1. Associated professor of pathology Afzalipour Medical School
Journal club session
Malekpour M.D
Associated professor of pathology
Afzalipour Medical School

3. History Journal club session
The first journal club was founded by Sir James Paget, a British Surgeon in the mid-1800’s
“Small room over a baker’s shop near the Hospital-gate where we could sit and read the journals”
Journal club session

4. History
Sir William Osler organized a journal club at McGill University in 1875
Several authors suggest that journal clubs were found in certain European countries (in particular, Germany and England) prior to that time.
Journal club session

5. History Journal club session
In the early 1900s in Germany, journal clubs were routinely found in departments of medicine and medical schools.
From , journal clubs evolved into a forum for continuing medical education.
Journal club session

6. History Journal club session
Journal clubs are currently found in the fields of medicine, surgery, psychiatry, nursing, pharmacy, obstetrics and gynecology, pediatrics and geriatric social service.
Journal club session

7. History Journal club session
This powerful educational tool has played an active role in medical education for over a century. The journal club should be more formally incorporated into the medical educational curriculum.
Journal club session

8. Significance Journal club session
In a 1995 survey of program directors in the eastern United States, Sidorov found:
95% of internal medicine training programs had an active journal club.
More than 80% of internal medicine, family practice, emergency medicine, and physical medicine journal clubs meet at least once monthly, usually during the working hours, typically reviewing between two and three articles per session..
Journal club session

9. Educational Objectives
Provide update of current clinical evidence about a topic
Promote EBM and evidence-based clinical practice
Advance critical appraisal skills
JC:Objective &Goals

10. Educational Objectives
Improving clinical practice – bridge between research and practice, between knowledge and care
Build database of reviewed material for group
Learn skills relevant to performing research, research design
Develop presentation skills
JC:Objective &Goals

11. Preparation to publish results Be a stimulus for research ideas
Research Objectives
Preparation to publish results
Be a stimulus for research ideas
Provide accreditation
JC:Objective &Goals

12. Goals may vary between meetings
Objective and Goals
Goals may vary between meetings
JC:Objective &Goals

13. Present situation of journal club session
Objective and Goals
Present situation of journal club session
Journal club session

14. Reinforcement of learning
Traditional JCS
information need
Teaching and leaning
Use of information
Reinforcement of learning
Journl club session

15. Trainee chooses topic at random Lack of clinical context
information need
Trainee chooses topic at random
Lack of clinical context
Lack of systematic literature search
Traditional JCS

16. Lack of deep leaning process
Teaching and leaning
No critical appraisal
Mentors comments are generally based on personal experience and opinion
Lack of deep leaning process
Traditional JCS

17. Information is quickly for gotten
Use of information
Information is quickly for gotten
It can not be easily retrieved when required
Traditional JCS

18. Reinforcement of learning
In the absence of a clinical context , acquired knowledge is seldom applied
There is no assessment of educational activity
Traditional JCS

19. Lack of Problems Acquisition Appraise Application Assessment
Traditional JCS

20. Critical appraisal Three important question
Are the results of the study valid ?
What are the results ?(Sensitivity ; specifity ; PPV and NPV)
Will the results help locally
Journal club session

21. The way of the problem resolution
Use of articles with different methods and similar results
Journal club session

22. The way of the problem resolution
Use of articles with contradictive results
Journal club session

23. The way of the problem resolution
CPC-like Presentation
Journal club session

24. The way of the problem resolution
Detailed analysis of article
Journal club session

25. The way of the problem resolution
Problem based journal club
Trainee centered journal club
Problem solving journal club
Journal club session

26. Reinforcement of learning
Trainee centeredJCS
information need
Teaching and leaning
Use of information
Reinforcement of learning
Journal club session

27. Trainee identifies a clinical problem
Information need
Trainee identifies a clinical problem
Problem are discussed in a small group
( Answerable questions )
Trainee centered JCS

28. Systematic literature searching ( computerized ; Cochrane library )
Teaching and learning
Systematic literature searching ( computerized ; Cochrane library )
Critical appraisal
Trainee centered JCS

29. Information is stored electronically
Use of information
Information is stored electronically
It can be easily retrieved when required
Trainee centered JCS

30. Reinforcement Trainee centered JCS Practical use of acquired knowledge
Resolution of clinical problem
Use of feed back and assessment
Recognition of effort by electronic dissemination
Trainee centered JCS

31. Transforming a traditional JC into an EBCP JC
design and implement a formal patient-based or problem-based curriculum
sources of evidence
Evidence-based clinical practice JC

32. Preparing for one journal club:3-6 weeks before:
Presenter chooses a “real patient” scenario in which a clinical question has arisen
Presenter discusses with faculty mentor & develops PICO question (patient, intervention, comparison intervention, outcome)
Presenter searches for evidence (utilizes librarian, library, resources)
Presenter and mentor decide if patient problem & evidence are appropriate for JC
Evidence-based clinical practice JC

33. Preparing for one journal club:3-6 weeks before:
Presenter develops synopsis of patient scenario/problem/question
Presenter selects one key article (and possibly supportive papers)
Presenter & mentor select appropriate method for analyzing, appraising, & presenting
Evidence-based clinical practice JC

