The Clinical Topic Review (CTR) is a required part of the FRCEM – though it is shortly to be phased out as the FRCEM is changing significantly.

StEmlyns

RCEM advice (these links have a tendency to migrate but will be on the RCEM site somewhere)

Writing it

I chose to write mine on Age Adjusted D-Dimer. No doubt like lots of other people. It’s somewhat trendy and has a reasonably small list of decent literature behind it. I felt I knew the topic fairly well to start with as I’d done some local research on it before and being involved in the VTE Dublin conference meant I was exposed to lots of the VTE literature.

One of my current trainers has examined on the CTR before and was able to give me a really good idea of whether or not the topic is doable and passable. There’s no point choosing something putting a bunch of work into it and only then finding out it’s not a goer.

I then met our local librarian to discuss search strategy. Our hospital uses a proprietary EBSCO host interface which searches a lot of different databases. It’s great but having the expertise to provide and be able to reproduce a detailed search with boolean terms was beyond me and 30 mins with the librarian was well worth it and got me up to speed.

The fact that I knew the literature reasonably well before I did my search came in handy as I had an idea of what particular papers I wanted to include (in my case I excluded all papers with retrospective data collection). So when my search came up with 330 abstracts I had a clear description defined about what papers I was going to include and exclude.

Having an objective way to assess the papers looks good on a CTR and I used QUADAS-2 but even after using it I felt that my own reading and critical appraisal of the papers picked up things that the QUADAS-2 was a bit soft on.

The key then is in presentation. How can you make this easy on the reader. Think about it from their perspective. For example my papers presented their results in a mind boggling variety of ways – there was no simple sensitivity/specificity, authors would instead report all kinds of numbers. So i simplified it into broad categories of results rather than present every permutation.

I spent a fair bit of time on the table that summarises the included papers so that this can become the key reference point for the examiner to see the studies compared side by side.

The job of the CTR (in my humble opinion) is to criticise and synthesise the question in a way that makes it easy for the examiner. You can’t sweep problems under the rug just to make it more straightforward for the examiner.

My personal work had thankfully been completed prior to finishing the CTR but it was great to be able to submit something more than a “survey”

The viva

Our local trainers set up a mock viva for us which was by far the most useful thing I did in preparation for the viva.