Virtual journal clubs (VJCs) provide a standardized, easily accessible forum for evidence-based discussion. The new virtual reality setting in which journal clubs and other online education events now take place offers great advantages and new opportunities for radiologists in academic medicine and private practice. VJCs continue to evolve, largely due to many emerging technologies and platforms. VJCs will continue to play an increasingly important role in medical education, interdisciplinary interaction, and multi-institutional collaboration. In this article, we discuss how to conduct and lead a critical review of medical literature in the setting of a virtual or traditional journal club. We discuss the current applications of VJCs in medical and graduate medical education and continued lifelong learning. We also explain the advantages and disadvantages of VJCs over traditional venues. Finally, the reader will be given the tools to successfully implement and run a VJC.
Introduction
The concept of the traditional journal club as a key component in medical education has been radically revised in the past decade in the advent of widely available Web 2.0 tools, ubiquitous access to social media, and increasingly mobile and affordable smart devices, which now enable “anytime, anywhere” access to learning and information . The new virtual reality setting in which journal clubs and other online education events now take place offers great advantages and new opportunities for radiologists in academic medicine and private practice. In this article, we undertake to summarize the applications of the journal club in the traditional sense and in its modern virtual existence, and offer specific steps and helpful information on how to set up and run an effective virtual journal club (VJC).
Research has shown that the quality of health care in the United States varies significantly among hospitals, cities, and states . Health systems are not widely successful in appropriate application of evidence-based medical practices, resulting in errors, inefficiency, and reduced quality of life and longevity . In the specialty of radiology, many diagnostic imaging tests have not been sufficiently researched according to evidence-based medicine (EBM) criteria , with as little as 10% of imaging procedures having adequate evidence . Radiologic literature tends to lag behind advances in technology, the latter of which often outpace studies of clinical performance . Additionally, reviews of diagnostic methods in the literature, even in journals with a high impact factor, are suboptimal . As such, teaching medical students and radiology residents how to retrieve, critically appraise, and apply results in the literature is paramount . Journal clubs provide an ideal setting for this essential component of medical education.
Because radiologists must keep abreast of literature and be able to incorporate it into patient care , the ability to critically assess the literature is essential for their successful practice. Understanding the validity of a study requires evaluating the process of patient selection, potential biases, adequacy of the reference standard, sample sizes, statistics, and reasoning behind resultant clinical recommendations . Before integrating the literature into daily practice, readers should question: Is it true? Is it relevant? Is it sufficient ?
EBM is as applicable to radiology as to other specialties. Its goal is to establish medical practices based on the best scientific evidence, including measures of safety, effectiveness, and cost . In the United States, EBM is considered the fourth revolution of health care, following the introduction of health insurance, backlash of payers to reduce costs, and outcomes-based research . Journal clubs can facilitate EBM by encouraging evidence-based learning (EBL). EBL consists of four critical elements: question development, literature search, relevant article selection, and critical appraisal . EBL ensures that individual clinical expertise is combined with the best available clinical evidence, as neither factor is sufficient to provide proper patient care .
Medicine, in general, and radiology in particular, has shifted from being a vocation learned by memorization of facts to a lifelong process of active learning and analysis. EBM can help mitigate uncertainties in clinical medical decision-making , by providing evidence-based guidance for each facet of the patient care including the clinical history, physical examination, diagnostic tests, prognostic markers, and therapeutic interventions . Journal clubs help physicians examine the wide breadth of available literature, judge its validity, and apply it to a given clinical scenario . There has also been a recent push for evidence-based quality metrics that are often intimately tied to provider reimbursement and pay-for-performance models .
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History and Evolution of Journal Clubs
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Virtual Journal Club
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TABLE 1
Examples and Characteristics of VJC in Radiology
Year Established Organizer Live Webinar Prerecorded Invited Experts Residents/Fellows Presenters 2011 International Society for Magnetic Resonance in Medicine X X 2012 American College of Nuclear Medicine-Residents Organization X X 2012 The American College of Radiology- Resident and Fellow Section X X 2012 Society of Interventional Radiology X X 2013 The American Journal of Roentgenology X 2014 American Journal of Neuroradiology official blog X X
VJC, virtual journal club.
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Emerging Role of VJCs
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TABLE 2
Characteristics of a Successful Journal Club
• Gives the participants flexibility on when they can view the recorded session, download the materials, or access the study guide • Recruits experts (or the journal’s authors) to facilitate the presentation • Provides a free technology platform requiring a one-time registration • Uses an article as a means to review a wider topic
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Application of VJC to Medical and Graduate Medical Education
Medical School Curricula
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Radiology Residency and Fellowship Programs
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Practicing Physicians
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Interprofessional Journal Clubs
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How to Establish and Maintain an Effective VJC
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TABLE 3
Summary of Steps to Establish and Maintain a VJC
Task Action Item Designate key members Director, social media webmaster Establish home repository Create a blog or website or affiliate with existing website Incorporate platforms Use several social media avenues Know your participants Select pertinent topics, meeting time, and frequency Select meeting format Try live, asynchronous or hybrid format Manage expectations, maintain engagement Supplementary media, platform for communication Support intellectual growth Provide evaluative resources: critical appraisal Follow up Post summary following sessions, monitor success
VJC, virtual journal club.
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Designate Key Team Members
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Establish a Home
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Incorporate Social Media
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Know Your Participants
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Select Meeting Format
Synchronous Session
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Asynchronous Session
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Hybrid Model/Synchronous Session
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Manage Expectations and Maintain Engagement
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Provide Members with Evaluative Resources
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Follow-up Activities
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Opportunities and Emerging Applications
Opportunities
Networking
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Faster Translation of New Knowledge to Clinical Practice
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Policy Change
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Global Outreach
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Perceived Barriers/Shortcomings of VJCs
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TABLE 4
Opportunities of Virtual Journal Clubs
• Networking: fosters research and collaboration • Faster translation of new knowledge to clinical practice • Facilitates medical innovation • Facilitates policy change
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Conclusion
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