Background/Purpose:

Critical appraisal self-efficacy, defined as confidence in one’s ability to appraise the clinical literature, may impact trainees’ ability to optimally use and incorporate literature in practice. Self-efficacy has been shown to influence behavior to engage in subsequent related tasks.¹ Little is known about critical appraisal self-efficacy in rheumatology trainees or how it relates to learning behaviors.

Methods:

All ACGME-accredited rheumatology training programs were invited to enroll trainees in an online learning tool for epidemiology and biostatistics (epi/biostats): Hospital for Special Surgery Critical Literature Assessment Skill Support – Rheumatology (HSS CLASS-Rheum). Once enrolled, trainees completed a Baseline Questionnaire in order to access 10 educational modules. The Baseline Questionnaire included the 6 items most relevant to critical appraisal self-efficacy from the validated 92-item Clinical Research Appraisal Inventory (CRAI),¹ as well as 5 other critical appraisal self-efficacy items developed internally. Items ranged from 0 (no confidence) to 10 (total confidence). Analyses were performed with t-tests, Pearson correlations, and Cronbach’s alpha.

Results:

33/150 programs enrolled in HSS CLASS-Rheum, and 118/125 trainees (94%) completed the Baseline Questionnaire: 63.6% female; 54.2% Caucasian, 31.4% Asian, 4.2% African American; 8.5% Hispanic/ Latino; 47.5% in 1^st year of fellowship, 42.4% 2^nd year; 55% had prior courses in epi/biostats.

The mean score of the 6 items from the CRAI was 4.28 (range 0.5-8.17; 10 highest possible score). These 6 items demonstrated internal consistency (Cronbach’s alpha 0.95) and a strong correlation with our internally developed critical appraisal self-efficacy items (r=0.84; p<0.001). Trainees had significantly lower scores on the 6 CRAI items if they had no previous coursework in epi/biostats (3.6 vs. 4.8; p<0.001), rated their understanding of epi/biostats lower than their peers (3.3 vs. 4.9; p< 0.001), reported being less likely to refer to studies to answer clinical questions (3.8 vs. 4.8; p=0.002), or were planning to enter private practice (3.9 vs. 4.6; p=0.04). Trainees who went on to complete at least 1 of the HSS CLASS-Rheum modules had higher baseline scores on these 6 CRAI items (4.5 vs. 3.6; p=0.02).

Conclusion:

These data suggest that the 6 CRAI items may serve as a useful measure of critical appraisal self-efficacy in rheumatology trainees. Higher scores on these 6 items were associated with prior training in epi/biostats, better self-reported understanding of epi/biostats, as well as with positive learning behaviors including self-reported utilization of the medical literature and objective use of the HSS CLASS-Rheum learning tool. Prospective studies are needed to validate these items as a measure of critical appraisal self-efficacy, evaluate the effect of educational interventions on critical appraisal self-efficacy, and measure the impact of improved critical appraisal self-efficacy on learning behaviors.

References:

1. Mullikin EA, Bakken LL, Betz NE. Assessing research self-efficacy in physician-scientists: the clinical research appraisal inventory. Journal of Career Assessment 2007; 15:367-87.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/critical-appraisal-self-efficacy-and-learning-behavior-in-rheumatology-trainees/