Literature Review
Summarising what the evidence says — so you don't have to re-read every paper ever written on the topic. You're welcome.
A literature review is one of the most intellectually rewarding Quality Improvement Activities a GP trainee can do. Done well, it sharpens your critical appraisal skills, deepens your understanding of a clinical area, and produces something genuinely useful for your practice and your portfolio. This page gives you everything you need — from understanding what counts to producing a write-up that will impress at ARCP.
Last updated: 25 April 2026
📥 Downloads
Handouts, sample reviews, assessment sheets, and teaching extras — ready when you are.
path: LITERATURE REVIEW
🔗 Web Resources
A hand-picked mix of official guidance and real-world GP training resources. Because sometimes the best pearls are not hiding in the official documents.
Core EBM & Literature Review
CASP Checklists
Free critical appraisal checklists for every study type — RCTs, systematic reviews, qualitative research and more.
CEBM Critical Appraisal Tools (Oxford)
Worksheets and worked examples for critically appraising different types of clinical evidence.
Cochrane Library
The gold standard for systematic reviews. Free access to many reviews. Excellent for GP topics.
PubMed / MEDLINE
The primary database for biomedical literature. Free abstract access; full-text often available via NHS OpenAthens.
Google Scholar
Quick, broad searching across academic literature. Useful for initial scoping before moving to formal databases.
TRIP Database
Searches NICE guidelines, Cochrane reviews, clinical evidence and primary research simultaneously.
RCGP & GP Training Guidance
RCGP: QIA Official Guidance
Official RCGP page on what counts as a Quality Improvement Activity, with examples from real GP registrars.
RCGP: QIP Guidance
The official QIP template, feedback levels, and completed examples. Essential reading before any QI activity.
Bradford VTS: Quality Improvement Hub
The parent page for all QI on Bradford VTS — frameworks, PDSA cycles, QIP vs QIA, and practical guidance.
Bradford VTS: Evidence-Based Medicine & Statistics
Comprehensive EBM resources — statistics, critical appraisal, and understanding research for GP trainees.
Databases & Access
NHS OpenAthens
Your free NHS login for full-text journal access. Register with your NHS email — unlocks thousands of papers.
NICE Guidelines
UK's primary source of evidence-based clinical guidelines. Always check here first for your topic.
NICE CKS (Clinical Knowledge Summaries)
GP-friendly summaries of current evidence and guidance. Ideal starting point for your literature review topic.
The BMJ
Leading UK medical journal. Free access to many articles. BMJ Best Practice is also useful for clinical topics.
British Journal of General Practice (BJGP)
The leading primary care journal in the UK. Essential for GP-focused literature reviews.
⚡ Quick Summary
In a hurry? Read this. Then come back to the detail later.
If You Only Read One Thing On This Page
- A literature review is a valid QIA that counts towards your annual RCGP portfolio requirement.
- It is a systematic, critical survey of existing evidence on a specific clinical or professional question — not just a list of papers you read.
- The key difference from a textbook summary: you must critically appraise the studies, identify themes and gaps, and draw conclusions relevant to your practice.
- Use a defined question (e.g. PICO), named databases (PubMed, Cochrane, NICE), and explicit inclusion/exclusion criteria — even for a narrative review.
- The write-up must show: what you searched, what you found, what it means for your practice, and what you will do differently as a result.
- Critical appraisal tools like CASP checklists demonstrate academic rigour — use them and mention them.
- A literature review on a topic relevant to your GP practice is also valuable for tutorials, CbDs, and clinical supervision.
- Upload the QIA as a Learning Log entry on your FourteenFish ePortfolio — not as a separate document upload.
- The RCGP requires at least one QIA per training year. A literature review comfortably satisfies this.
- Common mistake: producing a summary without critical appraisal. That is a reading list, not a literature review.
💡 Why Does This Matter in GP?
🩺 In Real Practice
Every day in GP, you make clinical decisions based on evidence. A patient asks about the benefits of statins. A trainer asks why you chose one antibiotic over another. A colleague questions your approach to depression management.
The ability to find, read, and critically evaluate evidence is not an academic exercise — it is a core GP competency. Literature reviews develop exactly this skill in a structured, documentable way.
📋 In GP Training
The RCGP requires a Quality Improvement Activity every training year. A literature review counts — and it is one of the most intellectually valuable options available.
Unlike some other QIA types, a literature review gives you deep understanding of an area. That understanding then feeds into better consultations, better CbD discussions, and stronger ePortfolio write-ups across multiple capabilities.
Why GP Trainees in Particular Should Do Literature Reviews
You are at the perfect career stage. You have enough clinical experience to ask meaningful questions, but you are also still embedded in a learning culture that supports protected time for research. A trainee who can critically evaluate evidence is a stronger clinician and a more impressive candidate for fellowships, training posts, and future CPD commitments. Start the habit now — revalidation requires it later anyway.
📖 What Is a Literature Review?
A literature review is a critical, structured survey of existing published evidence on a defined topic or question. It is not simply a list of papers you have read. The key word is critical — you are evaluating the quality, relevance, and implications of the evidence, not just describing it.
