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Strategies for Holding Successful Journal Clubs

Case study

Content details

Med ID: 196
Read Online: 575
Published Online: 31 , January, 2020
Condition: Accepted
In Subjects: Health care

Manuscript

Fatemeh Motamedi, Ali Tavakkoli, Narges Khanjani


Abstract

Background: Journal club is a well-known method for reviewing new scientific articles and information in different fields of medical sciences.

Objectives: The authors have attempted to explore strategies for holding successful journal clubs at the Health Management and Medical Informatics Faculty of Kerman University of Medical Sciences, Kerman, Iran.

Methods: This qualitative content analysis study was done by interviewing nine academics and post-graduate students at the Department of Librarianship at the Faculty of Health Management and Medical Informatics in 2015. One interview was conducted with each participant. All interviews were recorded and transcribed and notes were taken during interviews. Data collection was continued until data saturation.

Results: The main extracted strategies for holding better journal clubs were that journal clubs should be held at an appropriate time, have someone in charge of organizing the facilities and content; and let everyone participate in the discussion. Also, article appraisal should be taught to participants beforehand.

Discussion: Although in many great universities around the world journal clubs are routinely and correctly held, this task has not yet been maturely performed in many educational centers in Iran.

Conclusion: More efforts should be put into holding organized and appropriate journal clubs.

Keywords: Journal club, Postgraduate students, Kerman, Iran

Key messages:

1. Journal club should be held at the right time and everyone should get engaged in the journal club.

2. Journal club should have a person in charge and critical appraisal skills should be taught beforehand.

3. Holding journal clubs routinely and appropriately has not yet been maturely performed in many educational centers in Iran; and more efforts should be put into holding organized, appropriate and successful journal clubs.

Introduction

Journal clubs are routinely part of the medical education system and have been around for the past several decades (Deenadayalan, Grimmer‐Somers, Prior, & Kumar, 2008) and it is an active form of learning outside of laboratory (Glazer, 2000) that remains a worth part of teaching schedules (Dirschl, Tornetta, & Bhandari, 2003). Journal club can be defined as a group who meet regularly to discuss the latest published articles in the field of medicine (Alam & Jawaid, 2009; Linzer, 1987; Millichap & Goldstein, 2011). There are varietal and adaptable journal club formats that can be used to teach new basic sciences (Alguire, 1998).

The journal club has undergone change over time, as in the past, it was aimed at updating the knowledge of participants and now it is done mainly to discuss study methodology (Shokouhi, Ghojazadeh, & Sattarnezhad, 2012), teach critical assessment skills (Alavi-Moghaddam, Yazdani, Mortazavi, Chichi, & Hosseini-Zijoud, 2016; Ebbert, Montori, & Schultz, 2001; McLeod, Steinert, Boudreau, Snell, & Wiseman, 2010; Shokouhi et al., 2012), support evidence based medicine in clinical practice, promote knowledge of epidemiology and biostatistics (Ebbert et al., 2001; Shokouhi et al., 2012) and improve studying habits (Ebbert et al., 2001) and it can be said that the procedure of learning is active (Jenny Doust, Montgomery, Rachel Bidgood, David Jeacocke, & Geoffrey Spurling, 2008). These old and new approaches to journal clubs can be named traditional and evidence based journal clubs, respectively.

Studies confirm that evidence based journal clubs are more effective than traditional journal clubs and their aims have changed from the earlier times (Alam & Jawaid, 2009). In a study done among the anesthesiology residents of Shiraz University of Medical Sciences, Iran, teaching biostatistics terms and concepts was performed along with presenting scientific subjects and article review in the journal clubs. Results showed that, the new approaches could improve journal clubs, increase interdisciplinary communication, understanding and applying evidence based medicine and clinical competence; and does not have the problems of traditional journal clubs (Masjedi et al., 2014) that were presenting poorly selected articles (Misra, Kalita, & Nair, 2007) and not improving critical thinking. Now evidence based medicine (EBM) journal clubs consider patient related problems, involve a group of experts, faculty members and academics (Misra et al., 2007) and teach critical thinking (Milbrandt & Vincent, 2004), research methodology, biostatistics, epidemiology (Faridhosseini, Saghebi, Khadem-Rezaiyan, Moharari, & Dadgarmoghaddam, 2016) and evaluating old and new therapies in the field of medicine (Lehmann, 2001).

