Annals of Family Medicine Journal Club:

http://www.annfammed.org/site/AJC/

How It Works

In each issue of the Annals, the editors select an article or articles and provide discussion questions. We encourage you to take a RADICAL approach to these materials, and to post a summary of your conversation in TRACK, the Annals online discussion. For details, see A, B, and C, below.

A) Discussion Questions

Annals Journal Club discussion questions can be used to stimulate reflection and conversation. In particular, these questions are designed to help journal club participants, a) identify key points addressed by the article, and put them in context, b) discuss the scientific validity of the findings, and c) consider how the findings apply to practice, policy, education or research. The current selection(s) (above) and previous selections (below) include article citation(s), discussion tips, and discussion questions.

B) A RADICAL Approach

We encourage you to take a RADICAL approach to these articles. RADICAL stands for Read, Ask, Discuss, Inquire, Collaborate, Act and Learn. Journal clubs can get RADICAL by adopting these steps:
Read the article critically.
Ask the key questions for yourself.
Discuss the meaning and shared interpretation.
Inquire into other sources of knowledge and insight.
Collaborate with others who know or care about the issues.
Act by sharing an online (TRACK) comment and working to change practice, policy, training, or research.
Learn from what others share online and from your actions and collaborations and re-start the cycle.

C) Online Discussion (TRACK)

The Annals online discussion forum, called TRACK, is a way for you to share insights and conversation themes with other journal clubs and with readers worldwide. After discussing an Annals article in your journal club, we ask you to consider summarizing your conversation in a TRACK comment. (A sample comment is available at: http://www.annfammed.org/content/3/5/400/reply.) This is a unique opportunity for your journal club to be part of a global learning community.

To submit a comment in the online discussion, open the article online and click the link for "TRACK Comments: Submit a response." You may submit a brief, informal comment or a more structured, prepared commentary. Comments may be as short as one sentence and usually do not exceed 400 words and up to 5 references. Prepared comments would be appropriate to cite in your CV.

We highlight commonalities or uniquely important ideas from the online discussion in a regular editorial feature called On TRACK. Online comments submitted within two weeks after publication of an issue of Annals of Family Medicine will have the greatest chance of being referenced in On TRACK.

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Resources

• About the Annals Journal Club
• Bibliography (Extensive references about journal clubs and how to read and evaluate medical literature)

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Previous Selections

• Nov/Dec 2011: Saying Good-bye to Practice and Patients
• Sep/Oct 2011: Patients' Reasons for Not Disclosing Depression
• Jul/Aug 2011: Nonspecific Abdominal Pain in Children
• May/Jun 2011: A Patient-Physician Journey
• Mar/Apr 2011: Guided Care
• Jan/Feb 2011: Symbiosis Instead of Competing Demands: A Tale of 2 Preventive Services
• Nov/Dec 2010: Mitigating the Effects of Discontinuity
• Sep/Oct 2010: The Capability Framework
• Jul/Aug 2010: Guided Care
• May/Jun 2010: Causes of Dizziness in the Elderly
• Mar/Apr 2010: Point-of-Care C-Reactive Protein to Assist Antibiotic Prescribing for Respiratory Tract Infections
• Jan/Feb 2010: Steroids to Reduce Pain in Acute Pharyngitis
• Nov/Dec 2009: Medical Assistants' Role in Improving Preventive and Chronic Illness Care
• Sep/Oct 2009: The 'Yield' of Targeted Screening for Type 2 Diabetes
• Jul/Aug 2009: Symbiosis Instead of Competing Demands: A Tale of 2 Preventive Services
• May/Jun 2009: A Dirty Little Secret Revealed: The Downside of Screening Tests
• Mar/Apr 2009: The Decline of Maternity Care in Family Medicine
• Jan/Feb 2009: Symbiosis Instead of Competing Demands: A Tale of Two Preventive Services
• Nov/Dec 2008: The Course of Fatigue
• Sep/Oct 2008: Mortality from White Coat vs Sustained Hypertension
• Jul/Aug 2008: Hospital Care
• May/Jun 2008: Identity, Beliefs, and the Patient-Physician Relationship
• Mar/Apr 2008: Balint Groups and 'The Joy of Being a Doctor'
• Jan/Feb 2008: Pedometers for Promoting Walking and Weight Loss
• Nov/Dec 2007: Exemplars in Reducing No-Shows and Maximizing Volume
• Sep/Oct 2007: Novel Staffing for Improved Patient Disease Management
• Jul/Aug 2007: Challenges in Counseling Adolescents about HPV Vaccine
• May/Jun 2007: Acanthosis Nigricans and Diabetes Risk Factors
• Mar/Apr 2007: The Art of Family Medicine
• Jan/Feb 2007: Diagnosis of Deep Venous Thrombosis
• Nov/Dec 2006: Antibiotics for Common Respiratory Infections
• Sep/Oct 2006: Hot Flashes & Other Sleep Disorders
• Jul/Aug 2006: Implementing the Chronic Care Model
• May/June 2006: Annals Journal Club: A RADICAL Approach

How to Prepare an Outstanding Journal Club Presentation

By Rishi Sawhney, MD

January 1, 2006

Dr. Sawhney is a member of the ASH Trainee Council and a Fellow at the Medical University of South Carolina.

Journal club presentations provide a forum through which hematology trainees keep abreast of new developments in hematology and engage in informal discussion and interaction. Furthermore, honing presentation skills and mastering the ability to critically appraise the evidence add to our armamentarium as clinicians. Outlined here is a systematic approach to preparing a journal club presentation, with emphasis on key elements of the talk and references for electronic resources. Use of these tools and techniques will contribute to the success of your presentation.

