Structured Journal Club as a Tool to Teach and Assess Resident Competence in Practice-Based Learning and Improvement

The impact of journal clubs on postgraduate medical education in China

PURPOSE

Journal clubs hold significant importance in medical education, with numerous studies highlighting their contributions worldwide. However, studies specifically examining their role in China, particularly among Chinese medical postgraduates categorized into academic and clinical types, remain scarce. This research aims to investigate the participation, performance, and benefits of journal clubs, and explore the influence of student type and study phase on these aspects.

METHOD

A survey encompassing demographic information, participation rates, performance evaluations, and perceived improvements was distributed to postgraduates at Tongji Medical College of Huazhong University of Science and Technology. A total of 232 completed questionnaires were included for further analysis. Statistical analysis employed the Mann-Whitney U test and Gamma tests, with statistical significance set at p-value < 0.05.

RESULTS

Overall participation and performance in journal clubs among Chinese medical postgraduates were comparable to global findings. Notably, academic postgraduates exhibited higher levels of attendance rate and gained more research assistance than clinical postgraduates, while their performance levels were similar. When considering the study phase, a downward trend in academic postgraduates' attendance rate and listening attitude and an upward trend in clinical postgraduates' participation were observed with the seniority phase. Additionally, presentation comments, post-presentation progress, and research assistance showed improvements over time for both student types.

CONCLUSIONS

This study reveals academic postgraduates' fatigue, contrasting with clinical postgraduates' enthusiasm, and underscores academic postgraduates' superior research assistance. To address these findings, we recommend supporting and encouraging scientific research training for clinical postgraduates, aiding academic postgraduates in better time management and reducing non-essential responsibilities, and implementing critical appraisal skill education.

Ophthalmology Residency in the United States: The Case for a National Curriculum

To identify strategies for effective curriculum development and implementation in United States (US) ophthalmology residency training programs. A literature review was conducted for all English-language PubMed/Medline articles relating to ophthalmology residency education or curriculum/curricula. Despite ACGME-defined program requirements outlining curricular goals for US ophthalmology residency training programs, there is no comprehensive, national curriculum with detailed plans for instruction of necessary topics within the 36-month residency training period. Several articles identify a need for detailed curricula on various topics, propose ideas on how residency programs could create curricula, and explore ways of assessing resident competence. There is a paucity of literature evaluating how ophthalmology residents best learn various ophthalmology topics. We need to develop an intentional, comprehensive, and timely national curriculum for ophthalmology residency programs in the US, with detailed plans on how to meet curricular objectives and consideration of the most effective teaching strategies for different ophthalmology concepts.

Virtual Journal Club Beyond the Pandemic: An Enduring and Fluid Educational Forum

OBJECTIVE

Since its inception, journal club has been a cornerstone to the life-long process of medical education. The virtual journal club (VJC), initiated as a robust solution to many educational challenges encountered during COVID-19 pandemic-related distance learning, provides an enduring and fluid forum for multilevel teaching and learning.

MATERIALS AND METHODS

In this manuscript we share our institutions' reasoning and methods to implement a VJC for multi-level learners. A standardized format applicable to all VJC sessions was adopted to ensure reproducibility from presenter to presenter. Sessions were held via video conference platforms. Pedagogy regularly emphasized in undergraduate medical education was adopted. Informal assessment of each session's strengths and areas for improvement was performed.

RESULTS

A total of 30 sessions were held prior to manuscript submission, including discussion of 36 refereed journal articles from March 26, 2020, to April 20, 2021. The virtual journal club was very well received by all participants. The medical students and residents found the information current and engaging. The fellows stated that the journal club strengthened their knowledge base and enhanced communication and teaching skills. The attendings learned from its encouraged frank discussion of differing practice patterns. The format of these sessions offers an ideal setting to teach medical students and residents how to evaluate and employ evidence-based medicine and meets multiple LCME and ACGME requirements.

CONCLUSIONS

This VJC forum allows for development of essential nonclinical skills including lifelong active learning and analysis, peer collaboration, and technology adaptation and usage.

