Teaching evidence based medicine to surgery residents-is journal club the best format? A systematic review of the literature

A 10-month impact evaluation of a journal club among diagnostic radiographers in a single NHS Trust: A service evaluation study

INTRODUCTION

Journal clubs (JC) have emerged as a popular tool within medical and health professions to deliver outcomes such as promotion of evidence-based practice (EBP), improvement of critical appraisal skills, as well as stimulation of research interest among participating professionals. However, the delivery of these outcomes within the diagnostic radiography profession has not been evidenced and this is the aim of this service evaluation.

METHODS

This evaluation adopted a pre- and post-evaluation survey design to explore the impact of a novel JC introduced among diagnostic radiographers in a UK NHS Trust. Impact was assessed based on four pre-determined outcomes such as Knowledge of EBP, Attitude to EBP, Critical Appraisal Skill and Research interest. Open ended questions in the post evaluation survey were also used to obtain participants feedback on JC activities attended.

RESULTS

Evaluation of the four pre-determined outcomes indicated that JC activities participated by diagnostic radiographers resulted in positive changes across all evaluated categories. Attitude to EBP was the only outcome to show a statistically significant positive change across all participants, highlighting that the JC affected EBP attitudes positively for those that attended. Furthermore, thematic analysis of open-ended questions indicated that the collaboration experienced among JC members during critical appraisal of articles was a motivation for continued participation while factors such as high clinical workload and absence of management in meetings were identified as mitigating barriers.

CONCLUSION

Participation in the JC showed positive improvements in all pre-determined categories. The collaborative nature of JC was motivating for staff, however barriers such as management absence in meetings, and high clinical workload did cause some challenges. Research is recommended to look at the longer-term impact of JC activities amongst diagnostic radiographers.

Are popular books about diet and health written based on scientific evidence? A comparison of citations between the USA and Japan

OBJECTIVES

To describe and compare the references cited in popular books about diet and health between the USA and Japan.

DESIGN

Books were selected based on their best-seller rankings in the diet and health category of online bookstores. We identified references throughout all pages of the books and examined the number of references, reference format (identifiable or not) and presence of specific types of references, such as systematic reviews of human research. We compared the characteristics of references between the two countries and examined related factors to citation.

SETTING

Cross-sectional study.

PARTICIPANTS

Books (n 100 in each country).

RESULTS

Among 100 books from each country, sixty-five US and sixty-six Japanese books had references. Forty-five US books cited more than 100 references, against only five Japanese books. The number of books that cited systematic reviews of human research differed between the USA (n 49) and Japan (n 9). Additionally, the number of books that provided identifiable information for all references was significantly higher in the USA (n 63) than in Japan (n 42). Books whose first authors have licences of medical doctors were more likely to cite references than those without in both countries.

CONCLUSIONS

Two-thirds of books about diet and health cited references in both the USA and Japan, but Japanese books cited fewer references and were less likely to cite systematic reviews and provide identifiable references than US books. Further research into the scientific reliability of information in books about diet and health is warranted.

Effectiveness of Journal Club Presentation as a Learning Modality in the Endocrinology and Endocrine Surgery Module in an Integrative Undergraduate Medical Curriculum

Introduction

The journal club is widely used in most postgraduate programs of medical institutes; however, the use of journal clubs in undergraduate medical programs is nearly absent or very rare.

Aim

The aim of this work is to document the insertion of the journal club as a method for learning in the undergraduate starting with the endocrinology/endocrine surgery module to be fully implemented in all modules of the MBBS of FMBU. In addition, the study aimed to outline the steps of designing a journal club by following specific procedures and Identification of students' and faculty satisfaction through 5-years implementation of the journal club.

Material and Methods

A total of 453 students representing the five consecutive batches of medical students from 2019 to 2023 who studied the endocrinology/endocrine surgery module were entered into the study. Following guidelines for implementation of the journal clubs that were adopted by the quality and accreditation committee, the faculty select the types of papers from the articles chosen by students. The papers discussed were case reports, original research, and review articles. The students were asked to formulate critical appraisal topics, PICO, for each paper. A 20-question test was applied to all participants. The students' attendance, scores, and students/faculty satisfaction were estimated.

Results

A total of 50 papers were discussed in the 5-year journal club 15 case reports (30%), 26 original research (52%), and 9 review articles (18%). The student's attendance ranged from 72.53±3.74 to 98.07±3.15. The students and faculty's satisfaction were 3.52 and 3.82 respectively. The mean Students' score in A 20-question test in a 5-year journal club was 76.93 ± 9.78 and the lowest score was in the 2nd batch (online batch).

Conclusion

The insertion of a well-structured journal club in the undergraduate medical program is necessary to improve the knowledge including knowledge among students. In addition, journal clubs inspire students to be lifelong learners.

The impact of journal clubs on postgraduate medical education in China

PURPOSE

Journal clubs hold significant importance in medical education, with numerous studies highlighting their contributions worldwide. However, studies specifically examining their role in China, particularly among Chinese medical postgraduates categorized into academic and clinical types, remain scarce. This research aims to investigate the participation, performance, and benefits of journal clubs, and explore the influence of student type and study phase on these aspects.

METHOD

A survey encompassing demographic information, participation rates, performance evaluations, and perceived improvements was distributed to postgraduates at Tongji Medical College of Huazhong University of Science and Technology. A total of 232 completed questionnaires were included for further analysis. Statistical analysis employed the Mann-Whitney U test and Gamma tests, with statistical significance set at p-value < 0.05.

RESULTS

Overall participation and performance in journal clubs among Chinese medical postgraduates were comparable to global findings. Notably, academic postgraduates exhibited higher levels of attendance rate and gained more research assistance than clinical postgraduates, while their performance levels were similar. When considering the study phase, a downward trend in academic postgraduates' attendance rate and listening attitude and an upward trend in clinical postgraduates' participation were observed with the seniority phase. Additionally, presentation comments, post-presentation progress, and research assistance showed improvements over time for both student types.

CONCLUSIONS

This study reveals academic postgraduates' fatigue, contrasting with clinical postgraduates' enthusiasm, and underscores academic postgraduates' superior research assistance. To address these findings, we recommend supporting and encouraging scientific research training for clinical postgraduates, aiding academic postgraduates in better time management and reducing non-essential responsibilities, and implementing critical appraisal skill education.

Spanish Society of Medical Radiology Journal Club: History, analysis and perspectives after ten years of experience

We define a journal club as a group of people who meet to critically read and discuss scientific articles. In medicine, journal clubs are a very important part of training during residency programs. In 2013, the Spanish Society of Medical Radiology's (SERAM) journal club was established with the aim of promoting the acquisition of non-interpretative skills and training in scientific journalism during residency. After nearly 10 years, more than 137 reviewers at 54 hospitals have formed part of the SERAM's journal club. In this time period, the number of reviewers, publications, and visits to our website have increased progressively. The SERAM's journal club currently employs a structured workflow that is organized into quarterly groups and supported by a peer-review system. In the future, the SERAM's journal club aims to internationalize its content beyond the Spanish-speaking community, increase its presence in social networks, and incorporate audiovisual content.