34. Preparing for one journal club:3-6 weeks before:
Presenter selects a clinical content expert for guidance
Leader selects appropriate worksheet/checklist tool
Leader commits to attend or identifies a substitute facilitator
Evidence-based clinical practice JC

35. 2 weeks before:
Announcement to participants/attendees (2 weeks before)
Invite special clinical experts
Evidence-based clinical practice JC

36. 1-2 weeks before: Evidence-based clinical practice JC
Presenter prepares presentation of scenario + summary & critical appraisal of literature + discussion elements
Presenter meets with faculty mentor and reviews presentation
Leader prepares 5-10 minute interactive teaching points (Mini-Lesson)
Prepare extra paper copies of the key article
Evidence-based clinical practice JC

37. 2 days before: Reminder announcement to participants/attendees
Check food arrangement
Check materials: flip chart, pens, projector
Evidence-based clinical practice JC

38. Presenter Evidence-based clinical practice JC
presents patient scenario
provides summary analysis of the key papers
leads the discussion of critical appraisal of the evidence
leads a discussion of what this means for this patient –resolution of the patient scenario/question – what this means for our patients
Evidence-based clinical practice JC

39. Facilitator highlights EBCP elements & teaching points
guides discussion, uses open-ended questions
prompts debate, plays devil’s advocate if needed
Evidence-based clinical practice JC

40. Clinical Expert Evidence-based clinical practice JC
explains complex medical aspects
gives insight into study methods and design
provides commentary of current best practice
Evidence-based clinical practice JC

41. Participants read at least the key article prior to journal club
use worksheet to prompt critical appraisal thinking
Evidence-based clinical practice JC

42. Journal Club Format meet & greet 15-30 minutes social time with food
60-90 minutes journal club presentation and discussion
evaluation of presenter (private), evaluation of JC (open)
Evidence-based clinical practice JC

43. Factors associated with success
Sidorov defined successful journal clubs as those with longevity (at least 2 years) and high levels of resident participation (at least 50% attendance)
Journal club session

44. Factors associated with success
The overall satisfaction score was highest when the journal club was held in the evening or at a faculty member's home. The format of the journal club was not associated with the overall satisfaction score.
Journal club session

45. Factors associated with success
practice-based, problem-based case scenario(Slawson 2005, O’Brien Cochrane)
high attendee interest in subject matter (Heligman)
discussion of complex, controversial issues; care issues with uncertainty
Journal club session

46. Factors associated with success
valid articles
integrated teaching of critical appraisal skills
formal instruction in biostatistics and epidemiology
checklists: review instrument (Burstein 1996)
Journal club session

47. Factors associated with success
Discussion of impact of the articles on practice
involvement of faculty with interest knowledge skills
food provided prior to start of session
Journal club session

48. An Asynchronous International Journal Club
A Working Model
J Ellis, L Ellis, A Penstien, A Goldsmith
SUNY Downstate

50. Goals
JournalReview.org will create an engaged international community of physicians, researchers, universities, policy makers, and others interested in published medical literature.

51. Goals Members receive the following benefits:
The ability to comment, criticize, discuss, or ask questions about published literature.
Facilitated interaction with corresponding authors and colleagues around the world.
Ability to ‘watch’ an article, journal, or search term for new discussion on the topic.
Goals

52. Search
Browse by Specialty

53. Recent Reviews in Dermatology
Article Title
Journal Title
Review Title

56. Facilitates correspondence with Author

62. Conclusions
Journal Clubs have served a variety of purposes over the years, but are more important now than ever.
JournalReview.org is an on-line journal club that is in active use.
It is an excellent tool for the enhancement of journal clubs, as it facilitates global communication between peers in an organized way.
In the future, JouranlReview.org may also provide an ideal platform for research of long term educational outcomes.

63. Recommendation
Journal club session

64. Recommendation Journal club session Evaluation of present situation
Scheduling time
Supervised topic selection
Multi specialty analysis
Electronic recording
Remember 4A; especially assessment
Appropriate announcement
Journal club session

65. Great Dinner
Journal club session

66. A real journal club....
Journal club session

67. Mortality Conference

68. Mortality conference Purposes
Teaching / Educational sessions
Evaluating patient care
Improvement of patient care

69. Mortality Conference Deficiencies and problems
Lack of a national guide to the methodology and structure of death review committee.
Brief incomplete clinical history
Lack of documented clinical course; conclusions and actions
The results of diagnostic and imaging investigations are not available
Lack of final definite cause of death

70. Result of present situation
Mortality Conference Deficiencies and problems
Result of present situation

71. Mortality Conference Quality improvement
2 important questions:
Was the primary cause of this mortality
How similar problems be avoided in the future

72. Was the primary cause of this mortality
Diagnostic error
Technical error
Error in judgment
Nature of disease

73. How similar problems may be avoided in the future
Improved admitting practices and patient selection
Altered timing of imaging; Laboratory requisition ; surgery
Altered surgical technique or medical interventions
Improved communication between medical team
Altered indication of ICU admission.

74. Mortality conference Recommendation for improvement
Design of national or regional guidelines for mortality conference
Complete history ; physical exam., Lab. Tests ; imaging finding,……….etc
Presence of all individuals involved in patient care
Careful documentations of clinical course and all actions
Autopsy in unexpected deaths

75. با سپاس