Pharmacy student perceptions regarding understanding of and confidence in literature evaluation following a student-led journal club

BACKGROUND

Journal clubs are commonly used by healthcare professionals, including pharmacists, as a means of analyzing and applying research to clinical practice. The purpose of this research is to determine if participation in student-led journal clubs impacts students' understanding of and confidence in literature evaluation.

METHODS

First- through third-year pharmacy students attended co-curricular journal club sessions. Students attending these sessions completed a questionnaire (Journal Club Comprehension and Confidence Instrument [JCCCI]) immediately prior to [pre-survey] and following [post-survey] the journal club session (journal club group). The JCCCI was also delivered to student pharmacists not attending the co-curricular journal club sessions (control group). Wilcoxon Signed-Rank tests were used to compare the responses to the JCCCI questionnaire. Analysis was conducted using SPSS. This research was approved by the University's Institutional Review Board.

RESULTS

A total of 182 student pharmacists completed the survey (journal club group, n = 52; control group, n = 130). There were significant differences in the pre- and post-survey of the journal club group in eight of the 10 competencies; "process", "background", "methods", "intervention/treatment", "statistical analysis", "results", "clinical significance" and "strengths/limitations". There were significant differences discovered between the journal club group (post-survey) and control group in three of the 10 competencies; "process", "importance", and "intervention/treatment".

CONCLUSIONS

This study demonstrates that participation in a journal club yielded significant improvements in how students self-rated their confidence in and understanding of literature evaluation. Based on students' self-assessed understanding of and confidence in literature evaluation, student-led journal club sessions conducted outside of the traditional pharmacy curriculum offer a perceived benefit to students.

Determining effectiveness of EBM education in otolaryngology residents using modified fresno test

OBJECTIVE

To determine the effectiveness of education in evidence-based medicine (EBM) on the knowledge, competency, and skills of otolaryngology residents of Tehran University of Medical Sciences (TUMS) at Amir-Alam and Imam Khomeini Hospitals.

METHODS

In a quasi-experimental (before-and-after) study, all ear, nose, and throat residents of TUMS (n = 41) entered the study. The residents underwent the modified Fresno test. Then, two EBM workshops with a similar content were held on 2 separate days in each hospital, with each session lasting 6 hours. The learned material was practiced in weekly journal clubs. Six months after the workshop, the modified Fresno test was applied again, and the results were analyzed.

RESULTS

A significant improvement in the modified Fresno test score was observed. The mean score of the modified Fresno test was 57.43 ± 22.07 before the workshop and 79.26 ± 22.48 after the workshop (P < 0.001).

CONCLUSION

The results of the study show that EBM education and practice of the learned materials in journal clubs can improve the knowledge and skills of residents. Further research with larger samples is needed to improve the precision of our findings and to increase confidence in the results.

LEVEL OF EVIDENCE

2 Laryngoscope, 129:2291-2294, 2019.

Education in ophthalmology over the past 60 years

This paper summarizes the personal experience of an ophthalmologist who has been involved in medical education for over 60 years. With clinical experience and leadership positions within ophthalmology and in broad medical organizations, this paper chronicles the evolution of educational practice and approaches for over a half-century.

Residency evaluation and adherence design study: Young ophthalmologists' perception of their residency programs II: Academics and Research dissertation

Purpose:

To know the perception of young ophthalmologists about their dissertation and academics during residency training in order to improve the research output during present residency programs in India.

Methods:

A survey was conducted by Academic and Research Committee of the All India Ophthalmological Society, the world's second largest ophthalmic professional's organization, in 2014–2016 of young ophthalmologists (those who completed residency between 2005 and 2012) to gauge usefulness of dissertation or thesis during postgraduate residency.

