Effectiveness Impact of Journal Clubs in Medicine

Effectiveness Impact of Journal Clubs in class plosive speech sound of medicineAbstractBackground Journal clubs emerging goals atomic get along 18 now considered to be breeding critical estimate skills and learning how to use evidence based treat in practice. Although daybook clubs are well accredited, designing the right format to hold in members stimulated and educated remains a great challenge.Methods We conducted ledger club coordinate modifications in natural medicine residence program of a university interact hospital. Initially group-based sessions identified feasible changes and baseline data concerning residents knowledge of evidence based medicine (EBM) was collected by a questionnaire. Modifications implemented and a blink of an eye set of group discussions and data collection took place after 12 months.Results Total number of 78 residents participated. The most important identified changes were schedule adjustments and stage setting naked goals regardin g EBM, medical statistics and critical appraisal tenet. Group discussion showed outgrowthd satisfaction and questionnaire assessments showed significant improvement in residents knowledge of EBM.Conclusions Redesigning ledger clubs with emphasis on regularity and setting new horizons basically improves their effectiveness. Assigning entire sessions to augment participants skills in new areas of knowledge is a unique way to fit diary clubs as a novel and innovative teaching practice.Practice PointsJournal clubs are connecting bridges between knowledge and practice.Journal clubs have gradually evolved to be a teaching tool in modern medicine.Considering growing popularity of evidence based medicine, journal clubs can be a way to introduce this see into cultureal programs.Redesigning old journal club structure is somehow necessary to better keep up with growing knowledge of medicine.Furnishing journal clubs with innovative methods world power be a reasonable way of reform.Introd uctionThe earliest reference to the origin of the phrase journal club is in memoirs and letters of Sir James Paget, describing a small room near St. Bartholomews Hospital in London in the period 1835-1854 in which pupils met and read journals (Paget 1901). More than a century has passed since Sir William Osler started the first save journal club in North America in 1875 as a way of sharing periodicals he could not afford individually and by and by established a club at Johns Hopkins University to review the latest medical research (Alguire 1998 Sleeman 1990). Todays journal clubs have evolved a great plug and are found in nearly every medical school and residency training program in almost all fields of medicine (Valentini Daniels 1997 Sidorov 1995 Green 1999).Traditionally journal clubs are educational run intos in which a group of individuals meet to discuss and critically evaluate the current articles in the scientific literature (Mcleod et al. 2010 SVN Research Committee 20 09). The major aim of journal clubs was to keep their attendees up to date with the latest medical literature (Valentini Daniels 1997 Forsen 2003 Goodfellow 2004). Gradually they have mystify a means for teaching critical appraisal skills, improving biostatistical knowledge, getting familiar with epidemiologic methods and most recently promoting the practice of Evidence Based Medicine (EBM) (Valentini Daniels 1997 SVN Research Committee 2009 Woods Winkel 1982).Critical appraisal skills and basing clinical decisions on the best published evidence available (i.e. EBM) have become an important look in clinical medicine and are part of core general competencies required by the Accreditation Council for Graduate Medical Education (ACGME) in all residency programs (ACGME 2009 Yew Reid 2008 Carpenter et al. 2010). In the ensuing years, EBM has enjoyed widespread popularity. Todays journal clubs are effectively assisting practiti angiotensin-converting enzymers translate knowledge int o practice and serve as an brilliant bridge between research and clinical work.While journal club has been a mainstay in postgraduate medical education for some(prenominal) years, some(prenominal) authors have pointed out the diversity of its format (Alguire 1998 Sidorov 1995 Ebbert et al. 2001). The desirability of journal clubs in internal medicine has been reinforced by accreditation requirements that mandate residents participation in journal clubs. Although the goals and purposes of journal clubs are well established, selecting the right format and setting to keep members stimulated and educated remains a great challenge (Kelly Cronin 2010 Hartzell et al. 2009).With the growing taste perception of evidence based medicine (EBM) and its widespread application in clinical decision making, we thought of revising and implementing possible modifications in our journal club structure to improve quality of sessions and weigh their effects on our journal club program.MethodsWe cond ucted revision program into our journal club structure involving internal medicine residents attendance the internal medicine residency program in a teaching university affiliated hospital.The modification process consisted of several steps. First we conducted group-based discussion sessions with participation of 2 clinical experts, two research experts, the program manager and chief resident. Group discussion primarily consisted of brain storming, reviewing similar works and their outcomes and sharing experiences. Five such meetings were held with main purpose of gauging current program features and identifying possible essential changes required to improve the program. Findings of these sessions so were shared with residents delegates, 2 residents from each year, with three discipline sessions. Identified feasible modifications were finally determined out of group-based discussions and implemented to make a new journal club structure.The group-based discussion took place for the second time, 12 months after executing alterations. Group participants were the same. This time the group assessed different aspects of changes