Reliance on trusted secondary sources, such as clinical practice guidelines, has emerged as a pragmatic solution for evidence-based practice. This editorial underscores the necessity of adapting medical education to equip clinicians with skills aligned with practical clinical demands and introduces a streamlined version of Shaughnessy's G-TRUST tool tailored for swift guideline assessment in clinical settings.

El respaldo en fuentes secundarias fiables, como las guías de práctica clínica, ha surgido como una solución pragmática para el ejercicio de la práctica basada en la evidencia. Este comentario editorial subraya la necesidad de adaptar la educación médica para fortalecer en los profesionales la adquisición de habilidades alineadas con las demandas clínicas prácticas, a la vez que presenta una versión simplificada de la herramienta G-TRUST de Shaughnessy para la evaluación rápida de las guías en entornos clínicos.

Practice Guidelines as Topic Evidence-Based Medicine Quality of Health Care Medical Education Continuing Medical Education Guías de Práctica Clínica como Asunto Medicina Basada en la Evidencia Calidad de la Atención de Salud Educación Médica Educación Médica Continua

Colleagues have recently challenged the traditional emphasis on critical appraisal skills in medical education. The authors of a compelling paper argue that the expectation for clinicians to regularly evaluate the risk of bias in primary studies is unrealistic1. They observe that most clinicians are either uninterested in acquiring sophisticated critical appraisal skills, lack the necessary training, or do not have enough time to apply these skills effectively in their practice. Furthermore, even those who are competent in critical appraisal face limitations in applying these skills in clinical practice due to time constraints. The authors also argue that evidence-based practice for most clinicians can be achieved through selected and trustworthy secondary sources, such as clinical practice guidelines, rather than through direct critical appraisal of primary research. They finally suggest that medical education should focus on teaching clinicians how to identify trustworthy secondary sources of information and understand the quality of evidence they provide. Their approach recognizes the limitations in time and resources that most clinicians face, as well as the practical need to rely on synthesized and evaluated evidence presented in guidelines and systematic reviews1.

The AGREE criteria, initially created for evaluating the quality of guidelines, was not designed to be used in the clinical setting2. Alternatively, Shaughnessy's G-TRUST3 has gained traction as a viable option. However, its extensive scope might render it impractical for use in the generally fast-paced environment of clinical care and clinical teaching. This paper introduces a streamlined version of G-TRUST, which is more suited to meet the practical requirements of physicians and was recently published in a Canadian family medicine journal4. We contend that this simplified approach is effective for swiftly assessing clinical practice guidelines and choosing the highest-quality guidelines that correspond with both clinical demands and patient needs, particularly in scenarios where various guideline options are available.

Montori et al. recently advocated that clinical practice guidelines should consider the time required for clinicians to implement them5. They highlight the challenge of balancing efficient, high-quality care with the practicalities of clinical practice, emphasizing that guideline recommendations should be realistic and not overly time-consuming for clinicians. Similarly, an article published in Evidencia has underscored the importance of balancing the necessary clinician time with the expected benefits when creating or applying clinical guidelines6.

While G-TRUST tool was initially created for continuing professional development, we argue it may be feasible to use in clinical practice, and is valuable in medical education, particularly in this short version (see Table 1).

To effectively appraise clinical practice guidelines using this tool, healthcare practitioners can focus on three critical elements: relevance, interpretation, and confidence.

Healthcare practitioners can use these focused sections in the simplified G-TRUST tool to conduct a structured and useful appraisal of clinical practice guidelines. This process helps identify potential threats to the reliability and applicability of these guidelines, thereby ensuring that the care provided is based on solid, trustworthy, and relevant evidence.

At any point, if any concerns are identified, the use of a guideline should be reconsidered. While the tool can be used to critically appraise a guideline, we believe that one of its strengths lies in its capacity to quickly compare key features between guidelines, to help physicians and learners select the guideline that is best suited for their practice. This represents an interesting way to quickly compare clinical practice guidelines in various settings: formal teaching, during clinical supervision or during continuing medical education conferences. Empowering physicians and learners with this tool may help foster critical thinking and appraising recommendations beyond expert opinion.