Results:

There were 1005 respondents, of whom 531 fulfilled inclusion criteria. On a scale of 0–10, residents rated level of supervision of their dissertation as adequate (mean 5.9/10, standard deviation [SD] = 3.1, median = 6). The level of infrastructure available was for dissertation rated as 5.9/10 (median = 7, SD = 3.1), and 6.2/10 was the score that residents said about value added by the dissertation (median = 7). The dissertation was presented at local (33.5%), state (28.1%), national (15.4%), and international (4%) levels. Students, not supervisors, did most of the local and state level presentations. It was published in some forms at local 210 (39.5%), state (140, 26.4%), national (94, 17.7%), and international (39, 7.3%) levels. On a scale of 0–4, seminars (3/4) and case presentations were (3/4) rated higher than didactic lectures (2.2/4), journal clubs (2.2/4), and wet laboratory (1.1/4).

Conclusion:

Peer-reviewed publications from Indian residency training dissertations were few. Residents felt dissertation added value to their training, but there was a huge range among the responses. Journal clubs and wet laboratories were not graded high in academic programs, unlike seminars and case presentations.

Role of journal club in Canadian ophthalmology residency training: a national survey of program directors

OBJECTIVE

To conduct a national survey of journal club curricula in Canadian ophthalmology residency programs.

DESIGN

Cross-sectional web-based survey.

PARTICIPANTS

Fifteen Royal College of Physicians and Surgeons of Canada (RCPSC) ophthalmology residency program directors.

METHODS

The 15 RCPSC ophthalmology residency program directors were invited to participate in a 31-item online survey. The survey inquired about the purpose, educational goals, and structure of journal club. Basic statistics were performed to compare responses across institutions.

RESULTS

Thirteen of the 15 program directors replied, representing an 87% response rate. Twelve (92%) institutions maintained a journal club. All of the program directors surveyed felt that journal club had educational value. Resident attendance was typically mandatory (75%) and correspondingly high across programs. There was 100% agreement that randomized controlled trials were most often selected for review. The primary journal club objectives were for residents to develop critical appraisal skills and to conduct a literature search (67%). Formal teaching and evaluation of these skills were not prioritized by any program. Seventeen percent felt the most important objective was to impact clinical practice.

CONCLUSIONS

Canadian ophthalmology program directors expressed high levels of satisfaction that journal club was effective in meeting its stated objectives. This indicates that the teaching model promoted resident critical appraisal skills; however, objective evaluation methods to assess resident competence in evidence-based medicine were not described by any respondents. As RCSPC ophthalmology programs transition to competency-based medical education, program directors may consider modifying journal club curriculum, broadening its utility toward a means of outcome assessment.

A Structured, Debate-Style Cardiothoracic Surgery Journal Club for Trainee Acquisition and Application of Seminal Literature

INTRODUCTION

The acquisition of specialty-specific seminal literature and its application to daily, clinical patient-care decisions are critical components of clinical training. This structured, debate-style cardiothoracic surgery journal club module engages trainees in discussion of realistic patient scenarios, incorporating an extensive body of literature identified as the best evidence for the practice of cardiothoracic surgery.

METHODS

We designed the structured, debate-style cardiothoracic surgery journal club and delivered it to University of Texas MD Anderson Cancer Center cardiothoracic surgery trainees. Overall assessment of knowledge acquisition consisted of both direct judging of debates by faculty facilitators and a year-end written test of trainee knowledge. Associated materials include guidelines and resources for faculty facilitators and trainees to prepare them for the journal club debate. Also included are cardiothoracic surgery patient cases, PowerPoint presentation slides, a debate score sheet, and multiple-choice knowledge tests with answer keys.

RESULTS

Our structured, debate-style cardiothoracic surgery journal club is an effective educational intervention for cardiothoracic surgical trainees to gain practice in applying specialty-specific, literature-based evidence to particular patient problems.

DISCUSSION

This resource may be used by course directors for surgery, for independent study by individuals planning to matriculate into surgical residencies, or as a review for those already in surgical training. Moreover, this curriculum can be delivered at other clinical training programs.

Education in ophthalmology over the past 60 years

This paper summarizes the personal experience of an ophthalmologist who has been involved in medical education for over 60 years. With clinical experience and leadership positions within ophthalmology and in broad medical organizations, this paper chronicles the evolution of educational practice and approaches for over a half century.

The effect of an evidence-based medicine curriculum on breast cancer knowledge and satisfaction of surgical residents

OBJECTIVE

The current study was performed to determine if evidence-based medicine (EBM) curriculum would affect education of surgical residents.

