In a previous podcast on promoting evidence-based practice in the clinic, Sue Perry, PT, DPT, NCS, suggested journal clubs as one way to encourage colleagues to use the literature to guide clinical decision making.
There are many ways to run a journal club, but one common format is to have the facilitator or presenter choose and distribute an article, and club participants meet to summarize the article and decide whether and how to apply its conclusions to practice.
APTA’s Neurology Section has its own free online journal club resources, and provides a quarterly article with a completed downloadable appraisal for PTs to discuss in their face-to-face journal clubs. This is similar to the model promoted by the International Centre for Allied Health Evidence (iCAHE) in Australia.
Whatever your model—and regardless of whether you have a journal club that’s thriving or struggling to gain traction, or just want to know how to set up a club— here are some helpful (evidence-based!) suggestions.
#1. Think about potential barriers to participation. Before you decide on your exact journal club model, consider factors that may impede participation. For example, no time to read and analyze the article, no place to physically meet, colleagues’ perceived lack of critical appraisal skills, or lack of access to research.
The last item brings up subject of copyright. It is illegal to distribute paid journal articles for free, in hard copy or electronically, without permission from the publisher. However, open access articles are free to read and available from PubMedCentral and several journal websites; search FreeMedicalJournals.com to discover open access journals in your subject area. Also, if all of the club members are APTA members, they have free access to PTNow ArticleSearch—but you already know that!
#2. Choose a leader/facilitator. An effective journal club leader will select and circulate articles for discussion, as well as guide the discussion. Or, the leader may choose a different presenter for each meeting, to encourage active participation. The facilitator can choose to circulate guiding questions for the group to consider during the discussion.
#3. Define clear short-term and long-term objectives. Is your immediate goal to increase colleagues’ or employees’ subject matter knowledge? Critical appraisal skills (eg, levels of evidence, quality of study, etc)? How does application of evidence fit into your plan? Defining objectives may involve discussion with facility managers.
Just remember that if you are looking at one article, you’re looking at only one article. That is, changes in patient care strategies aren’t based on the findings from a single study, but on a synthesis of many studies (eg, through systematic reviews, clinical practice guidelines, etc).
#4. Establish a structured review process. Providing a template can help guide the discussion. APTA’s Neurology Section has free downloadable appraisal form template that can be used for any research article, along with a journal club cheat sheet.
#5. Meet regularly and allot adequate time. Whether you meet weekly or monthly, it helps to have a set schedule. Make sure you allow enough time to make it through all the areas you want to discuss, and end the meeting on time. Depending on the size of the group, 30–45 minutes should provide more than enough time to review one article.
#6. Give people time to prepare. Everyone is busy, and no one wants to come to a meeting unprepared. Circulate articles or links to articles at least a week in advance to allow colleagues enough time to read, evaluate, and note their observations for discussion. (Regarding circulating articles in hard copy or electronically, see #1.)
#7. Try different formats. While you could have a presenter each time, other options suggested by Kelly and Cronin (2010) are to select 2 articles with opposing conclusions or methods and have 2 teams debate, or to provide small groups with a list of questions to discuss and then report back to the full group.
#8. Evaluate your progress. Survey the group members on a regular basis to find out what’s working, what might be improved, and how they have improved their knowledge and skills.
#9. If at first you don’t succeed, try, try again. This last one isn’t necessarily evidence-based, but it was suggested by a commenter on Sue Perry’s blog post. Even if you only have a few members to start, it is a start, and hopefully it will catch on after some time.
One controversial topic is mandatory attendance. It does show institutional support for evidence-based practice, but some may feel pressure, especially if they are not confident in their ability to critically appraise an article. But, it’s food for thought.
For some evidence on journal clubs, see here, here, here, here, and here.
Do you have a successful journal club? Share your tips and experiences in the comments below, or on social media (hashtag #PTNow).