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Critical Appraisal Skills Programme (CASP)

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Dr Agnes Hibbert, Head of Educational Development, Public Health Resource Unit

The Public Health Resource Unit (PHRU) is an NHS unit set up in 1997 to support developments in public health and evidence-based healthcare in the NHS and beyond.

PHRU is part of the NHS, and has core funding to support the health authorities of Berkshire, Buckinghamshire, Oxfordshire and Northamptonshire. It is managed by a board that has health authority, primary care, NHS trust and Institute of Health Sciences representatives. It is based at the University of Oxford's Institute of Health Sciences, and helps bridge the gap between research and service.

PHRU has around 48 staff, including data analysts, health service researchers and social science researchers (many with a health service professional background), public health doctors and specialists.

PHRU works in five major areas:

  • Educational programmes
  • Project/consultancy work
  • Public health information
  • Support to public health professional development
  • Primary care support.

Educational programmes

The education team runs educational activities, supported by a 'Training the trainer' programme. The educational activities are as follows:

  • Critical Appraisal Skills Programme (CASP) (see Table 1, below)
  • Introduction to Epidemiology (IntrEpid)
  • Using Discern (a tool for critically appraising consumer health information)
  • Public involvement
  • Public health learning sets
  • Interactive learning games.

The PHRU was awarded NHS Beacon status in 1999 for its educational programmes.

Table 1: Critical Appraisal Skills Programme (CASP)

Range

Critical appraisal of:

  • Meta-analyses
  • Systematic reviews
  • Randomised controlled trials
  • Qualitative research articles
  • Economic evaluations
  • Cohort studies
  • Case control studies
  • Diagnostic tests
  • Finding the evidence
  • Using rigorous search strategies
Access

CASP training workshops are 1 day, 11/2 days or 11/2 hours (mini-CASP). The mini-CASP workshops aim to deliver key elements of critical appraisal in a short period and can therefore be undertaken in the workplace or at more convenient times for busy professionals.

Self-directed learning is possible through computer-aided learning (CASPCAL- Workbook and CD-ROM) and paper-based open learning resources.

Availability
CASP training is operated through a cascade model and workshops are organised by regional coordinators with support from central office at PHRU.

Critical appraisal is a systematic way of assessing the validity, results and usefulness of published research papers, and is an essential part of evidence-based practice. Accessing research evidence and changing practice as a result of research are important. Critical appraisal, however, is the route to closing the gap between research and practice and thereby makes an essential contribution to improving healthcare quality.1

CASP's target audience includes all healthcare professionals, social services practitioners, consumers, and those working in other healthcare organisations.

CASP operates a cascade model to disseminate skills, offering 'Train the trainer' programmes and support to regional coordinators.

Since its origins in 1993, CASP has developed a range of workshops offering critical appraisal skills of different research designs and approaches. Developing new products, such as the popular CASP in qualitative research, has resulted in widening audiences. One particular area of ongoing development is programmes such as IMPACT, which helps users of healthcare services to develop skills that better influence decisions about healthcare.

To increase access to skill development, programmes that cover key areas in a short period (e.g. mini-CASP) have been created, enabling them to be delivered at more convenient times and places such as the workplace, or in the evenings, or Aitting within a continuing professional development workshop.

Paper-based open learning packages and CD-ROM computer-based learning have been extremely successful, enabling users to learn all the skills they require, to find and appraise evidence in their own time, in a place that suits them and at a pace that is appropriate to each individual.

Further educational outputs

  • A national networking conference (CASP fest) to support coordinators and trainers of the 70 workshops and 12 'Train the trainer' programmes in 1999–2000, including a CASP newsletter.
  • Further development of the CASP International Training Week offered in July 1999 and now held annually. This event trains healthcare professionals to set up their own cascade system of training and further develops the work of the CASP International Network.
  • Presentations and interactive workshops held at national conferences, such as NICE 2000 and UKPHA 2000.
  • Creation of two new tools to support teaching of public health skills/knowledge by PHRU:
  • Gov is a board game to promote multidisciplinary understanding of the concepts behind and questions raised by clinical governance. This has now been distributed with funding from the Regional Office to all PCGs in the South East Region.

