Postgraduate journal club as a means of promoting evidence-based obstetrics and gynaecology

Evidence-Based Medicine Course in Combination With Journal Clubs to Promote Evidence-Based Surgery

Introduction To provide high-quality surgical care, surgeons must critically appraise medical literature to adapt their clinical practice whenever convincing evidence emerges. This will promote evidence-based surgery (EBS). Over the last decade, we have organized monthly journal clubs (JCs) and more extensive quarterly EBS courses for surgical residents and PhD students, supervised by surgical staff. We evaluated the participation, satisfaction, and knowledge gained by this EBS program, to make the program future-proof and aid other educators. Materials and methods An anonymous digital survey was distributed via email among residents, PhD students, and surgeons of the Amsterdam University Medical Centers' (UMC) surgical department in April 2022. The survey included general questions on EBS education, specific course-oriented questions for the residents and PhD students, and questions about supervision for surgeons. Results The survey was completed by 47 respondents from the surgery department of the Amsterdam UMC University Hospital, of whom 63.8% (n=30) were residents or PhD students and 36.2% (n=17) were surgeons. During one year of the combined EBS course and JCs, the EBS course was attended by 40.0% (n=12) of PhD students and was rated with a mean score of 7.6/10. JCs were attended by 86.6% (n=26) of residents or PhD students and received a mean score of 7.4/10. Reported strengths of the JCs were their easy accessibility and the acquisition of critical appraisal skills and scientific knowledge. A reported point of improvement was to focus more deeply on specific epidemiological topics per meeting. Of the surgeons, 64.7% (n=11) had supervised at least one JC and gave a mean score of 8.5/10. The main reasons to supervise JCs were the distribution of knowledge (45.5%), scientific discussion (36.3%), and contact with PhD students (18.1%). Conclusion Our EBS educational program, including JCs and EBS courses, was well appreciated by residents, PhD students, and staff. This format is advocated for other centers aiming to better implement EBS in surgical practice.

Effectiveness of a web-based virtual journal club to promote medical education (Web-Ed): protocol of a multicentre pragmatic randomised trial

INTRODUCTION

A journal club (JC) is a commonly used medical educational tool. Videoconferencing technology can facilitate the delivery of JCs, however, there remains no evidence on the role of web-based virtual JCs in promoting the acquisition and retention of medical knowledge. The Web-Ed trial aims to evaluate the educational benefits, feasibility and acceptability of web-based virtual JCs compared with traditional face-to-face ones.

METHODS AND ANALYSIS

Web-Ed is a multicentre pragmatic parallel-group randomised trial across teaching hospitals within the UK National Health Service (NHS). We will enrol qualified doctors or medical students who are >18 years old, proficient in English and able to use online videoconferencing software. Block randomisation will be used to allocate participants in 1:1 ratio to either intervention group. Both groups will be presented with the same educational material and follow a standardised JC structure hosted by nominated moderators and medical faculty members.The primary outcome is the difference in participants' knowledge acquisition and retention 7 days after the JCs evaluated using standardised multiple-choice questions. We will report secondarily on the feasibility and acceptability of the JCs using Likert scale questionnaires. Assuming a 30% drop-out rate, we aim to enrol 75 participants to detect a 20% improvement in knowledge acquisition at 80% power and 5% significance. We will report using mean difference or risk ratio with 95% CIs and assess significance using parametric/non-parametric testing. Where relevant, we will adjust for predetermined characteristics (age, grade of training and session duration) using multivariate regression analyses.

ETHICS AND DISSEMINATION

Web-Ed was designed by doctors in training to address their learning needs and evaluate the preferred mode of learning. The trial results will be published in peer-reviewed journals and presented at relevant scientific conferences. The trial has been approved by the NHS Health Regulation Authority (21/HRA/3361).

TRIAL REGISTRATION NUMBER

ISRCTN18036769.

