- Email: [email protected]
Running a successful journal club
PERSONAL PRACTICE
Running a successful journal club
How do you establish one? If your department does not have a journal club and you would like to set one up, planning is essential. Be prepared for it to take some effort to get things up and running, but it will be of benefit in the end. It is important to think about when and where to have your journal club and consider the audience.
Joanna Coghill
Timings Timing is often the first hurdle to consider. Look at everyone’s diaries, clinic commitments and get a consensus when most colleagues are available. Would you be naturally excluding someone by picking a day when they don’t work? Do mornings or lunchtimes work best? Will it be weekly or monthly? Depending on your department, different timings will suit different specialties. Just remember, you will never be able to please everyone. Ensure that you run the club regularly at the same time on the same day of the week or month so that it becomes an established fixture.
Abstract Journal clubs are long established features of health care teaching programmes. The explosion of research and the ability to decipher what is useful data make them all the more important today. They allow participants to develop skills in critical appraisal and presentation of research. However, running or presenting a journal club can be a daunting task. This article aims to discuss the benefits of journal clubs and offer tips to ensure they are run successfully.
Keywords continuing professional development; critical appraisal; evidence-based medicine; journal club; medical education
The environment It is essential to find a space that suits the needs and size of the group. This is often best chosen away from the busy hustle and bustle of the ward or outpatient area. Always choose the same location and don’t swap and change. Seating the participants in a horseshoe or circle shape encourages eye contact and thus more active participation. Although face to face journal clubs seem to be best for developing critical appraisal skills, web-based options should be considered. A department could hold a physical journal club meeting with an internet one as an adjunct for those unable to attend.
As busy professionals, it is difficult to keep up with the breadth and speed of medical research. In order to maintain an evidencebased approach to our clinical practice it is imperative to regularly access this information. Health-based journal clubs have been in place for over 100 years. The earliest reference to the term ‘journal club’ is in the memoirs of Sir James Paget, describing a small room near St. Bartholomew’s Hospital in London during 1835e1854 where pupils met and read journals. The first organised journal club is widely accredited to Sir William Osler who established one at McGill University, Montreal, in 1875. Today, a journal club remains similar with participants meeting on a regular basis to critically appraise literature and ascertain key clinical messages. Journal clubs have often been described as a “bridge between research and clinical practice” as they encourage the application of research in day to day clinical work.
The audience Think about who the journal club is primarily for. Inviting all levels of experience often provides a useful learning platform. If participants differ widely in knowledge and skills, it is important to provide access to training, so people feel competent and confident when presenting in front of their colleagues. Try to find ways of offering something for all. A journal club should be promoted as a safe environment to share information and ask questions. It may be useful, on occasion, to open the journal club to wider members of the multi-disciplinary team when relevant.
Why are journal clubs important? The advantages of journal clubs have long been recognised as a way of keeping up with medical literature and highlighting new findings. They also allow teaching and consolidation of critical appraisal skills, an essential part of being a competent paediatrician. Journal clubs can improve debating skills and help demonstrate leadership skills. They also offer a suitable platform for peer mentorship. For trainees, they allow the development of appraisal skills and application of new knowledge. For others, a journal club is an ideal place to complete continuing professional development (CPD). By reflecting on discussions and linking to clinical practice the attended journal club can be included as part of one’s CPD portfolio (see Table 1).
Library support The clinical library in your place of work can be an excellent source of support for journal clubs. They can aid the initial setting up of a journal club by providing evidence and examples from other NHS journal clubs. Library assistance also ensures the smooth running of pre-existing journal clubs. They can help source suitable journal articles for discussion and advise on getting copies. Most libraries can provide critical appraisal skills training and offer advice on which critical appraisal tools to use. Contact your library to see if they can also help with planning and structuring sessions.
How do you get people to attend? Joanna Coghill MBChB (Hons), MRCPCH, MSc, PgCert Med Ed, Consultant in Paediatric Neurodisability, Cambridgeshire and Peterborough NHS Foundation Trust, UK. Conflicts of interest: none declared.
