Journal Club will be held monthly at noon.
The format will be to use one or two articles that can be applied to the management of a patient you have seen. Each resident will present a brief case followed by article presentations, with interactive participation with faculty and residents.
Each resident is expected to achieve these goals:
1) To gain familiarity with the interpretation of journal articles. The emphasis is on determining the strength of the evidence for the conclusions in the article. Residents should recognize sources of bias and be able to evaluate the relative importance of bias.
2) To develop an appreciation of the unmet needs in clinical medicine and how to address them.
3) To develop a basic appreciation of how articles are constructed.
Each resident is expected to have read each article and to be prepared to discuss each article in a thoughtful manner.
Key metrics for the critical review of articles
Survival Guide to Clinical Research
Primer on Statistics
There are five types of articles which we may discuss:
1) Clinical trials - A study in which a group of human patients or normal volunteers is compared with another group. Clinical trials may also compare multiple groups. Clinical trials may be randomized/nonrandomized, blinded/unblinded (masked/unmasked), crossover, parallel groups, delayed start, or some combination.
2) Case report - A description of one patient with a generally unusual presentation or treatment.
3) Case series - A description of more than one patient with generally unusual (or sometimes typical) presentations.
4) Editorial - An opinion from a respected author (or authors), typically based upon a clinical trial.
5) Review - A compilation of multiple trials or cases, typically coupled with an editorial. Sometimes practice guidelines are also included.
The US Preventative Services Task Force uses a letter classification scheme for the committee recommendations, and a Roman numeral scheme for quality of evidence:
| Grade | Definition |
|---|---|
| A | The USPSTF recommends the service. There is high certainty that the net benefit is substantial. |
| B | The USPSTF recommends the service. There is high certainty that the net benefit is moderate, or there is moderate certainty that the net benefit is moderate to substantial. |
| C | Note: The following statement is undergoing revision.
Clinicians may provide this service to selected patients depending on individual circumstances. However, for most individuals without signs or symptoms there is likely to be only a small benefit from this service. |
| D | The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits. |
| I Statement | The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits & harms of the service. |
I: Properly powered and conducted randomized controlled trial (RCT); well-conducted systematic review or meta-analysis of homogeneous RCTs
II-1: Well-designed controlled trial without randomization
II-2: Well-designed cohort or case-control analytic study
II-3: Multiple time series with or without the intervention; dramatic results from uncontrolled experiments
III: Opinions of respected authorities, based on clinical experience; descriptive studies or case reports; reports of expert committees