Incorporation of Evidence-Based Surgery into the Curriculum

Surgeons have historically learned their craft through the apprenticeship model from their mentors. Knowledge and practices acquired this way can rapidly become outdated. Providing high-quality care to patients requires surgeons to keep their knowledge up to date in line with evolving new evidence. The principles of evidence-based medicine (EBM) and its application to surgery, evidence-based surgery (EBS), are pivotal in updating and refining surgical practice. Changing from the conventional practice of surgical education to a structured evidence-based format requires a transformative process in all the levels of surgical practice encompassing trainees and trainers. Equally important is providing an optimal environment to review the evidence and deliver the surgical teaching and incorporate effective assessment tools to monitor the process. In this article, we revisit the levels of evidence and explore the different issues related to EBS such as barriers to EBS, incorporation of EBS to the surgical curriculum and discuss practical ways to implement EBS in the surgical curriculum.

Comparison of two formats of journal club for postgraduate students at two centers in developing critical appraisal skills

Journal club (JC) is an integral part of postgraduate medical education. Although several innovations have been attempted to improve its effectiveness, the influence of the number of sessions remains unexplored. The current study investigated the effect of the number of sessions (one vs. four) of conduction of journal club on critical appraisal skills of postgraduate students at two institutions. A quasi-experimental study was conducted comparing the effectiveness of JC in a one- versus four-session JC format using two objective tests: Critical Appraisal Skills Test (CAST) and Population, Intervention, Comparison, Outcome (PICO) score. The degree of changes (pre-JC vs. post-JC session) after each format exposure, association of prescores to postscores, and correlation between the CAST and PICO scores were discerned. CAST score was higher in the four-session format (P = 0.03), whereas PICO score increased in the single-session format of JC (P = 0.03). Also, the change in CAST score was higher in the four-session versus single-session JC format (P = 0.04). We conclude that a four-session format of JC is more effective in augmenting critical appraisal skills of postgraduate students, whereas a single session is sufficient for improving factual knowledge.

Beyond Average Information: How Q-Methodology Enhances Course Evaluations in Anatomy

Course evaluations can be used for curriculum improvement and have the potential to better the student learning experience. However, because most are based on Likert scales and open-ended feedback, understanding diversity in student opinion and uncovering optimal options for course change and improvement are often difficult. Alternatively, Q-methodology can be used to investigate patterns of thought within a group and may offer greater potential for course reform. This manuscript offers a tutorial-based explanation of the three components of Q-methodology studies (1) survey instrument development, (2) data collection, and (3) analysis and interpretation, then demonstrates, via case study, the use of Q-methodology to evaluate a fourth-year undergraduate pathoanatomy course. The goal of this article is to enable the reader to broadly apply Q-methodology in other courses to gain insight and feedback beyond that offered by traditional Likert scale methods. As demonstrated through the pathoanatomy case study, Q-methodology highlights groups (denoted by factors) of like-minded students that share opinions, preferences, and values. Overall, Q-methodology analyses support course instructors in identifying areas of course strength and improvement in an evidence-based way. This alternative to traditional Likert scales represents a promising solution to ongoing course evaluation limitations.

Teaching Evidence-Based Practice: Considerations for Dental Education

The motivation for teaching evidence-based practice is that, through the use of high-quality clinically relevant evidence, clinicians will make rationale decision that optimally improve patient health outcomes. Achieving that goal requires clinicians who are able to answer patient care-relevant clinical questions efficiently, which means that they must be able rapidly to retrieve, assess, and apply evidence of direct relevance to their patients. Educational programs designed to accomplish this vary in their effectiveness. This article reviews the evidence on educational approaches that may be beneficial when developing educational programs for both dental students and practicing dentists.

Evidence appraisal: a scoping review, conceptual framework, and research agenda

Objective

Critical appraisal of clinical evidence promises to help prevent, detect, and address flaws related to study importance, ethics, validity, applicability, and reporting. These research issues are of growing concern. The purpose of this scoping review is to survey the current literature on evidence appraisal to develop a conceptual framework and an informatics research agenda.

Methods

We conducted an iterative literature search of Medline for discussion or research on the critical appraisal of clinical evidence. After title and abstract review, 121 articles were included in the analysis. We performed qualitative thematic analysis to describe the evidence appraisal architecture and its issues and opportunities. From this analysis, we derived a conceptual framework and an informatics research agenda.

