Journal clubs

Authors: Martina Esisi 

Publication date:  13 Oct 2007


Martina Esisi considers how to get the most out of them

Journal clubs are educational meetings where individuals meet regularly to critically evaluate recent articles in the scientific literature. They have often been cited as a bridge between research and practice, as they encourage the application of research in clinical practice.[1]

After a literature search, the earliest reference to a journal club I found is described by Sir James Paget who, in the mid-1800s, described a group at St Bartholomew's Hospital in London, as a “kind of club . . . a small room over a baker's shop near the hospital-gate, where we could sit and read the journals.”[2]

Why journal clubs?

Many academic training programmes include a journal club. They have long been recognised as a means of keeping up to date with the literature; promoting evidence based medicine; and teaching critical appraisal skills, which I found particularly useful when preparing for the critical review paper to part 2 of the Royal College of Psychiatry's membership exam. In order for trainee doctors to be able to adapt to ever-changing circumstances, in clinical practice, they need to equip themselves with the skills of critical appraisal, and the ability to apply new knowledge. Journal clubs also help to keep permanent staff updated.[3]

Advantages of a journal club

  • Help people to learn and improve their critical appraisal skills

  • Encourage evidence based medicine

  • Promote awareness of research skills

  • Keep abreast with new literature

  • Encourage use of research

  • Promote social contact

  • Provide continuing medical education

  • Stimulate debate, and improved understanding of current topics.

Unfortunately, in my experience these clubs are often poorly attended. There are various reasons for this, including the way they are organised.

Organising journal club sessions

There is no single ideal format for a journal club. Many variations have been described, and this is influenced by the goals set by the organisers, and the needs and interests of the target participants.

Participants often differ widely in knowledge and skills, and, for example, if part of the goal is to teach critical appraisal skills and thereby help trainees (such as in psychiatry) to prepare for the critical review paper component of the membership exams, the critical appraisal journal clubs will be particularly useful.

In this respect, access to basic and refresher courses are helpful, so that people feel more confident to participate at meetings. Some postgraduate education centres provide this.

If on the other hand the main aim is to contribute to the application of research then it might be more appropriate to structure each meeting to look at specific topics, rather than articles, or perhaps a combination of both will be useful.

Generally, the two main variations are critical appraisal journal clubs and evidence based journal clubs. Even within these broad types, there are variations in the way they are run.

Critical appraisal clubs

Critical appraisal is the process of systematically examining research evidence to assess its validity, results, and relevance before using it to inform a decision.[4] It is thus an essential part of evidence based clinical practice, as it helps close the gap between research and practice. In critical appraisal journal clubs, generally an article is reviewed. Usually, the presenter introduces the paper, which is either a classic paper, or one that has been chosen by the presenter, often using a critical appraisal checklist. The main problem with this sort of club is that participants may not feel confident in their critical appraisal skills and are therefore reluctant to join in.

Evidence based clubs

Evidence based medicine is the process of systematically reviewing, appraising, and using clinical research findings to aid the delivery of optimum clinical patient care.[5] The main elements include posing a question, carrying out a literature search, and then selecting relevant papers, as well as critical appraisal. It may become necessary to spend one session of this journal club finding a relevant paper. and spend another session appraising it. Alternatively, the presenter could select a paper that is then appraised at the club.

Whatever the format, certain factors remain relevant in the structure of a successful journal club. Successful clubs are generally those with a single leader and a mandatory attendance. The environment is also important.

Role of the leader

Having someone who takes overall responsibility for the club is useful. This is usually the leader. Additionally, some clubs have a chairperson who chairs the meeting on different occasions. Usually, as well as organising the meeting the leader decides on the chairperson for each meeting. The advantage of this system is that different people take turns to share experience. Frequently, consultants with interests in medical education, such as tutors, take the role of leaders, and senior trainees such as senior registrars take the role of the chair.

Choosing an article

It is important to consider what you want to achieve in your presentation and then choose a paper accordingly.[6] Think of recent articles that perhaps contradict old truths. Alternatively choose a classic paper in the history of your specialty. You might also want to consider articles of topical issues.

The presentation

Consider the needs of your target audience and remember how long you've got. Use PowerPoint or an equivalent package, with user friendly slides. Bring enough copies of articles for everyone, including multiple copies of a quick (one page) appraisal tool. If an article being reviewed seems only vaguely related to the question, take the opportunity to critically appraise the methodology in a systematic way.[7] It is often useful to include the limitation and clinical implication of an article. Remember to anticipate possible questions you might be asked, and prepare answers.

The environment

The room should suit the group. The larger the group, the larger the room, and vice versa. A large room with a small group of people encourages passivity. On the other hand, a small room with a large number of people discourages attendance. Providing free good food at any educational meeting is only one way of improving attendance; there are others:

  • Mandatory attendance for trainees (use of registrar)

  • Bleep-free for trainees not on call

  • Setting boundaries (strict start and finish time)

  • Early week rather than late week slots (Mondays, not Fridays)

  • Distribute time, place, topics, and roles.

Journal clubs can be stimulating and entertaining, but they will only continue to be interesting if they respond to the needs of participants. Although there is no ideal format, the common themes for successful journal clubs seem to be that they are question driven and appraisal focused.[7] They need to be well structured yet flexible and creative within the limitations of a traditional format.

References

  1. Kleinpell RM. Rediscovering the value of the journal club. American Journal of Critical Care   2002;11:42.
  2. Linzer M. The journal club and medical education; over one hundred years of unrecorded history. Postgraduate Medical Journal  1987;63:475-8.
  3. Swift G. How to make journal clubs interesting. Advances in Psychiatric Treatment  2004;10:67-72.
  4. Hill A, Spittlehouse C. What is critical appraisal?   London: Hayward Medical Communications, 2006. (www.evidence-based-medicine.co.uk
  5. Rosenberg W, Donald A. Evidence based medicine; an approach to clinical problem solving. BMJ  1995;310:1122-6.
  6. Hallas P. Tips on—Choosing an interesting paper for the journal club. BMJ Careers  2005;331:252. http://careerfocus.bmj.com/cgi/content/full/331/7529/252
  7. Phillips R, Glasziou P. What makes evidence based journal clubs succeed? Evidence Based Medicine  2004;9:36-7.

Martina Esisi staff grade doctor, psychiatry  Oritsesemisan@btinternet.com Warwickshire

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