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Measuring critical-appraisal skills is a key step in assessing physicians' abilities to engage in self-directed learning. The authors developed an instrument to evaluate the abilities of residents to critically appraise a journal article.In 1991, 62 residents in the categorical internal medicine program at the New England Medical Center were asked to respond to a questionnaire, evaluate a sample article, and complete a self-assessment of competence in evaluation of research. Critical-appraisal skill was determined by calculating the resident's deviations from a "gold standard" critique developed through a modified Delphi technique, using a panel of five physicians. Spearman correlation coefficients were used to compare the residents' actual and self-perceived abilities.Twenty-eight residents returned the questionnaire, for a response rate of 45%. The composite score for the residents' objective assessments was 63% of the gold standard, and was not significantly correlated with post-graduate year, prior journal club experience, or self-assessed critical-appraisal skill.After further validation in other settings, the assessment instrument in this study may be used to objectively assess critical-reading skills. It may also provide feedback and measure outcomes for interventions designed to improve critical reading.

We describe a noninvasive quantitative way of measuring muscle with a specially-designed digital ultrasound scanner. Reliability and reproducibility of echo amplitude were determined in 16 normal male volunteers--10 runners and 6 non-runners. Echo amplitudes were recorded from the quadriceps femoris muscle. The muscle was scanned at mid-thigh in a relaxed state with 18 degrees flexion and in an isometrically contracted state with the leg in full extension. Echo amplitudes obtained in the non-runner group were: (1) mean value of the muscle in the relaxed state (174.9 +/- 30.8) and (2) mean value of the muscle in the contracted state (121.8 +/- 31.4). The difference in these values (53.1) was significant at p less than 0.05. Echo amplitudes for runners were: (1) mean value of the muscle in the relaxed state (146.6 +/- 39.2) and (2) mean value of the muscle in the contracted state (107.1 +/- 30.1). The difference in these values (39.5) was significant at p less than -0.01. The data indicate that: values of echo amplitudes are reproducible; there is a statistically significant difference in the mean amplitudes of muscle in a contracted and relaxed state; and while the difference between runner and non-runner muscle is not statistically significant (p greater than 0.1), there is a trend toward significance. Because ultrasound amplitude is a function of tissue structure, this technique may provide a noninvasive method for quantifying muscle collagen and fat.