Results

We identified 68 themes in 10 categories. This analysis revealed that the practice of evidence appraisal is quite common but is rarely subjected to documentation, organization, validation, integration, or uptake. This is related to underdeveloped tools, scant incentives, and insufficient acquisition of appraisal data and transformation of the data into usable knowledge.

Discussion

The gaps in acquiring appraisal data, transforming the data into actionable information and knowledge, and ensuring its dissemination and adoption can be addressed with proven informatics approaches.

Conclusions

Evidence appraisal faces several challenges, but implementing an informatics research agenda would likely help realize the potential of evidence appraisal for improving the rigor and value of clinical evidence.

How Well Are We Doing at Teaching Critical Appraisal Skills to Our Residents? A Needs Assessment of Plastic Surgery Journal Club

Objective

To perform a needs assessment of journal club in plastic surgery residency programs. Specifically, this study focused on potential gaps in journal club associated with teaching and assessing critical appraisal of the literature, an important component of medical education and practice.

Methods

This is a qualitative study that utilized an online survey tool to collect information about the characteristics of journal club in plastic surgery residency programs in both Canada and the United States. Both program directors and residents were surveyed.

Results

When presented with a range of objectives, both program director and resident responses identified that teaching critical appraisal skills was often the main goal of journal club in their program (67.1%). Most trainees perceived that journal club was at least somewhat effective in improving their critical appraisal skills. Despite this perception, many residents felt that they had minimal to no experience in critical appraisal of the literature upon entry into their respective residency programs (46.2%), and only 29.2% indicated that they received formal instruction regarding critical appraisal. Three-quarters of residents indicated that there was no tool provided to aid them in their analysis of the literature. Finally, most residents also responded that they were not assessed objectively with regard to their performance.

Conclusions

Although residents in our study perceive journal club to at least somewhat improve their critical appraisal skills, evidence in the literature has been controversial. It cannot be assumed that residents are learning the skills they need by simply attending and reading the articles associated with journal club. Future study should focus on the best way to meet these objectives.

Survey of methods used to determine if a patient has a deep vein thrombosis: An exploratory research report

BACKGROUND

The use of evidence-based practice (EBP) is encouraged in the physical therapy profession, but integrating evidence into practice can be difficult for clinicians because of lack of time and other constraints.

OBJECTIVE

To survey physical therapy clinical instructors and determine the methods they use for screening for deep vein thrombosis (DVT), a type of venous thromboembolism (VTE) in the lower extremities.

DESIGN

Exploratory survey.

METHODS

Twelve survey questions written specifically for this study were sent to a convenience sample of clinical instructors associated with seven universities across 43 states.

RESULTS

Eight hundred fifty clinical instructors (22.4% response rate) completed the survey. Of those who responded, 80.5% were taught to use Homans sign to screen for a possible DVT in their entry-level education and 67.9% continued to use Homans sign in clinical practice. Regardless of post-graduate education, respondents were more likely to choose Homans sign than a clinical decision rule (CDR) to screen for a suspected DVT. Additionally, nearly two-thirds of respondents failed to correctly identify one or more of the major risk factors for developing a DVT/VTE.

LIMITATIONS

The response rate was 22.4% and therefore may not fully represent the population of physical therapy clinical instructors in the United States.

CONCLUSIONS

Results from this exploratory survey indicated that approximately two-thirds of physical therapy clinical instructors used outdated DVT/VTE screening methods that they were taught in their entry-level education and nearly two-thirds did not identify the major risk factors associated with DVT/VTE. These results suggest that change is necessary in physical therapy education, clinical practice, and continuing professional development to ensure a more evidenced-based identification of DVT and VTE.

