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Old Curiosity Shop - Journal Clubs



Bandolier is aware that there is some interesting literature around examining the benefits of various interventions to improve education in healthcare. One such is the Journal Club, adored by some and hated by many. But when you have a good, well-directed journal club, or even one which just works, benefits ensue.

A study examined the effects of journal clubs in the southeastern USA [1]. A Questionnaire was sent to 74 family practice residency programmes, and 1450 residents of the programmes. Response rates were 89% and 49% respectively.

Results

A few clear results shine through. The first was that most of the directors of the programmes thought journal clubs (usually monthly, examining 4 papers) at least important, and sometimes vital. Attendance averaged 16 people (range 5 to 35), and attendance was highest where directors thought the journal club important, and lowest where they thought it had no impact (some circularity here!).

But the most interesting thing was that those in training, the residents, reported significantly more reading hours of journals, texts and newsletters where there was a journal club (mean 6.6 hours) then where there wasn't (4.8 hours).

How best to do it



Don't mess around, go straight to the experts [2]. Sackett & Co's now classic book has a pile of useful teaching tips - said to be for EBM, but generic really. For journal clubs the advice is a three part approach:
First session: members describe patients who exemplify clinical problems where they are unsure of management. Discuss till a problem can be defined. Members then set out to search for evidence for next journal club.
Second session: results of search for evidence are shared. Discuss and agree which are worth studying, for detailed discussion at next journal club.
Third session: discuss and critically appraise the evidence relating to the problem defined in session one and triaged in session two. Discuss how the evidence can be applied to future patients.
Now all three parts form one journal club meeting, with the third session being the "meat and potatoes". But the systematic approach through consecutive meetings of problem-search-solution provides ongoing glue.

And for those who lecture or organise lecturers or grand rounds, Sackett & Co's book has lots of useful information on that, too. It has had rave reviews recently in both JAMA and Annals of Internal Medicine in the USA. Bandolier likes and uses it a lot.

References:

  1. 1 JG Van Derwood, PE Tietze, MC Nagy. Journal clubs in family practice residency programs in the Southeast. Southern Medical Journal 1991 84: 483-7.
  2. 2 DL Sackett et al. Evidence-based medicine: how to practice & teach EBM. Churchill Livingstone 1997 ISBN 0-443-05686-2, £14.99.



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