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Proof of concept: all-virtual guideline development workshops using GRADE during the COVID-19 pandemic
  1. Madelin R Siedler1,2,
  2. M Hassan Murad1,3,
  3. Rebecca L Morgan1,4,
  4. Yngve Falck-Ytter1,5,
  5. Reem A Mustafa1,6,
  6. Shahnaz Sultan1,7,
  7. Philipp Dahm1,8,9
  1. 1 US GRADE Network, Cleveland, Ohio, USA
  2. 2 Kinesiology & Sport Management, Texas Tech University, Lubbock, Texas, USA
  3. 3 Preventive Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
  4. 4 Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
  5. 5 Division of Gastroenterology and Hepatology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
  6. 6 Department of Internal Medicine, University of Kansas Medical Center Department of Internal Medicine, Kansas City, Kansas, USA
  7. 7 Division of Gastroenterology, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
  8. 8 Urology, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
  9. 9 Department of Urology, University of Minnesota, Minneapolis, MN, USA
  1. Correspondence to Professor Philipp Dahm, Urology, Minneapolis VA Health Care System, Minneapolis, USA; pdahm{at}

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The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework is an approach to assessing the certainty of evidence and developing clinical practice recommendations based on a systematic review of the relevant literature.1 Since 2014, the US GRADE Network (USGN) has held a total of 16 semiannual guideline development workshops for attendees ranging from healthcare organisation staff to patients to guideline panel members. Using an in-person format in different cities of the continental USA, experienced educators with extensive methodological background have taught participants how to apply the GRADE approach. In October 2020, the COVID-19 pandemic forced us to shift to a virtual format. Since that time, we have held a total of three online workshops, which provided us with the unique opportunity to compare the experiences of in-person and virtual participants. As part of a routine quality improvement effort and based on our retrospective analysis of post-workshop feedback surveys, we compared attendees’ self-perceived understanding of GRADE, determined how the virtual format affected those participants’ ability to attend, and assessed whether their perceived level of engagement and interaction was similar when compared with that of in-person participants. We present our experience in accordance with the Guideline for Reporting Evidence-based practice Educational interventions and Teaching.2

Characteristics of the workshops

The learning objectives were as follows: After completing the workshop, participants should be able to:

  • Formulate a focused clinical question.

  • Rate the importance of relevant patient-important outcomes, both desirable and undesirable on a scale of 1 (not important) to 9 (critically important).

  • Describe and apply the five domains for rating down the certainty of evidence and the three domains for rating up the certainty of evidence (derived from a body of non-randomised studies).

  • Create evidence profiles/summary of findings tables for a given clinical question based on a systematic review.

  • Apply the GRADE evidence-to decision framework …

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  • Collaborators N/A.

  • Contributors PD developed the study idea and drafted the first manuscript draft. MRS provided substantial revisions and contributed the table and figure. MHM, YF-Y, RAM and RLM all provided considerable input and recommended important revisions.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests All authors are members of the U.S. GRADE Network and the Evidence Foundation. They declare no relevant conflicts of interest. MRS is a fellow of the Evidence Foundation and receives direct financial support.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.