1. DR. DAN BUFFINGTON, PHARMD, MBA JOHN ALLEN, PHARMD CANDIDATE JESSICA FARACH, PHARMD CANDIDATE Conducting a Journal Club

2. Objectives Definition History Goals Benefits to practice site Benefits to students How to select an article for evaluation

3. Objectives (cont’d) Journal club questions Conducting a journal club  The presentation  Learning Outcomes  Learning/Teaching Methods  Assessment Factors associated with successful journal clubs Journal club models

4. 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.

5. © 2007 University of Cambridge Department of Pharmacology

6. 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.

7. 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.

8. 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.

9. Benefits to Practice Site Keep abreast of new knowledge Promote awareness of current research findings Stay familiar with the best current clinical research Encourage research utilization Improve patient outcomes Network 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.

10. 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.

11. 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.

12. 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

13. 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.

14. 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

15. Choosing a Journal Club Topic Choosing a topic may vary from practice to practice Factors to Consider  Audience  Scope of Practice  Research projects/interests

16. 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.

17. 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.

18. 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.

19. Analysis Methods Conclusion Discussion Introduction Bigby M, Gadenne AS. Understanding and evaluating clinical trials. J Am Acad Dermatol 1996;34:550-590.

20. 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?

21. 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.

22. 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.

23. 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.

24. 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.

25. 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.

26. 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.

27. 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.

28. 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

29. 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

30. 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

31. 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

32. 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.

33. 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.