Multidisciplinary evidence-based medicine journal clubs: curriculum design and participants' reactions

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.

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.

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.

Inviting a statistician to join an evidence-based journal club

AIMS AND METHOD

In response to frequent cancellations, we recently changed the format of our journal club. We invited a statistician to attend and each meeting focused specifically on critical appraisal and statistical analysis. Active learning principles were used where every participant critically appraised an aspect of the paper presented at each meeting. The aim of this paper was to evaluate the impact of the new format on attendance and satisfaction levels. Attendance and satisfaction levels were measured in the 3 months before and the 3 months after the new format was introduced.

RESULTS

Average attendance increased from 10 to 15, with two psychologists and two trainees who did not work in the hospital starting to attend regularly. Satisfaction levels also increased significantly with respect to academic interest, enjoyment, usefulness and overall satisfaction.

CONCLUSION

Combining statistical expertise with principles of active learning has led to increased satisfaction levels among participants in our journal club.

One Model of Residency Journal Clubs With Multifaceted Support

PROBLEM

The field of medical education is represented by a fairly wide variety of models for utilizing journal clubs as an effective teaching tool, each with varying levels of empirical support. Our own prior attempts at developing and implementing an effective journal club required improvements.

INTERVENTION

Our intervention consisted of an innovative, effective journal club model that has more well-defined elements that are readily adaptable for other residency programs. The collective strategies were based on the previous literature and our own experiences.

CONTEXT

Our intervention was implemented in a department of psychiatry within a university-based medical school. Study participants came from a psychiatry department's residency programs (N = 36) during academic year 2011-2012 with senior residents having the option to attend journal club. Using a multifaceted approach, measures included attendance, presession quizzes, postsession evaluations, and a final postcourse evaluation of 11 dimensions (e.g., goals, objectives).

OUTCOME

Thirty-one (86%) trainees attended journal club-a substantial increase from previous years. The presession-quiz median was 4.4 total correct out of 6 questions (range = 3.3-5.3), indicating that the articles were generally read before the session. The postsession-evaluation median was 4.6 (1-5 scale, 5 the highest; range = 4.1-4.8), indicating sessions were well received. The final postcourse-evaluation overall mean was 3.9 (1-5 scale, 5 the highest; subscale M range = 3.4-4.5). Qualitative and quantitative analyses of the postcourse evaluation indicated the following positive aspects: educational objectives generally met, overall structured format, quality of discussions, individuals involved (e.g., course directors, trainees, faculty facilitators), and availability of food. Areas of possible improvement included time management within the sessions, more contemporary and clinically relevant articles, consistency in faculty moderators, and evaluation process. Engagement in learning appeared to have been dramatically increased through five strategies: (a) meaningful incentives; (b) assigned, engaged consistently prepared faculty; (c) meaningful evaluation; (d) prejournal club preparations that helped residents assimilate critical appraisal with time-and-task-management skills; and (e) a planning group that developed and improved curricula and instruction to meet the objectives of the course.

LESSONS LEARNED

Overall, effective, and successful journal clubs require systematic planning, implementation, modification, and refinement.

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

OBJECTIVE

Systematic reviews were performed to assess methods of teaching the evidence-based medicine (EBM) process and determine which format or what components of journal club appear to be most effective in teaching critical appraisal skills to surgical residents and have the highest user satisfaction.

DESIGN

MEDLINE, Embase, Web of Science, AMED, PsychINFO, PubMed, Cochrane Library, and Google scholar were searched to identify relevant articles. To be included, studies had to provide details about the format of their EBM curriculum or journal club and report on the effectiveness or participant satisfaction. Potentially relevant articles were independently reviewed by 2 authors and data were extracted on separate data forms.

RESULTS

Seven studies met the inclusion criteria for assessment of teaching EBM and 8 studies (including 3 in the EBM systematic review) met criteria for assessment of journal club format. Overall, study quality was poor. Only 2 studies were randomized controlled trials. Five were before-after studies, which showed significant improvement in critical appraisal skills or statistical knowledge following an EBM course or journal club. The 2 randomized controlled trials (RCTs) compared teaching EBM or critical appraisal skills in lecture format or journal club to online learning. There was no significant difference in mean scores in 1 study whereas the other reported significantly better scores in the journal club format. Four studies reported high participant satisfaction with the EBM course or journal club format.

