Evidence-Based Practice, Research Methods and Critical Appraisal
Domain focus
This domain tests whether you can turn a clinical uncertainty into a searchable question, appraise evidence and apply it to a patient. The exam expects understanding of study design, bias, effect measures, diagnostic accuracy and guideline use, not memorised statistics alone.
Core rules and concepts
- A PICO question defines population, intervention, comparison and outcome. The design must match the question: randomised trials for treatment, cohort or case-control studies for prognosis or rare exposures, diagnostic accuracy studies for tests, and systematic reviews for synthesis.
- Randomisation and allocation concealment reduce selection bias; blinding reduces performance and detection bias; intention-to-treat analysis preserves randomisation.
- Effect measures include risk ratios, odds ratios, mean differences, confidence intervals and number needed to treat. A p-value alone does not show clinical importance.
- Diagnostic accuracy uses sensitivity, specificity, predictive values and likelihood ratios. Predictive values depend on prevalence.
- Critical appraisal asks whether the study is valid, what the results are and whether they apply to your patient.
- Guidelines are useful when current, transparent and applicable, but they are not a substitute for patient-specific reasoning.
Worked example
A colleague claims a new taping method reduces knee pain because a small trial reported p less than 0.05. Reasoning: check whether the trial was randomised, blinded, adequately powered and used a patient-relevant outcome. A statistically significant mean pain change of 0.4 points on a 10-point scale may be below clinical importance. Look at confidence intervals, adverse events and whether the population matches your patient. Do not adopt the method solely because of a significant p-value.
Traps that cost marks
Confusing statistical and clinical significance; ignoring confidence intervals; using a diagnostic test without prevalence context; and cherry-picking a single study. Another trap is assuming a systematic review is always high quality without appraising search, bias and heterogeneity.
Key points
- Match study design to the clinical question.
- Bias control determines trustworthiness.
- Effect size and confidence intervals matter.
- Diagnostic accuracy depends on prevalence and context.
- Appraise applicability to the individual patient.
Patient Safety, Infection Control and Manual Handling
Domain focus
This domain tests everyday safety behaviours: infection prevention, safe patient handling, equipment use, falls prevention, incident reporting and escalation. The exam expects practical risk assessment before and during treatment, with infection control and manual handling treated as clinical skills rather than paperwork.
Core rules and concepts
- Standard precautions apply to all patients: hand hygiene, risk-based gloves, gowns, masks and eye protection, safe sharps handling, waste segregation and equipment cleaning.
- Hand hygiene follows the WHO moments, including before patient contact, before aseptic tasks, after body fluid exposure, after patient contact and after touching surroundings.
- Clean equipment between patients; follow manufacturer and local policy for disinfection. Do not share contaminated items.
- Manual handling begins with risk assessment: patient size, cooperation, cognition, falls risk, lines, equipment and environment. Use hoists and slide sheets when indicated, and work with trained colleagues.
- Do not lift a patient manually when a hoist is required. Protect your back and the patient by planning the route and checking equipment.
- Report incidents and near misses according to policy; document objectively.
Worked example
A 90-kilogram patient with a stroke cannot weight-bear and needs bed-to-chair transfer. He is confused and has an intravenous line. Reasoning: this is an unsafe manual lift. Check the hoist, sling size and route; explain the procedure; use two trained staff; protect the line; and confirm the chair brakes. Do not attempt a bear-hug lift because he is confused. If the hoist is unavailable, stop and escalate rather than improvise an unsafe transfer.
Traps that cost marks
Using gloves instead of hand hygiene; wearing jewellery or contaminated sleeves; skipping equipment cleaning between patients; and performing manual lifts because it is faster. Another trap is moving a patient without checking lines, drains, cognition or falls risk.
Key points
- Standard precautions apply to every patient.
- Hand hygiene is the core infection control action.
- Clean shared equipment between patients.
- Assess manual handling before moving anyone.
- Use hoists and help; report incidents.