DESIGN

A 5-year prospective study was designed to determine if EBM curriculum could improve residents' satisfaction and understanding of breast cancer management during a breast surgical oncology rotation. During the first 2 years, 45 journal articles were used. During the subsequent 3 years, journal articles were not used. The proportion of patients seen in clinic was collected as an objective measure of the "effort" made by the resident. The final assessment was a 120-question examination.

SETTING

Maricopa Medical Center, Phoenix, AZ. Safety net institution with General Surgery residency program.

PARTICIPANTS

Postgraduate year 2 general surgery residents.

RESULTS

Over 5 years, 30 postgraduate year 2 residents were involved. Univariate analysis showed that female sex (p = 0.04), residents with peer-reviewed publications (p = 0.03), younger age (p = 0.04), American Board of Surgery in-service training examination score (p = 0.01), and clinical effort (p < 0.01) were associated with higher scores. Although residents taught using the journal articles scored 7 points higher on the final examination, this was not significant (p = 0.10). Multivariate analysis showed that American Board of Surgery in-service training examination score and clinic efficiency remained statistically significant. Residents who were taught using the EBM curriculum had significantly higher satisfaction (4.4 vs 3.5, p = 0.001) compared with those who did not go through the EBM curriculum.

CONCLUSIONS

The current study demonstrates that an EBM curriculum significantly improved resident satisfaction with the rotation. The EBM curriculum may improve residents' breast cancer knowledge. The most important predictor of resident performance was the effort of resident.

Journal Club presentation in research orientation at Bahria University Medical & Dental College

Objective:

To determine faculty perception on journal club (JC) presentation at Bahria University Medical and Dental College (BUMDC), Karachi. Pakistan.

Methods:

It was a cross sectional study conducted from January 2009 to December 2012 to acquire faculty member’s feedback on JC presentations in structured meeting at BUMDC. Feedback was acquired by a self-reported questionnaire on a 3-pt Likert scale with a score of 1= disagree, 2= neutral, 3 = agree. Respondents were divided into Group I; senior faculty (professors, associates and assistants) and Group II of junior faculty (lecturers). Chi square test was applied to compare categorical variables; results considered significant with p value< 0.05.

Result:

A total of 75JC presentations were made in study period. In Group I, response was acquired by 5 Professors, 3 Associate Professors and 7 Assistant Professors whereas 34 lecturers comprised of Group II. Both groups responded to usefulness of JC equally without any significant difference. JC encouraged literature search in 35(72%), enabled 38(78%) to recall their knowledge and 34(70%) to understand study objectives. The participants 34(70%) were able to comprehend research methodology, 19(38%) understood biostatistics and 29(59%) evaluated the paper critically. The exercise motivated 36(74%) and 30(62%) participants were able to design their research projects.

Conclusions:

Orientation of research at BUMDC was made possible by JC discussions which encouraged literature review from reputable journals, understanding of research methodology and critical appraisals that facilitated formulation of research plans.

Surgical journal club as a community of practice: a case study

BACKGROUND

Journal club has become a signature pedagogy in postgraduate medical education. In this article, social learning theory, through the lens of "communities of practice" (CoP), is applied to elucidate the process of learning in journal club.

MATERIALS AND METHODS

The study is a case study of a surgical journal club. Video recordings of 2 journal club sessions were followed by semistructured audio-recorded interviews with a sample of journal club participants. Thematic content analysis was performed, mapping data to themes arising based on the key tenets of CoP.

RESULTS

Features of the 4 tenets of CoP learning (community, meaning, identity, and practice) were identified in both the video recordings of journal club and the participant interviews. A shared enterprise and common sense of purpose (community) was seen throughout the video recordings, but feelings of belonging to the community were much stronger for senior members (consultants/attending staff and senior trainees) compared with junior members (junior trainees and students). Experiences and perspectives were more commonly exchanged between senior trainees and consultants, with junior trainees not partaking in discussions, an example of newcomers beginning at the periphery. The main impediment to learning was found with low senior member attendance at journal club, thus limiting access to narratives of senior experience of practice and feedback.

