With the expanding volume of medical literature, meta-analysis, a form of systematic review, has become indispensable for clinicians for evidence-based decision making. While the number of meta-analyses has substantially increased during recent years, there are still controversial issues regarding their methodology, interpretation and clinical application. In this review, the basic concepts of meta-analysis have been discussed from a clinician's perspective in order to facilitate its understanding, appraising and applicability in clinical practice. Although randomised controlled trials are the usual source for meta-analysis, observational studies are also being increasingly considered for meta-analysis. Like every other research design, meta-analysis starts with formulating a question, followed by searching for related data, based on predefined criteria and strategies. Inclusion of studies must be carried out with careful consideration of their quality and assessment of homogeneity using graphical means as well as statistical tools such as Q statistics, I(2) statistics and meta-regression. The pooled effect size is commonly calculated using either a 'fixed effect model' or 'random effect model'. Publication bias and other source of bias should be investigated and the impact of potential confounders should be eliminated as required. Given the above-mentioned considerations, meta-analysis can provide a more precise estimate of an effect size to be used in clinical decision making.

The delivery of healthcare that meets the requirements for quality, safety and cost-

Aims and methodThis study analyses whether there is a relationship between a psychiatry placement during the UK Foundation Programme and appointment to psychiatry training. A survey was distributed to all foundation year 2 doctors in the UK to determine how many have exposure to psychiatry before specialty applications and whether such exposure correlates with choosing psychiatry as a career.ResultsThe study showed that 14.6% of foundation doctors had exposure to psychiatry prior to specialty applications. Of these, 14.9% chose psychiatry as a career in contrast to only 1.8% of those who did not have psychiatry exposure (χ2P = 0.0008; risk ratio 8.19).Clinical implicationsThis study adds weight to calls to increase the proportion of psychiatry posts in the Foundation Programme as part of a broader strategy to improve recruitment. To answer this question categorically, we suggest a prospective cohort study looking at how attitudes and career preferences change with exposure to psychiatry posts.

Aims and methodPsychiatry in the UK has long-standing issues in recruiting UK-trained doctors. A key potential influence on interest in psychiatry during medical school is the clinical attachment. This narrative review investigates how the clinical experience of psychiatry affects medical students' attitudes towards the specialty.ResultsWe identified 107 studies, of which 46 were included. They showed that clinical attachments in psychiatry did result in more positive attitudes towards the specialty and increased career interest. There was inconsistent evidence on whether interest was maintained, with some studies indicating that the increase is transient. Factors which may influence attitudes include attachment setting, duration and student demographics.Clinical implicationsThe results suggest a need to actively maintain interest in psychiatry throughout medical school. Research with long-term follow-up and evaluation of schemes to maintain students' interest is needed.

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