malekpour m.d associated professor of pathology afzalipour medical school
TRANSCRIPT
Malekpour M.D
Associated 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
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rnal clu
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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.
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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
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Journal clubs are currently found in the fields of medicine, surgery, psychiatry, nursing, pharmacy, obstetrics and gynecology, pediatrics and geriatric social service.
History
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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
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b sessio
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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..
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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 &
Go
als
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 &
Go
als
Research Objectives
Preparation to publish results
Be a stimulus for research ideas
Provide accreditation
JC:O
bjective &
Go
als
Objective and Goals
Goals may vary between meetings
JC:O
bjective &
Go
als
Objective and Goals
Present situation of journal club session
Traditional JCSTraditional JCS
information needinformation needTeaching and leaningUse of informationUse of informationReinforcement of learning
Jou
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information needinformation need
Trainee chooses topic at random
Lack of clinical context Lack of systematic
literature search
Trad
ition
al JCS
Trad
ition
al JCS
Teaching and leaning
No critical appraisal
Mentors comments are generally based on personal experience and opinion
Lack of deep leaning process
Trad
ition
al JCS
Trad
ition
al JCS
Use of informationUse of information
Information is quickly for gotten
It can not be easily retrieved when required
Trad
ition
al JCS
Trad
ition
al JCS
Reinforcement of learning
In the absence of a clinical context , acquired knowledge is seldom applied
There is no assessment of educational activity
Trad
ition
al JCS
Trad
ition
al JCS
ProblemsProblems
Lack of Acquisition AppraiseApplicationAssessment
Trad
ition
al JCS
Trad
ition
al 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
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The way of the The way of the problem resolutionproblem resolution
Use of articles with different methods and similar results
Jou
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The way of the The way of the problem resolutionproblem resolution
Use of articles with contradictive results
Jou
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The way of the The way of the problem resolutionproblem resolution
CPC-like Presentation
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The way of the The way of the problem resolutionproblem resolution
Detailed analysis of article
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The way of the The way of the problem resolutionproblem resolution
Problem based journal club
Trainee centered journal club
Problem solving journal club
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Trainee centeredJCSTrainee centeredJCS
information needinformation needTeaching and leaningUse of informationUse of informationReinforcement of learning
Jou
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Information needInformation need
Trainee identifies a clinical problem
Problem are discussed in a small group
( Answerable questions )
Train
ee centered
JCS
Train
ee centered
JCS
TeachingTeaching and learning and learning
Systematic literature searching ( computerized ; Cochrane library )
Critical appraisal
Train
ee centered
JCS
Train
ee centered
JCS
Use of informationUse of information
Information is stored electronically
It can be easily retrieved when required
Train
ee centered
JCS
Train
ee centered
JCS
ReinforcementReinforcementPractical use of acquired knowledge
Resolution of clinical problem
Use of feed back and assessment
Recognition of effort by electronic dissemination
Train
ee centered
JCS
Train
ee centered
JCS
Transforming a traditional JC into an EBCP JC
design and implement a formal patient-based or problem-based curriculum
sources of evidence
Evid
ence-b
ased
clinical p
ractice 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
Evid
ence-b
ased
clinical p
ractice JC
Preparing for one journal club:3-6 weeks before:
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
Evid
ence-b
ased
clinical p
ractice JC
Preparing for one journal club:3-6 weeks before:
Presenter selects a clinical content expert for guidance
Leader selects appropriate worksheet/checklist tool
Leader commits to attend or identifies a substitute facilitator
Evid
ence-b
ased
clinical p
ractice JC
2 weeks before:
Announcement to participants/attendees (2 weeks before)
Invite special clinical experts
Evid
ence-b
ased
clinical p
ractice JC
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
Evid
ence-b
ased
clinical p
ractice JC
2 days before:
Reminder announcement to participants/attendees
Check food arrangement Check materials: flip
chart, pens, projector
Evid
ence-b
ased
clinical p
ractice JC
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
Evid
ence-b
ased
clinical p
ractice JC
Facilitatorhighlights EBCP elements
& teaching points guides discussion, uses
open-ended questions prompts debate, plays
devil’s advocate if needed
Evid
ence-b
ased
clinical p
ractice JC
Clinical Expert
explains complex medical aspects gives insight into study methods
and design provides commentary of current
best practice
Evid
ence-b
ased
clinical p
ractice JC
Participantsread at least the key
article prior to journal club
use worksheet to prompt critical appraisal thinking
Evid
ence-b
ased
clinical p
ractice JC
Journal Club Formatmeet & greet15-30 minutes social time with
food60-90 minutes journal club
presentation and discussionevaluation of presenter
(private), evaluation of JC (open)
Evid
ence-b
ased
clinical p
ractice JC
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)
Factors associated with success
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.
Factors associated with success
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
Factors associated with success
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
Factors associated with success
An Asynchronous International Journal Club
A Working Model
J Ellis, L Ellis, A Penstien, A Goldsmith
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
Conclusions
1. 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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