Evidence-Based Medicine Course in Combination With Journal Clubs to Promote Evidence-Based Surgery

Introduction To provide high-quality surgical care, surgeons must critically appraise medical literature to adapt their clinical practice whenever convincing evidence emerges. This will promote evidence-based surgery (EBS). Over the last decade, we have organized monthly journal clubs (JCs) and more extensive quarterly EBS courses for surgical residents and PhD students, supervised by surgical staff. We evaluated the participation, satisfaction, and knowledge gained by this EBS program, to make the program future-proof and aid other educators. Materials and methods An anonymous digital survey was distributed via email among residents, PhD students, and surgeons of the Amsterdam University Medical Centers' (UMC) surgical department in April 2022. The survey included general questions on EBS education, specific course-oriented questions for the residents and PhD students, and questions about supervision for surgeons. Results The survey was completed by 47 respondents from the surgery department of the Amsterdam UMC University Hospital, of whom 63.8% (n=30) were residents or PhD students and 36.2% (n=17) were surgeons. During one year of the combined EBS course and JCs, the EBS course was attended by 40.0% (n=12) of PhD students and was rated with a mean score of 7.6/10. JCs were attended by 86.6% (n=26) of residents or PhD students and received a mean score of 7.4/10. Reported strengths of the JCs were their easy accessibility and the acquisition of critical appraisal skills and scientific knowledge. A reported point of improvement was to focus more deeply on specific epidemiological topics per meeting. Of the surgeons, 64.7% (n=11) had supervised at least one JC and gave a mean score of 8.5/10. The main reasons to supervise JCs were the distribution of knowledge (45.5%), scientific discussion (36.3%), and contact with PhD students (18.1%). Conclusion Our EBS educational program, including JCs and EBS courses, was well appreciated by residents, PhD students, and staff. This format is advocated for other centers aiming to better implement EBS in surgical practice.

Impact of podcasting on novel and conventional measures of academic impact

OBJECTIVE

Altmetric Attention Score (AAS) is an alternative metric for estimating the impact of academic publications. We studied the association of using podcasting to highlight publications about gynecological cancer with AAS and citation scores.

METHODS

Articles that were featured in the International Journal of Gynecological Cancer (IJGC) podcast series January 2019 to September 2022 were matched 1:1 to control articles by the journal in which the article was published, study topic and design, single/multicenter data, and year of publication. Podcast articles were compared with matched-controls by citation metrics and altmetric scores.

RESULTS

A total of 99 podcasted articles published in 16 journals were matched. Median AAS was significantly higher in the podcast group than the matched-control group (22 (14-42) vs 5 (1-17), p<0.001). In a multivariable regression analysis, podcasting was the only factor associated with a high AAS (adjusted odds ratio (aOR) 8.6, 95% CI 3.8 to 19.7). In the podcast group, the median number of citations per year was higher than matched-control studies (5.5 (3.0-12.7) vs 4.5 (2.0-9.5), p=0.047). The only article characteristics that were independently associated with ≥12 citations per year were if the publication described a randomized controlled trial (aOR 4.7, 95% CI 1.6 to 13.6) or featured cervical carcinoma as the subject focus (aOR 2.9, 95% CI 1.3 to 6.5). Compared with all articles published in IJGC during the study period, articles that were featured in a podcast had higher median citations per year (5 (2-10) vs 1 (0-2.5), p<0.001).

CONCLUSION

When compared with matched-controls, podcasting an article is associated with a higher AAS but is not associated with generating a high (≥12) number of citations per year. When compared with all articles published in the same journal during the same study period, articles that were featured in a podcast had higher median citations per year.

The Current State of Journal Clubs in Psychiatry Residency Programs: Results from a National Survey of Program Directors

OBJECTIVE

This study aimed to investigate journal club prevalence, implementation, and perceived effectiveness among psychiatry residency program directors in order to highlight best practices.

METHODS

The authors distributed a 44-item thoughtfully designed and peer-reviewed questionnaire electronically via Qualtrics to 235 accredited U.S. psychiatry residency program directors identified using the American Medical Association database.

RESULTS

Eighty-nine programs (38%) responded. Of these, 83 (93%) had a journal club. Journal clubs were mandatory in 80 programs (96%), met biweekly or monthly in 62 programs (75%), and lasted 46-60 min in 66 programs (80%). Twenty-three programs (28%) offered a list of articles to choose from, and 22 programs (27%) provided a critical appraisal tool. Only 7 programs (8%) measured learner outcomes from journal clubs. Respondents believed that promoting lifelong learning and practicing evidence-based psychiatry were the most relevant educational goals of journal club (2.57 and 2.51 on a Likert scale of 0 to 3). Journal club's effectiveness in achieving those goals was believed to be lower (2.16 and 2.09).

CONCLUSIONS

Journal clubs are common in U.S. psychiatry residency programs and tend to follow a traditional format. In order to boost journal club's effectiveness in achieving the desired educational goals, more programs might elect to infuse elements known to augment learning.

Redesigning Journal Club to Improve Participant Satisfaction and Education

OBJECTIVE

Journal clubs are a fundamental part of medical training that allow residents and faculty to critically analyze literature, keep up-to-date with new advancements, and implement evidence-based medicine. The aim of this study was to describe one otolaryngology residency program's efforts towards reformatting its journal club, evaluate how well the re-designed format enabled participants to achieve journal club goals compared to the prior format, and assess faculty and resident qualitative perceptions of both formats.

DESIGN

An 11-question survey was sent to all department faculty and residents to obtain feedback regarding the original journal club format. The results of this initial survey were then used to redesign the journal club format, which consisted of 3 rotating session types: evidence-based, deep-dive, and landmark. A 6-month pilot program using the redesigned format was implemented, and surveys were sent at the halfway mark and at the conclusion of the pilot to evaluate the effectiveness of these format changes.

SETTING

A single academic center with an otolaryngology residency program PARTICIPANTS: : Residents and faculty in the department of otolaryngology RESULTS: Compared to the original format, the 6-month pilot demonstrated a more consistent attainment of journal club goals and a near-unanimous preference for the new format. This preference was consistent among both faculty (90.9%) and residents (89%). All respondents agreed that the intended goals of journal club were more frequently met under the revamped format, and statistically significant differences in approval rate were observed in the specific areas of critically assessing the literature, highlighting new findings, and translating forefront knowledge. The overall time required to prepare for sessions was lower for faculty, and higher for residents.

CONCLUSIONS

The findings from this study help to support programmatic efforts towards redesigning journal clubs with the goals of improving participant satisfaction and educational benefit. With the paucity of data in the literature evaluating journal club format overhauls, this study provides compelling evidence for programs to perform similar assessments and consider redesigns if warranted.

Multisite assessment of emergency medicine resident knowledge of evidence-based medicine as measured by the Fresno Test of Evidence-Based Medicine

CONTEXT

Evidence-based medicine (EBM) is the application of scientific evidence while treating a patient. To date, however, there is very little evidence describing how residents in emergency medicine understand and incorporate EBM into practice.

OBJECTIVES

The aim of this study was to determine EBM theoretical and quantitative knowledge in emergency medicine residents in community hospital-based training programs.

METHODS

A sample of emergency medicine residents from nine hospitals was enrolled to complete a cross-sectional assessment of EBM skills from April 2021 through June 2021. Performance on the Fresno Test of Evidence-Based Medicine (FTEBM) was assessed utilizing descriptive statistics, t tests, and one-way analysis of variance.

RESULTS

A total of 50.8% (124/244) of current emergency medicine residents completed the FTEBM during the study period. No significant difference on FTEBM scores was noted between the different types of medical degrees (DO vs. MD) (p=0.511), holding an advanced research degree (p=0.117), or between each postgraduate year of training (p=0.356). The mean score of those residents who rated their knowledge of EBM as average or higher was 36.0% (32.8-39.1%). The mean score of those residents who rated their programs as having an "average" or higher institutional focus on EBM was 34.9% (32.2-37.6%).

CONCLUSIONS

Participating emergency medicine residents show an incomplete understanding of EBM both in theory and applied computations despite rating themselves as having an average understanding. Emergency medicine residencies would be well suited to implement a standardized EBM curriculum that focuses on longitudinal reinforcement of key concepts needed for the practicing physician.