I. ARTICLE SELECTION:

The foundation of an outstanding journal club presentation rests on the choice of an interesting and well-written paper for discussion. Several resources are available to help you select important and timely research, including the American College of Physicians (ACP) Journal Club and the Diffusion section ofThe Hematologist. McMaster University has created the McMaster Online Rating of Evidence (MORE) system to identify the highest-quality published research. In fact, the ACP Journal Club uses the MORE system to select their articles¹. Specific inclusion criteria have been delineated in order to distinguish papers with the highest scientific merit². Articles that have passed this screening are then rated by clinicians on their clinical relevance and newsworthiness, using a graded scale³. With the help of your mentors and colleagues, you can use these criteria and the rating scale as informal guidelines to ensure that your chosen article merits presentation.

II. ARTICLE PRESENTATION:

• Study Background: This section provides your audience with the necessary information and context for a thoughtful and critical evaluation of the article's significance. The goals are 1) to describe the rationale for and clinical relevance of the study question, and 2) to highlight the preclinical and clinical research that led to the current trial. Review the papers referenced in the study's "Background" section as well as previous work by the study's authors. It also may be helpful to discuss data supporting the current standard of care against which the study intervention is being measured.


• Study Methodology and Results: Clearly describe the study population, including inclusion/exclusion criteria. A diagrammatic schema is easy to construct using PowerPoint software and will help to clearly illustrate treatment arms in complex trials. Explain the statistical methods, obtaining assistance from a statistician if needed. Take this opportunity to verbally and graphically highlight key results from the study, with plans to expand on their significance later in your presentation.


• Author's Discussion: Present the authors' conclusions and their perspective on the study results, including explanations of inconsistent or unexpected results. Consider whether the conclusions drawn are supported by the data presented.

III. ARTICLE CRITIQUE:

This component of your presentation will define the success of your journal club. A useful and widely accepted approach to this analysis has been published in JAMA's series "User's guide to the medical literature." The Centre for Health Evidence in Canada has made the complete full-text set of these user's guides available online⁴. This site offers review guidelines for a menu of article types, and it is an excellent, comprehensive resource to focus your study critique. A practical, user-friendly approach to literature evaluation that includes a worksheet is also available on the ASH Web site for your use⁵.

While a comprehensive discussion of scientific literature appraisal is beyond the scope of this discussion, several helpful tips warrant mention here. In assessing the validity of the study, it is important to assess for potential sources of bias, including the funding sources and authors' affiliations. It is also helpful to look for accompanying editorial commentary, which can provide a unique perspective on the article and highlight controversial issues. You should plan to discuss the trade-offs between potential benefits of the study intervention versus potential risks and the cost. By utilizing the concept of number needed to treat (NNT), one can assess the true impact of the study intervention on clinical practice. Furthermore, by incorporating the incidence rates of clinically significant toxicities with the financial costs into the NNT, you can generate a rather sophisticated analysis of the study's impact on practice.

IV. CONCLUSIONS, IMPLICATIONS, AND FUTURE DIRECTIONS:

Restate the authors' take-home message followed by your own interpretation of the study. Provide a personal perspective, detailing why you find this paper interesting or important. Then, look forward and use this opportunity to "think outside the box." Do you envision these study results changing the landscape of clinical practice or redirecting research in this field? If so, how? In articles about therapy, future directions may include moving the therapy up to first-line setting, assessing the drug in combination regimens or other disease states, or developing same-class novel compounds in the pipeline. Searching for related clinical trials on the NIH Web site⁶ can prove helpful, as can consultation with an expert in this field.

Good journal club discussions are integral to the educational experience of hematology trainees. Following the above approach, while utilizing the resources available, will lay the groundwork for an outstanding presentation.

WEB BASED REFERENCES

1. www.acpjc.org


2. hiru.mcmaster.ca/more/InclusionCriteria.htm


3. hiru.mcmaster.ca/more/RatingFormSample.htm


4. www.cche.net/main.asp


5. www.hematology.org/education/training/index.cfm


6. www.cancer.gov/clinicaltrials

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Lectura crítica. Residencia de Clínica Médica. Hospital Italiano de Buenos Aires.

http://www.journalhiba.blogspot.com/

Espacio de lectura crítica de la Residencia de Medicina Interna del Hospital Italiano de Buenos Aires. Tenemos una reunión semanal donde se discuten artículos relevantes a la práctica diaria o importantes desde una perspectiva metodológica.

Contacto:journalhiba@gmail.com

What makes evidence-based journal clubs succeed?

Do you catch up on valuable rest time once a week at your local journal club? Or doze while somebody presents an article that has been allocated to them, without reference to “question,” “search strategy,” or “assessing performance”? While the rest may bring health benefits, it is unlikely to advance the quality of care. Evidence-based journal clubs, however, have documented benefits.¹

Having made most possible “errors,” we’d like to share some tricks and traps that we think make evidence-based journal clubs work or not. We have gathered our information from personal experience, a systematic search of the literature, and stories told by colleagues and members of the evidence-based-healthcare mailing list (see acknowledgements). One of us (PG) runs an evidence-based journal club in general practice; the other (RSP) runs an evidence-based journal club in the paediatric department of a teaching hospital² and facilitates journal club meetings for pharmacists. While running these disparate events, we, quite separately, stumbled on many of the same tricks and traps, many of which are supported by the findings of a large survey of the factors that predict the life span of (any) journal club.³

Cochrane Journal Club articles

http://www.cochranejournalclub.com/

ochrane Journal Club is a free, monthly publication that introduces a recent Cochrane review, together with relevant background information, a podcast explaining the key points of the review, discussion questions to help you to explore the review methods and findings in more detail, and downloadable PowerPoint slides containing key figures and tables. You can even contact the review authors with your questions.