** Please note ** the FCEM exam is changing in the UK.  The CTR will now be replaced by the Quality Improvement Project (QIP), please follow this link to the college website for more information. We will be updating this page soon.

Clinical Topic Review

CEM CTR Guidance

College advice on writing CTR
Advice on CTR from EMJ by Mike Clancy and Ruth Brown for the CEM
List of CTRs from previous exams

CTR examples

"RSI by Emergency Physicians" Colin Dibble
Echocardiography in Thoracic Trauma” Nick Gili
“IV Magnesium in Acute Paediatric Asthma” Rachel Jenner (FFAEM)
“Anti-emetics for vomiting secondary to gastroenteritis in children” Reddy Mahu
“Physiological Scoring in the Emergency Department” Henry Morriss
Should Personnel who transfer critically ill Children be on a specialist register?” Nick Payne (FFAEM)
“Buckle fractures of the wrist - diagnose and discharge” Gabby May (FCEM 2010)
“Intravenous magnesium sulphate in Acute Paediatric Asthma” Mark Riley (FCEM 2010)

 *Please do not reproduce or distribute*


Critical Appraisal 

Here you will find articles and links to help with revision for the Critical Appraisal exam.

We have just discovered this free Critical appraisal app which looks useful.  Called Critical Appraisal it is available on iOS, Android and Amazon app store

Feedback from 2010 exam
Sample Questions/Answers Sep 10 for this paper
Sample Question/Answer Mar 10 for this paper

Best Practice doing Clinical Audits
CONSORT check list for conducting a Randomised Controlled Trial
Diagnostic Tests
Sample Size Calculation
Likelihood ratio tables
Likelihood ratio presentation
Odds Ratio vs Relative Risk
Parametric vs Non-parametric tests 
Statistical Definitions made simple (thanks to Nick Payne)

Material from FFAEM Critical Appraisal Course:
Concepts and definitions
Systematic Review

Critical Checklists for: (also check out the subheading ‘BestBets CA lists’ for more check lists)
Intervention studies
Diagnostic studies
Systematic reviews

Lectures (Sarah Collins) on:
Diagnostic studies
Yes No Outcomes

Critical Appraisal Course Brighton: CEM Approved Click HERE for more information

Critical Appraisal Course for Emergency Medicine Trainees
Module 1: Concepts and Definitions
Module 2: Statistics
Module 3: Evaluation of Therapy
Module 4: Studies Evaluating Service Organisation and Delivery
Module 5: Evaluation of a Diagnostic Test
Module 6: Systematic Reviews

Examples of Papers with their critical appraisals:
Flanagan Paper and appraisal
Kendall Paper and appraisal
Kline Paper and appraisal
Konstantinides Paper and appraisal
Morrison Paper and appraisal
Ong Paper and appraisal
Rodrigo Paper 1 and appraisal 1
Rodrigo Paper 2 and appraisal 2

Trish Greenhalgh
How to read a paper
Drug trials
Qualitative research
Statistical Tests
Stats 1
Stats 2

The book has a lot more details and is worth reading cover to cover at least once. The details are on the Links and Resources page

BestBets Critical Appraisal Checklists
Case control studies
Cohort Studies
Decision Rules
Diagnostic studies
Economic (cost-benefit) studies
Educational intervention
Clinical Guidelines
Prognostic Studies
Qualitative Studies
Systematic Reviews
Screening Studies
Clinical Trials

For more information about critical appraisal including a large number of completed appraisals done on a wide range of papers, please follow the link to the BestBets website.

EMJ Critical Appraisal

This is a series of articles from The EMJ about critical appraisal in the ED by Steve Goodacre

1. Concept and Definitions
2. Statistics
3. Evaluation of Therapy
4. Evaluation of Service Organisation and Delivery
5. Evaluation of Diagnostic Test
6. Systematic Reviews