AKT- Research in general practice

Rachel Nguyen, aged 45, is a GP in regional Victoria who is interested in running a quality improvement project on diabetes care in her clinic. She reviews recent HbA1c data for 112 patients and notices a mean HbA1c of 8.3% with a standard deviation of 1.1%. She wants to determine if this is significantly higher than the national mean HbA1c of 7.5%.

What statistical test should Rachel use to assess this?

Jesse Turnbull, aged 38, is planning a research study on the effectiveness of a new smoking cessation intervention in general practice. He plans to randomise 100 patients into two groups: intervention and usual care. He wants to ensure the groups are comparable at baseline to control for confounding.

What is the MOST appropriate strategy to ensure comparability of groups in this study design?

Isla Thomas, aged 51, reviews a recent RCT comparing two antihypertensive medications. The study reports a relative risk of stroke of 0.60 (95% CI 0.45–0.80) in the intervention group. She is unsure what this means for clinical practice.

How should Isla interpret this result?

Nathan Wallace, aged 60, attends for his annual check-up. His GP, Dr Jasmine Lim, discusses participation in a research study involving a new blood pressure monitoring device. Nathan is interested but asks what his rights are if he agrees to take part and then changes his mind.

Which of the following best describes Nathan’s rights in relation to research participation?

A general practice registrar, Priya Sharma, is reviewing a cross-sectional study examining the association between BMI and depression scores in adult patients. She notes that the authors report a Pearson correlation coefficient (r) of -0.25 with a p-value of 0.01.

How should she interpret these findings?

Gabrielle O’Connor, aged 72, is reading a patient information sheet for a clinical trial on arthritis. The sheet states that the study is double-blinded and placebo-controlled. Gabrielle asks her GP, Dr Wong, what ‘double-blinded’ means in this context.

Which of the following BEST defines a double-blinded study?

Sebastian White, aged 67, has type 2 diabetes. His GP, Dr Ahmed, is reviewing a recent cohort study that suggests a new medication reduces cardiovascular events. The study reports a hazard ratio (HR) of 0.70 (95% CI 0.52–0.94). Dr Ahmed explains this to Sebastian.

What does the reported hazard ratio indicate?

Julian King, a 34-year-old GP registrar, is preparing for his college exams and studying concepts of evidence-based medicine. He is revising the GRADE system used to assess the quality of evidence in guidelines and systematic reviews.

Which of the following would MOST likely lead to a downgrade in the quality of evidence under GRADE?

Olivia Bradshaw, aged 50, is a practice manager helping the GPs at her clinic design a patient satisfaction survey. One of the GPs asks about the best method to maximise response rates.

Which of the following strategies is MOST effective in increasing survey response rates?

Dr Anjali Rao is analysing data from a quality improvement audit on antibiotic prescribing. She compares prescribing rates before and after an educational intervention. Data is paired by individual GP. She wants to know if the intervention significantly reduced prescribing rates.

What is the MOST appropriate statistical test?

Linda Beaumont, aged 29, is reviewing a research paper that reports a statistically significant p-value of 0.03 for an intervention. She is unclear about what this means and asks her GP for clarification.

What does a p-value of 0.03 MOST accurately represent?

Yusuf Ibrahim, aged 46, is a GP undertaking a study on the prevalence of sleep disorders among shift workers. He plans to recruit participants using posters in the local hospital and cafes.

What type of sampling method is he using?

Dr Martin Chan is reading a meta-analysis comparing different treatments for insomnia. The forest plot shows several studies with overlapping confidence intervals and an I² statistic of 70%.

How should Dr Chan interpret the I² value?

Katie O’Donnell, aged 34, is reviewing a prospective cohort study on the effect of physical activity on mental health. The study reports an adjusted odds ratio of 0.6 for depression among those who exercise regularly, with a 95% CI of 0.40–0.90.

What does this result BEST indicate?

During a research presentation, Dr Stephanie Chan states that the study used intention-to-treat (ITT) analysis. An intern asks what ITT analysis means in this context.

Which of the following BEST describes an intention-to-treat analysis?

Gemma Fraser, aged 58, is participating in a clinical trial testing a new cholesterol-lowering drug. She is randomised to receive the active drug. Halfway through the study, she is diagnosed with cancer and withdraws. Her outcome data is not collected.

What is the PRIMARY risk introduced by Gemma’s withdrawal?

Dr Kevin Lo is developing a questionnaire to assess anxiety in adolescent patients attending his clinic. He wants to ensure that it measures anxiety consistently over time and in different contexts.

What psychometric property is Dr Lo MOST concerned with?

Janelle Ritchie, a public health researcher, presents results from her epidemiological study. She reports a prevalence of 8% and an incidence rate of 2 per 1000 person-years for a chronic condition in a defined population.

What does the incidence rate MOST accurately represent?

Tommy Nguyen, aged 36, is a GP registrar conducting an audit on opioid prescribing. He compares the clinic’s data with current guidelines and national averages. He finds that 75% of opioid prescriptions are consistent with guidelines.

Which of the following BEST describes this type of study?

Charlotte Mills, aged 44, is reading a study comparing a new antihypertensive medication to placebo. The absolute risk of stroke was 6% in the placebo group and 3% in the treatment group. She wants to understand what this means in practical terms.

What is the number needed to treat (NNT) to prevent one stroke?

Dr Arjun Patel, a rural GP, is asked to participate in a pharmaceutical company-sponsored trial for a new asthma medication. He is offered a free overseas conference trip if he recruits at least 10 patients.

What is the MOST appropriate course of action?

Dr Zoe Tang conducts a systematic review on treatments for chronic knee pain. She includes only randomised controlled trials and grades each for risk of bias. She notes that most studies are small, unblinded, and have incomplete follow-up.