CONCLUSIONS

In attempting to improve journal club design for learning, ensuring the participation of senior community members and thus access to narratives of experience along with active engagement of junior members to allow them develop their own meaning should be incorporated into the journal club design.

A pilot investigation of a Pediatric Surgery Journal Club

BACKGROUND

The CanMEDS competency "scholar" encompasses the creation, dissemination, application, and translation of medical knowledge. We hypothesize that a structured journal club (JC) for pediatric surgical trainees would meet these objectives in an enjoyable and long-lasting manner.

METHODS

A JC involving two pediatric surgery training programs was created with each session focusing on a specific study design. Pre-tests/post-tests were administered before/after each session with durability of learning assessed during the following session. Metrics analyzed included participant satisfaction and an appraisal of evidence-based medicine (EBM) principals. Test results were analyzed using the paired T-test with p<0.05 considered significant.

RESULTS

On average, 14 participants attended each session, with all trainees present (4). While participants believed they understood EBM principles, 40% were unfamiliar with question formulation, 48% were unfamiliar with critical appraisal tools, and 60% had not appraised an article within the previous year. Pre-test to post-test comparison yielded an improvement in mean score (20=perfect score): 10.8 to 16.9, p<0.01. Measures of participant satisfaction were uniformly positive.

CONCLUSION

A structured Pediatric Surgery Journal Club addresses scholarly training objectives in a highly satisfactory manner and yields durable learning. A web-based curriculum based on this model could serve as an important educational tool for trainees and attending staff alike.

An online guided e-journal exercise in pre-clerkship years: oxidative phosphorylation in brown adipose tissue

The rationale for this mandatory, guided online e-journal exercise is to foster the ability of students to independently read medical and scientific literature in a critical manner and to integrate journal reading with their basic science knowledge. After a lecture on oxidative phosphorylation, students were assigned to read an article on brown adipose tissue published in New England Journal of Medicine and were guided to analyze the article by answering online questions. After two iterations, student surveys about the project, its key pedagogical features, and ways to improve it suggest that the students perceived these exercises as active learning, which is clinically relevant and built on their course material. Furthermore, students agreed that the e-journal project was useful for learning how to read an article, for reviewing the material learned in class, and for promoting evidence-based medicine. This online e-journal exercise models some aspects students will experience as future physicians, where it is essential to keep up with literature and extract relevant information on a tight physician's schedule. This study demonstrated the usefulness of guided e-journal exercises as a simple effective active teaching tool for preclinical medical students, which can also be used for prehealth undergraduate programs.

Implementing a successful journal club in an anesthesiology residency program

Journal clubs are an integral element of residency training. We report the successful implementation of a monthly structured journal club in our anesthesia residency program. Based on resident surveys before and one year after its start, the journal club led to a significantly higher confidence in how to critically appraise literature and present a manuscript. The journal club also improved the residents' ability to search the literature and their statistical knowledge, skills that are essential in the practice of evidence-based medicine. We describe key features that may aid other training programs in organizing a stimulating an educational and sustainable journal club.

Teaching evidence based medicine to surgery residents-is journal club the best format? A systematic review of the literature

OBJECTIVE

Systematic reviews were performed to assess methods of teaching the evidence-based medicine (EBM) process and determine which format or what components of journal club appear to be most effective in teaching critical appraisal skills to surgical residents and have the highest user satisfaction.

DESIGN

MEDLINE, Embase, Web of Science, AMED, PsychINFO, PubMed, Cochrane Library, and Google scholar were searched to identify relevant articles. To be included, studies had to provide details about the format of their EBM curriculum or journal club and report on the effectiveness or participant satisfaction. Potentially relevant articles were independently reviewed by 2 authors and data were extracted on separate data forms.

