VCU Internal Medicine Training Program
Guidelines for Resident Facilitators of EBM (Journal Club) Conference

Revision Date: 7/10/2006
Revised by: Stephanie A. Call, MD, MSPH; Venkat Ramachandran, MD

 

Resources, Schedules and Guidelines

• Reading Smarter. . .Not Harder: Evidence Based Medicine Principles and Practice (pdf)
  Presentation by Stephanie Call
• Evidence Based Medicine Resources
• 2007-2008 Journal Club Assignments (pdf)
• Printable version of the EBM Guidelines (pdf)
• Women's Health Journal Club Guidelines (pdf)

Objectives of the conference:

By the end of the first year, learners will be:

1. Able to formulate a well-designed clinical question
2. Familiar with the various EBM resources available to answer clinical questions
3. Able to perform an efficient and successful literature search using OVID/Medline
4. Able to define EBM terms listed in the EBM glossary (attached)
5. Able to define and calculate the following: RRR, ARR, NNT, NNH, OR, RR, sensitivity, specificity, PPV, NPV, LR
6. Able to apply concepts listed in #4, #5 in the evaluation of a specific journal article
7. Familiar with the series “Users’ Guides to the Medical Literature”, and able to use this resource in critiquing specific journal articles
8. Able to assess the validity of a journal article of types: therapy, prognosis, harm/etiology, diagnostic testing
9. Able to apply the results of a specific study to the clinical setting
10. Develop a personal strategy for using the medical literature

By the end of the second and third years in journal club, learners will be able to guide others in the critical assessment of a journal article and how to apply the results of the article to a specific clinical question/patient. This will be accomplished by each resident facilitating a clinical question-based journal club and through attendance at monthly journal clubs. The study types covered will include: therapy, prognosis, etiology/harm, diagnostic testing, systematic reviews, guidelines and cost analyses. Residents will gain an appreciation of the importance of this skill in lifelong learning and daily patient care.

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Guidelines for Resident Facilitators

This is a recommended format for EBM Conference. This format has been utilized by several institutions and rated highly by both facilitating residents and participating residents. Most importantly, EBM conference should be patient-oriented rather than article-oriented. Furthermore, you, the resident, are primarily responsible for facilitating the conference (i.e. you will direct the flow of the discussion and be primarily responsible for most of the teaching). EBM-trained faculty members will be present to join in the discussion and to help if there are any problems or difficult concepts that are beyond an expected resident level of understanding. The following outlines a suggested format for journal club and the objectives that you should strive to meet during the EBM session.

Major goals for residents in EBM conference:

• Answer patient care questions
• Acquire evidence-based medicine skills
• Improve teaching skills

Expectations

Third year residents:

• Develop a focused clinical question.
• Find article/s that answer your clinical question.
• Please send the article at least 7 days prior to the chief medical resident.
• Get guidance/input from an EBM-trained faculty member or CMR. It is STRONGLY suggested that you contact S. Call or another EBM-trained faculty member at least 7 days before the session
• After asking the initial clinical question, ask the group's opinion on management and see if it changes after the session.
• Involve all the residents in the discussion. It is okay to call on others.
• Use visual aids to explain topics, particularly difficult ones.
• Distribute the Critically Appraised Topic (CAT) handout.

Second year residents:

• Second years will present interesting/landmark papers in a topic related to the core conference topic for that month. For example residents in July and August will present articles in Nephrology.
• Articles will be distributed to them by the chief medical resident 2 weeks prior to the journal club date.
• Dr. Call or the chiefs are available for help with analysis. Please meet with us at least 7 days prior.
• After asking the initial clinical question, ask the group's opinion on management and see if it changes after the session.
• Involve all the residents in the discussion. It is okay to call on others
• Use visual aids to explain topics, particularly difficult ones.

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Format of the EBM session:

Practicing EBM involves several steps: 1) asking an answerable clinical question, 2) searching for the best available evidence to answer the question, 3) appraising the evidence for its validity, 4) applying the evidence to patient care, and 5) evaluating the evidence in your practice. EBM conference is structured around these 5 steps.

Step 1: Objectives
start your session by discussing your teaching objectives for the session (topics you plan to discuss). Write them on the board and check them off as you cover them. If the group suggests other topics, write them to the side of the board and discuss them at the end of the session.
(suggested completion time - one minute)

Step 2: Clinical scenario
Present a clinical scenario for which you will shape your discussion. It should only be 2-3 sentences long so that the clinical problem is understood (e.g. 65-year-old previously healthy male was found to have an elevated blood pressure, 160/90, at a community health fair. This was subsequently confirmed and evaluation was negative for complications and secondary causes. The medical student in the clinic wonders what medication should be given to this pt.)
(suggested completion time - 1-2 minutes)

Step 3: Develop a focused clinical question
Help the other residents at journal club develop an appropriate focused clinical question. Walk them through the appropriate components, including the patient population, intervention of interest, comparison intervention, and outcomes of interest. Then give your clinical question if different than the one developed by the group. (e.g. In elderly patients with hypertension are B-blockers efficacious in preventing morbidity and mortality in comparison to diuretics?)
(suggested completion time - 1-5 minutes)

Step 4: Finding the evidence
Discuss how you found the evidence you used to answer the clinical question. If you used a MEDLINE search, discuss search technique and results.
(suggested completion time - 3-5 minutes)

Step 5: Brief summary
Summarize the article by reviewing the methods briefly; this should not be comprehensive! The participating residents should have read the article already. During this summary, you can refer to the next section for areas that you are going to expand upon .
(suggested completion time - 10-15 minutes)

Step 6: Discuss the validity of the article
Frame your discussion around the User's Guides series. Feel free to go into more detail if you want, but you do not have to. Stephanie Call is available to help you learn and teach any concepts that you do not understand.

Step 7: Review the results
Review the primary results – you do not have to go over all of the data. Focus on what you think is important.

During either step 6 or step 7 – teach one EBM skill or topic. For example, discuss the importance of at least one of the validity topics in depth during this time and its implications for study validity (e.g. randomization). Alternatively, teach something about reading, interpreting and applying results (e.g. calculations of NNT, interpretation RR, etc). (suggested completion time - 15 minutes)

Step 8: Answer the question
Answer the clinical question that began the journal club session and discuss the applicability of the study to your patient (use the "applicability" discussion questions from the User's guides).
(suggested completion time - 3-5 minutes)

Step 9: Hand out the CAT you developed
A CAT=Critically Appraised Topic; it is a one page summary of the above steps. An article describing a CAT is available; several examples are posted to the website and S. Call will assist anyone in developing his or her CAT. The CAT is REQUIRED for scholarly credit and will be kept in a database on the website for future reference by other clinicians!

Step 10: Restate the objectives
and review how you met each one.

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