Another Time, Another Space: The Evolution of the Virtual Journal Club

Virtual journal clubs (VJCs) provide a standardized, easily accessible forum for evidence-based discussion. The new virtual reality setting in which journal clubs and other online education events now take place offers great advantages and new opportunities for radiologists in academic medicine and private practice. VJCs continue to evolve, largely due to many emerging technologies and platforms. VJCs will continue to play an increasingly important role in medical education, interdisciplinary interaction, and multi-institutional collaboration. In this article, we discuss how to conduct and lead a critical review of medical literature in the setting of a virtual or traditional journal club. We discuss the current applications of VJCs in medical and graduate medical education and continued lifelong learning. We also explain the advantages and disadvantages of VJCs over traditional venues. Finally, the reader will be given the tools to successfully implement and run a VJC.

Does integrated training in evidence-based medicine (EBM) in the general practice (GP) specialty training improve EBM behaviour in daily clinical practice? A cluster randomised controlled trial

OBJECTIVES

Evidence-based medicine (EBM) is an important element in the general practice (GP) specialty training. Studies show that integrating EBM training into clinical practice brings larger benefits than stand-alone modules. However, these studies have neither been performed in GP nor assessed EBM behaviour of former trainees in daily clinical practice.

SETTING

GP specialty training in the Netherlands.

PARTICIPANTS

All 82 third year GP trainees who started their final third year in 2011 were approached for inclusion, of whom 79 (96%) participated: 39 in the intervention group and 40 in the control group.

INTERVENTION

Integrated EBM training, in which EBM is embedded closely within the clinical context by joint assignments for the trainee and supervisor in daily practice, and teaching sessions based on dilemmas from actual patient consultations.

COMPARISON

Stand-alone EBM training at the institute only.

PRIMARY AND SECONDARY OUTCOMES

Our primary outcome was EBM behaviour, assessed by measuring guideline adherence (incorporating rational, motivated deviation) and information-seeking behaviour. Our secondary outcomes were EBM attitude and EBM knowledge. Data were acquired using logbooks and questionnaires, respectively. Analyses were performed using mixed models.

RESULTS

Logbook data were available from 76 (96%) of the participating trainees at baseline (7614 consultations), 60 (76%) at the end of the third year (T1, 4973 consultations) and 53 (67%) 1 year after graduation (T2, 3307 consultations). We found no significant differences in outcomes between the 2 groups, with relative risks for guideline adherence varying between 0.96 and 0.99 (95% CI 0.86 to 1.11) at T1, and 0.99 and 1.10 (95% CI 0.92 to 1.25) at T2, and for information-seeking behaviour between 0.97 and 1.16 (95% CI 0.70 to 1.91) and 0.90 and 1.10 (95% CI 0.70 to 1.32), respectively.

CONCLUSIONS

Integrated EBM training compared with stand-alone EBM training does not improve EBM behaviour, attitude or knowledge of (future) GPs.

One Model of Residency Journal Clubs With Multifaceted Support

PROBLEM

The field of medical education is represented by a fairly wide variety of models for utilizing journal clubs as an effective teaching tool, each with varying levels of empirical support. Our own prior attempts at developing and implementing an effective journal club required improvements.

INTERVENTION

Our intervention consisted of an innovative, effective journal club model that has more well-defined elements that are readily adaptable for other residency programs. The collective strategies were based on the previous literature and our own experiences.

CONTEXT

Our intervention was implemented in a department of psychiatry within a university-based medical school. Study participants came from a psychiatry department's residency programs (N = 36) during academic year 2011-2012 with senior residents having the option to attend journal club. Using a multifaceted approach, measures included attendance, presession quizzes, postsession evaluations, and a final postcourse evaluation of 11 dimensions (e.g., goals, objectives).

OUTCOME

Thirty-one (86%) trainees attended journal club-a substantial increase from previous years. The presession-quiz median was 4.4 total correct out of 6 questions (range = 3.3-5.3), indicating that the articles were generally read before the session. The postsession-evaluation median was 4.6 (1-5 scale, 5 the highest; range = 4.1-4.8), indicating sessions were well received. The final postcourse-evaluation overall mean was 3.9 (1-5 scale, 5 the highest; subscale M range = 3.4-4.5). Qualitative and quantitative analyses of the postcourse evaluation indicated the following positive aspects: educational objectives generally met, overall structured format, quality of discussions, individuals involved (e.g., course directors, trainees, faculty facilitators), and availability of food. Areas of possible improvement included time management within the sessions, more contemporary and clinically relevant articles, consistency in faculty moderators, and evaluation process. Engagement in learning appeared to have been dramatically increased through five strategies: (a) meaningful incentives; (b) assigned, engaged consistently prepared faculty; (c) meaningful evaluation; (d) prejournal club preparations that helped residents assimilate critical appraisal with time-and-task-management skills; and (e) a planning group that developed and improved curricula and instruction to meet the objectives of the course.

