|Year : 2012 | Volume
| Issue : 3 | Page : 208-211
Journal club: Why, what, and how?
Department of Oral Medicine and Radiology, Goa Dental College and Hospital, Bambolim, Goa, India
|Date of Web Publication||19-Feb-2013|
M S Archana
Senior Resident, Department of Oral Medicine and Radiology, Goa Dental College and Hospital, Bambolim, Goa
As the body of medical education continues to expand, physicians must develop the necessary skills to keep up with the vast amount of information available. The journal club provides a forum to allow residents to remain updated with the literature while also teaching them the methods to evaluate it critically. The articles are evaluated as to their quality and also whether and how the findings can be applied to practice. Recently, journal clubs have been designed to teach critical appraisal skills to physicians-in-training. This powerful educational tool has played an active role in medical education for over a century. Although this tool has been incorporated in the postgraduate curriculum, there still remains a lack of understanding of the concept and importance of journals. This paper provides a comprehensive review about what a journal article discussion is and how to evaluate a journal club.
Keywords: Critical evaluation, education, journal club, literature
|How to cite this article:|
Archana M S. Journal club: Why, what, and how?
. SRM J Res Dent Sci 2012;3:208-11
| Introduction|| |
Journal clubs have been used as a teaching format in academic medicine for over 100 years. More recently in postgraduate medical education, journal clubs have become a forum to teach its members critical appraisal techniques, thereby enriching their understanding of the medical literature. They have emerged as a method to promote the practice of evidence-based medicine.  They also help the postgraduates to get familiar with the advanced literature in the new field of study.
This paper highlights the approach to the development of an effective journal club as a part of the postgraduate education programme.
| What is a journal club?|| |
A journal club is a group of individuals who meet regularly to critically evaluate recent articles in the scientific literature. Journal clubs are usually organized around a defined subject in basic or applied research. 
| History|| |
The earliest reference to a journal club is found in a book of memoirs and letters by the late Sir James Paget, a British surgeon, who described a group at St. Bartholomew's Hospital in London in the mid-1800s as "a kind of club. a small room over a baker's shop near the Hospital-gate where we could sit and read the journals."  Sir William Osler established the first formalized journal club at McGill University in Montreal in 1875. The original purpose of Osler's journal club was "for the purchase and distribution of periodicals to which he could ill afford to subscribe." 
| Goals of a Journal Club|| |
In a journal club, articles are evaluated for their quality and also whether and how the findings can be applied to practice. Goals of a common journal club are: 
- Providing participants an update of the medical literature.
- Teaching techniques in the critical appraisal of the medical literature.
- Promoting evidence-based medicine.
- Demonstrating continuing medical and dental education.
- Improving skills specifically for the critical review.
- Promoting social contact.
Steps for starting a journal club
There are six steps to starting a journal club:
Select a director
The most important step in establishing a journal club is to have an interested person or a small group who are committed to the programme. The person or group should be responsible for the journal club. Having a designated leader correlates with effectiveness. He should be someone with a strong interest in postgraduate education and one who believes that a journal club plays an important role in it. 
Define the goals
The goals of nearly all the journal clubs are to keep the residents up to date with the literature, improving clinical practice and teaching critical appraisal skills. 
Scheduling the journal club at a time convenient to the busy schedule of the residents and faculty is often difficult, but is very important. It should be done at a specific day and time, allowing faculty and residents to plan their calendar around it. Journal clubs reported in the literature typically meet during working hours for a 1-h period on a monthly basis. 
Generate resident interest
The director must generate an enthusiastic atmosphere about the role of the journal club. The journal club requires audience participation to best educate the participants. It is the constant exchange of ideas and interactions among the members that help optimize its teaching potential. A round table discussion to maximize eye contact between members can be effective. Groups should ideally consist of 10-12 members; it may be necessary to form several groups of 8-12 members in a well-attended journal club. 
Consider the curriculum
Programmes aiming to teach critical appraisal techniques may include some type of formal teaching of these techniques, either as supplemental lecture series or by devoting some journal club sessions to the analysis of the articles. A journal club should be guided by the subject matter and type of studies frequently addressed. 
| Journal Club Preparation|| |
- Structure the journal club to conveniently fit into the residency schedule.
- Preselect one or two residents to lead the discussion.
- Article selection should occur at least 3 weeks before the scheduled presentation.
- Assigned resident(s) should meet with the faculty advisor before presentation to plan areas of emphasis and approach to moderating the discussion.
- Distribute the articles to participants 2 weeks before the meeting.
- Encourage participants to read the article in preparation for the discussion. 
| Journal Club Presentation Formats|| |
There are various formats that could be used for the presentation of the journal club. 
- Selecting articles emphasizing different aspects of experimental design: Select articles in the first one or two sessions that use different methods to study the same subject matter. For example, prospective or retrospective.
- Creating a controversy utilizing a debate format: A debate format usually stimulates resident discussion and interest. Selecting articles with opposite hypotheses, results, or conclusions on the same subject matter will force participants for discussion.