📌 What it IS
- A critical evaluation of evidence
- Answering a specific question
- Identifying themes & gaps
- Drawing practice conclusions
- Using named databases and search terms
- Applying appraisal tools
❌ What it is NOT
- A reading list or bibliography
- A textbook summary
- An uncritical "what the papers say"
- A journal club write-up of one paper
- A clinical guideline summary only
- A Google search result printout
💡 Why it matters for ARCP
- Counts as your annual QIA
- Evidence for multiple capabilities
- Shows intellectual engagement
- Demonstrates EBM competence
- Useful for tutorial discussions
- Builds lifelong CPD habit
The RCGP's Definition
The RCGP recognises a literature review as a valid QIA. It should be robust, systematic and relevant, involve a personal connection to your work, and demonstrate an element of evaluation and action. The key requirement is that it leads to a change in practice — or a confirmation that current practice is already evidence-based. Either outcome is valid and valuable.
🗂 Types of Literature Review
Not all literature reviews are the same. Knowing the types helps you choose the right one for your question — and describe it correctly in your portfolio.
| Type | What it involves | Best for GP trainees when… | Rigor level |
|---|---|---|---|
| Narrative Review Most common for QIA |
Broad survey of literature on a topic. Flexible structure. Author selects and interprets relevant papers. Synthesises themes. | You want to understand an area thoroughly and answer a broad clinical question. Ideal for QIA. | Moderate |
| Systematic Review Advanced — rare for QIA |
Follows strict protocol: predefined question, comprehensive search, explicit inclusion/exclusion criteria, formal quality assessment of each study. | You have significant time (weeks to months) and want to produce publishable research. Rarely appropriate for QIA alone. | Very High |
| Scoping Review | Maps the breadth of a topic — what is known, what the gaps are, what types of research exist. Less about answering a specific question. | You want to explore a new or emerging area where you are not sure yet what question to ask. | Moderate-High |
| Rapid Review Good for QIA |
A streamlined systematic review — same structure but smaller scope, fewer databases, faster. Used in time-limited settings. | You want the structure of a systematic review but within a realistic GP training timescale. | Moderate-High |
| Critical Review | Highly analytical — focuses on evaluating methodology and quality of each paper in depth. Less about summarising findings, more about evaluating the evidence base. | You are examining a controversial area where evidence quality is highly variable. | High |
Which type should I do for my QIA?
For most GP trainees, a narrative review with structured search methods is the sweet spot. It gives you the academic rigour that impresses supervisors and ARCP panels, without requiring the months of work that a full systematic review demands. The key is to use a defined question, named databases, and explicit search terms — even if your overall approach remains narrative.
💡 Topic Ideas — For When You're Stuck
Staring at a blank page trying to think of a topic? These are areas that have produced strong literature reviews for UK GP trainees — with good evidence bases and clear GP relevance.
| Clinical Area | Example Topic / PICO Focus | Why It Works Well |
|---|---|---|
| Prescribing | Proton pump inhibitor (PPI) deprescribing in long-term users without clear indication | High-quality evidence, strong GP relevance, NICE guidance exists, practical action possible |
| Mental Health | Efficacy of brief psychological interventions for mild-to-moderate depression in primary care | Cochrane evidence available, highly relevant to GP workload, clear capability coverage |
| Antimicrobials | Impact of delayed antibiotic prescribing on patient outcomes in acute respiratory tract infections | Strong RCT evidence, antimicrobial stewardship angle, directly actionable in daily practice |
| Chronic Disease | Effectiveness of structured education programmes (e.g. DESMOND) for type 2 diabetes self-management | Reasonable evidence base, QoF relevance, links to CHES and HPHS capabilities |
| Cardiovascular | Do statins reduce cardiovascular events in primary prevention? What does the evidence show? | Controversial area with lots of literature — great for demonstrating critical appraisal skills |
| Frailty / Elderly | Effectiveness of falls prevention programmes in community-dwelling older adults | Cochrane reviews available, increasingly important in GP, links to MC and HPHS |
| Professional | What is the evidence for brief mindfulness interventions in reducing burnout in doctors? | Growing literature, personally relevant to trainees, links to PLT and FtP capabilities |
| Health Inequalities | Barriers to cervical cancer screening attendance in minority ethnic women in the UK | Qualitative and quantitative evidence, strong CHES and HPHS capability evidence |
The Golden Rule for Topic Choice
The best topic is the one you actually want to know the answer to. If you're going through the motions on a topic you chose because it seemed "safe", that will come through in your write-up. Pick something you've wondered about in clinic — even if it seems small or obvious. The evidence base for many common GP interventions is surprisingly patchy, and finding that out is itself a genuinely interesting discovery.
🏔 The Hierarchy of Evidence
Understanding where different study types sit in the evidence hierarchy helps you critically evaluate papers in your review — and explain why you weighted some evidence more highly than others.
Different types of research evidence carry different levels of reliability. In clinical decision-making, we prefer evidence higher up the hierarchy — where the risk of bias is lower and the reliability is higher.
