Journal Club is ready for the 21st century



Journal Club is ready for the 21 st Century

Journal club -- a regular reading, analysis and discussion of a selected article -- is a traditional component of resident education. In theory, regular participation at journal club should hone a resident's critical-thinking skills and ability to appraise the literature, and hopefully, improve care for his or her patients.

However, journal club's impact on physician practice in emergency medicine has been called into question,1,2 with no studies demonstrating the evidence-based medicine taught in journal club changes clinical behavior.3,4

What limits the efficacy of journal club is the difficulty in integrating complex data and nuanced interpretation into the environment of daily practice – and nowhere is this more problematic than the chaotic, fast-paced emergency department.

If there was a way to convene journal club at the bedside, residents and patients might benefit from a thoughtful, timely discussion of the evidence. Since that's impractical, other ways of transferring the merits of journal club to the ED must be investigated.

1. Kuhn GJ, Wyer PC, Cordell WH, Rowe BH; “SAEM Evidence-Based Medicine Interest Group: A survey to determine the prevalence and characteristics of training in Evidence-Based Medicine in emergency medicine residency programs.” J Emerg Med 28.3 (2005):353-9.

2. Carley SD, Mackway-Jones K, Jones A, Morton RJ, Dollery W, Maurice

S, Niklaus L, Donnan S. “Moving towards evidence based emergency

medicine: use of a structured critical appraisal journal club.” J Accid

Emerg Med 15.4 (1998):220-2.

3. Bazarian JJ, Davis CO, Spillane LL, Blumstein H, Schneider SM.

“Teaching emergency medicine residents evidence-based critical

appraisal skills: a controlled trial.” Ann Emerg Med. 34.2 (1999):148-54.

|What is a Blog?

It's short for “web-log,” and started as a kind of online diary. Blogging has experienced widespread growth in recent years, as people have come to appreciate the value of sharing their interests and viewpoints over the internet. An important feature of blogs is reader participation, allowed through a “comments” section published under each entry.

Early popular blogs focused on politics, but now there are many technology- and sports-centered blogs that draw newspaper-sized traffic. Most blogs, however, are intended for smaller audiences – updates on life for friends and family.5

As interest grows and software improves, blogs are finding a myriad of new uses – from public relations for corporations and garage bands, to project nerve centers and organizational newsletters.

Academic and medical blogging is finding an audience, as well. With hyperlinks to the latest healthcare news or published literature, plus thoughtful but conversational commentary from experts in the field, it's no wonder busy doctors are attracted to blogs, over staid print editorials.

Anonymity is obviously a concern – on the web, it's hard to verify credentials6,7(if that information is supplied, at all). But with scrutiny, over time, readers come to trust their sources, and fellow bloggers reward their reliable colleagues with links and support. In a new form of peer review, insightful writers of frequently-updated blogs tend to garner – and earn– a wide audience.

4. Carpenter CR, Katz E, Char D. “Re: Journal club and teaching

evidence-based medicine.” J Emerg Med. 31.3(2006):306-7

5. Pew / Internet Report: “Bloggers: A portrait of the internet's new storytellers.” 19 July 2006. _display.asp |Blogging is ideal for Journal Club

The narrative style of blogs, with their open invitation for reader participation, is an ideal match for traditional journal club's format of presentation and discussion.

On our Journal Club blog, developed using freely available software, residents can summarize and critique the methods, results, and conclusions of articles appearing in the emergency medicine literature. These “posts,” are written to include hyperlinks to the original article PDF, other relevant papers, EM practice guidelines, and evidence-based medicine tools and definitions.

The posts appear in reverse chronological order on the blog, but can be tagged with keywords for rapid searches. Other residents and program faculty members are invited to comment on individual posts, offering their interpretation of the literature and how they incorporate the findings into practice.

Being a resident-run adjunct to monthly journal club meetings, the blog is not intended to rival the breadth of EBM databases like UpToDate. But the depth of critical thinking, and discussion of data that impact EM physician decision-making, has not before been available in a readily searchable format designed for on-the-job use.

9.

For more, please visit

To start your own blog, visit

or

6. Painter, K. “Paging Dr. Blog: Online Discourse Raises Questions.” USA Today, 14 May, 2007.

7. Berger, E. “Emergency Medicine in the Blogosphere: The Irreverent Wit of the Specialty’s Unofficial Voice.” Annals of Emergency Medicine. 49.5 (2007):612-614 | |

|The Mount Sinai Experience |Journal Club blogs facilitate bedside EBM | |

| | | |

|Since its debut last year, the Sinai EM journal club blog has proven |The potential for blogs to enhance teaching has not gone unnoticed in the |The Journal Club Blog: |

|popular, engendering discussion long after the physical journal club meeting|medical world. User-generated content like blogs, wikis and podcasts can be |An Accessible, Searchable Reference to Enhance the Teaching of |

|adjourns, and acting as a searchable, indexed reference to current topics in|easily adapted and organized for educational benefit.8,9,10 |Evidence-Based Medicine |

|EM research -- from any internet-enabled computer. | | |

| |The use of the blogs as an online adjunct for journal club is novel, and has |[pic] |

|Thus, our residents can quickly access a growing database of reviewed |the potential to translate knowledge of evidence-based medicine from the | |

|articles, even in the middle of a busy shift. Decisions on patient care are |classroom to the bedside. |Nicholas Genes, MD, PhD |

|based on in-depth appraisals of the evidence, as opposed to hazy | |Lars K. Beattie, MD |

|recollections of classroom discussions. |Indeed, blogs might finally answer the question of whether journal clubs can | |

| |change physician behavior. By coupling blog usage trackers with computerized |Mount Sinai School of Medicine |

|Faculty participation on the blog, particularly from attendings unable to |physician order entry, researchers could infer what information doctors are |New York, New York |

|attend the physical journal club meetings, is increasing. Furthermore, |using before they make decisions. The impact of evidence-based medical | |

|faculty impressions on the literature reach a larger audience -- and don't |teaching can be measured -- through the use of accessible, searchable journal | |

|need to be repeated. |club blogs. | |

| | | |

|Some users have expressed a reluctance to comment publicly on journal | | |

|articles -- opinions change, but web searches invite others to take | | |

|viewpoints out of context in the future. While no one is obligated to | | |

|contribute with identifying information, we are nonetheless considering |8. Maged N, Boulos K,1 Maramba I, and Wheeler S. “Wikis, blogs and podcasts: a| |

|limiting access to parts of the site with password protection. |new generation of Web-based tools for virtual collaborative clinical practice | |

| |and education.” BMC Med Educ.15.6(2006):41. | |

|Resident usage in the ED so far is variable. Some residents refer to | | |

|specific blog entries for literature review as the need arises, while others|9. Schwimmer J, Dimov V. “Assessment of a Blog as a Medium for Nephrology | |

|simply use the practice resources featured prominently throughout the site. |Education.” American Society of Nephrology. Nov (2006): San Diego, CA. | |

|Many still report an unwillingness to use unfamiliar web resources during a | | |

|shift. As the database of reviewed articles grows, the blog's usefulness is |10. Poonawalla T, Wagner RF Jr. “Assessment of a blog as a medium for | |

|expected to increase. |dermatology education.” Dermatol Online J. 12.1 (2006 ):5. | |

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