YEAR 03 • CLINICAL TRANSITION

Research & Evidence-Based Medicine

20 learning units • 100 chapter sections • 200 explained questions. Build a question, judge the evidence and connect the answer with the person receiving care.

Original RAHBAR study material for the Year 3 learning pathway. Educational examples support supervised learning; institutional research and clinical requirements still apply. References & further reading ↓

MODULE 19 / 20

Applying Evidence & Shared Decisions

Translate research into a balanced conversation that respects baseline risk, practical constraints and personal goals.

Quick revision ↓ Medical Dictionary

01Assess applicability

Compare the patient's condition, age, comorbidities, disease severity and available care with the study population and setting. Consider whether exclusions removed the very people you care for. Differences do not automatically make evidence useless, but they create questions about transportability. Separate uncertainty about the treatment effect from uncertainty about the patient's baseline risk and discuss both with appropriate clinical supervision.

02Communicate absolute effects

Natural frequencies with a common denominator and time horizon often make comparisons clearer. Saying that events decrease from 20 in 100 to 10 in 100 over one year conveys more than saying risk is halved. Explain uncertainty and distinguish percentage points from relative percentages. Present benefits and harms using comparable formats so that one option is not made more attractive merely through framing.

03Explore what matters

Ask about the outcomes the person values, previous experiences, treatment burden, costs, practical support and acceptable trade-offs. Explain reasonable options, including watchful waiting when clinically appropriate, and check understanding. Shared decisions are not simply handing over a leaflet or asking for agreement after deciding. A student contributes by clarifying information and priorities within the clinical team's responsibilities.

04Decision thresholds and resources

A worthwhile choice depends on the balance of likely benefits, harms, burden and alternatives. Testing may be useful when its result would change management; additional information can also cause anxiety or unnecessary procedures. Resource use includes travel, time and follow-up capacity as well as price. Consider equity: an option that is effective in a trial may remain inaccessible to people without reliable transport or continuity of care.

05Worked choice and follow-up

Suppose an intervention lowers a one-year adverse-event risk from 10% to 8% but causes bothersome symptoms in some people. The absolute benefit is two fewer events per hundred treated, with NNT 50 for that year. Some patients may favour it; others may prioritise avoiding burden. Explain the uncertainty, agree an appropriate plan with the clinician and patient, and arrange review of adherence, effects and changing preferences.

High-Yield Revision

Use a common denominator and time horizon for benefits and harms.
A patient can reasonably value outcomes differently from the trial average.
Agree how the decision and outcomes will be reviewed.

Common Pitfalls

Do not present only relative benefit while hiding absolute risk.
Do not mistake a signed agreement for an informed shared decision.

References & Further Reading

Use the full methods and relevant chapters when appraising a paper. These sources support further study; the examples and questions above are original teaching exercises.

Reference review: 25 September 2026. Consult current institutional guidance for project approval and clinical decisions.