LESSONS LEARNED

Overall, effective, and successful journal clubs require systematic planning, implementation, modification, and refinement.

Radiologists' perspectives about evidence-based medicine and their clinical practice: a semistructured interview study

OBJECTIVES

To describe radiologist's attitudes and perspectives on evidence-based medicine (EBM) and their practice.

DESIGN

Face-to-face semistructured interviews, thematic analysis.

SETTING

24 institutions across six Australian states and New Zealand. Transcripts were imported into HyperRESEARCH software and thematically analysed.

PARTICIPANTS

25 radiologists.

RESULTS

Six themes were identified: legitimising decisions (validated justification, prioritising patient preferences, reinforcing protocols), optimising outcomes (ensuring patient safety, maximising efficiency), availability of access (requiring immediacy, inadequacy of evidence, time constraints, proximity of peer networks, grasping information dispersion), over-riding pragmatism (perceptibly applicability, preserving the art of medicine, technical demands), limited confidence (conceptual obscurity, reputation-based trust, demands constant practice, suspicion and cynicism), and competing powers (hierarchical conflict, prevailing commercial interests).

CONCLUSIONS

Radiologists believe EBM can support clinical decision-making for optimal patient outcomes and service efficiency but feel limited in their capacities to assimilate and apply EBM in practice. Improving access to evidence, providing ongoing education and training supplemented with practical tools for appraising evidence; and developing evidence-based guidelines and protocols may enhance feasibility and promote the confidence and skills among radiologists in applying EBM in radiology practice for better patient care.

Journal-based learning, a new learning experience building on PBL at HKU

OBJECTIVE

To evaluate the effectiveness of a new journal-based learning (JBL) programme designed to equip students with skills necessary to understand dental research publications, thereby preparing them for continuing professional development.

MATERIALS AND METHODS

A baseline evaluation of knowledge relating to key research terms was conducted on 52 final-year BDS students. 11 weekly seminars were conducted from 8 clinical disciplines driven by a reading list of 2-5 journal articles along with a series of 'guidance' questions relating to research terms and content knowledge aspects of each paper to focus their reading and learning. Seminars were facilitated by discipline experts with supporting notes. An exit test based on research process and terminologies for the programme was conducted with 4 repeated questions from the baseline assessment. A systematic marking scheme was used and the results analysed. A focus group was run to collect feedback regarding students' views and experiences on the JBL experience.

FINDINGS

Students showed significant improvements over the baseline score. The mean score rose from 3.5 to 11.5 in the repeated questions (P < 0.001). The focus group revealed that students had learnt new information about journal classification, evidence level determination, new research terms and the structure of research papers. From the first 4 years of PBL, students recognized the importance of learning from research papers since year 1. However, JBL gave them a deeper understanding of research and the development of critical appraisal skills.

IMPLICATIONS

JBL provided final-year students the opportunity to learn significantly more about dental research, terminologies, paper structure, critical analysis and content knowledge through active-learning small group seminars.

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.

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.

How to run an effective journal club: a systematic review

BACKGROUND

Health-based journal clubs have been in place for over 100 years. Participants meet regularly to critique research articles, to improve their understanding of research design, statistics and critical appraisal. However, there is no standard process of conducting an effective journal club. We conducted a systematic literature review to identify core processes of a successful health journal club.

METHOD

We searched a range of library databases using established keywords. All research designs were initially considered to establish the body of evidence. Experimental or comparative papers were then critically appraised for methodological quality and information was extracted on effective journal club processes.