Twitter Journal Club Impact on Engagement Metrics of the Neurocritical Care Journal

BACKGROUND

Twitter journal clubs are a modern way of highlighting articles published in a scientific journal. The Neurocritical Care journal (NCC) initiated a bimonthly, Twitter-based, online journal club in 2015 to increase the outreach of its published articles. We hypothesize that articles included in the Neurocritical Care Society Twitter Journal Club (NCSTJC) had greater engagement than other articles published during the same time period. We also investigated the relationship between number of citations and Altmetric score to assess whether the enhanced online activity resulted in higher citations.

METHODS

We gathered data in August 2020 on engagement metrics (number of downloads, Altmetric score, relative citation ratio, and number of citations) of all articles published in NCC between 2015 and 2018. Articles were analyzed into two groups: one featured in NCSTJC and the rest that were not (non-NCSTJC1), and the other comprised those that were not in NCSTJC but published under a similar category of articles as NCSTJC (non-NCSTJC2). Results were analyzed using descriptive statistics, and summary measures were used to report the spread. The groups were compared by using the Wilcoxon rank sum test, given that the data were not normally distributed. Spearman's rank correlation was used to assess correlation between Altmetric score and citations for the articles in the NCSTJC and non-NCSTJC groups. For comparison, the top ten cited articles in NCC were analyzed for similar correlations.

RESULTS

Between 2015 and 2018, NCC published 529 articles, 24 of which were included in the Twitter journal club. A total of 406 articles were published in the same category as the category of articles selected for NCSTJC. The articles discussed as a part of NCSTJC had a statistically significant trend toward a higher number of downloads, Altmetric score, relative citation ratio, and number of citations than rest of the articles published in the journal during the same time period and the rest of the articles published in same categories. Three NCSTJC articles were among the ten most-cited articles published by NCC between 2015 and 2018. We did not find a correlation between Altmetric scores and number of citations in the NCSTJC or non-NCSTJC1 or non-NCSTJC2 group, but there was a strong correlation between these two variables in high performing articles when the top ten cited articles were analyzed.

CONCLUSIONS

Scientific journals are evolving their social media strategies in attempt to increase the outreach of their articles to the medical community. Platforms such as Twitter journal clubs can enhance such engagement. The long-term influence of such strategies on the impact factor of a medical journal and traditional engagement metrics, such as citations, calls for further research.

Perception of journal club seminars by medical doctoral students: results from five years of evaluation

Objectives: A journal club is one of the well-established and popular methods of post-graduate education. In this work, we were interested to understand how the participants perceive journal club as a whole and how they evaluate their personal process of acquiring new scientific knowledge and development of soft-skills as an indispensable prerequisite of the lifelong learning. Project description: This study is a survey analysis examining perception of journal club sessions by post-graduate medical students. A checklist for journal club preparation as well as a questionnaire for evaluation of the journal club session by participants has been developed to determine if the journal club had met its aims. Data were collected by summing up all answers to each question of the questionnaire for each session. Qualitative data from a five-year evaluation period were compiled and analyzed. Results: The journal club checklist served as a guideline for the preparation of a journal club session as well as an evaluation questionnaire containing 24 items. Our work presents evidence that journal club seminars are well perceived by participants. Furthermore, a high percentage of participants deemed the working atmosphere to be constructive and found it worthwhile to participate in the sessions. The topics of the presentations have been positively evaluated, however only a minority of participants found that the topics of the journal club was related to their own specific research topic. Concerning the distribution of the journal article, we could show that distributing the paper one week before the journal club event provided sufficient time for preparation. Our evaluation revealed that two-thirds of the participants found discussions during journal club sessions rich and productive. The motivation to think more critically increased during journal club sessions. From our work, it is evident that the participants perceived the speakers´ soft-skills to have improved with the practice. Finally, we show a clear trend of improved perception of the value of journal club sessions from beginning to the end of the evaluation time. Conclusion: Based on the analyzed evaluations, we can conclude that journal club events are highly valued by participants and could be a good option for the development of certain soft-skills.

The Journal Club 3.0: A qualitative, multisite study examining a new educational paradigm in the era of open educational resources

BACKGROUND

The journal club is a ubiquitous and time-honored tradition within medical education. However, in recent years, open educational resources (OERs) have become increasingly influential in how physicians interact with the medical literature across multiple specialties. The authors sought to explore how emergency medicine (EM) resident physicians reconcile different perspectives across OERs into their educational experience at the journal club.

METHODS

From January 2018 to September 2019, the authors enrolled 25 EM residents from four teaching sites associated with the University of British Columbia, Canada, to participate in either a focus group (seven residents) or individual interviews (18 residents). The authors used a snowball sampling technique. Using a constructivist grounded theory analysis, two investigators independently reviewed transcripts, meeting regularly to discuss themes until sufficiency was achieved.

RESULTS

The study data expand the theoretical understanding of the resident journal club experience. Residents used multiple sources including OERs to learn about new evidence in the specialty. The rise of OERs helped residents to focus on developing critical appraisal skills and social bonds during the journal club. The local journal club gained a new relevancy in acting as a quality control mechanism against the premature adoption of research findings discussed in OERs.

DISCUSSION

To date, most educators assume that residents prepare for a journal club by reading the selected articles and applying knowledge from their previous education. Instead, our findings suggest a more dynamic experience that integrates OERs. OERs enhance the journal club experience by allowing junior residents to more easily participate in discussions and to broaden the discussion to multiple clinical settings. Understanding these processes could inform future educational strategies around the journal club.

Educational benefits of the online journal club: A systematic review

INTRODUCTION

Online journal clubs (JCs) have increased during the COVID-19 pandemic with the resulting social distancing and popularity of online platforms. This systematic review aims to explore current evidence of their use/benefits for clinicians and compare their value to face-to-face (F2F) JCs.

METHODS

PubMed, Web of Science, and Scopus were searched systematically, adhering to PRISMA guidelines. Articles were included if they involved clinicians in medical/surgical populations, using an online JC assessing utility, experience and educational value. Quality assessment was undertaken using MERSQI.

RESULTS

Fifteen studies were included with findings synthesised into five themes: critical appraisal skills, satisfaction/value, accessibility/environment, evidence-based practice, and preference of online JC. Studies revealed high satisfaction and equivocal or increased preference of online JCs compared to F2F due to ease of access, diverse participation, and less time/cost spent travelling. Online JCs were found to be educationally valuable, aiding development of critical appraisal skills, and promoting change in practice. Disadvantages included lack of discussion intensity, technical issues, and limited interaction on some platforms.

DISCUSSION

Online JCs are educationally valuable with high satisfaction rates and distinct advantages/disadvantages to F2F JCs. More high-quality studies are required to elucidate the ideal format to further improve their educational value, utility, and adoption.

Use of journal clubs and book clubs in pharmacy education: A scoping review

BACKGROUND

Journal clubs and book clubs are educational activities used in health sciences education to teach evidence-based decision-making, critical thinking, and appraisal skills, and build trainee understanding about important professional issues. The main objective of this scoping review was to identify and synthesize all research studies on journal or book clubs for pharmacy learners. A secondary objective was to identify gaps in the literature where future research would be beneficial to pharmacy educators and learners.

METHODS

A comprehensive literature search was run across five databases. Studies were screened using a two stage, blinded, independent screening process.