When writing your literature review, always comment on the level of evidence your key papers represent. A single expert opinion is very different from a meta-analysis of 20 RCTs — and your reviewer needs to see that you understand this.
Practical GP tip on hierarchies
For many clinical topics in primary care, you will not find an RCT. Observational data, cohort studies, and expert consensus are often what exists. This is not a failure of your search — it is an important finding in itself. Noting the absence of high-level evidence for a common GP intervention is a sophisticated and impressive observation.
OCEBM Levels of Evidence — simplified for GP training
🪜 Step-by-Step: How to Do a Literature Review
Follow these steps in order. Each one builds on the last. Do not skip the question-setting stage — it is the most important and most often rushed.
Choose Your Topic & Define Your Question
The best literature reviews come from a real clinical curiosity — a case that puzzled you, a tutorial discussion that raised a question, or a gap you noticed in your knowledge.
- Make the topic specific and manageable. "Management of type 2 diabetes" is a PhD topic. "The evidence for dual antiplatelet therapy duration post-NSTEMI in patients managed in primary care" is a literature review.
- Use the PICO framework to frame your question: Population, Intervention, Comparison, Outcome.
- Example PICO: P = adults with uncomplicated UTI; I = single-dose antibiotic; C = standard 3-day course; O = symptom resolution and recurrence rate.
Define Your Search Strategy
Before searching, plan: which databases, which keywords, what date range, what languages, and what types of study you will include or exclude.
- Use MeSH terms (Medical Subject Headings) in PubMed for more precise searching.
- Combine search terms using Boolean operators: AND narrows results, OR broadens them.
- Document your search terms exactly — this is crucial for demonstrating rigour in your write-up.
- Set a date range (e.g. last 10 years) unless older seminal papers are essential.
Search the Databases
Always search more than one database. No single database covers everything, and a good literature review is comprehensive.
- PubMed — biomedical literature (free; full text often via NHS OpenAthens)
- Cochrane Library — systematic reviews and RCTs (free in UK)
- NICE / NICE CKS — UK clinical guidelines (always include this for GP topics)
- BJGP / BMJ — primary care focused research
- Google Scholar — useful for initial scoping and grey literature
Screen & Select Papers
You will find far more papers than you can read. You need a systematic process for deciding what to include.
- First pass: screen titles and abstracts against your inclusion criteria. Be quick but consistent.
- Second pass: read the full text of promising papers.
- Record why papers were excluded — this shows rigour.
- Aim for a manageable final set of 10–25 papers for a QIA literature review.
Critically Appraise Each Paper
This is the heart of the literature review. Do not just describe what papers say — evaluate the quality of their evidence.
- Use CASP checklists appropriate to the study type (different checklist for RCTs, cohort studies, qualitative research, etc.).
- Key questions: Was the study well-designed? Were there important biases? Are the results generalisable to UK GP?
- You do not need to formally CASP every paper — but you should appraise the most important ones and mention their limitations.
Synthesise & Identify Themes
Now look across your papers as a whole. What themes emerge? Where do papers agree? Where do they contradict each other? What is missing?
- Organise your findings into themes, not a paper-by-paper description. "Paper 1 found X, paper 2 found Y" is weak. "Three studies consistently found X, although two smaller studies reported Y" is strong synthesis.
- Identify gaps in the evidence — this is valuable and sophisticated.
- Note any heterogeneity in study populations or settings that might affect applicability to UK primary care.
Draw Conclusions & Action Points
What does this evidence mean for your practice? This is the most important section for your QIA — without a conclusion and an action point, it does not count as quality improvement.
- State clearly what you will change, maintain, or implement as a result.
- If the evidence confirms current practice, say so explicitly — that too is a valid and valuable conclusion.
- Consider sharing your findings with your team — that multiplies the value.
Write Up & Upload to FourteenFish
The write-up is your evidence. A well-done literature review poorly documented is a missed opportunity. Upload as a Learning Log entry on your FourteenFish ePortfolio.
- Include: your question, your search strategy, what you found, your critical appraisal, your synthesis, and your conclusions.
- Attach your actual literature review document as supporting evidence.
- Map to relevant Professional Capabilities in your reflection.
🔍 Where to Search — A GP Trainee's Toolkit
🩺 Always Search First
- NICE / NICE CKS — UK clinical guidelines; always start here
- Cochrane Library — highest quality systematic reviews
- BJGP — primary care specific evidence
🔬 Core Academic Databases
- PubMed/MEDLINE — biomedical literature; use MeSH terms
- EMBASE — broader coverage; via NHS OpenAthens
- CINAHL — nursing and allied health evidence
🌐 Supplementary Sources
- Google Scholar — scoping; finding grey literature
- TRIP Database — searches multiple sources simultaneously
- BMJ Best Practice — clinical summaries for GPs
🔑 How to Access Full Text Freely
NHS OpenAthens
Register at openathens.net using your NHS email address. This gives you free access to thousands of journals including most major medical titles. Many trainees don't know this exists — now you do. Go register now. Seriously.