CONCLUSIONS

There is some evidence that courses with or without the addition of journal clubs lead to improved knowledge of the EBM process although the impact on patient care is unknown. Journal clubs seem to be the preferred way of teaching critical appraisal skills but while some components of journal clubs are favored by participants, it remains unclear which elements are most important for resident learning.

Using vote cards to encourage active participation and to improve critical appraisal skills in evidence-based medicine journal clubs

RATIONALE, AIMS AND OBJECTIVES

Evidence-based medicine (EBM) journal clubs are used by health care practitioners to critique and remain updated on relevant health literature. Vote cards, in three different colours (green/yellow/red), allow participants to express their opinions (agree/doubt/reject) on the quality and possibility of clinical application regarding the article being reviewed. Our aim is to assess the efficacy of using vote cards in EBM journal clubs.

METHODS

Evidence-based medicine journal club is held on a weekly basis in the Department of Surgery in Taipei Medical University Hospital, Taiwan. The participants of EBM journal clubs include medical students, resident doctors and primary care faculty members. After the presentation, participants use their vote cards to critically appraise the literature and decide if the rationales could be applied in their own practice. After a 12-week period, we evaluated the effectiveness of the vote cards based on survey findings of the participants.

RESULTS

The majority of 66 respondents agreed that vote cards can improve the overall quality of EBM journal clubs, may encourage active participation and improve critical appraisal skills. They also rated the vote cards more favourably than traditional hand voting and agree that vote cards should be used in future EBM journal clubs.

CONCLUSION

We suggest the regular and routine use of vote cards in EBM journal clubs.

Are journal clubs effective in supporting evidence-based decision making? A systematic review. BEME Guide No. 16

BACKGROUND

Journal clubs (JCs) are a common form of interactive education in health care aiming to promote the uptake of research evidence into practice, but their effectiveness has not been established.

OBJECTIVE

This systematic review aimed to determine whether the JC is an effective intervention in supporting clinical decision making.

METHODS

We searched for studies which evaluated whether clubs promote changes in learner reaction, attitudes, knowledge, skills, behaviour or patient outcomes. We included undergraduate, postgraduate and practice JCs and excluded studies evaluating video/internet meetings or single meetings.

RESULTS

Eighteen studies were included. Studies reported improvements in reading behaviour (N = 5/11), confidence in critical appraisal (N = 7/7), critical appraisal test scores (N = 5/7) and ability to use findings (N = 5/7). No studies reported on patient outcomes. Sixteen studies used self-reported measures, but only four studies used validated tests. Interventions were too heterogeneous to allow pooling. Realist synthesis identified potentially 'active educational ingredients', including mentoring, brief training in clinical epidemiology, structured critical appraisal tools, adult-learning principles, multifaceted teaching approaches and integration of the JC with other clinical and academic activities.

CONCLUSION

The effectiveness of JCs in supporting evidence-based decision making is not clear. Better reporting of the intervention and a mixed methods approach to evaluating active ingredients are needed in order to understand how JCs may support evidence-based practice.

Physician numeracy as the basis for an evidence-based medicine curriculum

Most medical schools and postgraduate programs devote some time to teaching evidence-based medicine (EBM). EBM encompasses five essential skills, including constructing a sound clinical question, literature searching, critical appraisal, gaining a full understanding of study results, and integration of results into patient care. Gaining a full understanding of results requires understanding the statistical aspects of and terminology associated with the design, analysis, and results of original research--hereby referred to as physician numeracy. Physicians and physicians-in-training recognize the importance of these concepts but are uncomfortable with and demonstrate poor knowledge of the quantitative aspects of research. This is not surprising since few curricula include physician numeracy. Current approaches to teaching EBM rely on journal clubs, which have not been shown to improve participants' self-perceived EBM skills. In this paper we describe a novel approach to teaching EBM which makes use of five guiding principles: (1) Journal clubs have important limitations, (2) understanding the quantitative aspects of research promotes an in-depth understanding of papers, (3) physician numeracy can form the basis of an EBM course, (4) consumers of original research ought to determine what is useful about a paper rather than whether or not it is useful, and (5) numeracy should encompass only those concepts needed to accurately interpret evidence and apply it to individual patients. An EBM curriculum based on physician numeracy is described, together with the challenges inherent to this approach.