- Selecting classic articles: Residents often rely on textbooks for established facts and analysis of the actual articles on which these presumed facts are based, which may be a worthwhile approach for conducting a journal club.
- Meticulous analysis of a single article: Devoting a full session to a single article allows a study to be examined in detail. This format improves skills in critical analysis and thus aids the participants in writing their own manuscripts.
- Problem-based learning method: This approach forces the most bashful of the members to get involved in the discussion. Each member should record their response without outside consultation. Groups of four to five members are formed to discuss and unify the process.
There are usually three main styles of journal club presentation: 
Current journal style
Each presenter is given a list of current journals from which relevant papers should be selected.
The most relevant papers on a subject area or theme in the past 5 years are presented.
A clinician describes a clinical problem at the end of one journal club meeting. At the next journal club, some systematic reviews are presented on that subject and the evidence is evaluated.
| Evaluation of a Journal Club|| |
Periodic refinements are necessary to keep the journal club stimulating. The best way to decide this is to ask the participants whether they are satisfied with the session. Different approaches to evaluate a journal club are: 
- Use periodic written surveys to assess the goals and overall satisfaction of the participants.
- Survey residents if attendance is suboptimal to decide whether a change in meeting time and/or duration may improve attendance.
- Evaluate knowledge gained by participants using either self-evaluation surveys or by more objective measurements using a pretest/posttest format.
| Organizing a Successful Journal Club|| |
Do's and dont's 
For the organizer
- Issue a timetable of who is presenting what and when.
- Do not choose a time when people may find it difficult to turn up.
- Make sure an enjoyable snack is available with coffee.
- Have a supportive senior clinician chair the meeting.
For the presenter
- Do not leave things to the very last minute; turn up early to set up.
- Choose clinically relevant papers.
- Use Power Point presentation and keep the slides simple.
- Do not run over your allocated time.
- Summarize the paper in own words, not the authors'.
How to present a paper in a journal club and its guidelines
The following guidelines serve as a framework around which the presenter can device an individualized talk. It is typically a 45 min to 1 h presentation. 
Introduction (10-12 min)
The presentation should begin by briefly stating the main problem(s) or hypotheses being addressed (2-5 min). Then is the introduction of the authors, the paper and why the paper is important. A short review of the necessary background information should be presented (8-10 min). Background information provides an intellectual framework for the problem or the area being covered in the paper.
Presenting and evaluating data from the research articles (30 min)
The specific problem being covered should be restated and the main conclusion should be presented upfront. This helps the audience to understand the logic behind the experiments being described (1 min). The experimental design should be outlined briefly. Explain a few figures from the paper, how the data support the conclusions and fit into the model.
Summary (5 min)
After the entire paper is covered, finish with a short summary of the conclusion, how they justify the original hypotheses and any general comments about the paper.
| Ending|| |
Conclude the presentation with a simple "Thank you for your attention" or "Thank you. Are there any questions?" or just "Thank you." This will eliminate the awkward pause that sometimes occurs when the audience does not realize that the speaker has finished.
Points to enhance the presentation
- All presentations should preferably be in the Power Point format and displayed on an LCD projector.
- Rehearse the talks. Verbalizing the talk helps one to work out the bugs and avoid hidden tongue twisters or logistical issues.
- Speaking should be to/with audience and not the screen.Speech should be loud enough such that it should be audible to those at the back of the room.
- Text and figures should be large. A single slide must show one piece of data or at most two.
- Superficiality should be avoided. The paper being presented should be known thoroughly.
- Any interruption should be welcomed. If appropriate, then use them as spring boards for discussion. Good presentation initiates and invites discussion.
- Not to be nervous.
| How to Critique a Journal Club|| |
The following are a few questions using which a journal club can be critiqued: 
- Was the aim of the paper stated?
- Was the study well designed?
- Was the research well carried out?
- Was ethical approval obtained?
- Were there conflicts of interest?
- How were patients selected?
- Was consent obtained?
- How was randomization performed?
- Were patients excluded or lost to follow-up, or did they die or refuse participation?
- What were the outcome measures, and were the statistics satisfactory?
- Are the patients similar to those seen in your unit?
- Is the subject important or relevant to your unit's clinical practice?
- Did the study persuade you to change your mind?
- Are the study's conclusions sufficiently evidence based and should they be incorporated into your unit's practice?
| Conclusion|| |
The earliest reference to a journal club reflects its potential for combining interest and pleasure. A journal club can educate and motivate staff and improve patient care. In a busy hospital time table, a well run journal club can be something to look forward to. Journal clubs will continue to be experienced as interesting if they respond to the needs of participants. Given the wide range of formats, these clubs can be both stimulating and entertaining.  Keeping these facts in mind, journal clubs should be more formally and more thoroughly incorporated into the postgraduate educational curriculum mandatorily, which is still not being done in many educational setups. This article gives a simple guide as to how one could go about with journal article presentation and its evaluation.
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