The science behind helping children with hearing loss and their families is constantly evolving. Clinicians only have so much time to read articles, though, and they may not even be able to access certain publications, depending on professional memberships.
Even if time and access were not barriers, many clinicians working with children who have hearing loss express limited confidence and even frustration in reviewing pediatric hearing research articles. They want to provide children and families with the most up-to-date, evidence-based hearing care possible but may be unsure about how to critically assess studies.
Clinicians with whom I've spoken report a lack of training in study design, statistics, and interpretation as major barriers to evaluating and keeping up with research in their field. Short of returning to school for another degree, here are some practical tips for clinicians to stay current.
Start a journal group.
Finding time to review research articles can be challenging, but having a journal group can help clinicians set aside space in their schedules to read articles relevant to their practice. Schedule a meeting at least once a month to discuss a new or favorite article with a group of colleagues.
Have a different member of the group select the article and lead the discussion for each session. Journal club meetings can happen during a lunch break or over happy hour to keep the discussions fun and informal.
Sign up for electronic table-of-content notifications for your favorite journals.
Most scholarly journals send e-mail notifications with the electronic table of contents for each issue they publish. These notifications are great for skimming the titles of newly available articles. The National Library of Medicine (pubmed.com http://www.pubmed.com/) also allows users to create custom searches for particular topic areas and e-mail alerts for specific journals or keywords.
Identify research questions and hypotheses.
One of the most helpful initial steps in reviewing a paper is to identify the research question and hypotheses, which are usually found in the introduction section.
The research question should identify a gap in our existing understanding of the topic. Ideally, the experiments described in the paper should help to fill this gap, at least partially.
As for the hypotheses, they should be specific predictions about the outcomes of the experiments being conducted.
In pediatric research, the introduction will often include a review of what is known about the topic from the adult literature and how children might be expected to differ from adults.
Move to the tables and figures.
The paper's introduction is typically followed by the methods and results sections. The methods component describes the subjects, stimuli, procedures, and other details about how the study was conducted. The results segment includes a description of the data and any statistical analyses.
The methods and results are typically the most arduous parts of the paper to read. Instead of reading the sections in the order they appear, an alternative approach is to move directly from the introduction to the tables and figures. Do the data displayed there address the research questions and match the hypothesized effects from the introduction?
Examine the average and the range.
In many cases, the average, or mean, is used to describe the results of a study across groups of individuals or conditions. However, there can be significant variability around the average, particularly in pediatric hearing research.
Statistical analyses can take the amount of variability into account, but the overall results are often described by contrasting the mean data.
The range of the data should be evident from tables or figures. If conclusions are made about the pattern of results observed in the study, check to see if there were individual subjects whose data showed a different pattern from the average.
Compare statistical significance versus clinical significance.
Many research studies rely on tests of statistical significance to evaluate the likelihood that the pattern of results observed in a study would be observed again if the experiments were repeated.
Statistical significance depends on the type of statistical test used, the number of children in the study, the variability of performance on the specific outcome measures, and a range of other factors.
However, the statistical significance of a study should not necessarily be used to imply that the pattern of results is clinically or practically significant. Clinical significance assesses whether the effects observed in the study are large enough to influence clinical practice.
For example, a comparison of two different methods of assessing hearing thresholds in children may yield a 3-dB difference that is statistically significant. The fact that thresholds are measured in 5-dB or 10-dB steps, however, could limit the impact of this difference on clinical measures of threshold.
Dissect the discussion.
The discussion section of the paper will often summarize the findings, but it also should include an elaboration of the theoretical and clinical implications of the study, the limitations of the design, and potential directions for future research.
The discussion can help clinicians relate the findings from the results section to clinical practice and determine whether the results observed in the study are likely to generalize to everyday clinical patients and situations.
Clinicians can make a huge impact on their pediatric patients by keeping up with the latest trends in the literature. Despite the challenges of doing that, there are resources to help busy clinicians make evidence-based clinical decisions.
For a more comprehensive introduction to clinical research, interested readers should consider the book Foundations of Clinical Research: Applications to Practice by Leslie Gross Portney and Mary P. Watkins.
Read past Building Blocks columns in a special collection on the HJ website: bit.ly/HJBuildingBlocks http://bit.ly/HJBuildingBlocks.