RCGP Library
RCGP members have access to journal articles, guidelines, and research resources through the RCGP library service. Contact your RCGP member services if you are unsure how to access this.
🧠 Critical Appraisal — The Heart of the Matter
This is what separates a good literature review from a mediocre one. Anyone can read papers. Critical appraisal means evaluating their quality.
Critical appraisal is the process of systematically examining research evidence to assess its validity, relevance, and results. In a GP context, you are asking: "Should I change my practice based on this evidence?" — and justifying your answer.
Three Core Appraisal Questions
1. Are the results valid?
Was the study well-designed? Was there appropriate randomisation, blinding, or control? Were important confounders accounted for? Could bias have affected the results?
2. What are the results?
How large is the effect? Is the result statistically significant AND clinically significant? What are the confidence intervals? What is the number needed to treat (NNT)?
3. Will the results help my patients?
Are the study patients similar to mine? Are all clinically important outcomes reported? Is the treatment feasible, available, and acceptable in UK GP?
CASP Checklists — Your Best Friend
The Critical Appraisal Skills Programme provides free, study-type specific checklists that guide you through the appraisal process. Use the right checklist for each paper.
| Study Type | CASP Checklist |
|---|---|
| Systematic Review | CASP Systematic Review Checklist |
| Randomised Controlled Trial | CASP RCT Checklist |
| Cohort Study | CASP Cohort Study Checklist |
| Case-Control Study | CASP Case-Control Checklist |
| Qualitative Research | CASP Qualitative Checklist |
| Economic Evaluation | CASP Economic Evaluation Checklist |
All available free at casp-uk.net
Insider Tip — From Trainee Experience
You do not need to formally CASP every paper in your review. A practical approach: use a CASP checklist on your 2–3 most important papers and mention this in your write-up. For the rest, briefly note their study type and any obvious limitations. This demonstrates rigour without turning your QIA into a three-week project. Supervisors at ARCP appreciate thoroughness, but they also understand time constraints — show you know the tools and have used them meaningfully.
📊 Common Biases to Know and Mention
Selection Bias
The study population is not representative of the patients you see in GP. Common in hospital-based studies — does their patient population match yours?
Performance Bias
Differences in care between groups other than the intervention being studied. More common in open-label (unblinded) trials.
Attrition Bias
Participants drop out of the study in a non-random way. High dropout rates — especially differential dropout — can skew results significantly.
Detection Bias
Differences in how outcomes are assessed between groups. Particularly relevant when outcome assessment is subjective or unblinded.
Reporting Bias
Selective reporting of outcomes — or entire studies. Studies with positive results are more likely to be published (publication bias). Important limitation of many literature reviews.
Confounding
A third variable explains the apparent relationship. Especially important in observational studies — was the association causal or coincidental?
📐 Key Statistical Concepts for Critical Appraisal
P-value
The probability that the observed result (or more extreme) occurred by chance if the null hypothesis were true. p<0.05 is the conventional threshold — but statistical significance does not equal clinical significance.
Confidence Interval (CI)
The range within which we are 95% confident the true effect lies. A wide CI means greater uncertainty. A CI that crosses 1.0 (for relative risk) or 0 (for difference) suggests no statistically significant effect.
Number Needed to Treat (NNT)
How many patients need to receive the intervention for one extra patient to benefit. Lower NNT = more effective. Essential for communicating evidence to patients in a meaningful way.
Relative Risk (RR) vs Absolute Risk Reduction (ARR)
A 50% relative risk reduction sounds impressive. If the baseline risk is 2%, the absolute risk reduction is only 1%. Always look at both — pharmaceutical companies love to quote the relative figure. Be suspicious if only one is reported.
Heterogeneity in Meta-Analyses
The I² statistic measures how much variation between studies is due to heterogeneity (true differences) rather than chance. I² >50% suggests substantial heterogeneity — the results of a pooled meta-analysis should be interpreted cautiously.
Generalisability
Were the study participants similar to your patients? Many large trials exclude elderly patients, those with multimorbidity, and those from deprived areas — exactly the patients you see most often in UK GP.
🎨 The Literature Review Process — At a Glance
Some people learn best from pictures. Here are the key frameworks, flowcharts, and visual tools for this topic.
🗺 The Complete Journey — From Question to Portfolio Entry
🎯 PICO Framework — Visualised
PICO is the tool that turns a vague question into a searchable, specific one. Here's how each part works — with an example built in.
🧪 Quick Appraisal Flowchart — Should I Trust This Paper?
When you don't have time for a full CASP checklist, run these five quick questions.
✅ Pre-Submission Checklist — Before You Upload to FourteenFish
Run through this before you submit. Each of these is something ARCP panels look for.
PICO question stated clearly?
Even one sentence counts — as long as it's specific.
Databases named?
PubMed, Cochrane, NICE — state which ones you used.
Search terms included?
What words did you actually type into the search box?
How many papers did you start with vs end up with?
"47 results → 12 included after screening" shows a systematic approach.
Appraisal mentioned?
Even "I used CASP to appraise the Cochrane review" is enough.