The results of another study done at the Neurology Department of Tabriz University of Medical Sciences showed there was a significant improvement in critical appraisal skills after holding evidence based journal clubs (Shokouhi et al., 2012). Likewise, a study on the surgical residents in Nigeria showed a journal club as a useful educational resource, that has an important effect on improving critical appraisal skills and the ability of reviewing literature (Ibrahim, Mshelbwala, Mai, Asuku, & Mbibu, 2014). Meanwhile, another study in the physiotherapy departments in England and Australia showed, evidence based medicine journal clubs and facilities for journal preparation were both important within physiotherapy departments (Turner & Mjolne, 2001).

Considering the importance of evidence based education in medical departments and the importance of a regular program for holding journal clubs (M Sadeghi, Khanjani, & Motamedi, 2011), it can be stated that journal clubs can contribute to medical students understanding of evidence based concepts and the application of the results of studies (Packard, Herink, & Lenz, 2011). It can be said that the evidence based journal club is as a bridge between the results of research and clinical applications in practice (Mukherjee, Owen, & Hollins, 2006). Other benefits of library journal clubs reported in another study include; raise current awareness, improving analysis skills, group unity, and intra-library knowledge; and providing a low-cost professional development opportunity in times of budget difficulties (Young & Vilelle, 2011).

A Journal club has been routinely held at the Health Management and Medical Informatics Faculty of Kerman University of Medical Sciences for about 3 semesters and with about 10 permanent participants. They were held on a specific day and time; and lasted about 1-1.5 hours depending on the type of topics and participation of the attendees. The maximum number of people attending the sessions were the number of department members in each semester (all academics and students).

However, many academics and students were not happy with the department journal clubs. This study was conducted to identify and solve the problems of the previous journal clubs. Authors acknowledged that one of the importances of journal clubs is to teach critical thinking and research methodology and to inform students and academics about the most important topics in their field. One way to evaluate journal clubs is to ask for feedback from participants (Alam & Jawaid, 2009). This qualitative study was done to explore strategies for holding successful journal clubs at the Health Management and Medical Informatics Faculty of Kerman University of Medical Sciences.

Methods

This qualitative content analysis study was done in Kerman in 2015. All eligible people who were six post-graduate students (Master students of Medical Librarianship at the Faculty of Management and Medical Informatics) and three academics of the Department of Librarianship at the Faculty of Health Management and Medical Informatics of Kerman University of Medical Sciences were invited to participate in the study.

All people who had a history of attending or presenting at a journal club and were willing to talk about their experience were eligible to participate. All of these participants except one had presented in the journal club for 1.5 hours from 8.5 am to 10 am. Only one student presented from 9.5 to 11 am.

One interview was conducted with each participant. The open questions used in the interviews can be seen in the article appendix.

Volunteers participated in semi-structured interviews done by the first author after consent. The interviews were conducted privately at a time and place that suited the participants. All interviews were recorded and field notes were also taken during interviews. The recorded interview was transcribed carefully by listening to the recordings.

Each interview lasted between half to one hour. The interviews were done according to schedule from May 9, 2015 until June 8, 2015.

Interviews were continued until data saturation and content analysis was used for data analysis. Content analysis is a research technique for making replicable and valid inferences from text material. It includes 4 stages, which are Decontextualisation (identifying meaning units), Recontextualisation (including content), Categorisation (identifying homogeneous groups) and Compilation (Drawing realistic conclusions) (Bengtsson, 2016).

Results

In the present study, several strategies were developed for better holding journal clubs, which are as listed below.

1. Journal club should be held at the right time:

The participants stated that journal clubs should be held at the right time. Some participants said it is better that journal clubs be held only once a week and preferably in the early days of the week and in the morning, to give academics and students more energy and attention. One of the participants also suggested that it should not interfere with classes and it is better to hold journal clubs at rest times between morning and afternoon classes (12pm to 2pm).

One of the students said: “… I’d prefer to participate in such a meeting at the early hours of the day when people have more energy, so they may pay more attention … and the meeting would be more efficient.”

In addition, many participants pointed out that the time should be notified in advanced and not too late, so that the participants are able to schedule their program for attending. It would be preferable for the secretary of the department to accept this responsibility and notify all through email and the web; and ensure that everyone receives notification and is informed. It is also better to plan the journal club's schedule for each month in advanced and let it be available for all.

