By Rishi Sawhney, MD
Dr. Sawhney is a member of the ASH Trainee Council and a Fellow at the Medical University of South Carolina.
Journal club presentations provide a forum through which hematology
trainees keep abreast of new developments in hematology and engage in
informal discussion and interaction. Furthermore, honing presentation
skills and mastering the ability to critically appraise the evidence
add to our armamentarium as clinicians. Outlined here is a systematic
approach to preparing a journal club presentation, with emphasis on key
elements of the talk and references for electronic resources. Use of
these tools and techniques will contribute to the success of your
I. ARTICLE SELECTION:
The foundation of an outstanding journal club presentation rests on
the choice of an interesting and well-written paper for discussion.
Several resources are available to help you select important and timely
research, including the American College of Physicians (ACP) Journal
Club and the Diffusion section of The Hematologist. McMaster
University has created the McMaster Online Rating of Evidence (MORE)
system to identify the highest-quality published research. In fact, the
ACP Journal Club uses the MORE system to select their articles1. Specific inclusion criteria have been delineated in order to distinguish papers with the highest scientific merit2.
Articles that have passed this screening are then rated by clinicians
on their clinical relevance and newsworthiness, using a graded scale3.
With the help of your mentors and colleagues, you can use these
criteria and the rating scale as informal guidelines to ensure that
your chosen article merits presentation.
II. ARTICLE PRESENTATION:
- Study Background:
This section provides your audience with the necessary information and
context for a thoughtful and critical evaluation of the article's
significance. The goals are 1) to describe the rationale for and
clinical relevance of the study question, and 2) to highlight the
preclinical and clinical research that led to the current trial. Review
the papers referenced in the study's "Background" section as well as
previous work by the study's authors. It also may be helpful to discuss
data supporting the current standard of care against which the study
intervention is being measured.
- Study Methodology and Results: Clearly describe the study
population, including inclusion/exclusion criteria. A diagrammatic
schema is easy to construct using PowerPoint software and will help to
clearly illustrate treatment arms in complex trials. Explain the
statistical methods, obtaining assistance from a statistician if
needed. Take this opportunity to verbally and graphically highlight key
results from the study, with plans to expand on their significance
later in your presentation.
- Author's Discussion: Present the authors' conclusions and their
perspective on the study results, including explanations of
inconsistent or unexpected results. Consider whether the conclusions
drawn are supported by the data presented.
III. ARTICLE CRITIQUE:
This component of your presentation
will define the success of your journal club. A useful and widely
accepted approach to this analysis has been published in JAMA's series
"User's guide to the medical literature." The Centre for Health
Evidence in Canada has made the complete full-text set of these user's
guides available online4.
This site offers review guidelines for a menu of article types, and it
is an excellent, comprehensive resource to focus your study critique. A
practical, user-friendly approach to literature evaluation that
includes a worksheet is also available on the ASH Web site for your use5.
While a comprehensive discussion of scientific literature appraisal
is beyond the scope of this discussion, several helpful tips warrant
mention here. In assessing the validity of the study, it is important
to assess for potential sources of bias, including the funding sources
and authors' affiliations. It is also helpful to look for accompanying
editorial commentary, which can provide a unique perspective on the
article and highlight controversial issues. You should plan to discuss
the trade-offs between potential benefits of the study intervention
versus potential risks and the cost. By utilizing the concept of number
needed to treat (NNT), one can assess the true impact of the study
intervention on clinical practice. Furthermore, by incorporating the
incidence rates of clinically significant toxicities with the financial
costs into the NNT, you can generate a rather sophisticated analysis of
the study's impact on practice.
IV. CONCLUSIONS, IMPLICATIONS, AND FUTURE DIRECTIONS:
Restate the authors' take-home message followed by your own
interpretation of the study. Provide a personal perspective, detailing
why you find this paper interesting or important. Then, look forward
and use this opportunity to "think outside the box." Do you envision
these study results changing the landscape of clinical practice or
redirecting research in this field? If so, how? In articles about
therapy, future directions may include moving the therapy up to
first-line setting, assessing the drug in combination regimens or other
disease states, or developing same-class novel compounds in the
pipeline. Searching for related clinical trials on the NIH Web site6 can prove helpful, as can consultation with an expert in this field.
Good journal club discussions are integral to the educational
experience of hematology trainees. Following the above approach, while
utilizing the resources available, will lay the groundwork for an
WEB BASED REFERENCES
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