Background: Randomized controlled trials (RCTs) are the gold standard for evaluating the effectiveness of interventions. However, understanding biases arising from a trial can be challenging for medical students to grasp.
Objectives: We used simulation scenarios in a Risk of Bias 2.0 (RoB 2.0) framework and engaged vote cards to teach the various biases that may affect RCTs and assessed whether including this interactive session in an evidence-based medicine course for third-year medical students can optimize their understanding of critical appraisal concepts.
Methods: Prior to this interactive session, third-year medical students were given a two-hour didactic lecture on critical appraisal. During the interactive session, students were given a scenario for each domain of bias, and options in which they could express their appraisal using color vote cards. At the beginning of each module, the facilitator presented a scenario for each domain of bias. Students expressed answers by holding up a red, yellow, or green card, each representing a particular option. Students were asked to explain their rationale and feedback was given by the facilitator after each module. Participants were asked to complete an anonymous survey about their level of satisfaction and understanding of the RoB 2.0 tool.
Results: We included 306 students across two pilot sessions. The students were least able to discern the following problems: baseline imbalances when assessing allocation bias (correct answers: 9.06%), missing outcome data when assessing attrition bias (correct answers: 11.65%), and balanced nonprotocol interventions when assessing performance bias (correct answers: 14.88%). The postcourse survey revealed several aspects of the interactive session that the students appreciated or found challenging.
Conclusions: These simulation scenarios based on a structured RoB framework were feasible for teaching critical appraisal. Through the use of vote cards, we further consolidated critical appraisal concepts, discovered areas that were challenging for medical students to understand, and encouraged their active participation.
Patient, public and/or healthcare consumer involvement: Learning theoretical concepts through didactic lectures can be challenging for medical students. Simulated scenarios and vote cards increase relevancy and can be used to clarify and reinforce abstract concepts. Furthermore, it was engaging, stimulating, and fun.