Special ArticleUsing the Journal Club to Teach and Assess Competence in Practice-based Learning and Improvement: A Literature Review and Recommendation for Implementation
Introduction
The volume of medical literature, even confined to one specialty area, that a clinician needs to review has exploded exponentially. Alper et al estimated that it would take an incredible and impossible 627.5 hours per month for a clinician to keep up with the primary care literature.2 The resident in training must not only learn a new skill set and acquire a new knowledge base but must also read the current literature, be familiar with principles of evidence-based medicine (i.e., practice-based learning), and use the evidence to improve practice and patient care (i.e., practice-based improvement).
One method to improve the efficiency and timeliness of reviewing the medical literature is the traditional journal club. For the purposes of our discussion, we define a medical journal club as any group of interested individuals meeting regularly to discuss the strengths, weaknesses, and clinical application of selected articles from the medical literature. Journal clubs, in one form or another, have been in existence since at least the time of Osler in 1875. The journal club has long been recognized as one method to involve learners in critical appraisal of the medical literature.
Indeed, most residency programs in the United States have a journal club in some format. The multiple advantages of a journal club format for teaching evidence-based medicine have been recognized for years but its value as an assessment tool has been less defined. The Accreditation Council for Graduate Medical Education (ACGME) has mandated that all residency programs teach and assess six new competencies.20, 21, 35, 36, 37 “Practice-based learning and improvement” is one of the more difficult and challenging competencies. New tools are needed to assess these competencies but the best tools will be reliable, valid, feasible, inexpensive, and fair. The journal club may be an ideal tool for evaluating evidence-based learning and practice-based competency. To our knowledge, this is the first report in the ophthalmic literature to discuss the ideal format and role of the journal club in ophthalmology residency training. We review the literature on journal club, collect and summarize best practices for implementation, and recommend that multicenter field testing begin for a standardized journal club tool to teach and assess practice-based learning in ophthalmology residency programs.
Section snippets
Methods
A PubMed literature search was performed using the search term journal club for the years 1966 to 2004. We did not include reviews of other databases, non-published works, oral presentations or meeting abstracts, or non-peer reviewed literature. The search was limited to English language, human, and abstracted citations only. The decision to include English language articles only was based upon the goal of using the journal club to manage the practice-based learning component of the ACGME
Results
The literature search generated 249 titles and limiting the search to “English” language and “human only” reduced the number of titles to 147. Of these 147 papers, 56 articles were included in our review.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58 Two additional unpublished references were evaluated by the content expert (AGL) and
Discussion
The basic premise of practice-based learning and improvement is that critical acquisition and appraisal of the medical literature (i.e., practice-based learning) is necessary to improve health care delivery (i.e., practice-based improvement). In its most simplistic application, the more familiar term evidence-based medicine is one common interpretation of the ACGME mandate for practice-based competency. The intent of the competency, however, is likely much broader than simply reading journal
Best Practices
Crank-Patton et al surveyed the program directors of general surgery regarding journal club.10 Although 65% of the surveyed directors had a journal club and most indicated that their journal club was important, few programs performed any systematic or formal evaluation of their journal club. Alguire reviewed the literature on journal club and critical appraisal. Journal clubs with the highest attendance and longevity had mandatory attendance, availability of food, and perceived importance by
Limitations
We recognize the limitations of our review. First, although we provide a summary of best practices (Table 2) for the format for journal club, it is likely that local institutional and departmental culture, available time and resources, and faculty preferences will determine some of the details for the style, format, and frequency of the journal club at a specific institution. We recommend this list as a menu of options rather than a checklist of requirements. Second, there are no studies
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The authors reported no proprietary or commercial interest in any product mentioned or concept discussed in this article. This work was supported in part by an unrestricted grant from Research to Prevent Blindness, Inc., New York, NY.