|Year : 2014 | Volume
| Issue : 2 | Page : 23-25
The impact of evidence based journal club on decision making capacity: a pilot study
JD Lakhani1, A Muley2, J Lodhari3
1 Professor & HOD, Department of Medicine, SBKS MIRC, Sumandeep Vidyapeeth, Piparia, Vadodara 391760, India
2 Associate Professor, Department of Medicine, SBKS MIRC, Sumandeep Vidyapeeth, Piparia, Vadodara 391760, India
3 Resident, Department of Medicine, SBKS MIRC, Sumandeep Vidyapeeth, Piparia, Vadodara 391760, India
|Date of Web Publication||24-Aug-2018|
J D Lakhani
Professor & HOD, Department of Medicine, SBKS MIRC, Sumandeep Vidyapeeth, Piparia, Vadodara 391760
Source of Support: None, Conflict of Interest: None
Introduction: Journal clubs (JC) are an integral part of medical curriculum. Evidence based journal clubs (EBJC) are now being preferred by some over traditional JCs claiming that EBJC answers questions regarding validity, reliability and applicability specifically. However, there is lack of studies addressing effect of EBJC on participants' understanding of results and critical appraisal capability.
Methodology: This was a pilot study. To test effect of EBJC on understanding of the specific topic and improvement in decision making ability, pre and post tests were conducted before and after each assessed EBJC presentation.
Results: Total 36 residents were included. 53% could not make up their mind about the acceptability of the results in the pretest. However, almost all could make a specific decision regarding reliability of results and applicability of the authors' conclusion at the end of the assessed EBJC presentation.
Conclusion: We concluded that exposure to EBJC resulted in significant improvement in the participants' understanding of the article and specific decision making capacity.
Keywords: Evidence based medicine, Journal club, Medical education, decision making skills
|How to cite this article:|
Lakhani J D, Muley A, Lodhari J. The impact of evidence based journal club on decision making capacity: a pilot study. J Integr Health Sci 2014;2:23-5
|How to cite this URL:|
Lakhani J D, Muley A, Lodhari J. The impact of evidence based journal club on decision making capacity: a pilot study. J Integr Health Sci [serial online] 2014 [cited 2021 Nov 30];2:23-5. Available from: https://www.jihs.in/text.asp?2014/2/2/23/239543
| Introduction|| |
Journal club (JC) is a meeting where individuals discuss latest articles to keep in touch with the current literature., They were held for the first time by Linzer The first JC for medical field was reported by late “Sir James Paget”, a British surgeon.
JCs which have evolved over the years to become an integral part of the medical curriculum; were initially held to incorporate understanding of articles and appraisal skills, to encourage debate on research while keeping abreast with the latest developments. However, through its evolution, three components have remained unchanged: to match pace with current literature, to impact clinical practice, and to teach critical reading skills.
Evidence-based medicine (EBM) stresses on using clinical expertise to combine the best available evidence with patient values to aid clinical decision making. Three questions that are specifically addressed and answered when using the principles of EBM to evaluate an article critically are regarding validity of the study, clinical utility of the results, and applicability of the results to individual patient or local population. 13 Traditional JCs usually answer the questions regarding validity and reliability by an indecisive ‘maybe’ and also, do not address the applicability issue specifically. EBJC is believed to address all these issues systematically and answer them specifically.
We conducted this pilot study to assess the impact of EBJCs on residents in terms of understanding the article and decision making capacity.
This pilot study was carried out in the department of medicine, SBKS MI & RC, Sumandeep Vidyapeeth after getting approval from the institutional ethical committee. The participants were all residents of the Deptt. of Internal Medicine attending the JC. The topic of JC was related to a controversy created due to banning of a diabetic medicine. One resident was given the responsibility of forming a PICO question (based on problem /patient, intervention, comparator and outcome) and searching to find the relevant articles from various major databases like Pubmed and Cochrane. A systematic review and metaanalysis was selected for presentation, while the others were included for discussion. The presentation was done on a powerpoint and included explanation of various statistical terms wherever required to aid understanding of the study design and results. Critical appraisal of the article was done in the end with the help of a check list for appraising systematic review to check for validity of the study, reliability of results and applicability to the local population. Thus, the JC was planned to include all the basic principles of evidence based medicine i.e; searching with PICO format and assessing validity, risk of bias, precision of effect, repeatability, reliability as well as applicability.
