6. Purpose of the Article?
“ To provide organizers with tools to plan and
execute successful journal clubs in Orthopedic
surgery training programs”
7. PURPOSE AND GOALS OF JOURNAL CLUBS
1. Keeping abreast with the current literature.
2. Unfortunately., has become an unrealistic goal-why?
3. So, the current goals include.
“promoting Evidence-Based Orthopedics and
learning general critical appraisal skills for
Residents.”
Thus, Journal clubs are the Ideal vehicle for
Evidence based orthopedic surgery Topic
8. What others have to say about this?
1. Greene surveyed 149 North American Orthopedic
surgery training programs.
1. 99% included a regularly scheduled journal clubs.
2. Most important goal – Teaching critical appraisal skills
to surgical residents.
2. General Surgery journal clubs in American
Institutions:
1. 64% - directors thought their journal club was important
or very Important to the educational mission .
2. 87.5% - Learning Literature Review Skills.
3. 52.9% - Provide training in research education.
4. 52.4% - Research design.
9. 3. Survey of Hand Surgery fellowship directors:
* 57 Hand Surgery fellowship directors.
* Felt- Very Important for Fellowship training.
Secondary Goals:
Increasing Reading Comprehension.
Fostering Resident- Faculty relations.
Learning Orthopaedics in an alternative manner.
10. PREVALENCE AND CHARACTERISTICS OF
ORTHOPEDIC JOURNAL CLUBS
1. Greene study:
“ The Role of journal clubs in Orthopedic surgery Residency
Programs”
Findings:
* 161 North Americn Orthopedic training programs.
* 99% - Regularly scheduled journal clubs.
* 78% - Once a month.
* 9% - Twice a month.
* 82% - More than 1 scientific journals were reviewed.
* 38% - Designated faculty member.
* 17% - Chairman of the Orthopedic program.
* 32% - Rotating faculty.
* 13% - Chief Resident.
11. * 50% - Departmental Office.
* 31% - Home of a Faculty member.
* 18% - Restaurant.
* 68% - Evening.
* 29% - At the start of the work day.
* 59% - (80-100%) attendance.
* 36% - (60-80%) attendance.
* 4% - (40-60%) attendance.
* 50% - Full meal.
* 37% - Light Snack.
Top 3 Goals:
1. Teaching Orthopedic Residents how to evaluate scientific
articles.
2. Instilling a habit of reading scientific journals.
3. Facilitating Residents learning about current research.
13. PLANNING AND ORGANIZATIONAL ISSUES
1. Not all journal Clubs are successful.
2. Sidorov et all., - Successful journal clubs means-
*Those that meets the educational objectives.
*Those that continually promote and maintain
resident interest.
3. Jones et all., - Regularly revise their selection of
journals in order to increase the value of this
important educational process.
15. LEADERSHIP
1. Designated leader.
* Effective journal clubs are correleted with having
a designated leader.
2. Essential attributes of a leader.
* An interest in medical education.
* A belief that the journal club is important.
3. Responsibilities
* Planning.
* Execution of the club.
* Evaluation of the club.
4. Use of having a skilled Moderator.
* Adds value to the discussion.
* Attendance of the club.
17. ENVIRONMENT
1. Maintaining boundaries is important to the success of
the club.
2. Thus Trainees should be relieved from clinical duties,
except Emergency patient care.
3. This aids the session to start and stop on time.
4. Room should be comfortable.
5. Papers to be distributed well in advance to attendees.
6. Environment should have a sense of security and thus
allow creative thinking.
19. AUDIENCE
1. Crucial to the success of journal clubs, unlike traditional
teaching conferences.
2. The educational value of the meeting is optimized by the
interactions of the attendees and the dynamic exchange
of opinions and ideas.
3. Mandatory attendance
4. Continuity is promoted by having a regular group of
attendees.
5. On the other hand, trainees may feel attendance is
imposed on them rather than viewing the club as an
educational opportunity.
6. This may be addressed by allowing residents to set their
own rules such as journal club presenter opportunities
and participating in choosing papers to discuss.
20. * Faculty support with independent running
of the journal club (by a senior trainee) was
shown to lead to high attendance rates.
* Having a trainee as a club leader may
make the fellow trainees feel less
intimidated in asking questions.
* Senior trainees, rather than the faculty,
may be more attuned to the needs of their
junior colleagues.
* Having journal clubs early in the
morning before the work day or
in the evenings is more convenient
for all involved.
22. FOOD
* The regular provision of food has been associated with
successful journal clubs.
* In orthopedics, 87% of meetings provide some sort of
food.
* Longevity and high attendance rates are correlated
with the provision of food.
* Funding journal club meals may be provided by
individual faculty or by divisional or departmental
support.
23. NUMBER OF PAPERS TO REVIEW
* A range of three to 10 papers seems to be a
reasonable
* Too many articles (limiting valuable discussion)
* Too few articles (limiting the breadth of
information).
* Be individualized by each training program.
24. LINKING JOURNAL CLUB TO THE CURRICULUM
* Many authors have studied the educational
effects of journal clubs in residency training
programs.
* Study of emergency medicine residents
* Study of two pediatric training programs
There were no significant differences between the
two groups of residents in objective testing of
knowledge of epidemiology, biostatistics, nor
critical evaluation.
25. IMPACTS OF JOURNAL CLUB ON READING
HABITS, KNOWLEDGE AND SKILLS
* Parkes et al revealed a small evidence base that journal
clubs probably do improve knowledge in biostatistics and
clinical epidemiology in a Cochrane review.
* Conflicting evidence exists on whether they enhance
critical appraisal skills.
* The impact of journal clubs on patient outcomes has
not yet been investigated in a well-designed trial, as there
is difficulty in measuring this process.
27. 1. EVIDENCE-BASED JOURNAL CLUBS
2. JOURNAL CLUBS BASED ON CRITICAL APPRAISAL
3. JOURNAL CLUBS BASED ON KNOWLEDGE
TRANSMISSION
4. THE NO PREPARATION JOURNAL CLUB
5. INTERNET-BASED JOURNAL CLUBS
28. Just deviating from the core journal to understand…
Evidence based Medicine.
Will cover….
1. Levels od Evidence based medicine.
29. Level of evidence Source of evidence Grades of recommend.
I SR, RCTs A
II Cohort studies
B
III Case-control studies
IV Case series C
V Expert opinion D
54. Evaluation Of The Journal Club
* Periodic Restructuring Of The Club Will Be Necessary To
Meet New Goals.
* This Will Help To Maintain Enthusiasm And Effectiveness.
* Periodically Asking The Attendees About Their Satisfaction
With The Club Is One Way To Modify The Meeting If Needed.
* Anonymous Feedback From The Residents May Alert
Organizers About Strengths And Weaknesses And Potentials
For Improvement.
* These Periodic Evaluation Methods Will Aid In Improving
The Educational Experience Of The Journal Club, Regardless
Of Its Format.
55. Conclusions
* Journal Clubs Are Integral To Graduate Medical
Education, Including Most Orthopedic Training Programs.
* Factors Associated With High Attendance And
Longevity Of The Club Include
- Mandatory Attendance,
- Availability Of Food,
- Perceived Educational Value Of The Program
Director,
- Having A Committed Leader,
- Good Faculty Participation,
- Formal Instruction In Epidemiologic Principles.
56. By evaluating the journal club and
responding to the needs of the
participants, journal clubs can continue
to evolve and improve to remain as a
valuable part of the orthopedic residency
training program.