Journal Club Presentation: Framework
A) Journal Club Slide Contents
- First Few slides should address current evidence on the topic which is presented
- Illustrate the importance of discussing the study which is presented
- Present the article: include basic structure, population distribution, inclusion–exclusion criteria, result of the study and author's conclusion
- Critical analysis of the article: this section should include the questions listed in worksheet
- Discuss where the clinical outcome of the study could be used, present an example if it is possible
- Leave 10 minutes at the end of presentation for open discussion
B) Type of Article Being Presented
- Articles that are either somewhat "controversial" or "novel" (introduce a new treatment or change in previous treatment guidelines, etc.)
- Articles based on research that could potentially change current practice
- Articles that are, ideally, applicable to the largest number of practitioners and/or patients (i.e. articles based on studies regarding common diseases rather than rare diseases that few patients suffer from and even fewer practitioners will see)
- Articles that are fairly recent (i.e. ideally within last 5-10 years)
C) Worksheet for Critical Review of the Medical Literature
- What is the study question?
- What study design is used to answer the question? (cohort, randomized control, meta–analysis, etc.)
- What is the exposure or intervention?
- What is the outcome (or disease) and how is it measured (or defined)?
- Who sponsored the study?
- Who was included in the study?
- Who was excluded from the study?
- What was the overall design of the study? How was it carried out (i.e. intervention/treatment, follow up, data gathering, etc.)?
- If randomization occurred, at what point did it occur (only in experimental design)?
- Are the study groups' characteristics comparable at baseline?
- What statistical tests/methods are used in the analysis of the results? Is the "intention to
treat" principle maintained (if the study is a clinical trial)?
- What were the results of the study?
- Are the results statistically significant? Are the results clinically significant?
- What are the biases/limitations of the study that could cause you to question the
author's conclusions? Reference is listed below (list of potential limitations/biases by study design).
- Comment on the overall internal validity of this article. Did the authors rule out chance, bias, and confounding as explanations for their findings?
- Comment on external validity or generalizability of this study. Would these results change your practice? How do these results fit into what we already know about this subject?
- How does this fit our current knowledge (refer to current practice, previous beliefs, and/or previous studies, cost of investigational treatment/intervention vs. current treatment/intervention)?
- Potential limitation/biases according to study design:
- Randomized Controlled Trials: too few patients to be statistically significant/endpoints may not reflect clinically significant outcomes/not true randomization (i.e. excluding eligible patients because the sponsor does not feel they would respond well)
- Cross-Sectional: no way to establish temporal relationship exposure and outcome measured at the same time/selection bias/self-reporting bias/response bias
- Case-Control: selection bias (of cases and controls)/recall bias/questionable temporal relationship (decrease exposure before outcome)
- Cohort: selection bias/loss to follow up/change in habits over time/may not account for other variables that may explain disease/outcome
- Experimental Design: selection bias/loss to follow up/improper or biased randomization procedures/inadequate blinding of participants and investigators to exposure/treatment
- Meta-Analysis: publication bias (studies showing little/no effect often excluded)/quality of design from original studies may be flawed