Journal clubs are a longstanding tradition in residency training, dating back to William Osler in 1875. The original goal of the journal club in Osler’s day was to share expensive texts and to review literature as a group. Over time, the goals of journal clubs have evolved to include discussion and review of current literature and development of skills for evaluating medical literature. The ultimate goal of a journal club is to improve patient care by incorporating evidence into practice.
Why are journal clubs important?
In 2004, Alper et al. reported that it would take more than 600 hours per month to stay current with the medical literature. That leaves residents with less than 5 hours a day to eat, sleep, and care for patients if they want to stay current, and it’s simply impossible. Journal clubs offer the opportunity for residents to review the literature and stay current. Furthermore, Lee et al. showed that journal clubs improve residents’ critical appraisal of the literature.
How do you get started?
The first step to starting a journal club is to decide on the initial goal. A good initial goal is to lay the foundation for critical thinking skills using literature that is interesting to residents. An introductory lecture series or primer on study design is a valuable way to start the journal club experience. The goal of the primer is not for each resident to become a statistician, but rather to lay the foundation for understanding basic study designs and the strengths and weaknesses of each design.
The next step is to decide on the time, frequency, and duration of the journal club. This depends on the size of your residency program and leadership support. Our journal club at Johns Hopkins is scheduled monthly during the lunch hour instead of a noon conference lecture. It is essential to pick a time when most residents in your program will be available to attend and a frequency that is sustainable.
How do you get residents to come?
Generally, if you feed them, they will come. In a cross-sectional analysis of journal clubs in U.S. internal medicine residencies, Sidorov found that providing food was associated with long-lasting journal clubs. Factors associated with higher resident attendance were fewer house staff, mandatory attendance, formal teaching, and an independent journal club (separate from faculty journal clubs).
The design or format of your journal club is also a key factor for attendance. Not all residents will have time during each rotation to read the assigned article, but you want to encourage these residents to attend nonetheless. One way to engage all residents is to assign one or two residents to lead each journal club, with the goal of assigning every resident at least one journal club during the year. If possible, pick residents who are on lighter rotations, so they have more time outside of clinical duties to dissect the article. To enhance engagement, allow the assigned residents to pick an article on a topic that they find interesting.
Faculty leadership should collaborate with residents on article selection and dissection and preparation of the presentation. Start each journal club with a 10- to 20-minute presentation by the assigned residents to describe the article (as detailed below) to help residents who did not have time to read the article to participate.
What are the nuts and bolts of a journal club?
To prepare a successful journal club presentation, it helps for the structure of the presentation to mirror the structure of the article as follows:
Background: Start by briefly describing the background of the study, prior literature, and the question the paper was intended to address.
Methods: Review the paper’s methods, emphasizing the study design, analysis, and other key points that address the validity and generalizability of the results (e.g., participant selection, treatment of potential confounders, and other issues that are specific to each study design).
Results: Discuss the results, focusing on the paper’s tables and figures.
Discussion: Restate the research question, summarize the key findings, and focus on factors that can affect the validity of the findings. What are potential biases, confounders, and other issues that affect the validity or generalizability of the findings to clinical practice? The study results should also be discussed in the context of prior literature and current clinical practice. Addressing the questions that remain unanswered and potential next steps can also be useful.
Faculty participation: At our institution, the faculty sponsor meets with the assigned residents to address their questions about the paper and guide the development of the presentation, ensuring that the key points are addressed. Faculty sponsors also attend the journal club to answer questions, emphasize key elements of the paper, and facilitate the open discussion after the resident’s presentation.
How do you measure impact?
One way to evaluate your journal club is to assess the evidence-based practice skills of the residents before and after the implementation of the journal club with a tool such as the Berlin questionnaire — a validated 15-question survey that assesses evidence-based practice skills. You can also conduct a resident satisfaction survey to evaluate the residents’ perception of the implementation of the journal club and areas for improvement. Finally, you can develop a rubric for evaluation of the resident presenters in each journal club session, and allow faculty to provide feedback on critical assessment of the literature and presentation skills.
Journal clubs are a great tradition in medical training and continue to be a valued educational resource. Set your goal. Consider starting with a primer on study design. Engage and empower residents to be part of the journal club. Enlist faculty involvement for guidance and mentorship. Measure the impact.
Michelle Sharp, M.D. is a Fellow in Pulmonary & Critical Care at Johns Hopkins Hospital.
Hunter Young, M.D., M.H.S. is the Medical Director of Patient Services at Johns Hopkins Medicine International and an Associate Professor of Medicine and Epidemiology.