How to Review a Paper: Critical Appraisal
Critical appraisal is the structured, reproducible assessment of a research paper’s validity, importance and applicability.
In emergency medicine exams (FRCEM SBAs and the CLA OSCE) and in clinical practice you should rapidly determine whether the research question is important, whether the design and conduct allow a reliable answer, whether the results are clinically meaningful, and whether they apply locally.
This section gives a stepwise approach mapped to NICE and RCEM guidance (NICE PMG20/PMG36; RCEM ACAF) and an exam‑focused template you can use in journal clubs or the OSCE.
Core concepts to hold in mind
- Internal validity: whether the study conclusions are believable for the participants enrolled and free from important bias.
- Precision: how certain the effect estimates are, judged by confidence intervals and whether the sample size/power was adequate.
- Effect size and clinical significance: whether the magnitude of effect is clinically important, not just statistically significant.
- External validity (applicability): whether the results can be applied to your patients and healthcare setting.
- Certainty of evidence: how confident we are in the effect estimate across outcomes, using approaches such as GRADE.
- Conflicts of interest and cost: whether funding sources, author conflicts or resource implications could alter interpretation or implementation.
Stepwise critical appraisal (practical sequence)
1. Purpose and research question Start by identifying the primary objective...