by Lony Castro, M.D. (November 2006)
JOURNAL CLUB
Department of Obstetrics and Gynecology, Arrowhead Regional Medical Center/ Western University COMP
Journal Club is held once per month at —usually in the home of one of the faculty members. .
The purpose of Journal club is to facilitate our development as “life long learners” of the practice of medicine, in a collegial setting, away from the constant demands of direct patient care. To this end we will critically review 3-4 published articles that address how we conceptualize, diagnose or manage different problems/diagnoses relevant to Obstetrics and Gynecology. Careful attention will be paid to the methodology and interpretation of results so that our residents are prepared to critically review articles independently once they have finished their residency. Priority in choosing articles is given to original peer reviewed research including, whenever possible, prospective trials. Review articles are discouraged. Meta analyses/ decision analyses/ cost-effectiveness research may be permissible but often are difficult to analyze and depend in large part on which papers the authors have chosen to include. Occasionally we may use the journal club format to discuss recently published guidelines and the evidence supporting them
The articles will be selected by the residents or assigned by the sponsoring faculty member. The sponsoring faculty member will be responsible for reviewing the articles with the presenting residents and helping to lead/monitor the discussion. The articles need to be available at least one week prior to Journal club so that all faculty and residents have time to review them.
Each paper will be presented by a resident—the resident will address what the goals of the proposed study were, what type of study was actually done, what statistics were used for analysis, what the results were and what the conclusions were (the structured abstract really covers much of this). The resident will need to critically think about the study and methods—were there any flaws with study design? Was the study adequately powered? What type of study was it? What were inclusion and exclusion criteria? Was there any possible bias? Were subjects lost to follow up? Were the study subject’s representative of patients we are likely to see/treat? Do the data/results support the conclusions? Are there alternate conclusions not considered by the authors that could explain the results? Could any potential flaws in study design have changed the findings?
The most important questions to ask are the following: Are the conclusions supported by the study data? And….Is this study likely to change how we conceptualize, diagnose or manage the problem or diagnosis under investigation?
Presentation Guidelines. (About 30 minutes per paper maximum). The goal is to present the paper in 10 minutes using a standardized format. This will allow us 15-20 min for discussion (the most interesting part). The resident needs to think about and prepare this in advance.
1) Why did you choose the paper? (i.e. did you have a recent case which this paper addressed?)
2) List authors, institutional affiliations and funding source
3) Study hypothesis, research question
4) Design—examples include: e.g. prospective vs retrospective, observational vs controlled trial, cohort or case control
5) Subjects—who was studied? What were inclusion/exclusion criteria? Were study subjects similar to those whom you would evaluate with the condition being studied?—were they broadly representative or only a small subgroup of most people with the condition being studied?
6) What were the independent and dependent variables? What were the outcome variables and were they clinically meaningful? How were the variables measured? For example if a trial looked at Vitamin E supplementation and preeclampsia the independent variable would be what group (vit E or no vit E) the subjects were assigned to and the outcome variable would be preeclampsia. How was preeclampsia defined?
7) What were the main statistical methods used to analyze the data?
8) Findings/Results. What were the main study findings? –Point out the main tables/figures and review these with the group.—discuss the statistical and clinical significance of the findings—often findings may be statistically significant but that does not mean they are clinically relevant.
9) What are the author’s conclusions?
10) Discussion
a. Part-1--the resident will give her/his assessment of the study’s validity and clinical significance.---If potential flaws are noted they should be mentioned but the resident needs to determine if they would have altered findings or conclusions—it is important to remember that no study will be perfect. To make the discussion more meaningful it may be necessary to review some of the key references the study cites for a more in depth knowledge of research done on the subject under discussion—this will also strengthen the resident’s ability to critique the study.
b. Part II—open up discussion to other residents and faculty. What do they think of the study and why? How does this study’s design, conclusions compare with other studies on this topic? Is this study likely to change our understanding, diagnosis or management of the topic under discussion—For example we can pose a clinical scenario similar to the topic under discussion and see what different faculty or residents would do in that situation based on the paper and journal club discussion.