PAEDIATRICS AND CHILD HEALTH xxx:xxx
Providing free food has been shown to correlate with longevity and high attendance for journal clubs. During my career I have experienced an incredible array of food presented during such
1
Ó 2019 Elsevier Ltd. All rights reserved.
Please cite this article as: Coghill J, Running a successful journal club, Paediatrics and Child Health, https://doi.org/10.1016/j.paed.2019.11.010
PERSONAL PRACTICE
give your colleagues the option to choose what they are interested in, what they have recently read, or learned at a course/ conference. It is useful to keep a log of the topics covered to avoid duplication and this can be used for CPD purposes. Try to encourage a broad search of journals, rather than everyone always bringing an article from their favourite paediatric journal!
Benefits of a journal club 1. 2. 3. 4. 5. 6.
Keep up to date with medical literature Learn and enhance critical appraisal skills Encourage evidence-based medicine (EBM) Promote shared learning and networking with colleagues Good platform for academic debate Publications are generated
What about structure? The goals and purposes of journal clubs are well established. However, selecting the right format to keep members stimulated and educated remains a great challenge. In general, there are two main variations: critical appraisal journal clubs and evidencebased journal clubs. There can be variations in different settings how they are operated.
Table 1
occasions, from homemade delights to treats from the hospital canteen. However, food shouldn’t be the only incentive. Ensuring that it is bleep free for trainees and mandatory for the team can also be helpful strategies. Mandatory attendance has been shown to be an important positive factor in attendance rates for journal clubs. Try to set clear boundaries for a strict start and finish time so people aren’t put off attending a long drawn out meeting.
Critical appraisal clubs In this approach, an article on a topic of interest is selected and appraised to assess its validity before using it to inform clinical decisions. It is useful if journal clubs use evidence appraisal tools, such as the Critical Appraisal Skills Programme (CASP) checklist. Critical appraisal allows research papers to be evaluated in a systematic way to address the following: 1. Is there a clear question that the study addresses? 2. Is the methodology used valid? 3. Do the results of the study have importance? 4. Can I apply the results to the patients I see? Sessions may consist of one presenter introducing a paper, briefly setting the clinical scene and then conducting the critical appraisal. If the results are valid, they would then discuss the use of the evidence in clinical practice before ending with a group discussion. To encourage group participation, the audience can be divided into small groups and once the presenter has briefly introduced the paper each group is assigned certain critical appraisal questions. Try to avoid pulling the paper to bits in critical appraisal, the aim is to objectively weigh up the paper’s strengths and weaknesses. The main difficulty with this style of journal club is participants may be reluctant to join in if they do not feel confident with critical review. It is imperative to access the correct resources to support training in critical appraisal to overcome this.
Assigning roles Often assigning specific roles helps place importance on individuals (see Table 2). As well as having the main presenter for the journal club, other members can play key roles which helps to boost attendance. How you decide to allocate roles depends on your own team and department. It is useful to have a leader who takes overall responsibility for the running of the club. Having a designated leader correlates with effectiveness. There may also be a chairperson who is responsible for the running of a specific meeting. Ensuring someone records discussions had during the journal club, thus acting as a scribe, is an excellent way of documenting for CPD and to ensure topics aren’t duplicated.
Topic selection The success of any journal club is determined by the relevance of the topic. Try to ensure topics are aligned with local clinical practice. Journal clubs can be neatly linked with key departmental objectives. Maybe you are considering a new procedure in your department and want to determine which technique gives the best results for patients? Or perhaps you are trying to justify a treatment to commissioners and the information gained from journal club might help support this. It is important to alternate who selects topics (often allowing the presenter to choose) to maintain enthusiasm and cover a breadth of relevant topics. Again, it is more likely to work if you
Evidence-based clubs In this style of journal club, participants try to understand how useable the evidence presented is in order to change clinical practice. It is based on the four key principles of Evidence-based medicine: 1. Question setting 2. Literature searching 3. Selecting the relevant papers 4. Critical appraisal Critical appraisal is only one aspect of EBM. This style of journal club often focuses on a topic rather than a single paper so can be a more time-consuming format. The basis is to start with a real-life clinical problem. The literature searching is often the step that is most onerous. This can be done as a search during one meeting, identifying the relevant articles and then spending the following session
Roles and responsibilities C
C
C
C C
“Leader” e in charge of the running and organisation of journal club “Chairperson” e introduce new members, provides food, ensures smooth running of meeting “Presenter” - the individual who picks and presents a journal article “Scribe” e records group discussions and share for CPD “Administrator” e provides copies of the article and sheets
Table 2
PAEDIATRICS AND CHILD HEALTH xxx:xxx
2
Ó 2019 Elsevier Ltd. All rights reserved.