RESULTS

Forty-two studies met all inclusion criteria; 86% reported on journal clubs and 14% on book clubs. Of the journal club studies, 50% were in didactic courses, 33% in experiential education, and 17% were co-curricular initiatives. Of the six book club studies, 67% were within didactic courses and 33% were co-curricular initiatives, including the only interprofessional education study. Most journal clubs were used to teach evidence-based practice, drug literature evaluation, or biostatistics. Book clubs were more focused on soft skills or topics students were less likely to encounter in the core curriculum.

IMPLICATIONS

Future research on journal clubs and book clubs in pharmacy education should continue to assess student learning outcomes and abilities. Specifically, future studies should move beyond evaluating student perceptions of journal clubs to investigate effectiveness for topics other than drug literature evaluation or evidence-based practice, and the impact of journal clubs and book clubs on interprofessional knowledge, communication, and team dynamics.

Promoting the Conduct of Medical Education Journal Clubs in Teaching Medical Institutions

Background A critical appraisal of a research article as a part of journal club sessions is an essential aspect of postgraduate training across different medical institutions in varied settings. The purpose of the current review was to explore the merits of medical education journal clubs and identify the potential factors that need to be considered for conducting these journal clubs in medical institutions. Methods An extensive search of all materials related to the topic was performed in the PubMed search engine and a total of 51 studies were included in the review based on the suitability with the current review objectives. Keywords used in the search include medical education journal clubs in the title only (viz., journal club [ti] AND medical education [ti]; medical education journal clubs [ti]; journal club [ti]). The articles published in English language only were included in the review. Results Regardless of the extensive employment of the journal clubs in different medical specialties, it is quite alarming to note that not many institutions conduct journal clubs targeting the field of medical education. These sessions offer a unique opportunity to the participants to assess the literature in a supportive fashion and play a defining role in ensuring better quality health care teachings to the medical students. However, we must understand that the successful conduct of medical education journal clubs requires specific considerations and groundwork, so that the students may benefit. Conclusion In conclusion, the medical education journal clubs have not been frequently conducted, as more preference has been given to the subject-specialty journal clubs. However, considering the scope and benefits that journal clubs add to improve teaching, all medical institutions should advocate to conduct medical education journal clubs within their premises in a structured manner.

Multi-Institutional Evaluation of a Debate-Style Journal Club for Cardiothoracic Surgery Trainees

BACKGROUND

Traditional journal clubs address individual articles and are limited in terms of breadth and depth of content covered. The present study describes the outcomes of a novel debate-style journal club in a multi-institutional setting.

METHODS

Participating institutions were recruited through the Thoracic Education Cooperative Group (TECoG). The distributed curriculum included instructions, debate scenarios, suggested article lists, moderator slides, debate scoresheets, exams, and feedback surveys.

RESULTS

Six institutions participated in the study (2015-2019), consisting of a total of 10 years' worth of cumulative debates. Cardiothoracic surgery trainees participated in 10 monthly debates over each academic year. Trainee performance on the written examination in the realm of evidence-based medicine and critical appraisal improved over the course of the academic year (beginning 55.2% vs end 76.3%, p=0.040). Importantly, written examination after debates revealed a significant improvement in scores on questions relating to topics that were debated as compared to those that were not (+27.1% vs +2.5%, p=0.006), emphasizing the importance of the debates as compared to other sources of knowledge gain. Surveys completed by trainees and faculty overall favored the debate-style journal club as compared to the traditional journal club in gaining familiarity with seminal literature in the field, improving upon oral presentation skills, and applying published literature to questions encountered clinically.

CONCLUSIONS

In this multi-institutional prospective study, we demonstrate that the novel debate-style cardiothoracic surgery journal club is an effective educational intervention for cardiothoracic surgical trainees to acquire, retain, and gain practice in applying literature-based evidence to case-based scenarios.

Igniting Inquiry: Development and Implementation of a Novel Journal Club Curriculum in an Emergency Medicine Residency

BACKGROUND

The journal club is a long-standing pillar of medical education and medical practice, although its components and format are quite variable. In addition, selecting literature for discussion must strike a delicate balance between reviewing seminal and durable articles with that of emerging evidence, all while complementing a residency curriculum. Although the critical appraisal of literature is a fundamental skill of the practicing physician, a universal curriculum has not yet been optimized to facilitate journal club.

OBJECTIVE

We sought to design and implement a comprehensive, complementary, and evidence-based journal club curriculum that was modular in design, reproducible, and effective at generating participation.

METHODS

Our novel curricular design incorporates many evidence-based components, including optimizing the learning environment, providing ease of access to resources, and using educational methodology that immerses learners in the experience in a structured manner. In addition, the curriculum complements, but does not duplicate, the core residency curriculum. In 2020, we analyzed our data, using descriptive and comparative statistical methods.

RESULTS

We demonstrated significant improvement in common metrics used to analyze the efficacy of the journal club, including attendance and participation. Significant improvements were seen in both resident and attending participation.

CONCLUSIONS

Our design methods used resources easily available to our residency program and commonly available to others, with minimal time and resource cost. Further study is required to measure long-term educational outcomes.

Incorporation of Evidence-Based Surgery into the Curriculum

Surgeons have historically learned their craft through the apprenticeship model from their mentors. Knowledge and practices acquired this way can rapidly become outdated. Providing high-quality care to patients requires surgeons to keep their knowledge up to date in line with evolving new evidence. The principles of evidence-based medicine (EBM) and its application to surgery, evidence-based surgery (EBS), are pivotal in updating and refining surgical practice. Changing from the conventional practice of surgical education to a structured evidence-based format requires a transformative process in all the levels of surgical practice encompassing trainees and trainers. Equally important is providing an optimal environment to review the evidence and deliver the surgical teaching and incorporate effective assessment tools to monitor the process. In this article, we revisit the levels of evidence and explore the different issues related to EBS such as barriers to EBS, incorporation of EBS to the surgical curriculum and discuss practical ways to implement EBS in the surgical curriculum.

What are the effects of teaching Evidence-Based Health Care (EBHC) at different levels of health professions education? An updated overview of systematic reviews

BACKGROUND

Evidence-based healthcare (EBHC) knowledge and skills are recognised as core competencies of healthcare professionals worldwide, and teaching EBHC has been widely recommended as an integral part of their training. The objective of this overview of systematic reviews (SR) was to update evidence and assess the effects of various approaches for teaching evidence-based health care (EBHC) at undergraduate (UG) and postgraduate (PG) medical education (ME) level on changes in knowledge, skills, attitudes and behaviour.

METHODS AND FINDINGS

This is an update of an overview that was published in 2014. The process followed standard procedures specified for the previous version of the overview, with a modified search. Searches were conducted in Epistemonikos for SRs published from 1 January 2013 to 27 October 2020 with no language restrictions. We checked additional sources for ongoing and unpublished SRs. Eligibility criteria included: SRs which evaluated educational interventions for teaching EBHC compared to no intervention or a different strategy were eligible. Two reviewers independently selected SRs, extracted data and evaluated quality using standardised instrument (AMSTAR2). The effects of strategies to teach EBHC were synthesized using a narrative approach. Previously published version of this overview included 16 SR, while the updated search identified six additional SRs. We therefore included a total of 22 SRs (with a total of 141 primary studies) in this updated overview. The SRs evaluated different educational interventions of varying duration, frequency, and format to teach various components of EBHC at different levels of ME (UG, PG, mixed). Most SRs assessed a range of EBHC related outcomes using a variety of assessment tools. Two SRs included randomised controlled trials (RCTs) only, while 20 reviews included RCTs and various types of non-RCTs. Diversity of study designs and teaching activities as well as aggregated findings at the SR level prevented comparisons of the effects of different techniques. In general, knowledge was improved across all ME levels for interventions compared to no intervention or pre-test scores. Skills improved in UGs, but less so in PGs and were less consistent in mixed populations. There were positive changes in behaviour among UGs and PGs, but not in mixed populations, with no consistent improvement in attitudes in any of the studied groups. One SR showed improved patient outcomes (based on non-randomised studies). Main limitations included: poor quality and reporting of SRs, heterogeneity of interventions and outcome measures, and short-term follow up.

