How To Run An Evidence

Based Journal Club Dr. Dave Allen

Dr. Sam Stone

Conflict Disclosure Information:

Presenter: David Allen/Sam Stone

Title of Presentation: Evidence Based Journal Club

We have no financial or personal relationships to

disclose

How to run an evidence-based

journal club

The evidence for how to run an evidence based journal

club, and what works for teaching EBM skills and for

learning information from journal club that actually has

a positive impact on patient care, is sketchy at best

EBM

“The conscientious, explicit and judicious use of current

best evidence in making decisions about the care of

individual patients”

Sackett, Haynes et al.

EBM

Patient

Preferences

Research

Evidence

Clinical

Expertise

By applying EBM skills to journal club,

the learner learns to use the EBM

skills, and at the same time what’s

learned at the journal club becomes

more valid and clinically applicable.

All this happens in a setting which

tends to be popular with residents and

practitioners.

5 A’s of EBM

Ask

Acquire

Appraise

Apply

Assess

Ask

Often journal clubs are based on clinical scenarios

To get the best information, you have to ask the right question

One method is the PICO format:

Population

Intervention

Comparator

Outcome

The number needed to read to

identify one clinically important

manuscript in one specialty-

specific journal is estimated at

26

Characteristics of an unsuccessful

journal club- Carpenter

Lacks a single leader

Suboptimal article selection

Failure to use a formal critical appraisal instrument

Research nihilism

Statistical uncertainty

Insufficient individualized feedback

Evidence-based decision making is not supported at the bedside

Attributes of a successful journal

club- Carpenter

Having a single leader or champion

Organizing sessions far enough in advance

Inviting pertinent guests to attend

Incorporating formal critical appraisal instruments

Accessing online statistical support

Surveying participants regularly to identify

strengths/weaknesses and fresh ideas

Journal Club Frustrations

Lack of focus

Insufficient preparation time

No standardized approach

Feedback often lacking

No clear conclusions

Discussion forgotten after Journal Club

Lifelong learning skills neglected

Steps for a successful journal club

Know your target group

Define your goals

Have a designated, permanent leader or champion

Develop strategies to optimize attendance

Give presenters a framework or appraisal tools

Get presenters to search out others’ appraisals

Keep the group size manageable to encourage discussion

Know your target group

Is your group defined by educational status, specialty,

geographic location or a common interest?

It can be useful to have a special journal club involving

different groups to hash out common problems

Frequency of meetings will change depending on the

target group

If the group is too broad, the likelihood of finding

relevant papers and of maintaining good attendance

drops

Define your goals

Is the focus to keep up to date with clinical knowledge, to develop EBM skills, to improve practice, to enhance knowledge of critical appraisal, or to solve a particular problem?

The papers you select will depend on your goals

Do you want to pick a clinical topic, or a methodology topic?

If the focus is clinical knowledge and keeping up to date, get CME accreditation and have a leader vet the articles

If the focus is EBM skills, then bad articles can occasionally be useful to illustrate what makes a bad article. Too many, though, will discourage the group

Review the goals regularly, and make sure the goals are being met

Have a designated, permanent

leader or champion

“The single most important

determinant of a journal club that fails

to provide residents with lifelong

learning skills to find and appraise

practice-changing research is the lack

of an opinion leader who is solely

responsible for the content and quality

of every lesson each year”

Have a designated, permanent

leader or champion

If the journal club is resident or medical student based, have a permanent faculty member in charge

The journal club is much more likely to succeed long term if the leader is paid

The leader should be involved in article selection to avoid duplication or articles of little interest to the group

Others will be presenters or leaders for each session, but the permanent leader will oversee the process, and will often act as a methodology expert, rather than a content expert

Develop strategies to optimize

attendance

Ensure that the articles are relevant

Match the meeting frequency to the group, but try to follow a regular, predictable interval

Try to find the most effective time for the group

If lunchtime or evening meetings, consider food

If resident based, make attendance mandatory, but at a time that doesn’t interfere with on call or clinical duties

Encourage participation and use strategies to avoid alpha behaviour or bullying

Ensure that articles are sent out in lots of time to prepare

At the end of the meeting, put the articles into clinical context

Give presenters a framework or

appraisal tools

In all the NOSM residency programs, the JAMA Users’

Guide to the Medical Literature is the template, and all

residents are provided with a copy

Worksheets can be obtained at:

http://guides.mclibrary.duke.edu/content.php?pid=27437

3&sid=2262324

Consider using James McCormack’s How to Critically

Appraise an RCT in Ten Minutes, available for free at the

iTunes store in the book section

Get presenters to search out

others’ appraisals

Pre-appraised articles tend to be more clinically important, and more likely to change practice

Editorials and others’ appraisals can help the presenter understand the context and the strengths and weaknesses of the paper being presented

Consider finding articles using the ACP Journal Club or the journal Evidence-Based Medicine, both available through the NOSM library. ACP Journal Club is also available through the CMA website

InfoPoems or the BMJ/McMaster Plus website (join through the CMA website) also act as good sources for important papers

Keep the group size manageable

to encourage discussion

If there are more than 8-10 in the group, consider

breaking into smaller groups to discuss template

questions, and then regroup to discuss the answers

Larger groups tend to result in lower likelihood of pre-

reading and lower participation

Online journal clubs don’t seem to work as well as face

to face meetings

EBM Faculty Development

Traveling roadshow

InfoCritique

What topics would be most useful?

Royal College program tutor opportunities

Consider an in depth EBM workshop if you are interested

in taking a lead role in a journal club