13 Research methods, statistics, critical review and evidence-based practice13.12 Guidelines and reporting
13.12.1 Clinical guidelines
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Written by Resident Doctor Committee · Published
New in the 2027 syllabus
The College added this topic for exams from January 2027.
What guidance is
Clinical guidelines recommend care in defined circumstances. They draw on evidence and on explicit judgements about benefits, harms and practical consequences.
A protocol sets out local actions and who is responsible for each one. A guideline is different: it supports decisions that still need clinical judgement.
A reporting guideline lists the information a research report should include. It does not recommend treatment.
From evidence to recommendation
Stage | Main task |
|---|---|
Scope | Define the population, setting and decisions to be covered |
Evidence review | Search for, select, assess and synthesise (combine) the relevant research |
Certainty assessment | Judge how confident we can be in the evidence for each outcome |
Committee judgement | Weigh benefits, harms, resources, equity and preferences |
Consultation and publication | Explain the recommendations and respond to relevant comments |
Updating | Consider new evidence and changes in practice |
Patient involvement helps identify outcomes, burdens and preferences that clinical measures alone can miss.
Conflicts of interest must be managed, not just declared. This matters most when committee members or funders could gain from a recommendation.
Certainty and strength
Certainty of evidence is how confident we are in the evidence behind an estimate of effect. It is not the same as the strength of a recommendation.
Strong recommendations mean that most suitable patients, once informed, would choose the suggested approach.
Conditional recommendations leave more room for different choices, because benefits, harms, uncertainty or preferences vary.
Consensus advice may be needed where research is limited. The guideline should be open about what it is based on and how uncertain it is.
Using a guideline
Applicability: check the person against the guideline's scope. Look at age, diagnosis, comorbidity, setting, whether the intervention is available, and the person's own priorities.
Currency: whether a guideline is up to date depends on its evidence searches, updates and surveillance (ongoing checks for new evidence), not simply the date printed on the front page.
Competing recommendations: when someone has several conditions, reconcile the guidelines through one integrated decision rather than automatically adding every suggested treatment.
Justified departure: if you depart from a guideline, record the reasoning specific to that patient, the discussion and the agreed plan.
Appraisal tools: these assess how a guideline was developed and reported. A high score does not guarantee that every recommendation is right for an individual patient.