An Effective Journal Club Presentation: A Guide

Prabhaharan Renganathana,*, Suresh S. Venkitab

Technical Editor – Kauverian Medical Journal, Kauvery Hospital, Trichy, India

Group Medical Director, Kauvery Hospitals, India

*Correspondence: prabhaharan@kauveryhospital.com(R. Prabhaharan); gmd@kauveryhealthcare.com(Dr. Suresh Venkita)

What is a Journal Club?

A journal club is a dedicated meeting where medical practitioners gather to discuss published articles from peer-reviewed journals. These meetings help fellows and residents keep up with current research findings, exercise their critical thinking skills, and improve their presentation and debating abilities. A journal club is a core element of residency and fellowship training in almost every medical specialty.

History of Journal Club

A journal club is a form of meeting regularly held among health practitioners to discuss recently published literature. The first organized journal club is credited to Sir William Osler, one of the greatest teachers in Medicine, at Montreal, Canada, in 1875, although Sir James Paget described a kind of club among some pupils at St Bartholomew’s Hospital in London to read journals together in the period 1835 to 1854. Approximately a decade later, Osler started the first journal club in the United States at the Johns Hopkins Hospital in 1889 [1]. During the next 100 years and after, it has flourished in various disciplines in the medical field in many countries.

Formats of Journal Club

The format of a journal club has evolved over decades. The most commonly recognized formats include a traditional journal club format and a more recently introduced evidence-based format [2].

Traditional journal club

In the traditional journal club, one trainee presents previously selected articles, and attendees discuss the results and findings. Senior faculty give comments mainly based on their expertise and clinical experience.

Evidence-based journal club

The articles are chosen based on clinical questions arising from clinical practice. Discussions include the critical appraisal of methodological aspects of the study and whether the findings would modify clinical practice.

Recently, an innovative flipped journal club was introduced [3].

Flipped journal club

Flipped format requires senior faculty to select an important clinical topic and a related landmark article, and trainees to select an accompanying background paper and a social medical piece, while also preparing an in-depth discussion in advance.

In recent years, virtual, online, journal club has become increasingly popular.

Online journal club

Large institutions usually decide the topics for discussion and organize the journal club, whereas participants from other centres contribute to the discussion. This format provides great opportunities for practitioners in community hospitals to get updated.

However, each journal club format has its advantages and disadvantages (Table 1). Therefore, the flexible integration of different formats may be considered to fulfil various objectives.

Table 1. Advantages and disadvantages of different formats of a journal club

Formats of a Journal Club Specific Aim Advantage Disadvantage
Traditional format Keep up-to-date with recent literature No need to prepare in advance for the attendees Quality of selected articles is inconsistent; audiences might be ill prepared and disengaged
Grasp clinical updates in an efficient way
Evidence-based format Improve critique skills Promote critical appraisal skills and research skills Basic biostatistical and methodological knowledge are needed
Flipped format Engage all learners Provide in-depth discussions Spend more time on organizing and preparing
All learners are involved
Virtual online format Make the journal club more accessible Easy to access without location restriction Interaction among attendees is limited
Encourage communication among multiple centers

Principle Objectives of a Journal Club

  1.  The primary goal of a journal club is gaining knowledge on the advances in the medical field, together with improving presenting and communication skills for the residents and fellows.
  2. Practice-based learning and keeping up-to-date with medical knowledge shall become the core element of a journal club.

Choosing pertinent articles

  1. Articles may be selected based on their clinical relevance or educational value.
  2. A 5-crucial-steps method to select a paper include screening of (1) title, (2) authors, (3) abstract, (4) figures and tables and (5) references.
  3. Either one or a few related articles can be selected and presented in the journal club.
  4. Choosing original articles are suitable for improving critique skills, whereas reviews, including meta-analyses, are also great resources for a quick review of the background information and keeping medical knowledge up-to-date.

Template of a Journal Club

A journal club could be structured through a series of questions.

Background and overview

  1. Study Citation: Cite your article here using proper format.
  2. Purpose/Background: Give a brief summary about why this study is important. You can also provide a short background on the drug, disease state, or procedure that is being evaluated. In addition, relevant literature on the subject can be discussed.
  3. Study Objective: The objective, study aim or goal, should be clearly stated in the article and copied directly so as not the meaning does not get changed.
  4. Historical Context: What other related trials have been done prior to this study? Discuss any other relevant literature on the subject here. Be sure to cite these below in the reference list.

Methods

  1. Study Design: Things to consider
    1. Retrospective vs. prospective
    2. Randomization
    3. Blinding
    4. Case control vs. RCT vs. meta-analysis
    5. Superiority vs. non-inferiority
    6. Multicenter vs. single site
  2. Interventions or study procedures
    1. Describe the interventions performed in the trial.
    2. What was the dose of the medications used?
    3. How often were they administered?
    4. Was there a washout period for study drugs?
    5. Was there an enrolment period to determine adherence?
    6. How were study participants randomized (i.e. 1:1, 1:2:1, etc.)?
    7. How long was the intervention period?
    8. What was the median follow-up time-frame?
    9. Was the follow-up period similar between the groups?
  3. Outcomes
    1. Primary outcome/endpoint
    2. Secondary outcomes/endpoints
  4. Statistical Analysis
    1. What statistical tests were used for each set of data?
    2. Were these tests were appropriate for your discussion?
    3. Did the study include a sample size calculation?

Results

  1. You may include tables and/or points to describe and summarize the main results.
  2. Be sure to include how many patients dropped out of the study and why?
  3. Be sure to include the results of the primary and secondary endpoints, statistical significance (e.g. p-value, confidence interval, etc.)
  4. Consider directing the audience/readers to a specific table/figure within the article if available.
  5. Consider also including number needed to treat (NNT) or number needed to harm (NNH).
  6. Address noteworthy adverse event rates (if applicable).

Discussion and Conclusions

  1. Evaluation of study quality
    1. Strengths: List them here. Examples: large sample size, external validity, etc.
    2. Limitations: What could be improved about the study design? What weakens the overall impact of the trial? (e.g. internal/external validity, statistical vs. clinical significance, inclusion/exclusion criteria appropriateness).
  2. Author’s discussion and conclusion
    Summarize the author’s conclusion from the article.
  3. Personal discussion and conclusion
    Present your conclusions. You may reference other articles and how findings from those might play a role in interpreting this study.
  4. Application to Patient Care
    How will you use this information in practice (consider your practice site specifically)?

Conclusions

The main purpose, and format of the journal club is focussed on the specific educational goals – to gain knowledge about advances in the medical field, and to improve the skills of presentation and communication. The journal club has been recognized as an efficient tool in graduate medical training.

References

  1. Linzer M. The journal club and medical education: over one hundred years of unrecorded history. Postgrad Med J. 1987;63:475-8.
  2. Mohr NM, Stoltze AJ, Harland KK, et al. An evidence-based medicine curriculum implemented in journal club improves resident performance on the Fresno test. J Emerg Med. 2015; 48:222.e1-9.e1.
  3. Bounds R, Boone S. The flipped journal club. West J Emerg Med. 2018;19:23-7.

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