Synthesis by themes — not paper by paper?
Group your findings into themes. This is what separates good from great.
Specific action point included?
Not "I will prescribe better" — something real and measurable.
Supporting document attached?
Upload your actual review as a file. The portfolio entry alone is rarely enough.
Professional Capabilities linked?
PLT, OML, DD, CM — at minimum. Add justification for each one.
Did you share it with colleagues?
Optional but highly impressive. Five minutes at a practice meeting counts.
✍️ How to Write Up Your Literature Review
The write-up is as important as the work itself. This is your evidence. Make it count.
🎯 The FRAME Mnemonic — Structure Your Write-Up
Strong vs Weak Write-Ups
| Section | ❌ Weak example | ✅ Strong example |
|---|---|---|
| Question | "I looked at the evidence for antibiotics in UTI." | "Using a PICO framework: in adult women with uncomplicated lower UTI in primary care (P), does a 3-day course of nitrofurantoin (I) compared to a single dose (C) result in higher rates of symptom resolution at 7 days (O)?" |
| Search Strategy | "I searched PubMed and found some papers." | "I searched PubMed, Cochrane Library, and NICE CKS using the terms 'urinary tract infection AND antibiotic AND primary care' with a date range of 2014–2024. I identified 84 papers; after title/abstract screening, 12 met inclusion criteria for full-text review." |
| Appraisal | "The studies showed that 3-day courses are better." | "The Cochrane systematic review (Milo 2019) included 32 RCTs and showed higher resolution rates with 3-day vs single-dose regimens. I applied the CASP systematic review checklist — the review was methodologically sound, though heterogeneity in outcome definitions (I²=61%) means pooled results should be interpreted with caution." |
| Conclusions & Action | "This has been interesting. I will try to prescribe better antibiotics." | "This review confirms that 3-day nitrofurantoin is superior to single-dose treatment for symptom resolution with similar side effect profiles. Current NICE CKS guidance reflects this. I will ensure I discuss treatment duration explicitly in UTI consultations, particularly for patients who ask for single-dose options. I will share these findings at our practice prescribing meeting." |
What Gets You Extra Marks at ARCP
Supervisors consistently note these as the features that distinguish an excellent literature review QIA from an adequate one:
- Explicitly named databases and search terms — shows reproducibility and rigour
- Mentioning the level of evidence for key papers (e.g. "This was a high-quality Cochrane systematic review...")
- Acknowledging limitations of the evidence base — not just limitations of individual papers
- A clear, specific, actionable conclusion — not vague "I will improve my practice"
- Evidence that findings were shared with colleagues — multiplies the quality improvement value
- Noting where evidence is absent — this is a sophisticated and frequently missed observation
📋 Portfolio, ARCP & What Counts
📌 RCGP Requirements Summary
| Training Year | QI Requirement |
|---|---|
| ST1 | 1 QIA (or 1 QIP if in GP post, which counts as QIA too) |
| ST2 | 1 QIA (or 1 QIP if in GP post) |
| ST3 | 1 QIA (Leadership Project required separately) |
| Total | Minimum 1 QIP + 2 QIAs by CCT |
⚠️ Always verify current requirements with the RCGP website — these can change.
📱 FourteenFish ePortfolio
- A literature review QIA goes in the Learning Log — not the QIP section
- Select the QIA log entry type
- Write your reflection using the FRAME structure
- Attach your actual review document as supporting evidence
- Map to Professional Capabilities in the reflection field
- An LEA, reflection on feedback, or leadership project does NOT count as your QIA
Which Professional Capabilities Does It Evidence?
📊 DD — Decision-Making & Diagnosis
Demonstrates evidence-based clinical reasoning and use of research to inform diagnostic thinking.
💊 CM — Clinical Management
Using evidence to formulate management plans; updating practice based on current literature.
📖 PLT — Performance, Learning & Teaching
Active engagement with CPD; reflection on practice; contributing to others' learning if shared.
🔄 OML — Organisation, Management & Leadership
Quality improvement activity; leading change based on evidence; systematic approach to data gathering.
🏘 CHES — Community Health
If your review addresses population health, epidemiology, or public health evidence.
⚖️ EA — Ethical Approach
If the review topic involved ethical dimensions — e.g. prescribing equity, consent, or patient safety evidence.
⚠️ Common Pitfalls — Trainee Traps
The Most Common Reason QIAs Are Rejected at ARCP
A literature review QIA is rejected not because the review was poor — but because the write-up failed to demonstrate critical appraisal, a clear search strategy, or an actionable conclusion. The work was done but the evidence was not visible. Document everything.
❌ Common Mistakes
- No defined question: "I read about hypertension" is not a literature review question.
- Annotated bibliography: Listing papers with brief summaries is not critical appraisal — it is a reading list.
- Only reading NICE guidance: Guidelines are a synthesis of evidence, not the evidence itself. Go to the primary sources.
- No search strategy documented: Without this, you cannot demonstrate that your review is comprehensive or reproducible.
- No conclusion or action: Without this, it does not qualify as a QIA. It must lead somewhere.
