Read between the lines.
No matter where we are or what type of medicine we practice, it is likely that we all were told at one point that we were expected to be lifelong learners. This is important as medical knowledge is constantly evolving. Dr. David Sackett, the father of evidence-based medicine, once said:
The traditional way to stay current is by reading the relevant scientific literature. Except there’s one problem…
I never had anyone actually teach me how to read a research paper…
Do I read it like a book? Beginning to end? Can I skip around? What are the most important parts? What should I pay attention to? Can I skip to the end?
Anatomy of a Paper
Let’s start with the basics and talk about the sections of a paper.
Most traditional research papers have these key sections.
- Abstract – A summary of the entire paper
- Introduction – Provides some background on the topic and sets the stage for the research question being addressed in the paper.
- Methods – How the researchers went about answering the research question and what analyses were performed
- Results – What the researchers found out
- Discussion – A bit more in-depth talk about the results and limitations of the study
- Conclusion – What the authors think you should take away from the study
Whenever we pose a question in science, we embark on a noble quest for truth (or at least a point estimate of truth with a surrounding 95% confidence interval). The problem is that most research studies are imperfect and have biases. Biases are things that may steer us away from the “truth” we are seeking.
It is important to recognize where biases might occur in research and consider how they may impact the study. There’s a whole catalog of potential biases!
How I Have Learned to Read a Paper
The approach I use when reading a paper focuses on the sections that are the most objective, the methods, and the results.
But let’s start from the top:
Read this to determine whether or not this paper is of any interest to you or helps you answer a clinical question. If the answer is no, move on and don’t read this paper.
Unless you do not have any experience or knowledge of the topic being addressed, you can safely skip this section. Authors craft a compelling narrative for why their research topic is important, but this section is subjective. It is not a comprehensive summary of all the previously existing literature on the topic.
This is one of the most important sections of the manuscript. Think critically about whether or not the research design used by the authors to answer their research question was appropriate. Pay attention to what primary and secondary outcomes were specified. Are they patient-oriented outcomes?
If the methods are inappropriate for answering the research question, stop reading. The results and remainder of the paper are likely not useful or reliable.
If the methodology is appropriate, then read the results.
See if the authors reported the primary and secondary outcomes specified in the methods section. Sometimes, there may be discordance here.
Do not just read the text of the results. Scrutinize the tables and charts. The authors sometimes won’t mention everything in what they write. Also, do not forget to review the supplemental material or appendices. You can often find some great information there in the details.
After reading and thinking critically about the methods and results, STOP.
Draw your own conclusions.
Wait what? What about the rest of the paper?
Discussion and Conclusion
You can choose whether or not to read these two sections after you have stopped and drawn your conclusions based on the methods and results.
These sections are also subjective because they represent the authors’ opinions. The authors may provide insight in their discussion about challenges or limitations… or not. After all, who would want to reveal all of the reasons why you should question the conclusions of their research?
Determining the Quality of a Study
Checklists or guides can be handy to help you determine the quality of the study.
Some examples include:
- JAMA Users’ Guide to Medical Literature
- Best Evidence in Emergency Medicine Critical Appraisal Tools
- CASP Critical Appraisal Checklists
You do not have to use all of these tools, but choose one and be consistent!
There will be some who read this blog and disagree with this approach. That is perfectly fine. However, I believe these key principles hold:
Be sceptical. All published, peer-reviewed papers still warrant critical appraisal.
Use a checklist, tool, or guide to help assess the quality of a study.
The methods and results sections are your best friends. They are the only parts of the paper that are objective.
Draw your own conclusions first.
Practice, practice, practice.
Reading and critically appraising scientific papers feel daunting initially but stick with it. As you develop your skills, you will still find that there are times you still have questions. That’s the perfect time to talk nerdy with a colleague or friend.
You can do it! Have fun!
I want to thank the people who inspired, influenced, mentored, and challenged me by teaching me the skills of reading and critically appraising scientific literature.