Participants suggested that the journal club should be held regularly and every week to provide continuing education for academics and students. Participants also commented that holding the journal club in consecutive days is tedious and it is better to hold it once a week, in regular and equal intervals. One of the academics believed that every student should present at, at least five journal clubs during his whole course.

2. Journal club should have a person in charge:

The other suggestions were that journal clubs should have technical and scientific backup. Before the journal club starts, someone should check and fix the visual and audio systems, and ensure the suitability of the venue. This person should also facilitate the participation of all academics and make sure that everyone was informed about the holding time and place of the journal club; and inform people if the holding time or place has changed.

One of the students said: “The department secretary should be present before the beginning of the session to solve the problems that may affect the order of the meeting. For example … he/she should check that the projector is OK, the venue is ready, the participants are aware about the time and any changes …”

In addition, one of the academics should be responsible for supervising paper selection and make sure the paper that will be presented is the most valid published paper and has been chosen correctly. Also, academics should give regular feedback to the department about how to hold better journal clubs and keep it efficient.

3. Everyone should get engaged in the journal club:

Participants pointed out that the article should be made available for all in advance, to study and criticize before the session. Students should also be encouraged to participate in the discussion. Not only academics should be involved, but also students have to get engaged and make the journal club more productive.

An academic explained that the aim of journal clubs is to promote and strengthen critical appraisal skills among students, encourage them to participate in the discussions and prepare better scientific presentations. The academic also believed that journal clubs make students find a scientific viewpoint and avoid trusting weak evidence.

“… [In previous journal clubs] students’ participation was low because they did not read the paper before the session, so they were not able to make appropriate and correct comments.”

4. Critical appraisal skills should be taught beforehand:

Participants believed that for holding a better journal club, critical appraisal and critical thinking should be taught to the participants. They also stated that the speaker has to have sufficient knowledge about critical appraisal skills and know how to search and find the best evidence for the talk. Likewise, he/she has to know the statistical principals for critically appraising the results.

In addition, students have to participate regularly in the journal club in order to be able to think critically, participate in the discussions, understand the research methodology and appraisals, and be able to critique the results and make better and more precise statements.

Several academics believed that the presenter and participants should read the papers before the session and especially the presenter should clarify ambiguities by reading relevant resources or by the guidance of his/her supervisor in advance. The participants also suggested that the topics presented in the journal club should better be about current problems and dilemmas and address the more common problems and needs of the community.

One of the students said: “… Paper selection should be based on the workplace and university priorities.”

And another student said: “It is better to select articles that create motivation for further research … ”

It was also suggested that the presenter should be able to provide the most relevant content in a short time with a fewer number of slides, avoid wasting time, and spend more time to critique the article.

5. Avoid the barriers to holding good journal club:

One of the barriers mentioned was the lack of sufficient English proficiency.

Participants also commented that sometimes a student expresses his/her own perception, but not what the article means to say. The student must solve his/her scientific and linguistic problems and discuss them with his/her supervisor in advance.

One of the academics believed that, unfortunately, academics and students still do not understand the importance of journal clubs and they think it is just a simple speech, although it is very different and it aims to critically appraisal and scientifically discusses a paper.

Also, some participants thought some departments just hold journal clubs for their prestige and students participate without learning anything and leave the place as soon as the session is over and these are contrary to the main goal of journal clubs.

Discussion

In the present study, several strategies were developed for holding better journal clubs and different factors were thought to be associated with more successful journal clubs.

1. Journal club should be held at the right time:

According to the results, time is important and a suitable day, and hour, and frequency during the week, should be considered. It should also be held regularly and according to a schedule. It should be set up at a convenient and fixed time (weekday and day hour) and should not interfere with classes.

Likewise, in other studies, it has been pointed out that for having successful journal clubs, the time and location should be properly adjusted (Kleinpell, 2002). Hosseini’s study showed, among the most important factors in the success of journal clubs are their regularity and people’s continuous participation (Hossini, 2002). Likewise, Deenadayalan et al pointed out that the most important features for holding successful journal clubs are regular sessions, based on a schedule and at a convenient time (Deenadayalan et al., 2008).

Lizarondo et al did a qualitative study in Australia and showed that lack of time and workload in clinical departments is one of the barriers for attending journal clubs (Lizarondo, Grimmer-Somers, & Kumar, 2011). Meanwhile, Khanjani et al in another study showed one of the obstacles for evidence based medical education in Iran is time limitations and heavy workload among clinical academics and students (Khanjani, Tabrizi, & Maghsoudi, 2013). Likewise, Khan’s study stated that, it is necessary to set aside adequate time for discussing articles (Khan, 2013).