- Vague action point: "I will prescribe more carefully" is not an action. "I will discuss antibiotic duration in all UTI consultations and present my findings at the practice meeting" is.
- Choosing too broad a topic: "Management of chronic pain in GP" could fill three systematic reviews. Narrow it down.
- Ignoring conflicting evidence: A review that only presents papers supporting your initial view is not a literature review — it is confirmation bias in action.
✅ What Good Looks Like
- Clearly defined, focused question using PICO
- Named databases, explicit search terms, date range documented
- Evidence of appraisal — CASP checklist applied to key papers
- Synthesis by themes, not paper-by-paper description
- Acknowledges conflicting evidence and explains how you weighted it
- Notes limitations of the evidence base overall
- Clear, specific, actionable conclusion
- Evidence shared with colleagues or practice team
- Mapped to relevant Professional Capabilities in portfolio
- Supporting document (the actual review) attached in ePortfolio
💎 Insider Pearls
Hard-won insights from GP trainee experience. The things people wish they had known earlier.
Insider Tip — Do It When The Question Is Fresh
The best literature reviews are born from a real clinical question that you couldn't answer on the spot. The moment you think "I'm not sure why we do it this way" or "I wonder if there's evidence for this" — that is your literature review topic. Write it down immediately. That intellectual itch, captured while it is fresh, produces a far more engaged and higher-quality review than a topic chosen three weeks before the ARCP deadline.
What Candidates Often Forget
Sharing your findings with colleagues transforms a personal learning exercise into a genuine quality improvement activity. Even a five-minute slot at a practice meeting to say "I reviewed the evidence on X — here are the key findings" elevates your QIA from individual reflection to team-level learning. Supervisors at ARCP notice this — and so will future job interviewers.
What Gets You Good Marks
Mentioning that you searched multiple databases, applied a CASP checklist to at least one paper, and found that the evidence either confirmed or conflicted with current practice — and then stating what you did as a result — will score consistently well at ARCP. You do not need to produce a publishable systematic review. You need to demonstrate that you can engage critically with evidence and change your practice accordingly.
Common Mistake Seen Again and Again
Trainees consistently produce literature reviews that are actually very good pieces of work — and then write them up poorly. They describe what they found without explaining how they found it or why they trusted it. The effort is wasted because the evidence of rigour is absent. Write your search strategy first. Then write your appraisal. The conclusions will follow naturally — and the portfolio entry will speak for itself.
Primary Care Shortcut — The "Golden NICE Check"
For any clinical literature review topic, start with NICE CKS, then NICE guidelines. These already synthesise evidence. Note what they say, which studies they cite, and where the evidence is strong vs where it is based on consensus. Then go to PubMed to look for more recent evidence that might have emerged since the guideline was written. This gives you a structured, defensible starting framework without reinventing the wheel.
When Not to Panic
If you search three databases and find very little high-quality evidence on your topic — do not panic. This is actually a valuable finding. Noting that "a comprehensive search of three major databases revealed limited RCT evidence for this common GP intervention, with existing guidance based primarily on observational data and expert consensus" is a sophisticated and impressive observation. The absence of evidence is itself evidence of a gap. Say so.
💬 What Trainees Say — Real Talk
These are the patterns that come up again and again in GP trainee discussions, peer communities, and trainee blogs across the UK. The kind of things nobody puts in official guidance — but everyone needs to know.
📊 Where Trainees Struggle Most With Literature Reviews
Based on recurring themes from trainee discussions, deanery feedback, and supervisor reports
Common Mistake — "I Did The Work But Forgot To Show It"
This comes up constantly. A trainee puts real effort in — reads 15 papers, takes good notes, changes their prescribing. Then writes two vague paragraphs in FourteenFish. The ARCP panel sees almost nothing. The work was done but the evidence is invisible.
The rule is simple: if you can't see it in the portfolio, it didn't happen. Write it up properly. Attach your document. Show your search terms. Your effort deserves to be visible.
Insider Tip — Use Your Trainer's Brain Before You Start
Before you begin your literature review, spend five minutes with your trainer. Tell them your topic idea and your PICO question. Ask: "Does this feel like the right scope? Would you find a review on this useful?" Trainers almost always have a good sense of whether a topic is too broad, too narrow, or already well-covered by NICE. This one conversation can save you hours of wasted effort.
What Gets You Noticed at ARCP
ARCP panels consistently respond well to three things that most trainees don't include:
- Mentioning explicitly that no high-quality evidence exists for the topic — and what that means for practice
- A named search strategy (even one sentence: "I searched PubMed and Cochrane using the terms X and Y")
- Evidence of sharing findings — a brief mention at a practice meeting turns a personal exercise into quality improvement
What Candidates Often Forget
The best topics come from an "I don't know why we do it this way" moment in clinic. These moments happen several times a week — but trainees rarely capture them. Keep a simple note on your phone called "Literature Review ideas". Every time you wonder something like "Is the evidence actually good for this?" — add it to the list. By the end of a month you'll have five or six genuinely interesting topics to choose from, rather than desperately searching for an idea close to the deadline.
