Malekpour M.D Associated professor of pathology Afzalipour Medical School

Malekpour M.DAssociated professor of pathology

Afzalipour Medical School

•The first journal club was founded by Sir James Paget, a British Surgeon in the mid-1800’s

•“Small room over a baker’s shop near the Hospital-gate where we could sit and read the journals”

History

Journal club session

History Sir William Osler

organized a journal club at McGill University in 1875

Several authors suggest that journal clubs were found in certain European countries (in particular, Germany and England) prior to that time.


In the early 1900s in Germany, journal clubs were routinely found in departments of medicine and medical schools.

From 1917-1975, journal clubs evolved into a forum for continuing medical education.

History


Journal clubs are currently found in the fields of medicine, surgery, psychiatry, nursing, pharmacy, obstetrics and gynecology, pediatrics and geriatric social service.

History


This powerful educational tool has played an active role in medical education for over a century. The journal club should be more formally incorporated into the medical educational curriculum.

History


Significance In a 1995 survey of program directors in the

eastern United States, Sidorov found: 95% of internal medicine training programs

had an active journal club. More than 80% of internal medicine, family

practice, emergency medicine, and physical medicine journal clubs meet at least once monthly, usually during the working hours, typically reviewing between two and three articles per session..


Educational Objectives

Provide update of current clinical evidence about a topic

Promote EBM and evidence-based clinical practice

Advance critical appraisal skills

JC:O

bjective &G

oals

Educational Objectives

Improving clinical practice – bridge between research and practice, between knowledge and care

Build database of reviewed material for group

Learn skills relevant to performing research, research design

Develop presentation skills

JC:O

bjective &G

oals

Research ObjectivesPreparation to publish

resultsBe a stimulus for

research ideasProvide accreditation

JC:O

bjective &G

oals

Objective and Goals

Goals may vary between meetings

JC:O

bjective &G

oals

Objective and Goals

Present situation of journal club session

Traditional JCSTraditional JCS

information needinformation needTeaching and leaningUse of informationUse of informationReinforcement of learning

Journl club session

information needinformation need

Trainee chooses topic at random

Lack of clinical context Lack of systematic

literature search

Traditional JCS

Traditional JCS

Teaching and leaning

No critical appraisal Mentors comments are generally based on personal experience and opinion Lack of deep leaning process

Traditional JCS

Traditional JCS

Use of informationUse of information

Information is quickly for gotten

It can not be easily retrieved when required

Traditional JCS

Traditional JCS

Reinforcement of learning

In the absence of a clinical context , acquired knowledge is seldom appliedThere is no assessment of educational activity

Traditional JCS

Traditional JCS

ProblemsProblems

Lack of Acquisition AppraiseApplicationAssessment

Traditional JCS

Traditional JCS

Critical appraisalCritical appraisalThree important question Are the results of the study valid ?What are the results ?(Sensitivity ; specifity ; PPV and NPV)Will the results help locally


The way of the The way of the problem resolutionproblem resolution

Use of articles with different methods and similar results



Use of articles with contradictive results



CPC-like Presentation



Detailed analysis of article



Problem based journal club

Trainee centered journal club

Problem solving journal club


Trainee centeredJCSTrainee centeredJCS

information needinformation needTeaching and leaningUse of informationUse of informationReinforcement of learning


Information needInformation needTrainee identifies a

clinical problem Problem are discussed in

a small group ( Answerable questions )

Trainee centered JCS


TeachingTeaching and learning and learning

Systematic literature searching ( computerized ; Cochrane library )Critical appraisal



Use of informationUse of information

Information is stored electronically It can be easily retrieved when required



ReinforcementReinforcementPractical use of acquired knowledge Resolution of clinical problem Use of feed back and assessmentRecognition of effort by electronic dissemination



Transforming a traditional JC into an EBCP JC

design and implement a formal patient-based or problem-based curriculum

sources of evidence

Evidence-based clinical practice JC

Preparing for one journal club:3-6 weeks before:

Presenter chooses a “real patient” scenario in which a clinical question has arisen

Presenter discusses with faculty mentor & develops PICO question (patient, intervention, comparison intervention, outcome)

Presenter searches for evidence (utilizes librarian, library, resources)

Presenter and mentor decide if patient problem & evidence are appropriate for JC



Presenter develops synopsis of patient scenario/problem/question

Presenter selects one key article (and possibly supportive papers)

Presenter & mentor select appropriate method for analyzing, appraising, & presenting



Presenter selects a clinical content expert for guidance

Leader selects appropriate worksheet/checklist tool

Leader commits to attend or identifies a substitute facilitator


2 weeks before:Announcement to

participants/attendees (2 weeks before)