RESULTS

Seven studies met the inclusion criteria for assessment of teaching EBM and 8 studies (including 3 in the EBM systematic review) met criteria for assessment of journal club format. Overall, study quality was poor. Only 2 studies were randomized controlled trials. Five were before-after studies, which showed significant improvement in critical appraisal skills or statistical knowledge following an EBM course or journal club. The 2 randomized controlled trials (RCTs) compared teaching EBM or critical appraisal skills in lecture format or journal club to online learning. There was no significant difference in mean scores in 1 study whereas the other reported significantly better scores in the journal club format. Four studies reported high participant satisfaction with the EBM course or journal club format.

CONCLUSIONS

There is some evidence that courses with or without the addition of journal clubs lead to improved knowledge of the EBM process although the impact on patient care is unknown. Journal clubs seem to be the preferred way of teaching critical appraisal skills but while some components of journal clubs are favored by participants, it remains unclear which elements are most important for resident learning.

Using vote cards to encourage active participation and to improve critical appraisal skills in evidence-based medicine journal clubs

RATIONALE, AIMS AND OBJECTIVES

Evidence-based medicine (EBM) journal clubs are used by health care practitioners to critique and remain updated on relevant health literature. Vote cards, in three different colours (green/yellow/red), allow participants to express their opinions (agree/doubt/reject) on the quality and possibility of clinical application regarding the article being reviewed. Our aim is to assess the efficacy of using vote cards in EBM journal clubs.

METHODS

Evidence-based medicine journal club is held on a weekly basis in the Department of Surgery in Taipei Medical University Hospital, Taiwan. The participants of EBM journal clubs include medical students, resident doctors and primary care faculty members. After the presentation, participants use their vote cards to critically appraise the literature and decide if the rationales could be applied in their own practice. After a 12-week period, we evaluated the effectiveness of the vote cards based on survey findings of the participants.

RESULTS

The majority of 66 respondents agreed that vote cards can improve the overall quality of EBM journal clubs, may encourage active participation and improve critical appraisal skills. They also rated the vote cards more favourably than traditional hand voting and agree that vote cards should be used in future EBM journal clubs.

CONCLUSION

We suggest the regular and routine use of vote cards in EBM journal clubs.

Are journal clubs effective in supporting evidence-based decision making? A systematic review. BEME Guide No. 16

BACKGROUND

Journal clubs (JCs) are a common form of interactive education in health care aiming to promote the uptake of research evidence into practice, but their effectiveness has not been established.

OBJECTIVE

This systematic review aimed to determine whether the JC is an effective intervention in supporting clinical decision making.

METHODS

We searched for studies which evaluated whether clubs promote changes in learner reaction, attitudes, knowledge, skills, behaviour or patient outcomes. We included undergraduate, postgraduate and practice JCs and excluded studies evaluating video/internet meetings or single meetings.

RESULTS

Eighteen studies were included. Studies reported improvements in reading behaviour (N = 5/11), confidence in critical appraisal (N = 7/7), critical appraisal test scores (N = 5/7) and ability to use findings (N = 5/7). No studies reported on patient outcomes. Sixteen studies used self-reported measures, but only four studies used validated tests. Interventions were too heterogeneous to allow pooling. Realist synthesis identified potentially 'active educational ingredients', including mentoring, brief training in clinical epidemiology, structured critical appraisal tools, adult-learning principles, multifaceted teaching approaches and integration of the JC with other clinical and academic activities.

CONCLUSION

The effectiveness of JCs in supporting evidence-based decision making is not clear. Better reporting of the intervention and a mixed methods approach to evaluating active ingredients are needed in order to understand how JCs may support evidence-based practice.

Lessons learned from a 5-year experience with a 4-week experiential quality improvement curriculum in a preventive medicine fellowship

BACKGROUND

Competency in practice-based learning and improvement (PBLI) and systems-based practice (SBP) empowers learners with the skills to plan, lead, and execute health care systems improvement efforts. Experiences from several graduate medical education programs describe the implementation of PBLI and SBP curricula as challenging because of lack of adequate curricular time and faculty resources, as well as a perception that PBLI and SBP are not relevant to future careers. A dedicated experiential rotation that requires fellow participation in a specialty-specific quality improvement project (QIP) may address some of these challenges.