A written pre-test and post-test was the primary method of evaluating. It consisted of 12 questions based on the primary contents of the article. The questions were framed so as to test the understanding of the article and decision making capacity before and after presentation of the JC. The questionnaire was validated and same questions appeared on both the Pre and Post-tests. The data collected was analysed for the change in opinion imparted by the JC.
| Results|| |
Total 36 residents were included in the study, 12 from each year. The assessed JC included an article about a new contraindication of a commonly used and effective oral hypoglycemic agent. The authors had presented a significant incidence of the adverse effect of the drug which caused anxiety and policy changes as well as decline in the use of this drug. In the pretest, 57.3 % were not sure if the drug caused the adverse effect in question, 53% could not make up their mind about the acceptability of the results, 54% thought that the policy change was justified. In posttest, almost 97% made up their mind about the significance of the contraindication and could point out the specific scenarios where the drug should be avoided. None of them answered in favour of the policy change in the posttest thus again clearing the dilemma. All students agreed that the EBJC improved their critical thinking.
| Discussion|| |
Traditional JCs include discussion of medical articles to either accept or reject the author's results and conclusions, however there is no systematic critical appraisal addressing validity and reliability. EBJCs as conducted in our department included: question from real scenarios and difficulties faced in managing the patients in wards, searching the databases and identifying all relevant articles available, presenting the authors' conclusions and their perspective on the study results including explanations for unexpected results. Apart from these a very important part of the EBJC was systematic critical appraisal of the article for validity, reliability and applicability by discussion in the group and in the end making own conclusion based on the local circumstances and patients' values and preferences. Another important component was explaining the statistical terms used in the article separately and individually so imparting better understanding of the results, minimizing the chances of misinterpretation.
Many studies have been done in the past to assess the outcome of various modalities of teaching on critical appraisal skills and decision making capacity. A study reported no correlation between self proclaimed competence and actual competence in these skills.15 Others reported little positive impact on performance after didactic Continuing Medical Education. 14,16 Another study reported 33-42% correct responses on assessing the critical appraisal skills among participants exposed to traditional JCs.
This was a pilot study to assess the effect of EBJC on the participants' understanding and decision making capacity. After the EBJC presentation, there was an encouraging increase in understanding of the contents and specific decision making capacity of the participants. All students agreed that EBJCs improved their critical thinking and reading habits over and above that by traditional JCs.
Looking at the encouraging results we plan to extend the study for six months. During this period, we plan to assess three JCs individually with pre and post tests in the same fashion as in this pilot study. We also intend to take another set of pre and post tests six months apart to assess the effect of EBJCs on general understanding study designs, quality of studies, statistical terms and critical appraisal amongst the residents.
When no conclusion could be made based on one article or a need is felt to analyse more studies addressing same question, the next session of JC will be kept for analyzing other studies in the context of results and questions raised from the first session. Another resident or a group of residents will be given the task of searching for all the relevant articles available to answer the questions raised. The relevant and valid studies will be discussed in the next session to arrive at a conclusion. A record of the conclusion made at the end will be kept and used to make evidence based protocols for efficient management of commonly confronted conditions locally.
| Conclusion|| |
There was a marked improvement in understanding of statistical terms, ability to make correct inferences from results, critical appraisal skills and decision making capacity of residents after exposure to the EBJC. Almost all residents felt that EBJC gave them better understanding of the published articles and all agreed that it aided immensely in decision making.
| References|| |
Dwarakanath LS, Khan KS. Modernizing the JC. Hosp Med. 2000;16:425-427.
Sidorov J. How are internal medicine residency JCs organized, and what makes them successful? Arch Intern Med. 1995;155:1193-1197.
Linzer M: The JC and medical education: over one hundred years of unrecorded history. Postgrad Med J 1987, 63:475-478.
Paget S: Memoirs and Letter of Sir James Paget. London: Longmans, Green, and Co; 1901:42.
Forsen JW Jr, Hartman JM, Neely JG: Tutorials in clinical research, part VIII: creating a JC. Laryngoscope 2003, 113:475-483.
Ebbert JO, Montori VM, Schultz HJ. The JC in postgraduate medical education: a systematic review. Med Teach 2001;23(5):455-61.
Rosenberg W, Donald A. Evidence based medicine: an approach to clinical problem-solving. BMJ 1995;310(6987):1122-6.
Sackett DL, Haynes RB, Guyat GH. Clinical Epidemiology: A basic science for clinical medicine. Boston. Little, Brown; 1991.
Davis DA: The Science and Practice of Continuing Medical Education: A Study in Dissonance. ACP JC 1993, 118: A-18.
Emerson JS: Use of Statistical Analysis in the New England Journal of Medicine. NEJM 1983, 309:709-713.
Linzer M, DeLong ER, Hupart KH: A Comparison of Two Formats for Teaching Critical Reading Skills in a Medical JC. J of Med Educ 1987, 62:690-692.
Linzer M, Brown JT, Frazier LM, DeLong ER, Siegel WC. Impact of a medical JC on house-staff reading habits, knowledge, and critical appraisal skills. A randomized control trial. JAMA 1988;260(17):2537-41.