Invite special clinical experts


1-2 weeks before: Presenter prepares presentation of

scenario + summary & critical appraisal of literature + discussion elements

Presenter meets with faculty mentor and reviews presentation

Leader prepares 5-10 minute interactive teaching points (Mini-Lesson)

Prepare extra paper copies of the key article


2 days before: Reminder announcement

to participants/attendees Check food arrangement Check materials: flip

chart, pens, projector


Presenter presents patient scenario provides summary analysis of

the key papers leads the discussion of critical

appraisal of the evidence leads a discussion of what this

means for this patient –resolution of the patient scenario/question – what this means for our patients


Facilitatorhighlights EBCP elements

& teaching points guides discussion, uses

open-ended questions prompts debate, plays

devil’s advocate if needed


Clinical Expert explains complex medical aspects gives insight into study methods

and design provides commentary of current

best practice


Participantsread at least the key

article prior to journal club

use worksheet to prompt critical appraisal thinking


Journal Club Formatmeet & greet15-30 minutes social time with

food60-90 minutes journal club

presentation and discussionevaluation of presenter (private),

evaluation of JC (open)


Factors associated with success

Sidorov defined successful journal clubs as those with longevity (at least 2 years) and high levels of resident participation (at least 50% attendance)


The overall satisfaction score was highest when the journal club was held in the evening or at a faculty member's home. The format of the journal club was not associated with the overall satisfaction score.


practice-based, problem-based case scenario(Slawson 2005, O’Brien Cochrane)

high attendee interest in subject matter (Heligman)

discussion of complex, controversial issues; care issues with uncertainty


valid articles integrated teaching of critical

appraisal skills formal instruction in

biostatistics and epidemiology checklists: review instrument

(Burstein 1996)

Discussion of impact of the articles on practice

involvement of faculty with interest knowledge skills

food provided prior to start of session


An Asynchronous International Journal Club

A Working Model

J Ellis, L Ellis, A Penstien, A Goldsmith

[email protected]

SUNY Downstate

Goals JournalReview.org will create an

engaged international community of physicians, researchers, universities, policy makers, and others interested in published medical literature.

Members receive the following benefits:1.The ability to comment, criticize,

discuss, or ask questions about published literature.

2.Facilitated interaction with corresponding authors and colleagues around the world.

3.Ability to ‘watch’ an article, journal, or search term for new discussion on the topic.

Goals

Browse by Specialty

Search

Recent Reviews in Dermatology

Journal TitleArticle Title

Review Title

Facilitates correspondence with Author

Conclusions1. Journal Clubs have served a variety of purposes over the

years, but are more important now than ever.

2. JournalReview.org is an on-line journal club that is in active use.

3. It is an excellent tool for the enhancement of journal clubs, as it facilitates global communication between peers in an organized way.

4. In the future, JouranlReview.org may also provide an ideal platform for research of long term educational outcomes.

Recommendation

Recommendation Evaluation of present situation Scheduling time Supervised topic selection Multi specialty analysis Electronic recording Remember 4A; especially assessment Appropriate announcement

Great Dinner

A real journal club....

Mortality Mortality ConferenceConference

Teaching / Educational sessions

Evaluating patient care

Improvement of patient care

Mortality conferenceMortality conference Purposes Purposes

Lack of a national guide to the methodology and structure of death review committee.

Brief incomplete clinical history

Lack of documented clinical course; conclusions and actions

The results of diagnostic and imaging investigations are not available

Lack of final definite cause of death

Mortality ConferenceMortality Conference Deficiencies and problems Deficiencies and problems

Result of present situation

Mortality ConferenceMortality Conference Deficiencies and problems Deficiencies and problems

1. Was the primary cause of this mortality

2. How similar problems be avoided in the future

Mortality Conference Quality improvement

2 important questions:

I. Diagnostic error

II. Technical error

III. Error in judgment

IV. Nature of disease

Was the primary cause of this Was the primary cause of this mortalitymortality

Improved admitting practices and patient selection

Altered timing of imaging; Laboratory requisition ; surgery

Altered surgical technique or medical interventions

Improved communication between medical team

Altered indication of ICU admission.

How similar problems may be avoided in the future

Design of national or regional guidelines for mortality conference

Complete history ; physical exam., Lab. Tests ; imaging finding,……….etc

Presence of all individuals involved in patient care

Careful documentations of clinical course and all actions

Autopsy in unexpected deaths

Mortality conferenceMortality conferenceRecommendation for improvementRecommendation for improvement

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Malekpour M.D Associated professor of pathology Afzalipour Medical School

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