Please cite this article as: Coghill J, Running a successful journal club, Paediatrics and Child Health, https://doi.org/10.1016/j.paed.2019.11.010
PERSONAL PRACTICE
appraising them. Another option could be the presenter completing the first steps with the journal club lead and the meeting time could be used for critical appraisal. The whole group could also be involved by setting the question as a debate between two teams. Each side argues its case, with a chairperson mediating.
clinical practice and improvements in evidence-based medicine. Regular, anticipated meetings coupled with enthusiasm and relevance are key to the successful running of journal clubs, often helped in the right direction by some tasty refreshments!
The presentation
Top tips for journal club success Discuss journals that link with real clinical problems relevant to your department Encourage questions and open discussion Aim for critical appraisal of methodology Provision of refreshments Be clear of time, place, topics and roles Finish discussion with clear clinical message learnt from the journal appraisal Refresh regularly e check it is still serving its purpose and meeting needs A
If you are presenting for journal club always check the target audience, this will allow you to pitch the paper, style and content appropriately. You may use a formal presentation with computer slides projected to help outline structure. Some journal clubs may favour an informal discussion with participants where the chairperson helps guide suitable questions. It is important to bring enough copies of the article for everyone and copies of a quick appraisal tool. It is useful to anticipate any potential questions that might arise and prepare for them!
Evaluation It is important to evaluate the success and relevance of journal club regularly. Very often it gets stuck in a certain format with the same audience attending and little impact being had on the wider department. When evaluating, it is important to question if the journal club is still meeting the learning needs of colleagues. An annual audit is a good method for such evaluation, or asking participants to complete satisfaction questionnaires.
FURTHER READING Aronson JK. Journal Clubs: 2. Why and how to run them and how to publish them. Evid Based Med 2017; 22: 232e4. Bowles PFD, Marenah K, Rogers BA. How to prepare for and present at a journal club. Br J Hosp Med 2013; 74: 150e2. Centre for evidence based medicine, University of Oxford https:// www.cebm.net/2014/06/critical-appraisal/. Esisi M. Journal clubs. BMJ 2007; 335: s138. Linzer M. The journal club and medical education; over one hundred years of unrecorded history. Postgrad Med J 1987; 63: 475e8. Kelly AM, Cronin P. Setting up, maintaining and evaluating an evidence-based radiology journal club: the University of Michigan experience. Acad Radiol 2010; 17: 1073e8. Phillips RS, Glasziou P. What makes evidence-based journal clubs succeed? BMJ Evidence-Based Medicine 2004; 9: 36e7. Sackett DL, Straus S, Richardson S, et al. Evidence based medicine: how to practice and teach EBM. 2nd edn. London: Churchill Livingstone, 1999. Swift G. How to make journal clubs interesting. Adv Psychiatr Treat 2004; 10: 67e72.
Limitations of journal clubs Journal clubs do have weaknesses and can fail to maintain participant interest. Common causes of failure are lack of time, unclear goals and objectives. Successful journal clubs have generally met for more than 2 years with good levels of participation. Seek support in the early stages and identify a lead for journal club who has experience in the process and can keep momentum flowing.
Summary Journal clubs are a great tradition and continue to be of value in medical education today. They address both good
PAEDIATRICS AND CHILD HEALTH xxx:xxx
3
Ó 2019 Elsevier Ltd. All rights reserved.
