An important, explicit educational goal of most journal clubs is to teach critical appraisal skills, and for most programs, this is rated higher than keeping up with the medical literature. A journal club is an integral part of most training programs, and is often the format used to teach clinical epidemiology and biostatistics. Success of journal clubs can be defined by many different parameters, but factors associated with high attendance and longevity include mandatory attendance, availability of food, and perceived educational value by the program director. The impact of a resident or faculty moderator on attendance rates is not clear, but educational satisfaction may be higher in clubs moderated by the faculty.
Residents exposed to critical appraisal techniques in a journal club report paying more attention to the methods and becoming more skeptical of the author's conclusions. However, the amount of resident reading and the degree to which the resident incorporates new information into patient care may not be influenced by a journal club experience. Well-designed educational trials have demonstrated that it is possible to improve basic knowledge in clinical epidemiology and biostatistics, but not critical appraisal skills, using a journal club format. It may be that teaching critical appraisal skills requires more time on task than was provided in these educational experiments. Critical appraisal skills have been successfully taught in other settings.29
Reading guides or checklists may be useful tools for journal clubs. They can help a trainee organize an oral presentation of an article, remind the trainee of potential methodologic flaws, and may be associated with higher trainee satisfaction with the journal club. Building on the foundation developed by the McMaster group,25–28
a second generation of users' guides have been published beginning in 1993 by The Evidence-Based Medicine Working Group in the Journal of the American Medical Association
and are increasingly used as a tool to help teach critical appraisal skills.33–50
It is clear from this literature review that an ideal journal club format does not exist. Rather, the format depends on the goals of the journal club, the parameters used to define success, and the available resources. Nevertheless, a few common steps can be suggested for those faculty charged with initiating or “overhauling” their existing journal clubs. First, clearly articulate the goals. This step will aid in the creation of learning objectives, teaching format, and evaluation strategies. Next, select the most appropriate format, keeping in mind that longevity and high attendance rates are associated with mandatory attendance, and the provision of food. It is likely that direct teaching involvement by the department chairman and other respected faculty members will increase resident participation. The club moderator, whether faculty or resident, needs to be skilled in facilitating small group activities. Faculty development sessions that teach small group leadership skills are frequently offered at national specialty meetings including the Society of General Internal Medicine and Society of Teachers in Family Medicine. Greater resident satisfaction with a journal club may be achieved by utilizing adult learning principles including relating the learning task to immediate patient care experiences, use of problem-solving techniques, multiple teaching formats, and active learner involvement. Finally, the use of a structured format to review the literature may improve the residents' understanding of the material, the efficiency of their presentations, and their satisfaction with the educational experience.
For example, if the major teaching goals for a journal club were to teach critical appraisal skills and to improve the care of patients, the journal club could be designed to answer one or more clinical questions that are currently active on the medical ward or ambulatory clinic. A small part of each journal club could be used to teach the basic elements of critical appraisal or clinical epidemiology to give the residents the necessary tools to succeed in this endeavor. The clinical question could be addressed by using evidence-based medicine techniques with the help of users' guides or other structured review formats. A group consensus could be reached, and compared with the actual care being rendered.
Journal club formats are educationally diverse, and can allow for the incorporation of many important principles of adult learning. Journal clubs remain a fertile area for educational research, and provide an adaptable format for the teaching of the “new basic sciences.”