CONCLUSIONS

Teaching EBHC consistently improved EBHC knowledge and skills at all levels of ME and behaviour in UGs and PGs, but with no consistent improvement in attitudes towards EBHC, and little evidence of the long term influence on processes of care and patient outcomes. EBHC teaching and learning should be interactive, multifaceted, integrated into clinical practice, and should include assessments.

STUDY REGISTRATION

The protocol for the original overview was developed and approved by Stellenbosch University Research Ethics Committee S12/10/262.

UPDATE OF THE OVERVIEW

Young T, Rohwer A, Volmink J, Clarke M. What are the effects of teaching evidence-based health care (EBHC)? Overview of systematic reviews. PLoS One. 2014;9(1):e86706. doi: 10.1371/journal.pone.0086706.

Evidence-based medicine curricula and barriers for physicians in training: a scoping review

OBJECTIVES

To describe the published literature on EBM curricula for physicians in training and barriers during curriculum implementation.

METHODS

We performed a systematic search and review of the medical literature on PubMed, Embase, ERIC, Scopus and Web of Science from the earliest available date until September 4, 2019.

RESULTS

We screened 9,042 references and included 29 full-text studies and 14 meeting abstracts. Eighteen studies had moderate validity, and 6 had high validity. The EBM curricular structure proved highly variable in between studies. The majority of the EBM curricula was longitudinal with different lengths. Only five studies reported using Kern's six-step approach for curriculum development. Twenty-one articles reported on EBM skills and knowledge, and only 5/29 full-text articles used a validated assessment tool. Time was the main barrier to EBM curriculum implementation. All the included studies and abstracts, independent of the EBM curriculum structure or evaluation method used, found an improvement in the residents' attitudes and/or EBM skills and knowledge.

CONCLUSIONS

The current body of literature available to guide educators in EBM curriculum development is enough to constitute a strong scaffold for developing any EBM curriculum. Given the amount of time and resources needed to develop and implement an EBM curriculum, it is very important to follow the curriculum development steps and use validated assessment tools.

Using the Timmer Scale to Standardize Pediatric Dentistry Residents' Scientific Appraisal Skills

INTRODUCTION

There is no consensus on the best methodology to apply evidence-based practice principles to develop a systematic approach to improve critical appraisal or research design evaluation skills in advanced education journal clubs.

METHODS

We implemented a tool-based approach for our pediatric dentistry residents' journal club centered on the use of a study quality assessment tool, the Timmer scale. The tool consisted of 19 standard questions that evaluated the research methodology, data collection, statistical analysis, and reporting of the findings of each article. Learners first underwent a 4-hour training session on study quality assessment. They were then assigned to read articles from monthly issues of core journals and appraised the quality of each article using the Timmer scale and submitted their scores in advance of the group session. Then, during a 1-hour journal club, the group came to a consensus on the Timmer scale score, and group and individual scores were compared to the course director's scores as prompts for feedback and further discussion.

RESULTS

Over 3 years, 24 pediatric dentistry residents participated in the course. A noticeable improvement in the pediatric dentistry residents' performance was noticed, with the discrepancy between their scores and group scores improving over time.

DISCUSSION

Using a quality assessment tool in journal clubs appeared to improve the residents' ability to critically assess articles in a systematic way. Additionally, the tool was useful for assessing residents' performance over time.

Critical appraisal of journal article by psychiatry PG residents using a new module: Impact analysis

BACKGROUND

A gap exists from evidence-based medicine (EBM) to clinical practice and there is a felt need to bridge this. Critical appraisal of scientific articles during Journal club by postgraduate (PG) residents will help them to understand and apply the scientific evidence into best clinical practice. Hence, a new module of critical appraisal of journal articles was used for Psychiatry Residents in a Medical College and its impact was assessed.

MATERIALS AND METHODS

Nine psychiatry PG residents from three academic batches participated in the study after informed consent and Institutional ethical committee clearance. They were trained in the Colorado Psychiatry EBM Examination Test module. Subsequently, three consecutive journal article presentations of them were assessed under seven Subtests of the module.

RESULTS

There was gradual increase in the assessment scores of all PG residents with each journal article presentation. They also expressed satisfaction of the assessment method and felt confident of applying the principles of critical appraisal in their clinical practice in future.

CONCLUSION

This study evaluated the impact of a new module of critical appraisal of journal article by psychiatry PG residents. It was found to be acceptable by residents and improved their competency to apply literature-based EBM into their clinical practice. It is recommended for further multicentric evaluation on a larger sample.

Examining aptitude and barriers to evidence-based medicine among trainees at an ACGME-I accredited program

BACKGROUND

The aims of Evidence-Based medicine (EBM) are to promote critical thinking and produces better patients' outcome (Profetto-McGrath J, J Prof Nurs Off J Am Assoc Coll Nurs 21:364-371, 2005). Accreditation Council for Graduate Medical Education (ACGME) competencies require trainees to locate, appraise and apply clinical evidence to patients' care. Despite the emphasis that ACGME place on EBM, few organizations provide adequate training in EBM. This is even more critical in regions where medical trainees matriculate from diverse backgrounds of undergraduate medical education, where EBM may not be emphasized nor taught at all. EBM practice has a history of research in the West, however, EBM has not been widely studied in the Middle East.

METHODS

Clinicians and trainees at Hamad Medical Corporation (HMC) matriculate from many countries in the Middle East and North Africa (MENA) and Asia. Because trainees in Graduate Medical Education (GME) come to HMC from a variety of geographic backgrounds, it is assumed that they also have a variety of experiences and aptitudes in EBM. To assess trainees EBM attitudes and knowledge in the internal medicine department at HMC in Doha, Qatar, the authors surveyed residents and fellows using a two-part survey. The first part was adapted from the evidence-based practice inventory by Kaper to assess trainees' attitudes and perceptions of EBM. Trainees were also asked to complete the Assessing Competency in Evidence Based Medicine (ACE) tool to evaluate their aptitude in different elements of EBM. The results from the two parts were analyzed.

RESULTS

The average score on the ACE tool among the participants was 8.9 (±1.6). Most participants rated themselves as beginners or intermediate in their EBM capabilities. Higher ACE scores were observed from participants with educational background from South Asia, and among those with more favorable attitudes towards EBM. There was no clear pattern that early incorporation of EBM into practice will result in better ACE score. Participants also reported reasonable abilities in EBM tasks and a favorable work atmosphere for EBM implementation. Lack of knowledge, resources, and time were the most reported barriers to utilizing EBM.

CONCLUSIONS

While it is clear that participants are enthusiastic about EBM and see it as a useful method for clinical decision making, their aptitude in EBM is not optimal and there are gaps and barriers for them to practice.

Findings from an OMFS journal club: is COVID-19 the catalyst we have needed to embrace technology?

