A recent white paper published in JAVMA highlights the challenge veterinarians face to stay informed about current research and practice evidence-based veterinary medicine. Best practice in decision-making includes finding, critically appraising, and synthesizing available research evidence. Too few systematic reviews and meta-analyses mean that veterinarians must find and synthesize the latest information from sources with variable reliability (e.g., websites, continuing education notes, academic research journals). Veterinarians have little time and resources to do this, thus the Evidence-Based Veterinary Medical Association (EBVMA) Board and invited colleagues developed the Quality and Uncertainty Indicator Triage (QUIT) tool to help readers recognize 10 common but important potential concerns in published research so they may rule out a study and set it aside rather than invest time for further critical appraisal.
The QUIT tool is to be used as a preliminary assessment tool to triage studies and is not to be used for ruling in studies for inclusion in decision-making; questions are inadequate to fully assess study validity. This is a subtle but important distinction. Readers are directed to formal Risk of Bias tools for assessing study validity.
Sheila Keay, DVM, MBA, MPH, PhD, is the current president (2025-2027) of the Evidence-Based Veterinary Medical Association (EBVMA). The EBVMA mission is to develop, promote, and share knowledge and resources about evidence-based veterinary medicine with all who have an interest in animal health. Its vision is a world where evidence-based veterinary medicine is consistently used with transparency and good judgment to improve animal health. She answered the following questions on behalf of the authors.
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Q: How did the EBVMA Board develop the format of the QUIT tool?
The QUIT tool started as a series of short podcast explanations of concepts for appraising research; and over many iterations, it evolved into its present form and accompanying online resources and interactive checklist. The QUIT tool consists of 10 binary (i.e., yes/no) questions that can be answered without a technical or nuanced understanding of bias and study design. Rather, these questions are intended as a guide to alert professionals to studies that are not relevant to their clinical question or have major or numerous potential concerns in the design, execution, or reporting of the research.
Q: How can veterinarians integrate the QUIT tool into the development of their clinical skills?
As a caveat, we recommend readers seek systematic reviews as a starting point to inform clinical decision-making. When this is not possible, and veterinarians turn to individual primary research papers, we suggest that QUIT is integrated into a 4-part process.
- Search for applicable studies.
- Apply QUIT to decide to keep or avoid a study.
- Critically appraise kept studies.
- Determine how to assimilate findings into their current knowledge.
On first use, QUIT may be cumbersome to apply. But with repeated use, we hope users will become adept at recognizing and flagging common and important shortcomings of published studies. We have purposely not set definitive thresholds for ruling-out studies and, instead, leave it to the reader to determine their own tolerance for accumulated flags within the context of their purpose for reading the study. We also recommend first-time users of QUIT review explanations of the 10 questions provided in the JAVMA publication.
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Q: At this point in time, the QUIT tool is a prototype that is accessible on the EVBMA website. Have you received feedback that will inform the next version of the QUIT tool?
Initial feedback is that it still takes considerable time to work through the questions. This is anticipated as the answers to the questions are not easily found, for example, in a well-written abstract. We haven’t yet found a work-around for this without compromising our intent. We intend to conduct a validation study to assess QUIT as both a triage tool and learning tool. We’ll assess validity in 2 ways: inter-rater (i.e., consistency of answers between novice users and users proficient with risk of bias tools) and intra-rater (i.e., consistency of answers of novice users before and after receiving instructions about the use of QUIT).
Q: Is there anything you would like our readers to know that has not been mentioned?
Two things:
- Provided we successfully validate QUIT, we hope the tool is helpful for those in the beginning stages of learning how to critically appraise research studies and that its use will be encouraged by educators.
- Designing QUIT was a truly collaborative, iterative effort; all user feedback and suggestions for improving this tool are welcomed via feedback forms sent to info@ebvma.org.
Read the full study
Introducing QUIT-the Quality and Uncertainty Indicator Triage tool: 10 questions to help veterinary professionals more confidently triage treatment study reports.
Keay S, Rey L, Larson R, et al. JAVMA | doi:10.2460/javma.26.01.0008