Dermatology internet resources

Many Internet resources for dermatologists benefit public health by providing education and information on the diagnosis and treatment of skin conditions. A variety of dermatology resources exist on the Web, but finding quality resources can be time-consuming. The authors provide a collection of high-quality, freely accessible, English-language Web sites that they have categorized as clinical, educational, or evidence-based medicine resources. They hope that this list of sources helps to meet the informational needs of dermatologists and promotes skin disease awareness and education.

Developing an integrated evidence-based medicine curriculum for family medicine residency at the University of Alberta

There is general consensus in the academic community that evidence-based medicine (EBM) teaching is essential. Unfortunately, many postgraduate programs have significant weakness in their EBM programs. The Family Medicine Residency committee at the University of Alberta felt their EBM curriculum would benefit from critical review and revision. An EBM Curriculum Committee was created to evaluate previous components and develop new strategies as needed. Input from stakeholders including faculty and residents was sought, and evidence regarding the teaching and practical application of EBM was gathered. The committee drafted goals and objectives, the primary of which were to assist residents to (1) become competent self-directed, lifelong learners with skills to effectively and efficiently keep up to date, and 2) develop EBM skills to solve problems encountered in daily practice. New curriculum components, each evidence based, were introduced in 2005 and include a family medicine EBM workshop to establish basic EBM knowledge; a Web-based Family Medicine Desktop promoting easier access to evidence-based Internet resources; a brief evidence-based assessment of the research project enhancing integration of EBM into daily practice; and a journal club to support peer learning and growth of rapid appraisal skills. Issues including time use, costs, and change management are discussed. Ongoing evaluation of the curriculum and its components is a principal factor of the design, allowing critical review and adaptation of the curriculum. The first two years of the curriculum have yielded positive feedback from faculty and statistically significant improvement in multiple areas of residents' opinions of the curriculum and comfort with evidence-based practice.

Principles of teaching evidence-based medicine

Teaching EBM is to impart the process of asking the question, acquiring and appraising the literature and applying it to the care of the patient, while weighing the risks, benefits and considering patient values. Teaching this process and its necessary content requires as with everything else, dedication, knowledge and practice. The best way to teach both patient care and EBM is by example.

Evidence-Based Medicine in Pediatric Residency Programs: Where Are We Now?

BACKGROUND

Evidence-based medicine (EBM) integrates the best research evidence with clinical expertise and patient values to optimize clinical outcomes for our patients.

OBJECTIVE

To examine incorporation of EBM into journal club (JC) and other venues within pediatric residency programs.

DESIGN/METHODS

A 30-question confidential survey was designed to determine how residents are taught and practice EBM. The survey was sent to the chief resident (CR) at all North American pediatric residency programs (N = 192). Nonrespondents were sent surveys 4 and 8 weeks later.

RESULTS

The response rate was 80% (n = 153). Pediatric residency programs varied in size from 12 to 132 residents from responses in 39 states. Most programs (97%, confidence interval [CI], 92-99) used EBM. JC (89%, CI, 83-93), noontime lectures (62%, CI, 54-70), and morning report (61%, CI, 53-69) were the most common venues used to teach EBM. JC (58%, CI, 50-66), morning report (11%, CI, 6-17), and resident workshop (11%, CI, 6-17) were the most effective venues to teach EBM, although resident workshops were as effective as JC to teach EBM in programs offering workshops (38% each, CI, 21-56). Most CRs felt confident in their ability to practice EBM (56%, CI, 48-64), but few CRs felt that their program could teach EBM (7%) or evaluate EBM effectiveness (20%).

CONCLUSIONS

EBM is common throughout pediatric residencies. JC was the most effective venue in which to teach EBM, unless a workshop was offered. Most CRs thought it was important to teach EBM, but did not feel confident in their program's ability to teach EBM.