The COVID-19 outbreak has rapidly progressed into a worldwide pandemic, and the need for social distancing has changed the way we learn and work. Our monthly OMFS journal club has been no different, and is currently meeting on the video conferencing application Microsoft Teams. The use of a virtual setting for training in medicine and dentistry is not new and, as in the case of our recent move to a virtual medium, it may be that COVID-19 has fast-tracked this digital transformation. There are of course disadvantages to online teaching that traditional face-to-face teaching overcomes. We conducted a survey to examine how trainees' attitudes and experiences have altered with this change, and to understand whether some elements of this new style of training may be advantageous in the post-pandemic world. We aimed to assess trainees' attitudes towards online teaching, and which elements, if any, would be beneficial once face-to-face teaching becomes possible again. A survey was created for all trainees taking part in journal club meetings at Bradford Teaching Hospitals. Multiple-choice and Likert scale questions were designed to ascertain the differences in experience between online and face-to-face settings. A Wilcoxon matched pairs signed test was used to analyse the results. Responses were kept anonymous. Results showed that the majority of trainees found it easier to attend the online journal club, and also indicated that the most found Microsoft Teams easy to use, though we did not have another online application for comparison. There was no significant difference in participation comfort between the two settings, though trainees felt that the online setting considerably improved learning effectiveness. Furthermore, 79% (11/14) thought that online tutorials and meetings should replace traditional face-to-face meetings in the future. The use of internet technology such as video conferencing is not new, and although journal clubs are typically held in academic institutions, online and virtual clubs are flourishing. With an array of advantages, there is no shying away from the trend to move our teaching to a virtual medium. COVID-19 may have just provided the stimulus that has forced this transformation to accelerate.

Knowledge and confidence level of Canadian urology residents toward biostatistics: A national survey

INTRODUCTION

Adequate knowledge of biostatistics is essential for healthcare providers to stay up to date with medical advances and maintain an evidence-based practice. However, training in clinical research in Canadian residency programs varies considerably. Our study aimed to determine Canadian urology trainees' knowledge of biostatistics and interpretation of the scientific literature.

METHODS

We conducted a national survey of all Canadian urology residents and fellows, which assessed experiences with biostatistics, self-reported confidence with statistical questions, and knowledge of biostatistical concepts.

RESULTS

Out of 201 urology trainees, 74 (36.8%) responded to the survey. The majority of respondents disagreed or strongly disagreed with the fact that they had sufficient training in biostatistics in medical school (67.6%) or that their current knowledge was sufficient for the rest of their career (66.1%). If given the chance, 82.3% of respondents would like to learn more about biostatistics. About half of respondents were able to correctly identify ordinal variables (51.5%), discrete variables (52.9%), or interpret adjusted odds ratios (50.0%). Despite senior residents reporting more confidence on biostatistical questions, our results did not demonstrate significant differences in overall knowledge according to level of training or experience with biostatistics.

CONCLUSIONS

Our results identified important knowledge gaps among current Canadian urology trainees. Most trainees do not believe they have sufficient training in biostatistics. Knowledge of basic statistical concepts was lower than expected and did not significantly differ according to level of training. Our results highlight the need for structured, dedicated training in biostatistics for urology trainees within the new Competence by Design teaching framework.

Evidence-Based Medicine (EBM) is properly perceived but its application is still limited in the orthopedic clinical practice: an online survey among the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) members

PURPOSE

To evaluate the knowledge and awareness of Evidence-Based Medicine (EBM) among members of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).

METHODS

A questionnaire was developed that explored the following areas: (i) respondents' attitudes to EBM; (ii) their motivation to implement EBM in daily practice; (iii) their educational background, knowledge and skills related to accessing and interpreting information; (iv) their level of attention to, and use of, scientific literature; (v) access to and availability of evidence; (vi) perceived barriers in using EBM in clinical practice. The resulting data were analyzed using descriptive statistics, and the correlation between age, educational background and country was further investigated.

RESULTS

Two-hundred and eighty-eight ESSKA members (11% of the total population) compiled the questionnaire. The participants covered all the five continents and an expected prevalence of European professionals (77%) was observed. The vast majority of participants were medical doctors (91%), mainly specialized in knee surgery with minimal involvement in research. 97% of the participants declared having some knowledge of EBM, acquired mainly during their professional education, with some geographical differences. The youngest clinicians and those from Eastern Europe reported the greatest difficulty in using EBM in daily practice. The application of EBM in clinical practice is positively affected by the time dedicated to research and negatively correlates with the time dedicated to patient care.

CONCLUSIONS

The results of this survey highlight the need for further investigation into the main reasons behind the limited diffusion of the EBM approach, despite the medical community's knowledge and interest in the concept. A wider application of EMB would upgrade clinical practice, linking medical knowledge and scientific evidence to patients' needs which would result of benefit to patients, but also more in general to the health system.

Evidence-Based Medicine Curriculum Improves Pediatric Emergency Fellows' Scores on In-Training Examinations

OBJECTIVES

The aim of this study was to determine if implementation of our evidence-based medicine (EBM) curriculum had an effect on pediatric emergency medicine fellows' scores on the relevant section of the in-training examination (ITE).

METHODS

We obtained deidentified subscores for 22 fellows over 6 academic years for the Core Knowledge in Scholarly Activities (SA) and, as a balance measure, Emergencies Treated Medically sections. We divided the subscores into the following 3 instruction periods: "baseline" for academic years before our current EBM curriculum, "transition" for academic years with use of a research method curriculum with some overlapping EBM content, and "EBM" for academic years with our current EBM curriculum. We analyzed data using the Kruskal-Wallis test, the Mann-Whitney U test, and multivariate mixed-effects linear models.

RESULTS

The SA subscore median was higher during the EBM period in comparison with the baseline and transition periods. In contrast, the Emergencies Treated Medically subscore median was similar across instruction periods. Multivariate modeling demonstrated that our EBM curriculum had the following independent effects on the fellows' SA subscore: (1) in comparison with the transition period, the fellows' SA subscore was 21 percentage points higher (P = 0.005); and (2) in comparison to the baseline period, the fellows' SA subscore was 28 percentage points higher during the EBM curriculum instruction period (P < 0.001).

CONCLUSIONS

Our EBM curriculum was associated with significantly higher scores on the SA section of the ITE. Pediatric emergency medicine educators could consider using fellows' scores on this section of the ITE to assess the effect of their EBM curricula.

Understanding the nature and scope of clinical research commentaries in PubMed

Scientific commentaries are expected to play an important role in evidence appraisal, but it is unknown whether this expectation has been fulfilled. This study aims to better understand the role of scientific commentary in evidence appraisal. We queried PubMed for all clinical research articles with accompanying comments and extracted corresponding metadata. Five percent of clinical research studies (N = 130 629) received postpublication comments (N = 171 556), resulting in 178 882 comment-article pairings, with 90% published in the same journal. We obtained 5197 full-text comments for topic modeling and exploratory sentiment analysis. Topics were generally disease specific with only a few topics relevant to the appraisal of studies, which were highly prevalent in letters. Of a random sample of 518 full-text comments, 67% had a supportive tone. Based on our results, published commentary, with the exception of letters, most often highlight or endorse previous publications rather than serve as a prominent mechanism for critical appraisal.

A Prospective Review of a Novel Electronic Journal Club Format in an Orthopedic Residency Unit

INTRODUCTION

Journal clubs are useful for teaching critical appraisal skills and maintaining contemporary knowledge in orthopedics. The didactic format is most common; however, work commitments can pose difficulty in full attendance. Also with the current legislative working time restrictions for residents in Europe and North America, work and training time require separation with times that may not suit all attendees. Online forums such as "Twitter" have recently been used to accommodate various journal clubs. We aimed to establish a journal club using smartphone messaging application "WhatsApp" to discuss key orthopedic papers and teach critical appraisal skills to residents.

DESIGN

A prospective cohort study including all residents and attendings in the department. A research practice questionnaire, the "Evidence-based Practice Questionnaire" and a 28-question MCQ on research methods from the American Academy of Orthopedic Surgeons resident question database was completed by all participants prior to the study. A paper was uploaded each Friday, and discussed the following Tuesday through Friday for 6 consecutive weeks. The original questionnaire and MCQs were again completed after the 6-week study period.

