Journal Club Objectives

Objectives

Defined by Sackett et al., evidence-based practice is 'the conscientious, explicit and judicious use of current best evidence in making a decision'. The exponential proliferation of research articles presents a challenge in differentiating between high-quality "best evidence" and less clinically useful research.

The principal goal of journal club is to gauge the validity of new literature by pursuing an in-depth appraisal of a high-impact article that is at most 2 years old. This appraisal will probe the details of the article's methodology and results, place the article in context of the subject matter, and ultimately build the audience's skills in article appraisal, while also discussing advances in medicine.

A successful journal club will feature an article that entices the resident audience with relevancy to practice and importance in the medical community, and use that article to illustrate and illuminate concepts in article appraisal that the audience member can apply to his/her future practice.

Key tasks:

1. Review a major recent research article of the internal medicine literature
2. Discuss the underlying argument of a paper, and whether the argument is supported by the research methodology.
3. Through discussion, illustrate takeaways that build the audience's appraisal skills
   1. If useful, include evidence-based medicine concepts in the discussion to aid in understanding and appraisal of the paper
4. Arrive at a conclusion as to how the presented research article impacts practice

The audience should come away with at least one EBM learning point and one clinical takeaway from the paper's conclusions.

Relevant EBM concepts:

1. State the benefits and threats to validity of major clinical research designs
   1. Randomized trial
   2. Cohort study
   3. Cross-sectional study
   4. Case-control study
   5. Prospective vs. Retrospective
2. Apply knowledge of threats to validity to selected major research articles
   1. Bias
   2. Confounding
3. Use basic statistical knowledge to describe the magnitude of effect and precision of research results
   1. Measures of association - odds ratio, risk ratio, absolute risk reduction, hazard ratio, etc
   2. Sensitivity and specificity, predictive values, likelihood ratios for diagnostic tests
   3. P values, confidence intervals
   4. Number needed to treat vs. number needed to harm
4. Apply above knowledge to come to a decision on a (preferably real-world) patient case
   1. Statistical significance versus clinical significance
   2. Internal validity vs. External validity