🌲 Choosing Your Topic — A Decision Flowchart
Follow this flowchart to decide if your topic idea is right for a literature review QIA.
The Portfolio Mindset Shift
Most trainees think about the portfolio as a task to complete. The trainees who find it easy are the ones who treat it as a record of genuine learning. A literature review done out of real curiosity — not out of deadline pressure — almost always produces a better write-up. The enthusiasm shows. ARCP panels read hundreds of entries. They can absolutely tell which ones were written from genuine intellectual interest and which ones were typed at 11pm the night before the deadline.
When Not to Panic — The "No Evidence" Finding
Searching four databases and finding almost nothing high-quality on your topic can feel like failure. It isn't. It is actually a sophisticated and valuable finding. Write it up clearly: you conducted a systematic search, you found limited evidence, and current practice appears to be based on consensus or lower-level data. That observation alone is worth something. It helps your colleagues understand why the area is uncertain — and that is genuinely useful.
📝 Before & After — What a Good Write-Up Looks Like
Here's the same QIA at two very different quality levels. Both trainees did roughly the same work. Only one will sail through ARCP.
❌ What Most Trainees Write
"I looked at the evidence for treating urinary tract infections in primary care. I found several studies which showed that antibiotics work. NICE also recommends antibiotics. I found this interesting and will prescribe antibiotics when appropriate for UTIs in future. This has helped me to improve my practice."
❌ No question stated. No search terms. No databases named. No appraisal. No synthesis. Action is meaningless. Will likely be flagged at ARCP.
✅ What a Good Write-Up Looks Like
"PICO question: In adult women with uncomplicated lower UTI in primary care, does a 3-day course of nitrofurantoin result in better symptom resolution than a single dose? I searched PubMed, Cochrane and NICE CKS (2015–2024) using the terms 'urinary tract infection AND antibiotic AND primary care'. I found 12 relevant studies after screening 47 titles. The strongest evidence (Cochrane review, Milo 2019, 32 RCTs) supports 3-day over single-dose regimens for symptom resolution. I applied the CASP RCT checklist to two key papers — both were high quality. Current NICE CKS guidance reflects this evidence. I will ensure I discuss treatment duration explicitly in all UTI consultations, particularly when patients request a shorter course. I shared these findings with our practice team at the monthly clinical meeting."
✓ PICO stated. Databases named. Search terms documented. CASP used. Synthesis made. Action specific. Finding shared. This sails through.
🧠 Cheat Sheet — The Literature Review at a Glance
🔑 Five Things You Must Always Include
- A clearly defined, focused question
- Named databases and explicit search terms
- Critical appraisal of at least the key papers
- Synthesis of themes across papers (not paper-by-paper)
- A concrete action point — what will you do differently?
🔍 Search Terms to Know
| Term | What it means |
|---|---|
| MeSH | Medical Subject Headings — standardised indexing terms used in PubMed |
| Boolean AND | Narrows search — finds papers including ALL terms |
| Boolean OR | Broadens search — finds papers including ANY term |
| Grey literature | Unpublished reports, guidelines, conference abstracts — not in standard databases |
| PICO | Population, Intervention, Comparison, Outcome — framework for defining a research question |
| PRISMA | Preferred Reporting Items for Systematic Reviews — the gold-standard reporting framework |
⏱ Realistic Time Estimates
- Choosing the topic & framing the question: 30 min
- Searching the databases: 1–2 hours
- Screening titles and abstracts: 30–60 min
- Reading selected full-text papers: 2–4 hours
- CASP appraisal of key papers: 1–2 hours
- Writing the review: 2–3 hours
- ePortfolio write-up: 45 min
- Total realistic estimate: 1–2 working days across several weeks
This is not a weekend project. Start early, work in focused chunks, and it is entirely manageable.
Tip: Use Zotero or Mendeley
Reference management software makes literature reviews significantly easier. Zotero is free, works with your browser, and automatically captures reference details from PubMed and journal websites. You can annotate papers, organise them into folders by theme, and automatically generate a reference list. Download it before you start your search.
🎓 Trainer & Teaching Pearls
Specifically for GP trainers, clinical supervisors, and TPDs supporting trainees with literature reviews.
Common Learner Blind Spots on This Topic
- Trainees confuse a literature review with an annotated bibliography
- Critical appraisal tools (CASP) are frequently unknown or underused
- Trainees read guidelines but not the primary studies guidelines cite
- The distinction between statistical significance and clinical significance is widely misunderstood
- Many trainees do not know they have NHS OpenAthens access for full-text journals
- The PICO framework is known but rarely applied correctly to frame the question
- Trainees often fail to note the absence of evidence — a sophisticated and important observation
- Action points in write-ups tend to be vague; trainees need modelling of specific, measurable actions
Tutorial Ideas & Discussion Prompts
📌 Tutorial: Introduction to EBM and Literature Searching
Run a live database search together in the tutorial. Choose a clinical question that arose that week in clinic and search PubMed together in real time. This demonstrates search technique and shows the trainee what is (and is not) available in the evidence base.