Please cite this article as: Coghill J, Running a successful journal club, Paediatrics and Child Health, https://doi.org/10.1016/j.paed.2019.11.010
Running a successful journal club
How do you establish one? If your department does not have a journal club and you would like to set one up, planning is essential. Be prepared for it to take some effort to get things up and running, but it will be of benefit in the end. It is important to think about when and where to have your journal club and consider the audience.
Joanna Coghill
Timings Timing is often the first hurdle to consider. Look at everyone’s diaries, clinic commitments and get a consensus when most colleagues are available. Would you be naturally excluding someone by picking a day when they don’t work? Do mornings or lunchtimes work best? Will it be weekly or monthly? Depending on your department, different timings will suit different specialties. Just remember, you will never be able to please everyone. Ensure that you run the club regularly at the same time on the same day of the week or month so that it becomes an established fixture.
Abstract Journal clubs are long established features of health care teaching programmes. The explosion of research and the ability to decipher what is useful data make them all the more important today. They allow participants to develop skills in critical appraisal and presentation of research. However, running or presenting a journal club can be a daunting task. This article aims to discuss the benefits of journal clubs and offer tips to ensure they are run successfully.
Keywords continuing professional development; critical appraisal; evidence-based medicine; journal club; medical education
The environment It is essential to find a space that suits the needs and size of the group. This is often best chosen away from the busy hustle and bustle of the ward or outpatient area. Always choose the same location and don’t swap and change. Seating the participants in a horseshoe or circle shape encourages eye contact and thus more active participation. Although face to face journal clubs seem to be best for developing critical appraisal skills, web-based options should be considered. A department could hold a physical journal club meeting with an internet one as an adjunct for those unable to attend.
As busy professionals, it is difficult to keep up with the breadth and speed of medical research. In order to maintain an evidencebased approach to our clinical practice it is imperative to regularly access this information. Health-based journal clubs have been in place for over 100 years. The earliest reference to the term ‘journal club’ is in the memoirs of Sir James Paget, describing a small room near St. Bartholomew’s Hospital in London during 1835e1854 where pupils met and read journals. The first organised journal club is widely accredited to Sir William Osler who established one at McGill University, Montreal, in 1875. Today, a journal club remains similar with participants meeting on a regular basis to critically appraise literature and ascertain key clinical messages. Journal clubs have often been described as a “bridge between research and clinical practice” as they encourage the application of research in day to day clinical work.
The audience Think about who the journal club is primarily for. Inviting all levels of experience often provides a useful learning platform. If participants differ widely in knowledge and skills, it is important to provide access to training, so people feel competent and confident when presenting in front of their colleagues. Try to find ways of offering something for all. A journal club should be promoted as a safe environment to share information and ask questions. It may be useful, on occasion, to open the journal club to wider members of the multi-disciplinary team when relevant.
Why are journal clubs important? The advantages of journal clubs have long been recognised as a way of keeping up with medical literature and highlighting new findings. They also allow teaching and consolidation of critical appraisal skills, an essential part of being a competent paediatrician. Journal clubs can improve debating skills and help demonstrate leadership skills. They also offer a suitable platform for peer mentorship. For trainees, they allow the development of appraisal skills and application of new knowledge. For others, a journal club is an ideal place to complete continuing professional development (CPD). By reflecting on discussions and linking to clinical practice the attended journal club can be included as part of one’s CPD portfolio (see Table 1).
Library support The clinical library in your place of work can be an excellent source of support for journal clubs. They can aid the initial setting up of a journal club by providing evidence and examples from other NHS journal clubs. Library assistance also ensures the smooth running of pre-existing journal clubs. They can help source suitable journal articles for discussion and advise on getting copies. Most libraries can provide critical appraisal skills training and offer advice on which critical appraisal tools to use. Contact your library to see if they can also help with planning and structuring sessions.
How do you get people to attend? Joanna Coghill MBChB (Hons), MRCPCH, MSc, PgCert Med Ed, Consultant in Paediatric Neurodisability, Cambridgeshire and Peterborough NHS Foundation Trust, UK. Conflicts of interest: none declared.
