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 Table of Contents  
EDITORIAL
Year : 2017  |  Volume : 3  |  Issue : 2  |  Page : 71-73

Guidelines for conduct of journal club for postgraduates: A tool for evidence-based medicine


Department of General Medicine, Pondicherry Institute of Medical Sciences, Kalapet, Puducherry, India

Date of Web Publication8-Jan-2018

Correspondence Address:
Kurien Thomas
Department of General Medicine, Pondicherry Institute of Medical Sciences, Kalapet, Puducherry
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrsm.jcrsm_63_17

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How to cite this article:
Thomas K. Guidelines for conduct of journal club for postgraduates: A tool for evidence-based medicine. J Curr Res Sci Med 2017;3:71-3

How to cite this URL:
Thomas K. Guidelines for conduct of journal club for postgraduates: A tool for evidence-based medicine. J Curr Res Sci Med [serial online] 2017 [cited 2018 Apr 25];3:71-3. Available from: http://www.jcrsmed.org/text.asp?2017/3/2/71/222426

The transition from undergraduate to postgraduate medical education is associated with significant changes in the teaching–learning process. From the basic essential background knowledge about diseases which is primarily the focus during the undergraduate period, there is a shift to more advanced knowledge related to diagnosis, prognosis, and interventions in the postgraduate period. With the vast amount of information that is available through different media, it is difficult even for the most motivated to keep pace with rapid advances. It is difficult for residents in most specialties and even more so under internal medicine and pediatrics which encompass many specialties, and therefore, the burden is higher. The information overload is highlighted in [Figure 1].
Figure 1: Publications contributing to information overload

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There are more than 5000 biomedical publications and more than 50 interventional studies being published every day in Medline alone, and in any subject, one needs to read nearly 17 articles every day to keep pace with the information.

It is important that interns and residents learn how to cope with this information overload and at the same time maximize the assimilation of knowledge from these sources.

Critical appraisal of scientific publication in journal clubs is one of the most accepted evidence-based learning techniques. This is a group activity involving self, peers, and tutors/faculty. There is a need to understand the role of each one of them.

Self:

  1. The resident has to carefully select publications that are likely to be of maximum benefit to the large majority of their peers since the objective is to maximize the benefit to the whole group and keep the session interesting and informative
  2. The resident has to critically evaluate the selected publication based on the type of publication (diagnosis, harm, prognosis, intervention, or meta-analysis) and choose different types so as to improves one's capacity to critically evaluate all types of publications
  3. Summarize and present this information succinctly within a time allocated for this purpose (usually <15 min).


Peers:

  1. They have to come prepared by reading the article and participate in the discussions on internal validity and generalizability of the results.


Faculty:

  1. Can help to select the articles based on interest
  2. Guide the residents/interns on issues related to assessing internal validity, generalizability, and presentation
  3. Moderate the discussions of the group and help to keep the time.



  The Choice of Article to Be Discussed in the Journal Club Top


The choice of the publication is dependent on the main learning objectives which can be any or all of the four:

  1. To inform, to diagnose, and to treat patients under their care more optimally based on available global evidence
  2. To resolve controversies generated among peers on the subject
  3. To learn the principles of critical appraisal
  4. To sensitize the group to advances in the field of interest and areas of future research.


For diagnosis and care of patients

When the choice of article is based on finding solutions to clinical problems of patients admitted under the care of the unit, the benefit is maximum and the application of the research can have direct benefit to all participants and also to the patients under their care. This improves evidence-based practices in the whole unit through consensus that develops on important issues related to diagnosis, prognosis, and treatment of common problems in the ward. However, internal validity and generalizability are of paramount importance, and hence, the resident should choose carefully what he/she considers as the likely to change behavior for the better. The subject content and methodological rigor of the publication have to be optimum for maximum benefit. Of course, critical appraisal is a very important component of this collective learning process.

To resolve controversies on diagnosis and management of patients

Healthy academic discussions in the department encourage questions and also naturally raise controversies among the faculty or residents on the best way forward in diagnosis and management. Journal clubs offer the best opportunity to resolve these controversies and arrive at a consensus. This is best done under the supervision of a senior faculty tutor.

To learn the principles of critical appraisal

In this process, subject content and methodological rigor are not as important as while discussing diagnosis and management. The principles of critical appraisal are emphasized and the cardinal learning points are in understanding the limitations of research and impact of methods on internal validity and generalizability of the publication. No research is bad research. The emphasis is on making right conclusions based on the results and methods used in the study.

To sensitize the group to advances in the field of interest and areas of future research

  1. Screening the abstracts of many journals can be one of the methods to quickly understand important advances in the field of science, although this is less rigorous than the full critical appraisal. However, this cannot be done without understanding the principles of critical appraisal
  2. It is important that the group is sensitized to advances in the field of interest and also to understand the areas of future research without direct relevance to any patients under their care. This allows relatively rarer issues to be addressed in the journal club. Journal clubs are often the most important areas where relevant research questions are generated for residents and also for unit research activity. Depending on the time available, it may be a full article or an abstract
  3. It is important to realize that one cannot understand the results without carrying out critical evaluation, and therefore, it is an important component of this type of presentation
  4. It is important for the resident to prepare the presentation in a structured format. Many journals now publish only “structured abstract.” The components of the structured abstracts are (1) Introduction (2) Methodology, (3) Results, and (4) Discussion and Conclusions
  5. It is important that conclusions are the presenter's own and based on the results and methods and not necessarily that of the author.



  The Role of Faculty Guidance Top


There are many places where group learning takes place without the presence of a faculty. The residents themselves select a group leader, and the teaching–learning process can proceed without much trouble. But, in my opinion, having faculty guidance is an advantage.

The role of constructive criticism in the teaching–learning process is important. One of the major problems of criticism of journal reading is that the resident/student may misunderstand the “criticism of the journal” as “criticism of the person.” This is particularly more for the junior resident who has not yet mastered the principles of evidence-based medicine (EBM). One needs to be aware of this.


  Principles of Critical Appraisal Top


I am not discussing the principles of evidence-based learning and critical appraisal, which are a broader issue and refer you to very good publications on the subject by Guyatt GH, Sackett DL, and Cook DJ entitled “Users' guides to the medical literature. II. How to use an article about therapy or prevention. What were the results and will they help me in caring for my patients? Evidence-Based Medicine Working Group.” Suffice to say that there cannot be any form of journal club reading without using the principles of EBM and critical thinking, regardless of whether it is abstract or is an abstract or a full article.


    Figures

  [Figure 1]



 

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