Are Journal Clubs Worth the Effort?

I admit to a fondness for journal clubs. And not only because I am a journal editor-in-chief. My experience with journal clubs as a plastic surgery resident increased my knowledge and profoundly shaped my views. I recall being invited to the homes of my professors, Drs John Bostwick and Maurice Jurkiewicz, which in itself seemed a rare privilege. In addition to our own Emory University faculty and residents, some of the community and private practice surgeons, such as Dr Carl Hartrampf Jr, were always there. Because I was well acquainted with the opinions of my professors on most topics, I often found the comments of these nonacademic plastic surgeons particularly thought-provoking. I appreciated journal club for many reasons, but significantly as a bridge between “town and gown,” helping to expose me and other residents to a variety of perspectives and building important relationships for the future. I remember the first paper, as a resident, that I was responsible for reviewing and discussing. It was a study by Mitz and Peyroni describing the superficial musculoaponeurotic system. When our senior resident, Dr Stephen Mathes, assigned it to me, he said, “You’d better do a good job, because this paper will be a classic.” He was right. Whether I did an adequate job of critically assessing the paper is, I’m afraid, lost to history. But what Mathes said to me made me realize that I needed to think long and hard about exactly what makes a paper truly great—and what detracts from that greatness. Although teaching critical appraisal skills is the most commonly cited goal for journal clubs,1 it is not the only goal. Others include knowledge expansion in the field; understanding biostatistics, epidemiology, and methodology; keeping up to date with current medical literature; and encouraging the application of new research in the clinical setting.2 Certainly, all these areas of investigation and practical application are extremely important. In my opinion, however, there is no higher calling for a journal club than to assist participants in developing the skills necessary to critically evaluate research methods and authors’ conclusions. These are vital “ever-green” skills they will need throughout their medical careers in order to provide optimum patient care. But how good a job are journal clubs doing in achieving this central goal? It appears that we can, and must, do better. Residents regularly participating in journal clubs have self-reported being more mindful of study methodologies and more careful in assessing published conclusions. However, studies have generally failed to support the claim that journal club participation actually does improve these and related critical assessment skills to any measurable degree.1,3,4 There is, however, some evidence that journal clubs show results in other areas such as motivating improved reading habits and helping teach principles of epidemiology and biostatistics to physicians in training.5 Additionally, although improved knowledge of the evidence-based medicine (EBM) process may be achieved through courses alone, participation in a journal club is often the preferred way of acquiring such knowledge and the accompanying critical appraisal skills. It is unclear which elements of the journal club format have the greatest impact on this type of learning.6 One of the problems in assessing best practices for journal clubs in which critical assessment skills are a primary goal is that research into effective approaches to this area of adult learning is sparse and mostly inconclusive. For resident training in conjunction with a journal club format, the usefulness of tools such as The Lancet Handbook of Essential Concepts in Clinical Research is suggested but remains unconfirmed by scientific studies.4 There are, however, a number of fairly well-established points that those responsible for organizing a traditional (not online) journal club may wish to consider to maximize the club’s success. Note that, in this context, “success” is defined as longevity (at least 2 years) and high levels of participation by residents (at least 50% attendance)1,7-9: Make attendance mandatory Articulate defined goals and structure the meeting format accordingly Include participation by program chair, other faculty, and community/private practice physicians Choose moderators skilled in leading small group discussion Use reading guides or EBM checklists to help teach critical appraisal skills Emphasize original research articles Regularly evaluate participant satisfaction Schedule meetings early in the week and in the evening Hold meetings at a faculty member’s home Provide food for attendees It is not unusual for journal clubs to flourish for a couple of years, and then interest wanes. Maintaining a stimulating environment and format for the journal club does not happen without forethought and constant reevaluation. Online journal clubs, such as the ASJ Journal Club, which convenes monthly, have the advantage of being able to feature live interaction with authors who can respond directly to questions about their work. Other noted experts can be drafted for participation as well, providing stimulating point-and-counterpoint discussion. (For information on the ASJ Journal Club, contact the Editorial Office at journal@surgery.org.) Training program journal clubs, on the other hand, offer a small, intimate environment for discussion and for the development of personal relationships with colleagues as well as academic and community-based leaders in the field. Residents are given the important opportunity to present and assess articles and to receive immediate feedback from peers. Whether traditional or online, thoughtfully designed journal clubs offer medical students, residents, and practicing physicians a unique forum in which to increase knowledge, share perspectives, and sharpen skills. Assistance in developing the ability to critically assess research is a vital aspect of what journal clubs can offer, but further research is needed to determine the best teaching methods applicable to the journal club format. Because of the limited time residents are involved in their training program’s journal club activities, additional exposure to critical thinking principles may be required for measurable improvement to be achieved. Online activities, such as the ASJ Journal Club and the EBM Hub, can supplement what is provided at the institutional level. Journal clubs, in one format or another, have been an important part of medical education for 150 years and, I believe, will continue to be a relevant and cherished experience for plastic surgery residents far into the future. The author declared no potential conflicts of interest with respect to the research, authorship, and publication of this article. The author received no financial support for the research, authorship, and publication of this article.