RESULTS

We identified 101 articles, of which 21 comprised the body of evidence. Of these, 12 described journal club effectiveness. Methodological quality was moderate. The papers described many processes of effective journal clubs. Over 80% papers reported that journal club intervention was effective in improving knowledge and critical appraisal skills. Few papers reported on the psychometric properties of their outcome instruments. No paper reported on the translation of evidence from journal club into clinical practice.

CONCLUSION

Characteristics of successful journal clubs included regular and anticipated meetings, mandatory attendance, clear long- and short-term purpose, appropriate meeting timing and incentives, a trained journal club leader to choose papers and lead discussion, circulating papers prior to the meeting, using the internet for wider dissemination and data storage, using established critical appraisal processes and summarizing journal club findings.

Pilot study of the knowledge and attitude towards evidence based medicine of otolaryngology higher surgical trainees

The objective of this survey is to provide an insight into the knowledge and attitude of the higher surgical trainees in Otolaryngology towards evidence based medicine and evaluate their understanding of medical statistics and use of evidence based medicine in patient management. A self administered anonymous questionnaire was distributed to twenty Specialist Registrars in Otolaryngology in Ireland during an annual National Otolaryngology Meeting. Of these, nineteen attempted the questionnaire and eighteen completed it. Three previously published questionnaires [Meserve et al. (2005) Med. Educ. Online.10, 1; McColl et al. (1998) BMJ.316, 361; Khan et al. (1999) J. Obst. Gynaecol.19, 231] were used in this survey. In general, there was a moderately welcoming attitude towards evidence based medicine. However, the survey findings indicate the need for incorporation of formal teaching of critical appraisal skills into medical education with a greater emphasis on involvement and dissemination of evidence based medicine in day to day practice.

A hierarchy of effective teaching and learning to acquire competence in evidenced-based medicine

BACKGROUND

A variety of methods exists for teaching and learning evidence-based medicine (EBM). However, there is much debate about the effectiveness of various EBM teaching and learning activities, resulting in a lack of consensus as to what methods constitute the best educational practice. There is a need for a clear hierarchy of educational activities to effectively impart and acquire competence in EBM skills. This paper develops such a hierarchy based on current empirical and theoretical evidence.

DISCUSSION

EBM requires that health care decisions be based on the best available valid and relevant evidence. To achieve this, teachers delivering EBM curricula need to inculcate amongst learners the skills to gain, assess, apply, integrate and communicate new knowledge in clinical decision-making. Empirical and theoretical evidence suggests that there is a hierarchy of teaching and learning activities in terms of their educational effectiveness: Level 1, interactive and clinically integrated activities; Level 2(a), interactive but classroom based activities; Level 2(b), didactic but clinically integrated activities; and Level 3, didactic, classroom or standalone teaching.

SUMMARY

All health care professionals need to understand and implement the principles of EBM to improve care of their patients. Interactive and clinically integrated teaching and learning activities provide the basis for the best educational practice in this field.

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.

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

PURPOSE

To describe the use of the journal club as a tool to teach and assess competency in practice-based learning (PBL) and improvement among residents in ophthalmology.

DESIGN

Interventional case series.

PARTICIPANTS

Ophthalmology residents.

SETTING

Three academic ophthalmology residency programs in the United States.

METHODS

A survey was performed of self-assessed skills in PBL among residents in ophthalmology training before and after the implementation of a structured review checklist during a traditional resident journal club. The survey had 5 domains, including (A) appraise and assimilate evidence, (B) read a journal article critically, (C) use a systematic and standardized checklist, (D) apply knowledge of study designs and statistical methods, and (E) maintain a self-documented written record of compliance. The respondents scored their ability (range, 1-5).

RESULTS

The use of a structured journal club tool was associated with a statistically significant improvement in self-assessed ability in all 5 domains.

CONCLUSIONS

Although validity, reliability, and long-term efficacy studies are necessary, the structured journal club is one method of teaching and assessing resident competency in PBL and improvement.

