EM Journal Clubs

The first rule of Journal Club is: You do talk about Journal Club.

The second rule of Journal Club is: You do talk about Journal Club

In the world of the blogosphere I sometimes wonder whether the concept of Journal Clubs is a bit risky. There is much talk out there at the moment about how useless journals are and how their days are numbered. If you don’t believe the concerns then hop over to the Guardian and have a wander through their excellent series on scientific publication, or even better read Richard Smith’s book on the trouble with medical journals for an insiders account of what’s gone wrong.

Anyway, we should not confuse the terminal diagnosis for medical journals from the need to ensure that critical appraisal is done well. Arguably the demise of journals means that the ability to critically appraise is even more essential as a core skill for emergency physicians. At least the journals tried to peer review and quality control what was published….in the blogosphere you can publish pretty much anything. In the world of the internet it is reader beware, or rather it should be reader ‘prepare’.

We’ve published a fair bit on critical appraisal in the past and of course we hacve both the bestbets site and our MSc in Emerg Med which contain modules on how to read the literature, but there is also a place for the practical tips of how top set up and run a JC for the ED.

So, how do we prepare and practice our abilities to seek, sift, appraise and share the evidence that is out there? We call it a journal club which seems a little historical, but we are British and we have a history so we like it. So this is what we would recommend for a successful journal club.

So, those are overarching principles for a sustainable, accessible and friendly JC. We hope that you share them, but what about the practicalities? What are you going to discuss and how?

Let’s start with how. You can, and I’ve seen it done, just chat about a paper in a fairly unstructured way. This can work amongst experienced readers  but it’s not so good in a mixed group and is not the best way to help people learn. We strongly advocate the use of checklists for critical appraisal and (no surprise) we use the BestBets ones we designed.

What then to discuss? The only key message here is that papers at JC should meet three criteria. They must be A – interesting AND, B – of decent quality AND, C- of relevance to practice. Life is too short and too busy to read uninteresting, irrelevant rubbish. Again there are options and these can broadly be described as either reactive or proactive.

• Reactive. Papers are selected by the presenter on the basis of what is hot/topical/of interest/exciting. This has some advantages as it means that the presenter will be keen and motivated and the relevance question is almost always answered. The downside is that it can end up with a JC that is themed around your comfort zones. It’s a bit like practicing a musical instrument – if you only the practice the elements of a piece of music you know then you don’t really get any better overall. It’s the same with EBM. I know quite a lot already about X already so I need JC to make me look at Y as well.
• Proactive. The second approach is to use JC as a collective way to scan, review and share papers from a range of journals and sources. In this model there is a plan that allocates a journal and a presenter to each week’s slot. The presenter is responsible for scanning the last x month’s worth of issues of that journal to look for something interesting, relevant and of decent quality. The advantage here is that collectively the group effectively looks at every EM journal every year. Try doing that on your own (Cliff Reid is the only man I know can do this and he is superhuman). The downside is that when it is your turn to present you might get a topic you’re not interested in.

So, ultimately you need to find your own way, your own system and your own structure, but should you wish to copy any of our ideas having run a successful journal club for over 10 years then please go right ahead.
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Simon Carley