The CLEAR course
At the Royal Australasian College of Surgeons Critical Literature Evaluation & Review Course (CLEAR) in Sydney.
The course teaches surgeons to read published research critically: how to judge whether a study's methods support its conclusions, where bias enters, and when a statistically significant result is not a clinically meaningful one. It is a useful counterweight to the volume of literature published each year, much of which does not hold up to scrutiny.
About the Royal Australasian College of Surgeons
The Royal Australasian College of Surgeons, usually shortened to RACS, is the body responsible for surgical training, examination and continuing professional development in Australia and New Zealand across the surgical specialties. Alongside training registrars and conducting the fellowship examination, it runs courses for surgeons already in practice, of which CLEAR is one.
Why critical appraisal matters in orthopaedics
A great deal is published in orthopaedics each year and the quality is uneven. Studies vary in design, from a case series describing one surgeon's patients through to randomised trials comparing two treatments. What a study can support depends on how it was constructed, who was included and excluded, how long patients were followed and how the outcome was measured.
Several problems recur:
- Short follow up can make a procedure look better than it is, because failures often appear late.
- Patients lost to follow up are rarely lost at random.
- Outcome scores measure different things and are not interchangeable between studies.
- A difference can be statistically significant and still be too small for a patient to notice.
Reading critically means asking those questions before accepting a result, and it is directly relevant to what a surgeon offers patients. Individual results vary.
Registries and the longer view
Joint replacement registries are a partial answer to the limits of individual studies. The Australian Orthopaedic Association National Joint Replacement Registry records joint replacements performed in Australia, including shoulder replacements, and follows them over time. Because it captures national practice rather than a selected series from one unit, it can identify implants and techniques being revised more often than expected, across many surgeons rather than one.
Related information
See also our post on the CLEAR course in Auckland, and our research and publications pages.