised controlled trial (RCT) - is the focus of this workshop. Using guidelines and checklists, participants appraise one or two RCTs within the context of a relevant decision-making scenario. Special attention is paid to the presentation and interpretation of results, including the concept of Numbers Needed to Treat (NNT).
   
   
4. SYSTEMATIC REVIEWS (1 session) This workshop assumes some basic knowledge of the concepts of evidence-based healthcare and some familiarity with the range of basic research methods. It is assumed that participants have either attended workshop 2 or have otherwise acquired the necessary understanding to critically appraise an RCT, with emphasis on interpreting results and deriving useful data from them (e.g. Numbers Needed to Treat). The session builds on this by introducing systematic reviews and meta-analysis. Consideration is given to the conduct of a systematic search of literature and how to pool quantitative results from relevant studies. When RCTs and Systematic Reviews are delivered over a full day, the first session is spent guiding participants through the critical appraisal of an RCT which is theme-linked to the systematic review presented during the second session.
   
   
5. CRITICAL APPRAISAL OF QUALITATIVE RESEARCH (2 sessions) Starting from the premise that not all evidence of value to health care is quantitative, this workshop considers the scope (and limitations) of qualitative research, its relationship to quantitative research and its relevance to evidence-based healthcare. A structured framework is provided to help participants evaluate evidence generated through qualitative research. The workshop does not assume any in-depth knowledge of qualitative research techniques and the first session is spent reviewing and exploring these in some depth. The second session's main focus is on the critical appraisal of published research in the context of a clinical scenario. This is followed by a review of the effectiveness of the checklist and guidelines as appraisal tools and discussion of the value of qualitative research in informed decision making.
   
   
6. SEARCHING FOR THE EVIDENCE (INCLUDING MEDLINE AND THE INTERNET) (1 or 2 sessions) This workshop gives an introduction to comprehensive search strategies and will improve participants' ability to obtain pertinent information on published research quickly and accurately. The sessions take place in a fully equipped computer-training facility with our experienced librarian trainers. Participants will learn about the Medline, Cochrane and other databases available via the Internet and other networks. They will be taught how to develop effective search strategies for these databases, along with a range of time-saving short cuts.
   
   
7. ECONOMIC EVALUATION The Economic Evaluation (EE) workshops consist of one or more of a series of modules. Each module addresses a specific methodological issue that is pertinent to the process of EE. These workshops can also address specific clinical topics such as the economics of HIV or hepatitis C. It is strongly recommended that all participants attend the basic introduction to EE before taking any other module. The emphasis of the introduction is equally weighted between 'teaching' the basics and critical appraisal, whereas subsequent units emphasise the critical appraisal and use of evidence.
   
   
   1. BASIC INTRODUCTION TO ECONOMIC EVALUATION (2 sessions)
      This workshop assumes no prior knowledge of health economics. The first session is spent de-mystifying some of the terminology of health economics and introducing the different types of studies in this area. The second session develops the notion of healthcare benefit in greater depth and includes critical appraisal of a relevant paper.
      
      
   2. TECHNIQUES OF ECONOMIC EVALUATION:
   • OUTCOME MEASUREMENT AND THEIR APPLICATIONS (1 or 2 sessions) Encompassing how to include health-related quality-of-life into an economic evaluation.
   • DECISION MODELLING (1or 2 sessions) Why do we do it? How do we do it? Uses and abuses.
   • IMPLEMENTATION (1 session) How do we use the results from an economic evaluation?

EXAMPLES OF CLINICAL TOPICS FOR ECONOMIC EVALUATION
(Note: the following list indicative only and other topics are available)

• Antidepressants
• Diabetes
• Hepatitis C (treatments or prevention).
• HIV (treatments or prevention).
• Statins (cholesterol lowering drugs).
• Stroke treatments

7. GUIDELINES (1 or 2 sessions)
   This workshop begins with an overview of guidelines - why they are needed, how to develop, disseminate, evaluate, review and amend them. Particular attention is paid to the types of situations that could benefit most, who should be involved in the development phase, some of the criteria for good guidelines, and how to assess whether they are being used. The general introduction is followed by critically appraising one or two existing guidelines, using a checklist devised for this purpose.
   
   
8. AUDIT (1 session)
   The concept of quality of care and the audit cycle are explored. Typically, a paper reporting a care audit is appraised (an observational study comparing 'before' and 'after') and its relevance to a decision scenario is considered. This topic frequently precedes a session on guidelines.
   
   
9. DIAGNOSIS AND SCREENING (2 sessions)
   These topics are usually presented as two linked sessions. The first session deals with the appraisal of papers reporting the characteristics of diagnostic tests. Topics include test characteristics (sensitivity, specificity and predictive value), the choice of a 'gold standard' and the importance of background prevalence. Likelihood ratios may be introduced as an alternative means of summarising test characteristics and the value of applying a diagnostic technique to a particular clinical decision scenario is assessed. The second session builds on the first by discussing the desirable attributes of screening programmes in the context of a management decision scenario.
   
   
10. PROGNOSIS AND HARM (1 or 2 sessions)
    It has long been recognised that not all quantitative evidence that is of value to health care can be obtained by RCTs. In particular, answers to questions such as "What are my chances, then?", and the estimation of background risk of events occurring in a population (deaths, illness, etc.) may require a prospective cohort design. Given a clinical scenario, the first session considers the essential attributes of a cohort study by critically appraising a particular paper on prognosis. The second session considers further applications and interpretations of longitudinal (cohort or case-control) studies in the context of 'harm', where a randomised design may be unethical.

Contact the NTRAG project office if you have any further questions.