ORIGINAL REPORTSEfficacy of Medical Student Surgery Journal Club
Introduction
Journal clubs exist in a variety of forms in medical schools across the United States. Many incorporate a full spectrum of medical specialties, some are specific to certain interest groups or specialties, and many widely vary in whether or not they are school mandated or student-run. While these clubs are ubiquitously scattered throughout medical education, there has been very little quantitative or qualitative analysis regarding the efficacy of these clubs in enhancing medical students’ abilities to evaluate clinical literature. As students transition from learning the basic sciences into becoming clinicians throughout their 4 years in medical school, the striking difference between learning from textbooks and learning from primary literature becomes apparent. The preclinical years of medical school often leave students ill-prepared to critically analyze evidence-based medicine. In studying for USMLE Step 1, students may gain a surface level understanding of the difference between randomized controlled trials (RCTs), retrospective cohort studies, case-control studies, cross-sectional studies, and many other type of articles and study designs. However, this is often not enough to prepare students to interpret literature in the clinical setting. One of the most common misperceptions among students is that a study must be “good” if it appears in a journal that they are given to read. However, many attending physicians will quote anywhere from 70% to 90% of articles as having severely flawed designs that lead to clinically irrelevant conclusions.1 The goal of early exposure to clinical literature is to begin developing some of these analytical skills at an earlier stage.
While there has been sparse literature regarding this subject in the past, there have been a few studies that arrive at some interesting conclusions. Hohmann et al. showed that first year surgical residents significantly improved their ability to evaluate literature after just 10 in-person meetings.2 Total assessment scores improved from 49.5% to 82.5% and the ability of surgical residents to come to the same conclusion as attending physicians regarding article acceptance improved from 0% to 60%. Ebbert et al. showed slightly more mixed results while conducting a systematic review of journal clubs in medical education.3 They showed certain RCTs of journal clubs that led to an improvement in knowledge of clinical epidemiology and biostatistics, reading habits, and the use of medical literature in practice, but no improvement of critical appraisal skills. However, 6 other studies found “possible” improvement in critical appraisal skills. This variability led them to conclude that more RCTs need to be done to fully evaluate the complete effects of journal clubs in medical education.
The purpose of this study was to evaluate the effects of attending Surgical Journal Club meetings at Eastern Virginia Medical School from both a qualitative and quantitative perspective. The authors’ hypothesis was that regular attendance of these sessions would improve student performance from a multitude of perspectives and demonstrate the value of clinical literature analysis earlier in medical education.
Section snippets
Methods
The Eastern Virginia Medical School Surgery Journal Club was founded with 3 goals: (1) improve literature analysis skills, (2) expose club members to different surgical specialties, and (3) prepare members for clinical rotations and residency programs. The club's meetings were advertised over social media, official EVMS e-mail, and by word of mouth. First, second, and third-year medical students from a single institution attended meetings voluntarily. A monthly, 1-hour evening block in a small
Results
Thirty-six medical students participated in journal club over a period of 9 months. Twenty-seven students were present and completed the survey at the conclusion of the fifth meeting for a response rate of 75%. Five of the 27 responders had previously presented an article, while 22 had not. Responders had attended an average of 3.85 meetings with a range from 1 to 6. Survey respondents agreed that the Surgery Journal Club was a positive experience in many different ways (Table 2).
The survey
Discussion
As the weighted-importance of board scores continues to increase, medical students often place little-to-no importance on developing their abilities to critically analyze evidence-based medicine. This lack of desire for students to develop these skills is compounded by the strong emphasis most US medical schools place on preparing students for USMLE Step 1 during the first 2 years of didactics. As noted by Small et al., third year medical students (after taking Step 1) are assumed to have
Conclusions
Journal clubs remain an integral part of medical education but their importance has been diminished in recent years due to the increasing demands of other aspects of the first 2 years in medical school. We described a medical student run or established journal club that was based on the principles of the Adult Learning Theory that increased student's interest in surgery, their perceived knowledge-base, and comfort in critically analyzing medical journal articles. We hope that our experiences
Acknowledgments
We would like to thank the medical students from Eastern Virginia Medical School who willingly participated in our club and helped make this study possible.
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