Research, Evidence-Based Practice, and Quality Improvement
Research, Evidence-Based Practice, and Quality Improvement
This domain tests whether you can ask an answerable question, appraise evidence, distinguish audit from research, and run a simple improvement cycle. The exam uses clinical scenarios, not statistics for their own sake.
Core rules
- Use PICO: population, intervention, comparison, outcome. Match the design to the question: RCT for effectiveness, cohort for prognosis, qualitative for experience.
- Appraise validity, bias, precision, and applicability; guidelines and systematic reviews sit above single studies.
- Evidence-based practice combines best evidence, clinical expertise, and patient values.
- Audit measures practice against a standard; research generates generalisable new knowledge and needs ethics approval.
- Quality improvement: define an indicator, measure baseline, test a change with PDSA, remeasure, and sustain. Use local data and a clear aim statement; avoid changing several variables at once.
Worked example
A clinic notices rising postpartum haemorrhage. Reasoning: this is an improvement problem. Audit AMTSL compliance and PPH rates, identify gaps, test a checklist or skills drill in one PDSA cycle, remeasure, then spread if effective. It is not research unless you intend to publish generalisable findings.
Traps
Calling an audit "research"; ignoring confounders; cherry-picking evidence; failing to obtain consent for research; and measuring without changing practice.