Critical Appraisal in Examinations

The new curriculum frameworks introduced under the Shape of Training initiative (2021–2024) place a renewed emphasis on the application of evidence-based medicine (EBM) across all medical specialities.

While the original Shape of Training report laid the foundation for modernizing postgraduate medical education in the UK, subsequent curricular developments have strengthened the role of EBM in clinical training.

Trainees are now expected to actively integrate EBM principles into their clinical practice. Trainees are encouraged to:

  • Engage with EBM Resources: Utilize available modules and courses to strengthen their understanding and application of EBM.
  • Apply EBM in Clinical Settings: Incorporate EBM principles into daily practice, ensuring that patient care decisions are informed by the best available evidence.
  • Develop Evidence of Competence: Document and present evidence of EBM competencies, aligning with the expectations set forth in updated curricula.

Evidence-based medicine (EBM) & Critical Appraisal Skills

The importance of EBM lies in its ability to improve patient outcomes, standardize care, reduce variability in clinical practice, and support more efficient decision-making.

By combining the best available clinical research with individual clinical expertise and patient preferences, EBM ensures that care is both scientifically sound and person-centered.

A core component of EBM is the ability to critically appraise scientific literature. Critical appraisal skills enable clinicians to evaluate the validity, reliability, and applicability of published evidence before incorporating it into patient care. As such, the development of robust critical appraisal abilities is essential for all trainees—not only as a means of academic competence but also as a tool for maintaining high standards of clinical care in an evolving healthcare landscape.

UK Medical and Dental Specialties Requiring Formal Critical Appraisal in Examinations

In the UK, several medical and dental specialities incorporate formal critical appraisal assessments as part of their training and certification. These evaluations are essential for ensuring that clinicians can effectively interpret and apply evidence-based medicine (EBM) in clinical practice. Below is an overview of the critical appraisal and EBM requirements across various specialities.

Dental Specialties – ISFE (Intercollegiate Specialty Fellowship Exam)

The ISFE is a pivotal examination for dental professionals aiming to attain a specialty fellowship in their respective fields. As of recent updates, the critical appraisal section of the ISFE has undergone changes to better assess candidates' abilities to evaluate scientific literature relevant to their specialty.

Starting from Autumn 2026, the ISFE will be replaced by the Dental Specialty Fellowship Examinations (DSFE), which will be delivered through a unified intercollegiate approach by the four UK and Ireland Surgical Royal Colleges.

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NEW (AUTUMN 2026): Dental Specialty Fellowship Examinations (DSFE)

Starting from Autumn 2026, the ISFE will be replaced by the Dental Specialty Fellowship Examinations (DSFE), which will be delivered through a unified intercollegiate approach by the four UK and Ireland Surgical Royal Colleges. 

The new DSFE assessments will commence in Autumn 2026, with the existing ISFE examinations concluding in 2027.

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Psychiatry (MRCPsych Paper B)

  • Assessment: MRCPsych Paper B (includes Critical Review)
  • Details: MRCPsych Paper B is a written paper which assesses critical review and the clinical topics in psychiatry.
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FRCPath (Medical Microbiology, Haematology, Chemical Pathology)

  • Applicable for: Chemical Pathology (Clinical Biochemistry), Medical Microbiology & Haematology.
  • Assessment: FRCPath Part 2 – Critical Appraisal
  • Details: The Royal College of Pathologists (RCPath) Part 2 examination includes a critical appraisal module. Candidates assess scientific literature in terms of study design, statistical validity, and implications for haematological practice.
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Membership of the Faculty of Occupational Medicine

  • Assessment: Critical appraisal exam
  • Details: Trainees are expected to provide evidence of critical appraisal skills through self-assessment and documentation. This is via a 90-minute written examination and takes place on the day before the OSPE.
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General Surgery – FRCS (Intercollegiate Exam)

  • Assessment: Academic Viva (includes Critical Appraisal
  • Details: Candidates are required to critically assess a published paper, demonstrating their ability to evaluate research methodology, statistics, and clinical applicability.
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Public Health (MFPHM)

  • Assessment: Part A – Critical Appraisal / Part B – Oral Assessment
  • Details: The Membership of the Faculty of Public Health Medicine (MFPHM) examination includes a critical appraisal component, where candidates analyse and apply material from a journal article. Additionally, a dissertation demonstrating competence in critical literature review and assessment of health service effectiveness is required. Part A includes statistical interpretation and appraisal of public health research. Part B may involve discussing evidence-based approaches and critique of research in applied scenarios.
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General Practice (MRCGP)

  • Assessment: Applied Knowledge Test (AKT) – includes Critical Appraisal
  • Details: The Membership of the Royal College of General Practitioners (MRCGP) examination features a critical reading paper designed to test candidates' ability to evaluate and interpret general practice literature, including applying EBM principles to clinical scenarios. The AKT contains questions on statistics, interpretation of research data, and application of evidence-based medicine in general practice.
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Emergency Medicine – FRCEM

  • Assessment: Clinical Topic Review and Oral Discussion
  • Details: The FRCEM Critical Appraisal was withdrawn in 2021. Instead, Candidates now submit two clinical topic reviews involving literature appraisal, with understanding assessed during oral examination.
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Anaesthetics – FRCA

  • Assessment: Final FRCA (Written and SOE) – includes Critical Appraisal
  • Details: The Final Written Exam contains data interpretation and EBM questions. The Structured Oral Exam (SOE) may include discussion of recent clinical trials and critical appraisal of anaesthetic literature.
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