DR. DAN BUFFINGTON, PHARMD, MBAJOHN ALLEN, PHARMD CANDIDATE

JESSICA FARACH, PHARMD CANDIDATE

Conducting a Journal Club

Objectives

DefinitionHistoryGoalsBenefits to practice siteBenefits to studentsHow to select an article for evaluation

Objectives (cont’d)

Journal club questionsConducting a journal club

The presentation Learning Outcomes Learning/Teaching Methods Assessment

Factors associated with successful journal clubs

Journal club models

Definition

A group of individuals who meet regularly to critically discuss applicability of current articles found in medical journals

Kleinpell RM. Rediscovering the value of the journal club. Am J Crit Care. 2002;11:412-4.

© 2007 University of CambridgeDepartment of Pharmacology

History

The earliest mention of a journal club occurred in London in 1835–1854 in the memoirs of Sir James Paget, a surgeon at St Bartholomew’s Hospital who described ‘‘a kind of club in a small room over a baker’s shop near the hospital gate where we could sit and read journals and play cards’’

Evidence of the first formal journal club dates back to 1875 when William Osler of McGill University Montréal found a way to make expensive periodicals affordable by purchasing expensive journals with fellow students at a group rate

Cave MT, Clandinin J. Revisiting the journal club. Medical Teacher 2007; 29: 365–370.Akhund S, Kadir MM . Do community medicine residency trainees learn through journal club? An experience from a developing country. BMC Medical Education 2006, 6:43.

Goals

To teach critical appraisal skills

To have an impact on clinical practice

To keep up with current medical literature

Alguire PC. A review of journal clubs in postgraduate medical education. J Gen Intern Med. 1998;13:347-353.

Organization

Meetings at least once a month

Generally review between two and three original research articles per session

Atzema C. Presenting a Journal Club: A guide. Ann Emerg Med. 2004;44:169-174.

Benefits to Practice Site

Keep abreast of new knowledgePromote awareness of current research findings

Stay familiar with the best current clinical research

Encourage research utilizationImprove patient outcomesNetwork and improve interpersonal relationships with other healthcare providers and specialists

Russell CL, Bean KB, Barry D. How to develop a successful journal club. International Transplant Nurses Society. 2006.

Benefits to Students

Journal clubs have been advocated as a bridge between research and practice

Goodfellow LM. Can a journal club bridge the gap between research and practice? Nurse Educ. 2004 May-Jun;29(3):107-10.

Benefits to Students (cont’d)

Acquisition of critical appraisal skills

Keeping up with current literature

Promotion of critical thinking

Improvement of reading habits

Strengthening of collegial relationships

Development of professional identity

Improvement of clinical practice Cave MT, Clandinin J. Revisiting the journal club. Medical Teacher 2007; 29: 365–370.Akhund S, Kadir MM . Do community medicine residency trainees learn through journal club? An experience from Goodfellow LM. Can a journal club bridge the gap between research and practice? Nurse Educ. 2004 May-Jun;29(3):107-10.

Benefits to Students (cont’d)

Examples of how a journal club setting can improve professional education:

Application of the learning task to the contextual problems

Active learner participation

Provision of timely and constructive feedback

Ebbert JO, Montori VM, Schultz HJ. The journal club in postgraduate medical education: a systematic review. Med Teach 2001, 23:455-61

Benefits to Students (cont’d)

Examples of core competencies valued by health professionals that a journal club setting can improve: The ability to interpret data

The ability to understand the implications of research findings

Familiarity with recent knowledge in the field

Akhund S, Kadir MM . Do community medicine residency trainees learn through journal club? An experience from a developing country. BMC Medical Education 2006, 6:43.

Selecting a Journal Club Article

Choosing the right article can be tedious Time-consuming

PubMed vs. Google vs. Wikipedia

Several steps to properly selecting an article Choosing the topic

Research

Selection

Evaluation

Choosing a Journal Club Topic

Choosing a topic may vary from practice to practice

Factors to Consider Audience

Scope of Practice

Research projects/interests

Research

Literature Search Specialty Journals

Pediatrics, Cardiology

Non-specialty Journals NEJM, Lancet, JAMA

Secondary Literature PubMed, Ovid

Kanthraj GR, Srinivas CR. Journal Club: screen, probe & evaluate. Indian J Dermatol Venerol Leprol 2005; 71(6):435-40.

Selecting the Right Article

Bigby, et al. devised a shortcut method to quickly select an article

It consists two important processes

Elimination

Analysis

Bigby M, Gadenne AS. Understanding and evaluating clinical trials. J Am Acad Dermatol 1996;34:550-590.

Elimination

Title, Abstract

Tables, Graphs, Figures

Results

Critical Questions

Bigby M, Gadenne AS. Understanding and evaluating clinical trials. J Am Acad Dermatol 1996;34:550-590.

Analysis

Methods

Conclusion

Discussion

Introduction

Bigby M, Gadenne AS. Understanding and evaluating clinical trials. J Am Acad Dermatol 1996;34:550-590.

Journal Club Presentation

What is the research question(s)?

Is the study design appropriate? Methods?

Does this study advance current practice?

What are the next steps in interpreting the data?

Journal Club Presentation (cont’d)

Summarize

Critique Strengths

Weaknesses/Limitations

Unanswered questions

Affect on current practice

Atzema C. Presenting a Journal Club: A guide. Ann Emerg Med 2004;44:169-174.

