CATWalk - University of Alberta
Centre for Evidence-Based Medicine - University of Oxford
Evidence-Based Medicine Worksheets - Dartmouth Biomedical Libraries
KT Clearinghouse - Canadian Institute of Health Research (CIHR)
The intention of the Journal Club is to advance Residents' knowledge and practice of the scholarly approach to evidence-based patient care.
Residents will:
This program will:
By the end of the longitudinal Evidence Based Medicine Curriculum, the Resident is expected to:
Demonstrate how to access clinical evidence in response to a clinical question.
Demonstrate how to appraise the evidence.
Demonstrate how evidence can be applied to patient care.
Gain practical experience in data searching and grading, statistical methods, and application to practice.
Conduct a critical appraisal of original research.
Use scientific inquiry principles in making clinical decisions.
Present and discuss medical literature effectively.
To demonstrate competence in these goals, the Resident is expected to display the following knowledge, skills, and attitudes by the end of the rotation:
Use the PICO method to formulate a clinical question about a patient, problem, or populations.
Utilizing library resources to complete a literature search.
Categorize, analyze, and appraise the evidence using an appropriate critical appraisal technique.
Assessing validity and relevance of the article
Synthesizing data
Applying the evidence to practice
Present at Journal Club and facilitate discussion.
Refer to the Journal Club Calendar posted on MedHub, Calcat, and in the resident room and confirm 1) which month and date you are to present 2) the faculty member who is responsible for participating in that month’s journal club.
30 days prior to your assigned presentation date, meet with the assigned faculty member to decide on a clinical question or problem that interests you.
Be prepared to talk about a clinical question arising from your practice. Did you have a patient who was challenging or interesting to you? Do you have a question about the efficacy of one treatment plan over another? What other questions have come up during your patient interactions?
Review the JAMA Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice Chapter 4: What Is the Question?
Refine your question as appropriate into PICO format (PICO Worksheet):
Patient/Population
Intervention
Comparison (optional)
Outcomes
Before continuing, discuss your question with the faculty member identified in step one.
3 weeks prior to your assigned presentation date, contact clinical librarian Janet Anderson (janet.anderson@und.edu) for a virtual or in-person meeting. With guidance from the librarian perform a literature search. Document a summary of your literature search (database searched, terms, results).
The librarian will help you narrow down your articles to 3 options and will email you and the assigned faculty member these articles and the appropriate slide deck you’ll use for your presentation.
Critically appraise the article. Critical appraisal is the systematic evaluation of a clinical research paper. Start with basic questions such as: Does this study address a clearly focused question? Did the study use valid methods to address this question? Are these valid, important results applicable to my patient or population?
Select the best journal article (i.e. most relevant and high level of evidence) from the results you have located.
Consider conferring with specialist, consider inviting them to Journal Club.
Prepare your presentation using the prepared Power Point templates (PPT) for your selected article type. The intent of this presentation tool is to help you organize the critical appraisal into a discussion with your peers. Include information in your discussion as indicated in the slide notes.
One week ahead of time, send the proposed article and your completed slides to the faculty member on rotation for your assigned month (if needed, another meeting can be scheduled with the faculty member). Please also email your article to Karen Rude so that your co-residents and attending physicians may read it ahead of time.
Present the article and a discussion of your critical appraisal at Journal Club. The assigned faculty and librarian will complete an evaluation of the resident’s preparation and presentation (the evaluation should be emailed to you ahead of time, but ask your assigned faculty member or the librarian for a copy if you do not receive it).
Prior to meeting with your assigned faculty member (30 days PRIOR to your presentation)
Read this short introduction to study design by Jeremy Howick : Introduction to Study Design
The faculty member will discuss the elements of a well-built clinical question and will guide you in formatting your clinical question in this manner, but you should come prepared with possible clinical questions related to your practice
Meeting with the Librarian (3 weeks before you present)
The librarian will further assist you in drafting the PICO question and help develop appropriate search terms
You will practice effective searching strategies in the PubMed database. Review Chapter 5 in User's Guide to Medical Literature for helpful information about where to search for information and descriptions of the hierarchy of information sources in terms of EBM value.
Further reading:
Guyatt, G., Rennie, R., Meade, M., & Cook, D. (2015). User's guide to the medical literature: A manual for evidence-based clinical practice. (3rd ed.) Chicago, IL: Medical Library Association.
NOTE: JAMA Evidence also provides access to audio discussions by the authors to accompany many chapters. If you prefer auditory learning, these are a good alternative to reading the chapters.
Windish, D. (2013) Searching for the right evidence: how to answer your clinical questions using the 6S hierarchy. Evidence-Based Medicine, 18(3): 93-97.
Prepare a presentation that includes the following elements:
Discuss the background & relevance of the article selected.
Discuss the clinical problem. Provide a brief description of the patient/population (age, gender, key clinical findings, and your assessment of the problem). Did you consult any background sources (textbooks, etc.) on the patient's condition? Did your background reading help you focus on a more specific question?
Share your PICO question.
Review the methods section. Discuss the accountability of the study design and the validity and rigor of the study.
Review the result section:
Look for statistical significance with the results, utilizing the data provided.
How large was the treatment effect?
How precise was the treatment effect?
Convert data to user-friendly data if possible (Number Needed to Treat)
Are the results clinically significant?
Are there other factors that could affect the outcome?
Use the Library’s “Statistics – explanations and formulas” guide to help interpret data.
Discuss how to apply the evidence:
Are the results clinically significance?
Can the results be applied to your patients?
Will the results change your practice?
Which conclusions are directly drawn from the analysis of the results?
Has the article supported the generally accepted thinking on this topic?
What does this article add to the subject field and potentially your medical practice?
Using the Levels of Evidence TABLE created by the Oxford Centre for Evidence-Based Medicine (CEBM), assign a Level of Evidence to the article.