How should the quality of evidence be classified using GRADE?

Dr Joshua Ng is planning a cluster randomised trial to assess a new chronic disease management program. He randomises entire clinics, rather than individual patients, to intervention or control.

What is the MAIN reason to use a cluster randomised design?

Samira Hassan, aged 52, is reading a newspaper article about a ‘miracle cure’ for obesity based on a case series of five patients. She asks her GP if this is strong evidence for treatment effectiveness.

What is the MAIN limitation of a case series?

During her GP placement, medical student Lily Gao hears a supervisor explain that a recent trial was stopped early due to ‘interim analysis’. She later asks what this typically means.

What is the MAIN purpose of interim analysis in clinical trials?

Elena Partridge, aged 63, is reviewing a study that reports a sensitivity of 95% and a specificity of 60% for a new diagnostic test for bowel cancer. She wants to understand what sensitivity means in this context.

What does a sensitivity of 95% MOST accurately indicate?

Dr Tony Farah is designing a qualitative study exploring patient experiences of telehealth. He plans to conduct in-depth interviews and analyse the transcripts for recurring ideas and themes.

What is the MOST appropriate method of data analysis for this study?

Patricia Yeo, a GP registrar, is reviewing research on screening for cervical cancer. One study reports a positive predictive value (PPV) of 12% for a new test. She asks her supervisor what this figure represents.

What does a positive predictive value of 12% MOST accurately indicate?

Dr Amelia Chen is conducting a focus group with new parents about their experiences with postnatal GP care. During the discussion, she realises one participant dominates the conversation and influences others’ responses.

What is the MOST appropriate strategy to minimise this issue in future focus groups?

A research paper comparing two antihypertensive medications reports a non-inferiority trial design. A medical student asks the supervising GP what this means.

What is the PRIMARY aim of a non-inferiority trial?

Dr James Lee is reviewing an RCT evaluating the effectiveness of a new migraine treatment. The authors state that the trial was powered at 80% with a significance level of 0.05.

What does the 80% power MOST accurately represent?

Louisa Kravitz, aged 48, is considering enrolling in a clinical trial but is unsure how her personal information will be used. Her GP explains that her data will be coded and anonymised to protect her identity.

What principle is BEST demonstrated by this practice?

Dr Sarah Malik is reviewing a case-control study that examines the association between HPV and head and neck cancers. She wants to calculate the strength of association.

What is the MOST appropriate statistical measure to use?

Dr Owen Kelly is presenting a small pilot study at a research meeting. He explains that one purpose of the study was to refine data collection tools and assess feasibility.

What type of study is he MOST likely referring to?

Angela Petros, aged 39, is reading a media article about a ‘new breakthrough’ in arthritis treatment. The article is based on a pre-print paper that has not been peer-reviewed. She asks her GP about the reliability of such studies.

Which of the following is the MOST appropriate response?

Dr Hannah Briggs is reviewing a study that compares two treatments using a confidence interval (CI). The CI for the difference in outcomes is -1.2 to 2.5 and includes 0.

What is the MOST appropriate interpretation of this confidence interval?

Dr Leon Yu is conducting a chart review audit on antibiotic prescribing in upper respiratory tract infections. He is not collecting any patient identifiers, and no intervention is planned.

Which of the following BEST describes the ethics approval requirements for this project?

Dr Sylvia Mendes is analysing data from a longitudinal study. One of her variables is not normally distributed and has several outliers. She wants to compare medians between two independent groups.

What is the MOST appropriate statistical test?

Dr Aisha Noor is supervising a registrar who asks how to identify whether a study’s findings are likely to apply to her patient population.

Which concept MOST directly addresses this question?

Samuel Chin, a medical student, is learning about systematic reviews. He asks what feature distinguishes a systematic review from a narrative review.

Which feature MOST clearly differentiates a systematic review?

Dr Michael Tran is comparing two independent groups of patients with normally distributed blood pressure data. He wishes to assess whether the mean systolic BP differs significantly between them.

Which statistical test should he use?

A general practice registrar is reading a research article. It states that participants were recruited using snowball sampling. She is unsure what this means and asks her supervisor.

Which BEST describes snowball sampling?

Dr Kim O’Leary is analysing data from a randomised controlled trial. She notices that several outcome assessors were aware of participant group allocations.

What type of bias is MOST likely introduced?

Dr Martin Woo is conducting a study involving Indigenous Australian communities. He is advised to seek guidance on culturally safe research practices and community consultation.

Which document provides national ethical guidance on research with Aboriginal and Torres Strait Islander peoples?

During a journal club, Dr Emily Griggs presents a paper that uses regression analysis to control for age, sex, and comorbidities when assessing treatment effects.

What is the PRIMARY purpose of using regression in this context?

Dr Alison Kent is reading a research article about a new diabetes medication. The study’s funding section reveals it was sponsored by the manufacturer of the drug. She is concerned about potential bias.

What type of bias is MOST likely in this situation?

Dr Clare Nguyen is reviewing a paper where the authors report a statistically significant result (p<0.05), but the difference in effect size is clinically minimal.

What is the MOST appropriate interpretation?

Dr Henry Shaw is preparing a patient handout summarising the evidence for managing low back pain. He wants to use the highest level of evidence available to support his recommendations.

Which of the following represents the highest level of evidence in the evidence hierarchy?

Dr Tariq Elmasry is analysing results from a trial where participants with incomplete data were excluded from the final analysis. The authors did not use imputation techniques.

What is the MOST likely consequence of this approach?

Dr Fiona Mackenzie is teaching medical students about the ethics of research. She asks what principle underpins the requirement for all participants to be fully informed before enrolling in a study.

Which principle is MOST closely related to informed consent?