2010-2011 Journal Club Format—WARD Month

GOALS:

·         Encourage residents to use evidence-based medicine, specifically by asking a clinical question pertaining to an actual patient and then referencing the medical literature for “the answer”.

·         Promote small-group discussion of a clinically-relevant journal article, reflecting a more traditional Journal Club format than the complementary Morning Report didactic format.

 

METHODS:

Scheduling:

·         PGY2 residents will be assigned to conduct a Journal Club during one of their Ward blocks.  The 2nd Journal Club they lead will be done according to the prior Morning Report lecture format.

·         For their “Journal Club Ward Month”, PGY2 residents will be placed on night-float for the 1st two weeks and days for the 2nd two weeks.  This order will enable them to develop their clinical question and conduct research while on nights, and then to lead the actual journal club discussion while on days at the end of the Ward block.

 

EBM Process:

·         Residents will develop a clinical question based upon a patient on the Ward.  (e.g. What is the optimal duration of Atrovent use during treatment of an acute asthma exacerbation?).

·         Residents will select an article which “answers”—or at least addresses—the clinical question.  (An ideal question and article is one that generates some clinical controversy.)

·         Residents will determine which TYPE of article they have selected, using the JAMA categories (e.g. article on therapy or prevention, article about a diagnostic test, article about harm, article about prognosis, overview article, clinical practice guidelines, treatment recommendations, screening recommendations).

·         Residents can and should refer to the Journal Club link on the NCCPeds website (under the “Residents” tab) for internal links to each of the relevant JAMA “Guide to the Medical Literature” articles.

·         Residents will read the article, as well as the relevant JAMA reference, and be prepared to lead a discussion amongst the Ward Team members on both (see Journal Club Process, below).

 

Journal Club Process:

·         After the above preparation, residents will lead the “Journal Club Discussion” during their 2nd two weeks of the Ward block.  They should select a specific date and time well in advance, with the guidance of their PGY3 resident and attending to ensure maximum attendance.

·         All Ward team members will be present for the Journal Club Discussion, if possible.  This includes MSIIIs, MSIV Sub-Is, interns, PGY3, and attending(s).  Appropriate consulting attendings and fellows should also be invited (e.g. GI attending and fellow for question about GI patient).

o   Residents will distribute their articles at least 3-5 days in advance of their Journal Club Discussion, so that all team members will have time to read and review the article.  All team members will be prepared to engage in an active, academic discourse.

 

·         Residents will be prepared to lead an interactive discussion amongst Ward Team members on the following issues related to their selected article:

1.       Ward patient who inspired clinical question

2.       Research question asked and main outcome of interest

3.       Methodology used: case-control study, case series, randomized trial, etc.

4.       Subjects used including inclusion and exclusion criteria

5.       How the study was done and how the outcome of interest was measured

6.       Describe the results of the study and statistical tests used

7.       What conclusions were drawn by the authors

·         Next, residents will be prepared to lead an interactive discussion amongst Ward Team members on the relevant questions included in the appropriate JAMA article.  All members of the team will be given relevant Critical Appraisal Worksheets to guide this portion of the discussion: http://www.mclibrary.duke.edu/subject/ebm?tab=appraising&extra=worksheets).

 

Evaluation:

·         The Ward attending(s)—Gen Peds or Heme-Onc, as appropriate—will evaluate the resident on their clinical question and selection of article, as well as their ability to lead an academic discussion on their article and the relevant JAMA research questions.

·         The Chief Resident and Dr. Adelman or Dr. Gorman will be present as Advisers/Moderators for the initial Ward-month Journal Clubs, to ensure that the above goals are met.