Professional Practice and Evidence
What you must know
This domain tests evidence-based practice (ask, acquire, appraise, apply, assess), levels of evidence (systematic reviews/RCTs above cohort/case studies/expert opinion), and critical appraisal concepts: validity, reliability, sensitivity/specificity, likelihood ratios, confidence intervals, and effect size. Know outcome measure properties (reliability, validity, responsiveness, MCID) and how to select a measure. Understand ethics and scope of practice, informed consent, documentation standards, confidentiality, and interprofessional collaboration. Be able to interpret a study result and decide whether it changes practice.
Traps in questions
- Statistical significance ≠ clinical importance: a small effect can be significant in a large sample; check MCID and effect size.
- Sensitivity vs specificity: high sensitivity rules out (SnNout); high specificity rules in (SpPin).
- Reliability vs validity: a test can be reliable but invalid.
- Levels of evidence: a single case report is low-level evidence, not proof of effectiveness.
- Scope of practice: delegating or performing outside competence/regulation is the wrong answer, even if it seems efficient.
- Consent must be informed, voluntary, and ongoing - not a one-time signature.
Rule of thumb
Before changing practice, ask: Is the study valid, are the results important, and do they apply to my patient? Use SnNout/SpPin to reason about test value, and anchor decisions in both evidence and patient values.
Worked example
A trial reports a 3-point DASH improvement (p < 0.01) but the MCID is 10 points. Although statistically significant, the change is below the MCID and unlikely to be clinically meaningful - do not change practice on this alone.