Journal Club for Dummies: How Not to Be Intimidated by Evidence-Based Medicine

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Have you ever looked at a journal club article and felt overwhelmed? You are not alone! Many residents are in the same boat. However, there is no way to escape it once you enter residency, nor should there be. Evidence-based medicine is an essential and integral part of our practice.

With the advent of the internet, the number of publications readily available has dramatically increased.1 It has become increasingly important for us to feel confident sorting through what is clinically relevant for our own practice. While this may feel like a tall order, here are a few tips and tricks that will make reading any article easier.

What is the Clinical Question?

All studies begin with a clinical question. This is the most important part of any study because the study was essentially crafted around this query. If you don’t comprehend the question, then you will struggle through the entire article. Sometimes, it may be necessary to do some background reading of your own to familiarize yourself with the topic. Typically, you can find it clearly stated in the abstract.

Use the PICO Model

PICO is a model that will help you determine the “who, what, when, where, why, how” of the study. This can be determined by reading the abstract or by skimming the relevant sections in the article. Knowing these 4 pieces of information will provide you with a framework for reading the study.2

  • “P” stands for patient, or population: Who is the subject of this conversation?
  • “I” stands for intervention: How did the study intervene on this subject?
  • “C” stands for comparison: To what group is the intervention group being compared?
  • “O” stands for outcome: What is the primary outcome for the study?

Determine the Level and Quality of Evidence

There are multiple types of studies, with the gold standard being the randomized controlled trial. In general, you can divide studies into primary vs. secondary literature. Primary literature studies the question directly. Secondary literature involves synthesizing and evaluating the primary literature. Both are necessary to answer a clinical question. Examples include:

Primary Literature: cohort studies, case control, case series, randomized control trials

Secondary Literature: meta-analyses, systematic review, evidence-based practice guidelines, critically appraised topics (CATs).

Of note, there are articles published in the medical literature specifically about how to evaluate an article, such as a meta-analysis. These articles may provide a helpful framework when evaluating the quality of the article that you are reviewing for journal club.

Read the Article in Your Preferred Order

Typically, one starts with the abstract, since this is the study’s skeleton. Some people prefer to read the article in its printed order. Others prefer to read the figures or methods first. Table 1 is usually a helpful tabulation of patient characteristics.

Ask Yourself: Would I Apply this to My Clinical Practice?

At the end of your reading, remind yourself of the clinical question. Did the article convince you the authors answered the question well? Was there a confounding variable they did not account for? Do you still have some unanswered questions or doubts? Ultimately, it is up to you to decide if you will change your practice based on this article.

In addition to using these techniques, there are several other resources that may help you digest articles. For example, there are certain apps (like Journal Club) and websites (Wiki Journal Club) that will clearly spell out the clinical question, major points, and bottom line.

You may need to experiment with different methods before you find the one that works best for you. Keep in mind: If you make learning article analysis a priority today, it will serve you for a lifetime.

References

  1. Walker R, da Silva, PR. Emerging trends in peer review—a survey. Front Neurosci. 2015;9:169.
  2. van Loveren C, Aartman IH. The PICO (Patient-Intervention-Comparison-Outcome) question. Ned Tijdschr Tandheelkd. 2007;114(4):172-178.
Cynthia Peng, MD

Cynthia Peng, MD

Emergency Medicine Resident, Wellspan York Hospital, York, PA
Krystle Shafer, MD

Krystle Shafer, MD

Critical Care Medicine Fellow, Chief Fellow, University of Pittsburgh Medical Center, Pittsburgh, PA
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