|
|
|
|
Residents: Why Journal Club Matters
|
|
|
|
|
|
|
Residents, this one’s for you. Let’s talk about journal club. Don’t stop reading! We’re not going to actually do an online journal club. This one is a little more philosophical than that.
|
|
|
When I bring this subject up with trainees, I usually get one of two responses. The trainee either demonstrates excitement to read and learn about a new topic or turns a sourpuss face because they hate journal club. I think this is an unfortunate attitude that demonstrates a lack of understanding about both the educational process as well as his or her own level of experience.
|
|
|
Recently, I assigned one of my brand new first year residents a question about rheumatoid forefoot reconstruction. My question was, Which procedure has better outcomes: pan met head resection with Keller or with first metatarsophalangeal joint fusion? Like the excellent resident he is, he went to the medical literature to find an answer. What I found interesting was a part of his email response to me:
| “Obviously from never having done either procedure and relying solely on what I have read; it makes it a rather difficult question.”
|
|
|
|
This comment reveals a misunderstanding about how to use the medical literature, and a few comments about this might help some of you more thoughtful residents to understand just why you want to use the literature.
|
|
|
|
|
One of the major reasons to use the medical literature is to support your decisions when you don't know the answer. If you already knew the answer then why would you need the research? And, yes residents, you have little to no experience. You may work at the busiest program in the country, but I can guarantee that you still have little actual experience. Let’s take rheumatoid forefoot reconstruction as an example. If you did one of these procedures on day one of your residency and then saw that patient on day 1,095 of your program (AKA your graduation day) then you would have at most one patient with a three-year follow-up.
|
|
One of the major reasons to use the medical literature is to support your decisions when you don't know the answer.
|
|
|
Like most residents, you will rely on the experience of your attendings, which, though important, is only level-five evidence. This is where the literature comes in. By finding the best evidence to support or refute what you do, then you will be able to use this information to make future decisions. You will be using the aggregate research experience, which will hold you over until you’ve generated your own long-term experience. Remember, even a relatively weak retrospective study is better evidence than having no experience at all.
|
|
|
If you don’t love your current journal club here’s a suggested method that might make it more useful and interesting.
|
|
-
Set up a schedule of residents assigned to “run” the club. The Council on Podiatric Medical Education (the people who accredit your residency programs) states the following in the 320 document:
| 6.8 |
A journal review session, consisting of faculty and residents, shall be scheduled at least monthly to facilitate reading, analyzing, and presenting medical and scientific literature.
|
| |
The curriculum must afford the resident instruction in the critical analysis of scientific literature. The resident should present current articles and analyze the content and validity of the research.
|
You should have at least one journal club per month, but I strongly recommend at least every other week for the simple reason that there is too much research to review only once per month.
-
Have the assigned resident consider a recent patient encounter in which she did not know the answer or in which a question was generated. The resident should create a clinical question using the PICO method. PICO stands for Patient Intervention Comparison Outcome.
| As an example from my resident’s issue, one could create the following PICO question: In patients with RA undergoing rheumatoid forefoot reconstruction (P) is the Keller procedure (I) versus first MTP joint fusion (C) more effective in reducing pain (O)? You could also look up other outcomes such as function.
|
The resident would then use these terms to search Pub Med, Google Scholar, or other medical databases for no more than three best journal articles that might answer the question.
-
During the journal club (no longer than one hour total) the resident should give a two-minute presentation on the clinical situation that generated the question.
-
Critically appraise the article for the results, the validity of the results (internal validity), and the generalizability of the results (external validity). This is where the bulk of the journal club (the next 50 minutes) should occur. If three articles were chosen then a slightly abbreviated appraisal should occur with the addition of comparing the three articles to each other.
-
Summarize the overall results of the journal club to reach closure (this should take maybe 5 minutes). Ask yourselves this question: Did we answer the original question and can I use the evidence we discussed to apply to my patients?
|
|
|
|
|
You might find that this method will add some interest and utility to your journal clubs. Think about it this way: journal clubs are mandatory, so you might as well figure out how to get the most interest and educational value from them. After 17 years in this profession, I still don’t know the answer to many questions and still look to the literature to both support my current practice and find answers to those topics in which I’m ignorant. If you do the same with your journal clubs, you’ll find they help you become a better resident physician.
|
|
|
|
Get a steady stream of all the NEW PRESENT Podiatry eLearning by
becoming our Facebook Fan.
Effective eLearning and a Colleague Network await you.
|
|
Grand Sponsor
Major Sponsor
|
|