PAEDIATRICS AND CHILD HEALTH xxx:xxx
Providing free food has been shown to correlate with longevity and high attendance for journal clubs. During my career I have experienced an incredible array of food presented during such
1
Ó 2019 Elsevier Ltd. All rights reserved.
Please cite this article as: Coghill J, Running a successful journal club, Paediatrics and Child Health, https://doi.org/10.1016/j.paed.2019.11.010
PERSONAL PRACTICE
give your colleagues the option to choose what they are interested in, what they have recently read, or learned at a course/ conference. It is useful to keep a log of the topics covered to avoid duplication and this can be used for CPD purposes. Try to encourage a broad search of journals, rather than everyone always bringing an article from their favourite paediatric journal!
Benefits of a journal club 1. 2. 3. 4. 5. 6.
Keep up to date with medical literature Learn and enhance critical appraisal skills Encourage evidence-based medicine (EBM) Promote shared learning and networking with colleagues Good platform for academic debate Publications are generated
What about structure? The goals and purposes of journal clubs are well established. However, selecting the right format to keep members stimulated and educated remains a great challenge. In general, there are two main variations: critical appraisal journal clubs and evidencebased journal clubs. There can be variations in different settings how they are operated.
Table 1
occasions, from homemade delights to treats from the hospital canteen. However, food shouldn’t be the only incentive. Ensuring that it is bleep free for trainees and mandatory for the team can also be helpful strategies. Mandatory attendance has been shown to be an important positive factor in attendance rates for journal clubs. Try to set clear boundaries for a strict start and finish time so people aren’t put off attending a long drawn out meeting.
Critical appraisal clubs In this approach, an article on a topic of interest is selected and appraised to assess its validity before using it to inform clinical decisions. It is useful if journal clubs use evidence appraisal tools, such as the Critical Appraisal Skills Programme (CASP) checklist. Critical appraisal allows research papers to be evaluated in a systematic way to address the following: 1. Is there a clear question that the study addresses? 2. Is the methodology used valid? 3. Do the results of the study have importance? 4. Can I apply the results to the patients I see? Sessions may consist of one presenter introducing a paper, briefly setting the clinical scene and then conducting the critical appraisal. If the results are valid, they would then discuss the use of the evidence in clinical practice before ending with a group discussion. To encourage group participation, the audience can be divided into small groups and once the presenter has briefly introduced the paper each group is assigned certain critical appraisal questions. Try to avoid pulling the paper to bits in critical appraisal, the aim is to objectively weigh up the paper’s strengths and weaknesses. The main difficulty with this style of journal club is participants may be reluctant to join in if they do not feel confident with critical review. It is imperative to access the correct resources to support training in critical appraisal to overcome this.
Assigning roles Often assigning specific roles helps place importance on individuals (see Table 2). As well as having the main presenter for the journal club, other members can play key roles which helps to boost attendance. How you decide to allocate roles depends on your own team and department. It is useful to have a leader who takes overall responsibility for the running of the club. Having a designated leader correlates with effectiveness. There may also be a chairperson who is responsible for the running of a specific meeting. Ensuring someone records discussions had during the journal club, thus acting as a scribe, is an excellent way of documenting for CPD and to ensure topics aren’t duplicated.
Topic selection The success of any journal club is determined by the relevance of the topic. Try to ensure topics are aligned with local clinical practice. Journal clubs can be neatly linked with key departmental objectives. Maybe you are considering a new procedure in your department and want to determine which technique gives the best results for patients? Or perhaps you are trying to justify a treatment to commissioners and the information gained from journal club might help support this. It is important to alternate who selects topics (often allowing the presenter to choose) to maintain enthusiasm and cover a breadth of relevant topics. Again, it is more likely to work if you
Evidence-based clubs In this style of journal club, participants try to understand how useable the evidence presented is in order to change clinical practice. It is based on the four key principles of Evidence-based medicine: 1. Question setting 2. Literature searching 3. Selecting the relevant papers 4. Critical appraisal Critical appraisal is only one aspect of EBM. This style of journal club often focuses on a topic rather than a single paper so can be a more time-consuming format. The basis is to start with a real-life clinical problem. The literature searching is often the step that is most onerous. This can be done as a search during one meeting, identifying the relevant articles and then spending the following session
Roles and responsibilities C
C
C
C C
“Leader” e in charge of the running and organisation of journal club “Chairperson” e introduce new members, provides food, ensures smooth running of meeting “Presenter” - the individual who picks and presents a journal article “Scribe” e records group discussions and share for CPD “Administrator” e provides copies of the article and sheets
Table 2
PAEDIATRICS AND CHILD HEALTH xxx:xxx
2
Ó 2019 Elsevier Ltd. All rights reserved.
