Malekpour M.D Associated professor of pathology Afzalipour Medical School

1. Journal club session Malekpour M.D Associated professor of pathology Afzalipour Medical School

3. History • The first journal club was founded by Sir James Paget, a British Surgeon in the mid-1800’s • “Small room over a baker’s shop near the Hospital-gate where we could sit and read the journals” Journalclub session

4. History • Sir William Osler organized a journal club at McGill University in 1875 • Several authors suggest that journal clubs were found in certain European countries (in particular, Germany and England) prior to that time. Journalclub session

5. History • In the early 1900s in Germany, journal clubs were routinely found in departments of medicine and medical schools. • From 1917-1975, journal clubs evolved into a forum for continuing medical education. Journal club session

6. History Journal clubs are currently found in the fields of medicine, surgery, psychiatry, nursing, pharmacy, obstetrics and gynecology, pediatrics and geriatric social service. Journal club session

7. History This powerful educational tool has played an active role in medical education for over a century. The journal club should be more formally incorporated into the medical educational curriculum. Journal club session

8. Significance • In a 1995 survey of program directors in the eastern United States, Sidorov found: • 95% of internal medicine training programs had an activejournalclub. • More than 80% of internal medicine, family practice, emergency medicine, and physical medicinejournalclubsmeet at least once monthly, usually during the working hours, typically reviewing between two and three articles per session.. Journal club session

9. Educational Objectives • Provide update of current clinical evidence about a topic • Promote EBM and evidence-based clinical practice • Advance critical appraisal skills JC:Objective &Goals

10. Educational Objectives • Improving clinical practice – bridge between research and practice, between knowledge and care • Build database of reviewed material for group • Learn skills relevant to performing research, research design • Develop presentation skills JC:Objective &Goals

11. Research Objectives • Preparation to publish results • Be a stimulus for research ideas • Provide accreditation JC:Objective &Goals

12. Objective and Goals Goals may vary between meetings JC:Objective &Goals

13. Objective and Goals Present situation of journal club session Journal club session

14. Traditional JCS • information need • Teaching and leaning • Use of information • Reinforcement of learning Journl club session

15. information need • Trainee chooses topic at random • Lack of clinical context • Lack of systematic literature search Traditional JCS

16. Teaching and leaning • No critical appraisal • Mentors comments are generally based on personal experience and opinion • Lack of deep leaning process Traditional JCS

17. Use of information • Information is quickly for gotten • It can not be easily retrieved when required Traditional JCS

18. Reinforcement of learning • In the absence of a clinical context , acquired knowledge is seldom applied • There is no assessment of educational activity Traditional JCS

19. Problems Lack of • Acquisition • Appraise • Application • Assessment Traditional JCS

20. Critical appraisal • Three important question • Are the results of the study valid ? • What are the results ?(Sensitivity ; specifity ; PPV and NPV) • Will the results help locally Journal club session

21. The way of the problem resolution Use of articles with different methods and similar results Journal club session

22. The way of the problem resolution Use of articles with contradictive results Journal club session

23. The way of the problem resolution CPC-like Presentation Journal club session

24. The way of the problem resolution Detailed analysis of article Journal club session

25. The way of the problem resolution • Problem based journal club • Trainee centered journal club • Problem solving journal club Journal club session

26. Trainee centeredJCS • information need • Teaching and leaning • Use of information • Reinforcement of learning Journal club session

27. Information need • Trainee identifies a clinical problem • Problem are discussed in a small group ( Answerable questions ) Trainee centered JCS

28. Teaching and learning • Systematic literature searching ( computerized ; Cochrane library ) • Critical appraisal Trainee centered JCS

29. Use of information • Information is stored electronically • It can be easily retrieved when required Trainee centered JCS

30. Reinforcement • Practical use of acquired knowledge • Resolution of clinical problem • Use of feed back and assessment • Recognition of effort by electronic dissemination Trainee centered JCS

31. Transforming a traditional JC into an EBCP JC • design and implement a formal patient-based or problem-based curriculum • sources of evidence Evidence-based clinical practice JC

32. Preparing for one journal club:3-6 weeks before: • Presenter chooses a “real patient” scenario in which a clinical question has arisen • Presenter discusses with faculty mentor & develops PICO question (patient, intervention, comparison intervention, outcome) • Presenter searches for evidence (utilizes librarian, library, resources) • Presenter and mentor decide if patient problem & evidence are appropriate for JC Evidence-based clinical practice JC

33. Preparing for one journal club:3-6 weeks before: • Presenter develops synopsis of patient scenario/problem/question • Presenter selects one key article (and possibly supportive papers) • Presenter & mentor select appropriate method for analyzing, appraising, & presenting Evidence-based clinical practice JC

34. Preparing for one journal club:3-6 weeks before: • Presenter selects a clinical content expert for guidance • Leader selects appropriate worksheet/checklist tool • Leader commits to attend or identifies a substitute facilitator Evidence-based clinical practice JC

35. 2 weeks before: • Announcement to participants/attendees (2 weeks before) • Invite special clinical experts Evidence-based clinical practice JC

36. 1-2 weeks before: • Presenter prepares presentation of scenario + summary & critical appraisal of literature + discussion elements • Presenter meets with faculty mentor and reviews presentation • Leader prepares 5-10 minute interactive teaching points (Mini-Lesson) • Prepare extra paper copies of the key article Evidence-based clinical practice JC

37. 2 days before: • Reminder announcement to participants/attendees • Check food arrangement • Check materials: flip chart, pens, projector Evidence-based clinical practice JC

38. Presenter • presents patient scenario • provides summary analysis of the key papers • leads the discussion of critical appraisal of the evidence • leads a discussion of what this means for this patient –resolution of the patient scenario/question – what this means for our patients Evidence-based clinical practice JC

39. Facilitator • highlights EBCP elements & teaching points • guides discussion, uses open-ended questions • prompts debate, plays devil’s advocate if needed Evidence-based clinical practice JC

40. Clinical Expert • explains complex medical aspects • gives insight into study methods and design • provides commentary of current best practice Evidence-based clinical practice JC

41. Participants • read at least the key article prior to journal club • use worksheet to prompt critical appraisal thinking Evidence-based clinical practice JC

42. Journal Club Format • meet & greet • 15-30 minutes social time with food • 60-90 minutes journal club presentation and discussion • evaluation of presenter (private), evaluation of JC (open) Evidence-based clinical practice JC

43. Factors associated with success • Sidorov defined successfuljournalclubsas those with longevity (at least 2 years) and high levels of resident participation (at least 50% attendance) Journal club session

44. Factors associated with success • The overall satisfaction score was highest when thejournalclubwas held in the evening or at a faculty member's home. The format of thejournalclubwas not associated with the overall satisfaction score. Journal club session

45. Factors associated with success • practice-based, problem-based case scenario(Slawson 2005, O’Brien Cochrane) • high attendee interest in subject matter (Heligman) • discussion of complex, controversial issues; care issues with uncertainty Journal club session

46. Factors associated with success • valid articles • integrated teaching of critical appraisal skills • formal instruction in biostatistics and epidemiology • checklists: review instrument (Burstein 1996) Journal club session

47. Factors associated with success • Discussion of impact of the articles on practice • involvement of faculty with interest knowledge skills • food provided prior to start of session Journal club session

48. An Asynchronous International Journal Club A Working Model J Ellis, L Ellis, A Penstien, A Goldsmith JEllis@JournalReview.org SUNY Downstate

50. Goals • JournalReview.org will create an engaged international community of physicians, researchers, universities, policy makers, and others interested in published medical literature.