Towards a broader agenda for training in critical appraisal

Much progress has been made in recent years towards an evidence-based approach to health care, ie the routine framing of an explicit decision sequence in the clinical encounter, the systematic search for published evidence, and the appraisal of relevant research articles. We argue that this is a commendable but limited milestone, and that training in evidence-based health care, particularly the use of critical appraisal techniques, is in need of a broader agenda. We outline a proposal through which the skills and attitudes needed for the critical appraisal of published articles may be applied to all other aspects of clinical practice, from planning research projects to presenting results and guidelines and peer review of articles submitted for publication.