Journal Club

A Brief Primer on Evidence-Based Medicine

Journal Club Presentation Framework

A) Journal Club Slide Contents

  1. First Few slides should address current evidence on the topic which is presented
  2. Illustrate the importance of discussing the study which is presented
  3. Present the article: include basic structure, population distribution, inclusion–exclusion criteria, result of the study and author's conclusion
  4. Critical analysis of the article: this section should include the questions listed in worksheet
  5. Discuss where the clinical outcome of the study could be used, present an example if it is possible
  6. Leave 10 minutes at the end of presentation for open discussion

B) Type of Article Being Presented

  1. Articles that are either somewhat "controversial" or "novel" (introduce a new treatment or change in previous treatment guidelines, etc.)
  2. Articles based on research that could potentially change current practice
  3. 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)
  4. Articles that are fairly recent (i.e. ideally within last 5-10 years)

C) Worksheet for Critical Review of the Medical Literature

  1. What is the study question?
  2. What study design is used to answer the question? (cohort, randomized control, meta–analysis, etc.)
  3. What is the exposure or intervention?
  4. What is the outcome (or disease) and how is it measured (or defined)?
  5. Who sponsored the study?
  6. Who was included in the study?
  7. Who was excluded from the study?
  8. What was the overall design of the study? How was it carried out (i.e. intervention/treatment, follow up, data gathering, etc.)?
  9. If randomization occurred, at what point did it occur (only in experimental design)?
  10. Are the study groups' characteristics comparable at baseline?
  11. 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)?
  12. What were the results of the study?
  13. Are the results statistically significant? Are the results clinically significant?
  14. 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).
  15. Comment on the overall internal validity of this article. Did the authors rule out chance, bias, and confounding as explanations for their findings?
  16. 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?
  17. 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)?
  18. 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

D) References & Link

For lecture and reference regarding board review, please visit our website