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.
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