SETTING

A Trauma & Orthopedic residency unit.

PARTICIPANTS

All orthopedic residents, from PGY1-4 and attendings.

RESULTS

An average of 22 questions were asked (min 13, max 28), and 55 responses per week (min 30, max 88). In the EBPQ questionnaire, an example question of "how often you critically appraised a paper you have discovered" improved from an average score of 2.45 to 5.4. Self-rating of research skills improved from a score of 3.27 to 5.9. MCQ scores improved from an average of 48.2% among the group to 69%.

CONCLUSIONS

Residents' critical appraisal skills were improved while providing adequate time and flexibility to reflect on questions. Subspecialty topic discussions led by attendings, stimulated discussion of clinical pearls of interest to all participants. The simplicity of this method, and its widespread availability potentiates the implementation by any specialty looking to educate its residents.

Neurosurgical resident research education: a survey of United States residency program directors

OBJECTIVE

The application of evidence-based medicine (EBM) has played an increasing role within neurosurgical education over the last several decades. The Accreditation Council for Graduate Medical Education (ACGME) has mandated that residents are now required to demonstrate academic productivity and mastery of EBM principles. The goal of this study was to assess how neurosurgery programs around the US are dealing with the challenges of fulfilling these program requirements from the ACGME in addition to standard neurosurgical education.

METHODS

A 20-question survey was developed and electronically delivered to residency program directors of the 110 ACGME-approved MD and DO training programs in the US. Data regarding journal club and critical appraisal skills, research requirements, and protected research time were collected. Linear regression was used to determine significant associations between these data and reported resident academic productivity.

RESULTS

Responses were received from 102 of the 110 (92.7%) neurosurgical training programs in the US. Ninety-eight programs (96.1%) confirmed a regularly scheduled journal club. Approximately half of programs (51.5%) indicated that the primary goal of their journal club was to promote critical appraisal skills. Only 58.4% of programs reported a formal EBM curriculum. In 57.4% of programs an annual resident publication requirement was confirmed. Multivariate regression models demonstrated that greater protected research time (p = 0.001), journal club facilitator with extensive training in research methods (p = 0.029), and earlier research participation during residency (p = 0.049) all increased the number of reported publications per resident.

CONCLUSIONS

Although specific measures are important, and should be tailored to the program, the overall training culture with faculty mentorship and provision of time and resources for research activity are probably the most important factors.

Information seeking and evaluation: a multi-institutional survey of veterinary students

Objective

To practice evidence-based medicine, clinicians must be competent in information literacy (IL). Few studies acknowledge the critical role that reading strategies play in IL instruction and assessment of health professional students. The purpose of this study was to understand the information-seeking and evaluation behaviors of doctor of veterinary medicine (DVM) students in regard to scientific papers.

Methods

The authors studied DVM student behaviors across eight programs in North America using a web-based survey of closed- and open-ended questions about finding and evaluating scientific papers, including a task to read a linked scientific paper and answer questions about it.

Results

A total of 226 individuals responded to the survey. The sections of a scientific paper that were most commonly read were the abstract, introduction, and conclusions. Students who reported reading a higher proportion of scientific papers were more likely to feel confident in their abilities to interpret them. A third of respondents answered open-ended questions after the paper reading task. Respondents felt the least amount of confidence with one of the final steps of evidence-based medicine, that of interpreting the significance of the paper to apply it in veterinary medicine.

Conclusions

DVM students may lack the skills needed to evaluate scientific literature and need more practice and feedback in evaluating and interpreting scientific papers. Librarians who support DVM students can (1) help DVM students to efficiently evaluate scientific literature, (2) seek training opportunities in alternative modes of teaching and learning IL skills, and (3) partner with veterinary faculty and clinicians to provide students with practice and feedback in information evaluation.

Theory-based strategies for teaching evidence-based practice to undergraduate health students: a systematic review

BACKGROUND

Undergraduate students across health professions are required to be capable users of evidence in their clinical practice after graduation. Gaining the essential knowledge and clinical behaviors for evidence-based practice can be enhanced by theory-based strategies. Limited evidence exists on the effect of underpinning undergraduate EBP curricula with a theoretical framework to support EBP competence. A systematic review was conducted to determine the effectiveness of EBP teaching strategies for undergraduate students, with specific focus on efficacy of theory-based strategies.

METHODS

This review critically appraised and synthesized evidence on the effectiveness of EBP theory-based teaching strategies specifically for undergraduate health students on long or short-term change in multiple outcomes, including but not limited to, EBP knowledge and attitudes. PubMed, CINAHL, Scopus, ProQuest Health, ERIC, The Campbell Collaboration, PsycINFO were searched for published studies and The New York Academy of Medicine, ProQuest Dissertations and Mednar were searched for unpublished studies. Two independent reviewers assessed studies using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument.

RESULTS

Twenty-eight studies reporting EBP teaching strategies were initially selected for review with methodological quality ranging from low to high. Studies varied in course duration, timing of delivery, population and course content. Only five included papers reported alignment with, and detail of, one or more theoretical frameworks. Theories reported included Social Cognitive Theory (one study), Roger's Diffusion of Innovation Theory (two studies) and Cognitive Apprenticeship Theory (one study). Cognitive Flexibility Theory and Cognitive Load Theory were discussed in two separate papers by the same authors. All but one study measured EBP knowledge. Mixed results were reported on EBP knowledge, attitudes and skills across the five studies.

CONCLUSIONS

EBP programs for undergraduate health students require consideration of multiple domains, including clinical behaviors, attitudes and cognitive learning processes; Interventions grounded in theory were found to have a small but positive effect on EBP attitudes. The most effective theory for developing and supporting EBP capability is not able to be determined by this review therefore additional rigorous research is required.

Pharmacy student perceptions regarding understanding of and confidence in literature evaluation following a student-led journal club

BACKGROUND

Journal clubs are commonly used by healthcare professionals, including pharmacists, as a means of analyzing and applying research to clinical practice. The purpose of this research is to determine if participation in student-led journal clubs impacts students' understanding of and confidence in literature evaluation.

METHODS

First- through third-year pharmacy students attended co-curricular journal club sessions. Students attending these sessions completed a questionnaire (Journal Club Comprehension and Confidence Instrument [JCCCI]) immediately prior to [pre-survey] and following [post-survey] the journal club session (journal club group). The JCCCI was also delivered to student pharmacists not attending the co-curricular journal club sessions (control group). Wilcoxon Signed-Rank tests were used to compare the responses to the JCCCI questionnaire. Analysis was conducted using SPSS. This research was approved by the University's Institutional Review Board.

RESULTS

A total of 182 student pharmacists completed the survey (journal club group, n = 52; control group, n = 130). There were significant differences in the pre- and post-survey of the journal club group in eight of the 10 competencies; "process", "background", "methods", "intervention/treatment", "statistical analysis", "results", "clinical significance" and "strengths/limitations". There were significant differences discovered between the journal club group (post-survey) and control group in three of the 10 competencies; "process", "importance", and "intervention/treatment".

CONCLUSIONS

This study demonstrates that participation in a journal club yielded significant improvements in how students self-rated their confidence in and understanding of literature evaluation. Based on students' self-assessed understanding of and confidence in literature evaluation, student-led journal club sessions conducted outside of the traditional pharmacy curriculum offer a perceived benefit to students.

Understanding the Modern Surgical Journal Club

OBJECTIVE

We sought to perform a comprehensive review of how journal club (JC) is utilized in surgical residencies, including the goals, structure and outcomes of the educational activity, and any changes made since the 2003 implementation of the 80-hour weekly resident duty hour limit.