Treatment Plan for Integrating Evidence-Based Decision Making into Dental Education

The aims of this paper are to present the findings from the scientific literature that discuss strategies that can contribute to a "best practices" treatment plan model for effectively integrating Evidence-Based Decision Making (EBDM) into curricula. MEDLINE, CINAHL, and HealthSTAR databases were searched, as was the Cochrane Database of Systematic Reviews. Studies and articles, ranging from systematic reviews to articles proposing models and recommendations for how to implement EBDM into curricula and faculty development were reviewed. Several common themes emerged and form the basis for a treatment plan model. The first step in developing any treatment plan is a thorough assessment of the current situation or problem. Recognizing that there are multiple phases to the assessment of an educational system, the focus of this paper will be to understand which teaching and learning strategies are most effective. These, in turn, will inform faculty of needed curricular changes and skill development training, requisites in order for them to prepare students to be successful in providing patient care using the best available evidence. Elements of a suggested treatment plan will be presented with the caveat that each dental school will need to develop an implementation plan based on an assessment of its own environment and needs.

A journal club is an effective tool for assisting librarians in the practice of evidence-based librarianship: a case study

OBJECTIVE

To establish a journal club for librarians, which aimed to develop appraisal skills and assist in the application of research to practice.

METHODS

Fourteen health librarians were invited to attend a journal club. Each month a librarian was responsible for preparing a scenario, choosing a research paper, and selecting a checklist. The paper was appraised by the club, and a critically appraised topic (CAT) prepared. Six months later, a questionnaire was sent to all librarians.

RESULTS

Six out of 14 librarians attended the journal club and five out of six returned the questionnaire. All five agreed that attending the journal club helped them develop appraisal skills, write a CAT and be more critical of research. Four agreed they always identified a research paper first, then formulated a question. One librarian agreed that applying results to their own practice was difficult, one disagreed and three were neutral.

CONCLUSION

Journal clubs can be effective at developing appraisal skills and writing a CAT, as well as increasing the reading of library research. Librarians still need assistance in identifying and using questions directly from their own practice. The journal club has helped some librarians to apply evidence to practice, but others find the research is not always directly relevant.

Critical Thinking and Evidence-Based Practice

Critical thinking (CT) is vital to evidence-based nursing practice. Evidence-based practice (EBP) supports nursing care and can contribute positively to patient outcomes across a variety of settings and geographic locations. The nature of EBP, its relevance to nursing, and the skills needed to support it should be required components of baccalaureate education and must be introduced early in students' development as independent, self-directed learners and as professional nurses. Among the knowledge, skills, and processes needed to support EBP, CT is paramount. The development of CT can prepare nurses with the necessary skills and dispositions (habits of mind, attitudes, and traits) to support EBP. The intents of this study were to explore the importance of CT as an essential skill to support EBP and to describe some of the strategies and processes considered key to the ongoing development of CT.

Using the Journal Club to Teach and Assess Competence in Practice-based Learning and Improvement: A Literature Review and Recommendation for Implementation

The traditional journal club has historically been used to teach residents about critically reading and reviewing the literature in order to improve patient care. The Accreditation Council for Graduate Medical Education competencies mandate requires that ophthalmology residency programs both teach and assess practice-based learning and improvement. A systematically conducted review of the literature regarding the use of the journal club in resident medical education was performed to define specific recommendations for implementation of a journal club tool. Selected best practices for a successful journal club were gleaned from the existing medical literature. These include the following: 1) the use of a structured review checklist, 2) explicit written learning objectives, and 3) a formalized meeting structure and process. The journal club might prove to be an excellent tool for the assessment of competencies like practice-based learning which may be difficult to assess by other means. Future study is necessary to determine if journal club can improve educational outcomes and promote lifelong competence in practice-based learning.