Evidence in practice

A clinical scenario is used to illustrate how the principles outlined in the previous articles in the series could be applied to help improve patient care. A practical demonstration of the art of formulating answerable clinical questions, finding evidence, critically appraising evidence, and putting evidence into practice is provided. The importance of integrating evidence with patient's preferences, and taking account of issues such as availability of interventions, costs, and so on is discussed. Finally, some of the issues involved in the development of evidence based policies within clinical teams are outlined.

Impact of education on smoking cessation counseling by surgical residents

BACKGROUND

Surgeons infrequently provide smoking cessation counseling for patients, in part because they lack training to do so. We investigated the efficacy of 2 methods of teaching smoking cessation counseling to surgical residents.

METHODS

Residents' knowledge and attitude toward smoking cessation counseling were assessed by written test. Counseling skills were assessed with standardized patients. Residents were randomized for smoking cessation education: a "Role-play" group received a 1-hour lecture plus an hour of role-playing. An evidence-based medicine (EBM) group attended a 1- hour EBM journal club on related articles. Changes in residents' knowledge, attitude, and skills were assessed after education.

RESULTS

Sixteen residents completed the study. After either form of education, residents demonstrated significant improvements in knowledge, attitude, and skills in smoking cessation counseling. There was no significant difference in improvement between the EBM and Role-play groups.

CONCLUSIONS

A brief educational intervention can significantly improve residents' knowledge, attitude, and counseling skills for smoking cessation.

Identifying barriers to the adoption of evidence-based medicine practice in clinical clerks: a longitudinal focus group study

OBJECTIVE

To identify and explore common barriers to the adoption of evidence-based medicine (EBM) practice in the undergraduate setting.

DESIGN

Nested longitudinal, focus group-based, qualitative study. Setting The University of Hong Kong Medical School, Hong Kong, China.

PARTICIPANTS

A group of 39 Year 4 medical undergraduates who participated in an EBM intervention cluster randomised crossover trial.

MAIN OUTCOME MEASURES

Students' attitudes, opinions and perceptions of barriers to EBM use.

RESULTS

General attitudes towards EBM and the teaching intervention were positive. Four sets of barriers to greater EBM use were identified as follows. (1) Learning environment including prevailing norms for student learning involving examination-oriented, textbook learning, prior availability of clinical practice guidelines, lack of encouragement from teachers and economy of time by utilising teacher expertise. (2) Limitations of evidence consisting of poor point-of-care access to medical literature, difficulty in locating evidence and the perceived low relevance of overseas evidence to Chinese patients. (3) Lack of opportunity to practise EBM due to lack of continuity of care and anxieties about negative teacher attitudes towards EBM use at the point-of-care. (4) Time constraints such as competing study demands and long evidence search time.

CONCLUSIONS

Significant barriers to the successful implementation of EBM learning in the clinical clerkship setting were identified. These can be specifically targeted to ameliorate any inhibition of clinical learning they may impose.

Designing, conducting, and evaluating journal clubs in orthopaedic surgery

The first record of a journal club was that founded in 1875 by Sir William Osler at McGill University for the purchase and distribution of periodicals to which he could not afford to subscribe as an individual. Evidence-based medicine is becoming an accepted educational paradigm in medical education at various levels. An analysis of the literature related to journal clubs in residency programs in specialties other than orthopaedic surgery reveals that the three most common goals were to teach critical appraisal skills (67%), to have an impact on clinical practice (59%), and to keep up with the current literature (56%). The implementation of the structured article review checklist has been found to increase resident satisfaction and improves the perceived educational value of the journal club without increasing resident workload or decreasing attendance at the conference. Periodic evaluation of the conference and the institution of appropriate changes ensures that the journal club remains a valuable and successful part of the training program.

An initial experience with "team learning" in medical education

Team learning is an approach to large-group teaching that combines the strengths of small-group interactive learning with teacher-driven content delivery. Team learning has been used successfully in professional disciplines other than medicine. The authors describe a field test of team learning in the setting of an internal medicine residency noontime lecture in the spring of 2000 at Baylor College of Medicine. They surveyed residents on their attitudes toward the usefulness of the lecture content before and after the session and surveyed them on their engagement in learning. Residents reported their engagement as high and demonstrated favorable changes in their attitudes about the usefulness of the lecture content to their daily medical practice. The authors describe their adaptation of the team-learning approach and conclude that team learning may be a useful new pedagogic tool in medical education.