Teaching Methods

Deciding how to respond to a clinical scenario (small-group discussion)

Understanding the guidelines for critical appraisal

Appraisal of research paper using the guidelines

Deciding how to respond to the findings of research article

Khan KS, Gee H. A new approach to teaching and learning in journal club. Med Teach 1999;21:289-293.

Assessment of a Journal Club

Peer assessment

Facilitator assessment

Self-assessment

Khan KS, Gee H. A new approach to teaching and learning in journal club. Med Teach 1999;21:289-293.

The Success of a Journal Club

Criteria for effective journal club More than 2 years of existence without periodic abandonment

More than 50% attendance of the expected audience

Akhund S, Kadir MM . Do community medicine residency trainees learn through journal club? An experience from a developing country. BMC Medical Education 2006, 6:43.

The Success of a Journal Club (cont’d)

Factors associated with effective journal club Explicit written learning objectives Having a designated club leader Mandatory attendance Formal teaching of critical appraisal skills Journal club independent of faculty journal club

Regular attendance by faculty

Akhund S, Kadir MM . Do community medicine residency trainees learn through journal club? An experience from a developing country. BMC Medical Education 2006, 6:43.

Factors associated with effective journal club High value given by program director Smaller residency program (12 or less residents)

Incorporation of adult learning principles Provision of free food Use of a structured checklist for article review

The Success of a Journal Club (cont’d)

Akhund S, Kadir MM . Do community medicine residency trainees learn through journal club? An experience from a developing country. BMC Medical Education 2006, 6:43.

Journal Club Models

Adult Learning Model

Problem-based Model

Experimental Design Format

Debate Format

Alguire PC. A review of journal clubs in postgraduate medical education. J Gen Intern Med. 1998;13:347-353.

Journal Club Models (cont’d)

Adult Learning Model: Each session is devoted to reviewing a single paper chosen by residents This article has been alluded to recently by faculty or other residents in the process of caring for patients

The presenting resident identifies the study’s objectives, hypotheses, conclusions, and application to the care of patients

The discussion leader then facilitates dialogue of the study by the residents

An attempt is made to determine whether the study’s inference is valid or flawed by methodologic problems and whether the local application of the study is appropriate

Journal Club Models (cont’d)

Problem-based model: Two or three residents each select a journal article for presentation

A faculty leader will prepare a set of open-ended questions for each article

Each resident is asked to individually record answers to the questions

After this, small groups of four to five residents are formed and each group is asked to arrive at consensual answers

Once the small groups have reached their conclusions, a representative from each group presents their answers to the larger group

Journal Club Models (cont’d)

Experimental Design Format: Emphasizes the strengths and weaknesses of various experimental methods in published articles

Attendees are encouraged to evaluate the strengths and weaknesses of a given study, determine the best approaches to statistical analysis, identify problems or inconsistencies with the study’s methodology, and consider alternatives

Journal Club Models (cont’d)

Debate Format: Articles selected for discussion represent opposing hypotheses, results, or conclusions

This learning process is highly consistent with cognitive learning principles and encourages attendees to support decisions using current evidence and persuasive communication skills

This format requires preparation time before the journal club for the teams to develop their strategies and some training in debate techniques and etiquette to be maximally effective

References

1. Kleinpell RM. Rediscovering the value of the journal club. Am J Crit Care 2002;11:412-4.

2. Cave MT, Clandinin J. Revisiting the journal club. Med Teach 2007; 29: 365–370.

3. Akhund S, Kadir MM . Do community medicine residency trainees learn through journal club? An experience from a developing country. BMC Med Educ 2006; 6:43.

4. Alguire PC. A review of journal clubs in postgraduate medical education. J Gen Intern Med. 1998;13:347-353.

5. Atzema C. Presenting a Journal Club: A guide. Ann Emerg Med 2004;44:169-174.

6. Russell CL, Bean KB, Barry D. How to develop a successful journal club. International Transplant Nurses Society. 2006.

7. Goodfellow LM. Can a journal club bridge the gap between research and practice? Nurse Educ 2004;29(3):107-10.

8. Ebbert JO, Montori VM, Schultz HJ. The journal club in postgraduate medical education: a systematic review. Med Teach 2001, 23:455-61.

References

9. Kanthraj GR, Srinivas CR. Journal Club: screen, probe & evaluate. Indian J Dermatol Venerol Leprol 2005; 71(6):435-40.

10. Bigby M, Gadenne AS. Understanding and evaluating clinical trials. J Am Acad Dermatol 1996;34:550-590.

11. Yancey JM.Ten rules for reading clinical research reports. Am J Surg 1990;159:533-9.

12. Stange KC, Miller, WL, McLellan LA, et al. Annals Journal Club: It’s time to get radical. Ann Fam Med 2006; 4:196-7.

13. Khan KS, Gee H. A new approach to teaching and learning in journal club. Med Teach 1999;21:289-293.

14. Linzer M: The journal club and medical education: over one hundred years of unrecorded history. Postgrad Med J 1987;63:475-78

15. Edwards R, White M, Gray J, Fischbacher C. Use of a journal club and letter-writing exercise to teach critical appraisal to medical undergraduates. Med Educ 2001;35:691-94.