1. Introduction to Journal Club
Karen E. Schetzina, MD, MPH
"It is astonishing with how little reading a doctor can practice medicine, but it is not astonishing how badly he may do it." Sir William Osler

2. WHAT ARE the GOALS? Learning evidence-based medicine (EBM) skills.
Learning about the best evidence to inform clinical decisions.
Learning about important new evidence that should change practice.

3. 5 Skills for Practicing Evidence-Based Medicine
Asking questions
Searching for evidence
Critical appraisal
Integration into decisions
Self-evaluation
Part of becoming competent in “Practice-Based Learning and Improvement”

4. Integration of EBM Skills into Journal Club
Four parts to every journal club:
Selection of an answerable clinical question
Presentation of abstracts and selection of full article to review
Presentation and discussion of full article
CAT based on article discussed distributed for peer review
* See schedule:

5. Foreground VS. Background Questions
Figure 1.1 Knowledge needs depend on experience with condition.

6. Answerable Clinical Questions
Background questions
Ask for general knowledge about a condition or thing
Example: How E. coli 0157:H7 trigger hemolytic uremic syndrome?
Foreground questions
Asks for specific knowledge to inform clinical decisions or actions
Have four essential components:
Patient and/or problem
Intervention or exposure
Comparison, if relevant
Clinical outcomes

7. Clinical Questions that arise
Clinical findings/manifestations
Etiology
Differential diagnosis
Diagnostic tests
Prognosis
Therapy
Prevention
Experience and meaning
Improvement

8. Quality of Evidence

9. Skill 1: Asking Answerable Clinical Questions
Your Turn:
Think about patients you saw yesterday or during your last call.
What questions did you have?

10. Skill 2: Abstracts Presentation
Show and discuss 3-5 abstracts that you think may answer your clinical question, focusing on the methods used in the study.
Research question/hypothesis
Population / setting / sample size
Design
Potential conflict of interest
Select (generally by majority consensus) what article to review in-depth.

11. Who/What Can Help with this Process?
Nakia, ETSU Medical Librarian ( ) can assist with literature searches.
You must meet with Dr. Kiana Johnson 2 weeks before your full article presentation:
Office hours: Mondays from 9am until 2pm, Tuesdays/Friday from 8:15am to 2pm
Dr. Schetzina can also assist you
Resources are posted
In August Nakia will present with Dr. Wallace on evidence searches/resources

12. Skill 3: Full Article Presentation and Discussion
Review your clinical question
Summarize your evidence search
Summarize the study
Discuss (with audience participation):
Are the results valid?
Are they important?
Are they relevant to our patient(s)?
Download/use worksheets to guide your critical appraisal:

13. Clinical Bottom Line
How does the evidence inform your clinical practice?
Do you plan to change anything that you do based on this review?

14. CAT: Critically-Appraised Topic
CAT must be distributed so feedback may be provided during your article presentation
Finalized CATs published to our website archive; you may cite on your CV
Citation example:
Schetzina, KE. Critically Appraised Topic: Use of Basal- Bolus Insulin Therapy at Time of Diagnosis of Type 1 Diabetes Mellitus in Pediatric Patients Provides Improved Glycemic Control Compared to Traditional NPH Regimens. ETSU Pediatric CATs. Available at:
Updated April 8, Accessed February 4, 2011.

15. Calendar
1=Discuss article
2=Present abstracts
3=Assigned a question
August: Evidence Searches (QCOM Librarians, Dr. Richard Wallace & Nakia Woodward)
2. Kalra
3. Reddy/Albracht
Sept:
1. Kalra
2. Reddy/Albracht
3. Armentrout/ Payne
Julie/Caitlin can assist by ing out your article to the department and
printing and bringing copies of your article and CAT to journal club

16. Any QUESTIONS?