DESIGN

A random, representative cohort of 75 of the 266 US general surgery residency programs was identified, and Program Directors were asked to complete an 18-question electronic survey about to the ways in which their program utilizes JC.

SETTING

General surgery residency programs of all types, sizes, and in all geographies.

PARTICIPANTS

Seventy-five general surgery Program Directors were contacted, 42 of whom (56%) completed the survey.

RESULTS

Most programs hold JC monthly (60.6%). University programs were more likely than others to hold JC during the evening or other nonprotected time (p = 0.04) and estimated the lowest proportion of residents in attendance (58.3%, p = 0.03). Twenty-one percent of programs indicated changes to JC related to the 80-hour work per week including making meetings less frequent and also optional. While 71.4% of respondents indicated that teaching biostatistics is a goal of JC, over half (57.1%) stated it is slightly or not at all effective at doing so.

CONCLUSIONS

JC is prevalent and, despite being 1 of its main goals, is not effective at teaching residents about biostatistics in its current form. Developing realistic, targeted curricula about biostatistics as adjuncts to current JC activities may help programs achieve these goals more readily.

Teaching Evidence-Based Practice: Considerations for Dental Education

The motivation for teaching evidence-based practice is that, through the use of high-quality clinically relevant evidence, clinicians will make rationale decision that optimally improve patient health outcomes. Achieving that goal requires clinicians who are able to answer patient care-relevant clinical questions efficiently, which means that they must be able rapidly to retrieve, assess, and apply evidence of direct relevance to their patients. Educational programs designed to accomplish this vary in their effectiveness. This article reviews the evidence on educational approaches that may be beneficial when developing educational programs for both dental students and practicing dentists.

A prospective mixed-methods study evaluating the integration of an evidence based medicine curriculum into an internal medicine residency program

INTRODUCTION

Evidence based medicine (EBM) skills are often lacking in the general internal medicine physician population. Our aim is to evaluate the impact of our internal medicine EBM curriculum on the residents' EBM skills and knowledge through mixed methods.

METHODS

A prospective study was performed that evaluated the EBM curriculum: quantitatively, with pre/posttests and qualitatively through a focus group that addressed residents' opinion on the educational and clinical impact of each aspect of the curriculum.

RESULTS

A total of 60 internal medicine residents were surveyed. Short-term EBM skills: therapy workshops (N=25) median pretest score of 8 (IQR): [6-9]) vs posttest 8 (IQR: [8-9]), (p=0.006); diagnosis (N=16) pretest score of 6 (IQR: [3-6]) vs posttest 7 (IQR: [6-9]), (p=0.006); systematic review (N=13) pretest score of 4 (IQR: [4-6]) vs posttest 7 (IQR: [6-8]), (p=0.002); and harm (N=16) pretest score of 6 (IQR: [5-7]) vs posttest 7 (IQR: [7-8]), (p=0.004). Long-term EBM skills: Fresno test of competence in EBM, pretest median score of 110.5/212 (IQR: 96.0-124.0) and a median posttest score of 115/212 (IQR: 100.0-130.0) (p=0.60). Having previous EBM training, being actively involved in research and being the first author on a publication was associated with higher Fresno test scores. Focus group provided qualitative feedback on the residents' EBM curriculum perception.

CONCLUSION

This curriculum adds a significant contribution to the current field of medical education as it fills an important educational gap, through defining ways of effectively delivering EBM concepts which led to improvement in residents' ability to evaluate and apply medical literature. The EBM curriculum was overall well received by the residents.

Five Years of Journal Clubs With Pediatric Nurses and Allied Health Professionals: A Retrospective Study and Satisfaction Survey

PURPOSE

Journal Clubs (JCs) for nurses and allied health professionals have been held in an Italian pediatric hospital since April 2008. This study aimed to: examine what type of articles have been used during JCs across 5years; investigate the potential implications for clinical and organizational practice; assess the participants' satisfaction about JCs and their contribution to professional development.

DESIGN AND METHODS

Using a retrospective design, all articles proposed in the JCs were examined. Specific criteria were used to evaluate the implications for practice within the hospital, which were classified as direct or indirect. Using a cross-sectional design, 63 JCs participants were asked to express their opinion and satisfaction about the JC sessions attended.

RESULTS

Overall, 132 articles were analyzed: most of them focused on pediatric care (64.4%) and nursing (96.2%). Almost half of the articles (n=60, 45.6%) were appraised as having brought implications for clinical practice, both direct (58.3%) and indirect (41.7%). Forty-one participants (12 attendees; 29 active participants) completed a questionnaire about their opinion about JCs. Most of participants (80.5%) reported that the topics selected for the JCs were interesting and relevant to their everyday practice.

CONCLUSIONS

Multidisciplinary JCs were considered useful for clinical practice, improvement of the quality of care, and professional development. However, lack of pragmatism and the difficulty to bridge the gap between research and practice were reported as weaknesses.

PRACTICE IMPLICATIONS

JCs can represent a quality improvement strategy for promoting research utilization among health professionals and thereby improving the quality of care.

Journal Club in Residency Education: An Evidence-based Guide to Best Practices from the Council of Emergency Medicine Residency Directors

Journal clubs are an important tool for critically appraising articles and keeping up-to-date with the current literature. This paper provides a critical review of the literature on the design and structure of journal clubs in residency education with a focus on preparation, topic selection, implementation, and integration of technology. Recommendations for preparation include developing clearly defined goals and objectives that are agreed upon by all journal club participants; mentorship from experienced faculty members to ensure appropriate article selection, maintenance of structure, and applicability to objectives; distribution of articles to participants 1–2 weeks prior to the scheduled session with reminders to read the articles at predetermined intervals; and the use of a structured critical appraisal tool for evaluating the articles. Recommendations for topic selection include selecting a primary objective of either critical appraisal or informing clinical practice and ensuring that the articles align with the objective; involving learners in the topic- and article-selection process; and having the article selection driven by a specific clinical question. Recommendations for implementation include hosting sessions in the evening and away from the hospital environment; providing food to participants; hosting meetings on a monthly basis at regularly scheduled intervals; mandating journal club attendance; and using theories of adult learning. Recommendations for integration of technology include using previously established, effective strategies and determining the feasibility of creating an online journal club versus joining an established journal club. It is the authors’ intention that after reading this paper readers will have new strategies and techniques for implementing and running a journal club at their home institutions.

Evidence appraisal: a scoping review, conceptual framework, and research agenda

Objective

Critical appraisal of clinical evidence promises to help prevent, detect, and address flaws related to study importance, ethics, validity, applicability, and reporting. These research issues are of growing concern. The purpose of this scoping review is to survey the current literature on evidence appraisal to develop a conceptual framework and an informatics research agenda.

Methods

We conducted an iterative literature search of Medline for discussion or research on the critical appraisal of clinical evidence. After title and abstract review, 121 articles were included in the analysis. We performed qualitative thematic analysis to describe the evidence appraisal architecture and its issues and opportunities. From this analysis, we derived a conceptual framework and an informatics research agenda.

Results

We identified 68 themes in 10 categories. This analysis revealed that the practice of evidence appraisal is quite common but is rarely subjected to documentation, organization, validation, integration, or uptake. This is related to underdeveloped tools, scant incentives, and insufficient acquisition of appraisal data and transformation of the data into usable knowledge.

Discussion

The gaps in acquiring appraisal data, transforming the data into actionable information and knowledge, and ensuring its dissemination and adoption can be addressed with proven informatics approaches.

Conclusions

Evidence appraisal faces several challenges, but implementing an informatics research agenda would likely help realize the potential of evidence appraisal for improving the rigor and value of clinical evidence.