2. Journal club should have a person in charge:

Having a technical backup or a person who checks and fixes the visual and audio systems, ensures the suitability of the venue and the participation of all academics, and informs everyone about the time and location of the session was another suggestion in the present study. Also, it was suggested that one of the academics should be responsible for supervising the selection of the papers and make sure the paper presented is scientifically valid and was chosen correctly. Deenadayalan et al’s study showed, one of the important factors for holding successful journal clubs is having a trained and responsible person for appropriate article selection and leading the discussion (Deenadayalan et al., 2008). Likewise, in Khan’s study, it was stated that journal clubs need a director to organize things for the journal club (Khan, 2013).

3. Everyone should get engaged in the Journal club:

Engaging everyone was one of the other results of the present study. Meanwhile, Lachance’s study showed that the common limitation in this type of teaching strategy is lack of participation (Lachance, 2014). Notifying and sending the full text of the article to all in advance, was one of the other suggestions in the present study. Sending the article before the meeting (Lachance, 2014) makes it possible for the participants to read and critique the paper before attending the session. In addition, students should also be encouraged to participate in the discussion. Sending and distributing the research article and the questions for discussion to all participants beforehand is one of the steps that should be considered and was pointed out in the other studies (Kleinpell, 2002). Likewise, Lizarondo et al in Australia showed, one of the problems that journal club participants faced, was limited access to full text articles and not having any background about it (Lizarondo et al., 2011).

4. Critical appraisal skills should be taught beforehand:

Teaching critical appraisal was another important factor that was considered in the present study for holding a successful journal club. It was suggested that, for better appraisal of the papers, critical appraisal and statistical concepts should be taught to participants before the session. In addition, as librarians have been supporting patient care teams in clinical settings, this shows the increasing importance of critical appraisal and teaching its skills (Tan & Maggio, 2013).

The academics believed that the presenter and participants should read the paper before the session and especially the speaker has to clarify ambiguities by reading relevant resources or by the guidance of his/her supervisor in advanced. Likewise, Zarghi et al pointed out that teaching critical appraisal skills is very important for successful journal clubs (Zarghi et al., 2014). The results of Alguire study showed, teaching critical appraisal is the most important goal of many journal clubs and the participants who know critical appraisal skills pay more attention to the methodology and the discussion of articles and it increases their clinical epidemiology and statistical knowledge (Alguire, 1998). Pearse-Smith has also confirmed the effectiveness of journal clubs at developing appraisal skills (Pearce‐Smith, 2006). Sidorov has stated that one of the effective factors in holding a successful journal club is the formal training of critical appraisal skills (Sidorov, 1995). Meanwhile, the results of Lizarondo et al’s study showed that lack of statistical knowledge is one of the obstacles for participants’ active engagement in the journal club (Lizarondo et al., 2011).

5. Avoid the barriers to holding good journal club:

Not understanding the importance of the journal clubs by academics and students is an obstacle for holding successful journal clubs. In addition, some researches have shown there is not sufficient knowledge about the evidenced-based decision-making process, its resources and proper article selection (M Sadeghi et al., 2011; Masoumeh Sadeghi, Khanjani, Motamedi, Saber, & Rad, 2011) and lack of proficiencies and self-confidence (Krugman, 2009). These issues could be obviated by teaching participants before the early sessions of journal clubs. In addition, the journal club should be evaluated to assess how the next session could be made more useful (Deenadayalan et al., 2008; Kleinpell, 2002).

Conclusion

Although in many great universities around the world journal clubs are held routinely and appropriately, this task has not yet been maturely performed in many educational centers in Iran. More efforts should be put into holding organized, appropriate and successful journal clubs. It is suggested that further studies be conducted in other medical departments for finding more barriers and facilitators for holding successful journal clubs.

Funding

None

Conflicts of Interest

The authors have no conflict of interest.

Acknowledgment

The authors thank all of the students and academics who participated in this study.

References

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Appendix:

Some of the open questions asked during the interviews:

1- How do you think we should plan and organize the Journal Club (JC)?

2- What do you think about the best time and order for the JC?

3- Who should organize the JC?

4- What type of evidence or articles should be discussed?

5- What type of knowledge do the attendees need to have?

6- What type of skills should the participants have ?

7- What are the characteristics of a good (or bad) JC?

Additional details