    Capital gains is a game offering a practical illustration of the wider determinants of health.

  • A Guide to Public Health Skills Learning Sets 1999, produced by PHRU, is a handbook for setting up and running learning sets.
  • Further development of programmes such as IMPACT, where professional and lay people gain a better understanding of each other's perspective and develop the skills and confidence to influence decisions made about healthcare.

Project and consultancy work

PHRU undertakes a range of short-term project work spanning primary care to specialist services. Projects are commissioned either from PCG/Ts and health authorities using core funding into PHRU, or independently from any NHS organisation requiring a specific piece of work to be undertaken.

Current work programmes include:

  • National Service Frameworks:

– Cancer audits and evaluations (breast, colorectal, lung, gynaecological)

– Healthcare Resource Groups four counties project

  • Local Specialty Commissioning Group and specialist services:

– Renal mapping and modelling of future requirements to inform local strategy development

– Needs assessment for interventional radiology

  • Our Healthier Nation:

– Development of Health Impact Assessment Rapid Appraisal Tool

– Review of public health requirements for PCG/Ts

– Evaluation of smoking cessation clinics

– Review of the guidance on Director of Public Health Annual Reports

  • Other national priorities:

– Prison health needs assessments.

Public health information

Public health information (also called intelligence) is information about the health of communities. PHRU is involved in collecting, analysing and disseminating health information for a number of nationally required programmes:

  • South East Region Public Health Observatory Core Coordinating Unit
  • Oxford Cancer Intelligence Unit
  • Confidential Enquiry into Still-births and Death in Infancy
  • Drug Misuse Database Unit.

Support to public health professional development

The Public Health Development Team acts as the focus for training and development of public health physicians and specialists in Berkshire, Buckinghamshire, Northamptonshire and Oxfordshire. Activities include:

  • Coordination of training and adoption of pastoral role for specialist registrars in public health medicine in the Oxford Deanery.
  • Facilitation of continuing professional development for public health doctors
  • Facilitation of training and development for people working in multidisciplinary public health (the Public Health Brokerage scheme)

PHRU is also engaged in multidisciplinary public health development in Hampshire and the rest of the SE Region. It is currently undertaking commissioned work for some London health authorities.

Primary care support

PHRU hosts the PCG Resource Unit which undertakes project work to support the development of PCG/Ts. One of the current projects is a repeat prescribing collaborative, funded through the SE Regional Office. Much of the health authority funded project work and consultancy is focused on primary care and PCGs, including development of the role of public health in primary care.

For further information about PHRU, contact Jackie Bowley, Administrator, PHRU, Institute of Health Sciences, Headington, Oxford OX3 7LF (tel 01865 226888; fax 01865 227154) or visit our website at http://www.phru.org.

critical appraisal skills programme (CASP)

Set up 1993
Objectives To enable decision makers, and those who seek to influence them, acquire the skills to make sense of, and act on, the evidence
Funding CASP was originally funded by NHSME Purchaser Development Funds. Anglia & Oxford R&D funded the Development of the programme from 1994, and since 1999 the Non-Medical Education and Training (NMET) Consortia have funded part of its work across the former Anglia & Oxford region.
Key personnel Director of PHRU: Dr Alison Hill
  Head of Educational Development: Dr Agnes Hibbert
  Business Manager: Ms Claire Spittlehouse
  Administrative Assistant: Ms Ann Davis
Contact details Address: PHRU, Institute of Health Sciences, Old Road, Headington, Oxford, OX3 7LF
  Telephone: 01865 226748
  Facsimile: 01865 226959
  E-mail: rowan.williams@phru.anglox.nhs.uk
  Website: http://www.phru.org/casp/

References

  1. Gray JAM. Evidence-based healthcare: how to make health policy and management decisions. Edinburgh: Churchill Livingstone, 1997.

Guidelines in Practice, November 2000, Volume 3
© 2000 MGP Ltd
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