made including residents attendance, residents satisfaction and the content of new sessions.Furthermore we measured the residents existing knowledge of EBM by a self- radicaled questionnaire, designed and internally validated by the discussion group. The questionnaire consisted of three questions to assess three fields residents knowledge of statistical significance, their acquaintance with evidence evaluation and their familiarity with consider design. Possible answers were as No familiarity, Fair familiarity, Good familiarity and Excellent familiarity.In order to alleviate supercharge comparison, the first two answers were classified as cluster 1 (limited knowledge) and the two remaining answers as cluster 2 (acceptable knowledge) therefore making comparison between two clusters. Each resident was disposed the questionnaire befor e applying changes and again 12 months after running the new program. Residents responses were withal discussed in the second set of group discussion.The results were collected anonymously and data was then imported to Excel software (2010, Microsoft) for examination. We specified the distribution of answers in each cluster before and after modifications and calculated the absolute difference between them exploitation descriptive statistics.ResultsSeventy-eight internal medicine residents (43 Female, 35 Male) were included into the survey. An almost even participation was observed among residents from all years of internal medicine training. Results of this study can be divided into two variants before applying changes and after implementing modifications.Phase IFounded on the primary group-based discussions, the acknowledged key points for developing our new journal club structure encompassed program and schedule modification, adding motives, defining new goals, content revision and implementing feedback mechanisms from which, content revision was considered the most critical one. The main aspects of modifications made are explained in details.Our new schedule was designed as weekly sessions on Thursdays (the day before weekend in our country). We planned the sessions to be held from 7 to 8 in the morning (Breakfast time) and on the day with minimal educational and clinical workload to assure maximal attendance. To ensure the regularity and predictability of our program, we already scheduled the sessions for the undermentioned entire year. Holidays, exam days and residents rotations were carefully noticed in planning the journal club calendar and the presenter for each session was specified at the beginning of the educational year.Furthermore we changed the place to a bigger room with better facilities. Also we decided to provide a mini breakfast meal during all sessions as a potential incentive that can increase participants interest.Defining new object ives was also emphasized by group members. Therefore, we set our new goals not only to keep updated with medical literature and review the current literature, but also to introduce medical statistics to residents, encourage arguments and develop critical appraisal skills and understanding EBM. We changed the composition of our journal club participants to include relevant attending physicians, medical statisticians and experts in EBM and critical thinking as well as internal medicine residents from all levels.In order to achieve the broad goal spectrum, our reformed program consisted of two different types of sessions. Three sessions of each month were use to presenting review articles and discussion about the main topic (analogous with former program). The last week of the month was devoted to evidence based journal clubs in which an authoritative article was presented to the audience and 2 to 3 relevant articles or guidelines were also considered. The main counselling of these sessions was to discuss the methodology and to point out statistical points through which critical appraisal skills were practiced and evaluation of the quality and validity of the results taught.Both types of sessions were moderated by an attending physician with experience in medical research and education background. Review article journal clubs were presented by a second year internal medicine resident employing slideshows hence each resident was provided the opportunity to clear from this chance at least twice a year. Evidence based journal clubs were presented by higher-ranking residents familiar with medical research and statistics and with acceptable teaching skills. These sessions were supervised by a team (at least 2 persons) of expert physicians in EBM and critical thinking skill.A support committee consisting of two senior internal medicine residents, journal club moderator and an EBM expert was formed for evaluating and choosing articles for presentation. The responsi ble resident had to provide up to 5 papers to the committee, who would then return one or two of them for presentation. The major selection criteria were relevancy and novelty of the topic and being in accordance with the interests of the participants. The other thing considered especially for articles to be presented in EBM sessions was being somehow controversial regarding the methodology or conclusion.At the end of each session a brief explanation was provided including critical points and a conclusion. For EBM sessions the effectualness and limitations of the article were also emphasized, inspiring the participants to involve in this process valuable in didactic endeavors. The conclusion of each session was then uploaded in the plane sectional forum of residents and interns for more discussion. Sometimes, a practical question was also provided in order to ascertain that residents have got the point correctly.Phase IISecond phase results are described after 12 months of runnin g the new program. Group-based discussion findings for new schedule clearly showed increased attendance and residents were more satisfied with the unflinching and pre-defined sessions. Nonetheless we noticed that providing food was not of residents concerns.Definition of new objectives for journal club sessions persuaded