METHOD

We describe a retrospective analysis of our 5-year experience with a dedicated 3-week PBLI-SBP experiential curriculum in a preventive medicine fellowship program at Mayo Clinic, Rochester, Minnesota.

RESULTS

Between 2004 and 2008, 19 learners including 7 preventive medicine fellows participated in the rotation. Using just-in-time learning, fellows work together on a relatively complex QIP of community or institutional significance. Since 2004, all 19 learners (100%) participating in this rotation have consistently demonstrated statistically significant increase in their quality improvement knowledge application tool (QIKAT) scores at the end of the rotation. At the end of the rotation, all 19 learners stated that they were either confident or very confident of making a change to improve health care in a local setting. Most of the QIPs resulted in sustainable practice improvements, and resultant solutions have been disseminated beyond the location of the original QIP.

CONCLUSION

A dedicated experiential rotation that requires learner participation in a QIP is one of the effective methods to address the needs of the SBP and PBLI competencies.

Which is the best method to learn ophthalmology? Resident doctors' perspective of ophthalmology training

The study aimed to gauge ophthalmology resident doctors′ perception of their teaching programs and various methods used in it and to formulate a well structured program for teaching ophthalmology. Closed ended and open-ended questionnaires were used for survey of ophthalmology residents in West Maharashtra, India. Sixty-seven out of 69 residents of seven residency programs completed the questionnaire. On a scale of 0 (most unsatisfactory) to 4 (best), lectures with power point presentation had a median score of 4, didactic lectures 2, seminar 3, case presentation 4, wet lab 3 and journal club 3. There was a discrepancy in the actual number of surgeries performed by the resident doctors and their perception of the number needed to master those surgeries. Phacoemulsification and non-cataract surgery training was neglected in most programs. The residents wanted to be evaluated regularly and taught basic ophthalmic examination, use of equipments and procedures in greater depth.

The successful journal club

Journal club is a structured meeting that is required at a residency program, which is designated to train residents in the necessary skills to evaluate and apply scientific literature critically to clinical decision making. A successful journal club is one in which residents develop competency in evaluating the scientific literature for evidence-based answers that can be applied to clinical questions. The objective in establishing a successful journal club is to build a forum for residents to formulate answers to their clinical questions through the development of essential critical appraisal skills. This article discusses the setting, format, content, and purpose of a successful journal club.

Do community medicine residency trainees learn through journal club? An experience from a developing country

BACKGROUND

Journal clubs are an internationally recognized teaching tool in many postgraduate medical education fields. In developing countries lack of funds for current print materials may have limited journal club use. But with advancing information technology trainees in developing countries increasingly have more access to high quality journals online. However, we are aware of no studies describing journal club existence and effectiveness in postgraduate medical training in Pakistan. Also we have found no published effectiveness studies of this teaching modality in Community Medicine (Public Health) in any country. This study evaluated the effectiveness of Community Medicine (Public Health) Resident Journal Club (CMR-JC) in Aga Khan University, Pakistan using international criteria for successful journal clubs (2 years continuous existence and more than 50% attendance) and examining resident and alumni satisfaction.

METHODS

Journal club effectiveness criteria were searched using electronic search databases. Departmental records were reviewed from September 1999-September 2005. Ninety percent of residents and alumni of Community Medicine Residency Programme participated voluntarily in a confidential survey.

RESULTS

The CMR-JC was regularly conducted. More than 95% of residents attended. (Total residents in the CMR-Programme: 32). Twenty-seven out of 29 current residents/alumni responded to the anonymous questionnaire. Acquisition of critical appraisal skills (23 respondents) and keeping up with current literature (18 respondents) were the two most important objectives achieved. Respondents recommended improved faculty participation and incorporating a structured checklist for article review.

CONCLUSION

CMR-JC fulfils criteria for effective journal clubs. Residents and alumni agree CMR-JC meets its objectives. Incorporating suggested recommendations will further improve standards. The journal club learning modality should be included in residency training programs in developing countries. Effective use of online resources to support journal clubs is demonstrated as a successful alternative to excessive expenditure for obtaining print journals. Those trying to start or improve journal clubs can benefit from our experience.