- Pick a question from a recent clinical encounter
- Construct a PICO question together
- Search PubMed using MeSH terms — note how results change with different terms
- Look at one paper together and apply the first section of a CASP checklist
- Discuss: is the evidence strong enough to change practice?
📌 Tutorial: Critical Appraisal of a GP Paper
Choose a paper relevant to the trainee's recent clinical experiences or upcoming CbD. Work through a CASP checklist together for 20 minutes, then discuss the paper's implications for your practice.
- Pre-read the paper; ask the trainee to pre-read it too
- Apply CASP checklist questions as a structured discussion, not a rote exercise
- Key question: "Would you change your practice based on this? Why / why not?"
- Explore: statistical significance vs clinical significance — test whether the trainee understands the difference
- Discuss generalisability to your local patient population
📌 Tutorial: Reviewing a Trainee's Literature Review Draft
Ask the trainee to share their draft or emerging literature review ahead of a tutorial. Use these reflective questions to structure the discussion:
- "What question were you trying to answer — can you state it as a PICO?"
- "Which databases did you search and what search terms did you use?"
- "How did you decide which papers to include or exclude?"
- "Which paper do you consider the strongest evidence and why?"
- "Where did the papers disagree — how did you handle that?"
- "What will you actually do differently as a result of this review?"
- "How could this be shared more widely with your colleagues or team?"
📌 Reflective Questions to Test Understanding
- "If a paper had a very significant p-value but a small absolute risk reduction — should I be impressed or cautious?"
- "What would make you trust a cohort study less than an RCT on the same topic?"
- "A Cochrane review concludes there is insufficient evidence to recommend treatment X. Does that mean we should stop using it?"
- "The paper you found was published in 2010. NICE guidance was updated in 2022. Which takes precedence for your practice — and why?"
- "What is the difference between a literature review and a clinical audit?"
📝 How This Connects to the AKT Exam
Doing a literature review properly also sharpens skills you need for the AKT exam. This is a happy coincidence — or perhaps it's exactly how the curriculum was designed.
Critical Appraisal is 10% of the AKT
The AKT is 80% clinical medicine, 10% health informatics and administration, and 10% critical appraisal and evidence-based medicine. That last 10% directly overlaps with what you practise when doing a literature review. Understanding NNT, confidence intervals, relative vs absolute risk, and study types is not just academic — it will come up in the exam.
📐 AKT Stats Topics to Know
- Sensitivity and specificity
- Positive and negative predictive value
- Number needed to treat (NNT)
- Relative risk vs absolute risk reduction
- Confidence intervals — what a CI crossing 1 or 0 means
- P-values — what they mean and don't mean
- Forest plots in meta-analyses
- Heterogeneity (I² statistic)
🔬 Study Design Questions
- When is an RCT better than a cohort study?
- What are the limitations of observational studies?
- When is a cross-sectional study appropriate?
- What is the difference between a meta-analysis and a systematic review?
- What is selection bias vs recall bias?
- What is blinding and why does it matter?
💡 How Literature Reviews Help
- Reading 10–15 real papers makes these concepts stick in a way that a revision book cannot
- You will have seen NNT applied to a real drug, in a real context
- You will have thought about why a trial might not apply to your patients
- You will understand forest plots because you read one — not because you memorised one
- The AKT tests applied understanding — literature reviews build exactly that
Trainee Tip — Use Your Literature Review as AKT Revision
Pick a topic that has a clear evidence base — a drug comparison, a screening programme, a common clinical question. Do your literature review on it. By the time you've read 10 papers and applied CASP to two of them, you'll understand the statistics in a way that no revision book can give you. You'll also have your QIA done. Two birds. One stone. Not a bad deal for a few evenings of focused work.
❓ Frequently Asked Questions
✅ Final Take-Home Points
The Bits To Remember Tomorrow
Everything you need to do a literature review well — condensed into ten points.
Start with a real clinical question — the best reviews come from genuine curiosity, not box-ticking.
Define your question using PICO before you search. A vague question produces an unmanageable review.
Search at least three databases. Always include NICE CKS and Cochrane. Register for NHS OpenAthens today if you haven't already.
Document your search terms, date range, and inclusion criteria. Without this, your review cannot be reproduced — and that matters to supervisors.
Apply a CASP checklist to at least your two or three most important papers. This demonstrates rigour without requiring weeks of work.
Synthesise by themes — not paper-by-paper. "Three studies consistently found X" is synthesis. "Paper 1 found X, paper 2 found Y" is a reading list.
Include a specific, measurable action point. Without this, it is not a QIA. "I will discuss X in future consultations" or "I will present findings at our practice meeting" — specific, real, achievable.
Upload as a Learning Log QIA entry on FourteenFish — not as a QIP. Attach your actual review document as supporting evidence.
Share your findings with colleagues. It takes five minutes in a practice meeting and transforms your personal exercise into team-level quality improvement.
A good literature review today saves you time in the future. When that topic comes up in a CbD, a tutorial, or a patient consultation — you will have the evidence already organised in your head.