residents to participate more. Experts in the group-based discussions were also satisfied with the new content of sessions and periodical devoting an entire session to EBM and teaching statistical points and critical thinking.Regarding questionnaire assessment, final results showed that in the field of evidence rating knowledge, the number of residents in cluster 1 reduced from 51 to 17 and accordingly the number of residents in cluster 2 increased from 27 to 61 (43.6% absolute change regarding the total number of participants PSimilarly, before-after comparison for the field of statistical significance acquaintance revealed the absolute change to be 23.1% i.e. th e residents acquaintance with concept of statistical significance was noticeably augmented, ever-changing from limited knowledge to acceptable knowledge, in 18 residents (PDiscussionOur conventional journal club structure first started in internal medicine department of Shariati hospital, Tehran University of Medical Sciences in year 2007. Since then it was running in a small room and on a weekly basis with focus on review article presentation only. Participants were mainly residents, internal medicine interns and medical students and presenters of sessions were selected from first year residents.There are considerable studies describing journal clubs conducted in different settings and for different health providers yet there appear to be no Gold Standard approach for conducting a journal club or assessing its effectiveness. It is therefore an ongoing challenge in designing effective journal club format that assists the participants to translate journal club activities into evidenc e based practice (Deenadayalan et al. 2008). As residency programs deal with work hour restrictions and implement expertness educations (Hatala et al. 2006 Goroll et al. 2004), they need to undergo intense reassessment and possible remodeling to determine if they are meeting their goals.Our questionnaire survey showed that our reformed program made significant change in residents knowledge and the number of residents significantly shifted from low knowledge to acceptable knowledge.We postulated that holding journal clubs on a regular basis is necessary to achieve continuous educational progress and gradually obtain the desired improvement in residents competency which is in accordance to most previous studies (Deenadayalan et al. 2008 ). Regularity of sessions basically show the importance of this type of learning, as a new method of education is being introduced to the learners (residents). On the other hand, disorderliness might suggest that the program is not so useful and coord inators are not sure of its value, which in turn provide dissuade participants from joining and following the schedule.Pre-defining the whole schedule would be a great way in achieving this goal. Although fixed schedule might seems impractical for many institutes but authors assumed that accurately considering some fine points such as work hours prerequisites before scheduling the program may be helpful. In addition, this would assist participants to adjust their time and for presenter to know their schedule and being prepared for that.Regarding best frequency, according to most of studies reporting this, it seems that monthly period is endorsed (Letterie Morgenstern 2000 Burstein et al. 1996). Our reformed structure had a weekly basis, though our new EBM sessions were held monthly, not to shrink residents enthusiasm for participating in these educational gatherings.Some studies have shown that quantify of journal clubs might be of importance considering attendance, especially wh en they were coincided with meal times (Bazarian et al. 1999 Langkamp et al. 1992). While they advised provision of food as a way to increase attendance, our group-based discussions and residents feedbacks did not show such relation. This might be due to .Authors believed that forward movement without adding new goals and/or lacking enough motivation would not be successful in improving participants competency. Increasing knowledge of medical statistics and understanding EBM were the primary new objectives of our program which is demonstrated to be well achieved regarding our survey.Participants of journal clubs must be in accordance to the aims and contents of the program. Similar to Hartzell (2009), authors think that inviting attending physicians and involving senior residents may contribute to fulfillment of journal club objectives. This composition would facilitate the arguments and give space for better discussion and reaching a practical point. Assigning an entire separate s ession to introduction of this new area would also be of great benefit, since innovative thinking and learning new skills necessitates more time.New educational goals for residency programs now include conduction of problem orient sessions, evidence based journal clubs and also experiencing critical appraisal. Considering that almost all of medical education programs have introduced journal clubs as a routine in their curricula, we thought of it as a useful tool to familiarize our residents with better interpreting medical literature, critical thinking and evidence based medicine. This approach has been back up by previous researches (Hatala et al. 2006 Ghali et al. 2000).Although this survey showed promising results and improvement in residents knowledge and participation, our results are far from perfect. Yet we must increase our efforts to recognize subtle obstacles and further improve effectiveness of journal club.ConclusionIn conclusion, journal clubs are of great value in to days medical education addressing both(prenominal) clinical practice and evidence based learning improvement. Yet there is no gold standard to achieve the best result with this regard. We have enjoyed revolutionizing our conventional structure of journal clubs and furnishing it with novel objectives and construction and noticed significant improvement in attendance and competency of our internal medicine residents.Declaration of interestThe authors report no declarations of interest.