Critical appraisal workshops to promote evidence-based healthcare

We evaluated the effect of literature appraisal workshops on participants views, attitudes and knowledge about evidence-based medicine in the West Midlands region in 1998. The performance of 55 practitioners was evaluated, before and after attending the workshop. After attending the workshop, participants paid more attention to the study design (81% vs. 98%, P=0.02), they did not find research evidence confusing (35% vs. 52%, P=0.05), and they felt more confident in assessing research evidence (26% vs. 59%, P=0.0001). Their mean knowledge scores improved from 47.3 (SD12.2) to 57.9 (SD 9.0) ( P=0.0001). Our critical appraisal skills workshops improved attitudes and knowledge needed for the provision of evidence-supported healthcare. Such workshops should be incorporated in postgraduate obstetrics and gynaecology training programmes.

What is the evidence that postgraduate teaching in evidence based medicine changes anything? A systematic review

OBJECTIVE

To evaluate the effects of standalone versus clinically integrated teaching in evidence based medicine on various outcomes in postgraduates.

DESIGN

Systematic review of randomised and non-randomised controlled trials and before and after comparison studies.

DATA SOURCES

Medline, Embase, ERIC, Cochrane Library, DARE, HTA database, Best Evidence, BEME, and SCI.

STUDY SELECTION

23 studies: four randomised trials, seven non-randomised controlled studies, and 12 before and after comparison studies. 18 studies (including two randomised trials) evaluated a standalone teaching method, and five studies (including two randomised trials) evaluated a clinically integrated teaching method.

MAIN OUTCOME MEASURES

Knowledge, critical appraisal skills, attitudes, and behaviour.

RESULTS

Standalone teaching improved knowledge but not skills, attitudes, or behaviour. Clinically integrated teaching improved knowledge, skills, attitudes, and behaviour.

CONCLUSION

Teaching of evidence based medicine should be moved from classrooms to clinical practice to achieve improvements in substantial outcomes.

Incorporating the views of obstetric clinicians in implementing evidence-supported labour and delivery suite ward rounds: a case study

OBJECTIVES

To implement evidence-supported delivery suite ward rounds using strategies to overcome barriers.

DESIGN

Qualitative case study to identify barriers and a quantitative assessment of outcomes on ward rounds.

METHOD

After an introduction to the proposed evidence-supported delivery suite ward round reactions were elicited from 15 clinicians. Responses were categorized into barriers related to knowledge, skills, attitudes and behaviour. Using strategies to overcome these barriers, a weekly evidence-supported ward round was established. During patient-centred discussions, clinical questions were formulated. Following literature searches, evidence was acquired and appraised.

RESULTS

Clinicians had limited awareness about the potential benefits of a clinical librarian's support during ward rounds. They were unsure of their skills in evidence-based practice. There was scepticism, fear of loss of autonomy, poor motivation and resistance to change. Clinicians identified several factors that could impinge on their practice. Using appropriate strategies when evidence-supported ward rounds were conducted, 67 questions were raised. However only seven articles were appraised in time to affect decisions on that ward round.

CONCLUSIONS

Knowledge of barriers was helpful in developing plans for implementation of evidence-supported ward rounds. The pilot study indicates the feasibility of this approach.

Critical appraisal in clinical practice: sometimes irrelevant, occasionally invalid

A core activity of evidence-based practice is the search for and appraisal of evidence on specific clinical issues. Clinicians vary in their competence in this process; we therefore developed a 16-item checklist for quality of content (relevance and validity) and presentation (useability, attribution, currency and contact details). This was applied to a set of 55 consecutive appraisals conducted by clinicians and posted at a web-based medical journal club site. Questions were well formulated in 51/55 (92%) of the appraisals. However, 22% of appraisals missed the most relevant articles to answer the clinical question. Validity of articles was well appraised, with methodological information and data accurately extracted in 84% and accurate conversion to clinically meaningful summary statistics in 87%. The appraisals were presented in a useable way with appropriate and clear bottom-lines stated in 95%. The weakest link in production of good-quality critical appraisals was identification of relevant articles. This should be a focus for evidence-based medicine and critical appraisal skills.

Modernizing the journal club

Traditionally journal clubs provide a forum to learn presentation skills. We propose a new approach to teaching and learning in journal clubs, focusing on literature acquisition and critical appraisal skills. This approach will enable trainees to use journal clubs for personal professional development as well as for application of new knowledge in clinical medicine to improve patients' outcomes.