Please cite this article as: Coghill J, Running a successful journal club, Paediatrics and Child Health, https://doi.org/10.1016/j.paed.2019.11.010
PERSONAL PRACTICE
appraising them. Another option could be the presenter completing the first steps with the journal club lead and the meeting time could be used for critical appraisal. The whole group could also be involved by setting the question as a debate between two teams. Each side argues its case, with a chairperson mediating.
clinical practice and improvements in evidence-based medicine. Regular, anticipated meetings coupled with enthusiasm and relevance are key to the successful running of journal clubs, often helped in the right direction by some tasty refreshments!
The presentation
Top tips for journal club success Discuss journals that link with real clinical problems relevant to your department Encourage questions and open discussion Aim for critical appraisal of methodology Provision of refreshments Be clear of time, place, topics and roles Finish discussion with clear clinical message learnt from the journal appraisal Refresh regularly e check it is still serving its purpose and meeting needs A
If you are presenting for journal club always check the target audience, this will allow you to pitch the paper, style and content appropriately. You may use a formal presentation with computer slides projected to help outline structure. Some journal clubs may favour an informal discussion with participants where the chairperson helps guide suitable questions. It is important to bring enough copies of the article for everyone and copies of a quick appraisal tool. It is useful to anticipate any potential questions that might arise and prepare for them!
Evaluation It is important to evaluate the success and relevance of journal club regularly. Very often it gets stuck in a certain format with the same audience attending and little impact being had on the wider department. When evaluating, it is important to question if the journal club is still meeting the learning needs of colleagues. An annual audit is a good method for such evaluation, or asking participants to complete satisfaction questionnaires.
FURTHER READING Aronson JK. Journal Clubs: 2. Why and how to run them and how to publish them. Evid Based Med 2017; 22: 232e4. Bowles PFD, Marenah K, Rogers BA. How to prepare for and present at a journal club. Br J Hosp Med 2013; 74: 150e2. Centre for evidence based medicine, University of Oxford https:// www.cebm.net/2014/06/critical-appraisal/. Esisi M. Journal clubs. BMJ 2007; 335: s138. Linzer M. The journal club and medical education; over one hundred years of unrecorded history. Postgrad Med J 1987; 63: 475e8. Kelly AM, Cronin P. Setting up, maintaining and evaluating an evidence-based radiology journal club: the University of Michigan experience. Acad Radiol 2010; 17: 1073e8. Phillips RS, Glasziou P. What makes evidence-based journal clubs succeed? BMJ Evidence-Based Medicine 2004; 9: 36e7. Sackett DL, Straus S, Richardson S, et al. Evidence based medicine: how to practice and teach EBM. 2nd edn. London: Churchill Livingstone, 1999. Swift G. How to make journal clubs interesting. Adv Psychiatr Treat 2004; 10: 67e72.
Limitations of journal clubs Journal clubs do have weaknesses and can fail to maintain participant interest. Common causes of failure are lack of time, unclear goals and objectives. Successful journal clubs have generally met for more than 2 years with good levels of participation. Seek support in the early stages and identify a lead for journal club who has experience in the process and can keep momentum flowing.
Summary Journal clubs are a great tradition and continue to be of value in medical education today. They address both good
PAEDIATRICS AND CHILD HEALTH xxx:xxx
3
Ó 2019 Elsevier Ltd. All rights reserved.
Please cite this article as: Coghill J, Running a successful journal club, Paediatrics and Child Health, https://doi.org/10.1016/j.paed.2019.11.010