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How to Prepare an Outstanding Journal Club Presentation

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Rishi Sawhney; How to Prepare an Outstanding Journal Club Presentation. The Hematologist 2006; 3 (1): No Pagination Specified. doi: https://doi.org/10.1182/hem.V3.1.1308

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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 presentation.

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 articles 1 . Specific inclusion criteria have been delineated in order to distinguish papers with the highest scientific merit 2 . Articles that have passed this screening are then rated by clinicians on their clinical relevance and newsworthiness, using a graded scale 3 . 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 online 4 . 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 use 5 .

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 site 6  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 outstanding presentation.

WEB BASED REFERENCES

www.acpjc.org

hiru.mcmaster.ca/more/InclusionCriteria.htm

hiru.mcmaster.ca/more/RatingFormSample.htm

www.cche.net/main.asp

www.hematology.org/Trainees

www.cancer.gov/clinicaltrials

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Expert Consult

Journal Club: How to Build One and Why

By Michelle Sharp, MD; Hunter Young, MD, MHS

Published April 6, 2022

Journal clubs are a longstanding tradition in residency training, dating back to William Osler in 1875. The original goal of the journal club in Osler’s day was to share expensive texts and to review literature as a group. Over time, the goals of journal clubs have evolved to include discussion and review of current literature and development of skills for evaluating medical literature. The ultimate goal of a journal club is to improve patient care by incorporating evidence into practice.

Why are journal clubs important?

In 2004, Alper et al . reported that it would take more than 600 hours per month to stay current with the medical literature. That leaves residents with less than 5 hours a day to eat, sleep, and care for patients if they want to stay current, and it’s simply impossible. Journal clubs offer the opportunity for residents to review the literature and stay current. Furthermore, Lee et al . showed that journal clubs improve residents’ critical appraisal of the literature.

How do you get started?

The first step to starting a journal club is to decide on the initial goal. A good initial goal is to lay the foundation for critical thinking skills using literature that is interesting to residents. An introductory lecture series or primer on study design is a valuable way to start the journal club experience. The goal of the primer is not for each resident to become a statistician, but rather to lay the foundation for understanding basic study designs and the strengths and weaknesses of each design.

The next step is to decide on the time, frequency, and duration of the journal club. This depends on the size of your residency program and leadership support. Our journal club at Johns Hopkins is scheduled monthly during the lunch hour instead of a noon conference lecture. It is essential to pick a time when most residents in your program will be available to attend and a frequency that is sustainable.

How do you get residents to come?

Generally, if you feed them, they will come. In a cross-sectional analysis of journal clubs in U.S. internal medicine residencies, Sidorov found that providing food was associated with long-lasting journal clubs. Factors associated with higher resident attendance were fewer house staff, mandatory attendance, formal teaching, and an independent journal club (separate from faculty journal clubs).

The design or format of your journal club is also a key factor for attendance. Not all residents will have time during each rotation to read the assigned article, but you want to encourage these residents to attend nonetheless. One way to engage all residents is to assign one or two residents to lead each journal club, with the goal of assigning every resident at least one journal club during the year. If possible, pick residents who are on lighter rotations, so they have more time outside of clinical duties to dissect the article. To enhance engagement, allow the assigned residents to pick an article on a topic that they find interesting.

Faculty leadership should collaborate with residents on article selection and dissection and preparation of the presentation. Start each journal club with a 10- to 20-minute presentation by the assigned residents to describe the article (as detailed below) to help residents who did not have time to read the article to participate.

What are the nuts and bolts of a journal club?

To prepare a successful journal club presentation, it helps for the structure of the presentation to mirror the structure of the article as follows:

Background: Start by briefly describing the background of the study, prior literature, and the question the paper was intended to address.

Methods: Review the paper’s methods, emphasizing the study design, analysis, and other key points that address the validity and generalizability of the results (e.g., participant selection, treatment of potential confounders, and other issues that are specific to each study design).

Results: Discuss the results, focusing on the paper’s tables and figures.

Discussion: Restate the research question, summarize the key findings, and focus on factors that can affect the validity of the findings. What are potential biases, confounders, and other issues that affect the validity or generalizability of the findings to clinical practice? The study results should also be discussed in the context of prior literature and current clinical practice. Addressing the questions that remain unanswered and potential next steps can also be useful.

Faculty participation: At our institution, the faculty sponsor meets with the assigned residents to address their questions about the paper and guide the development of the presentation, ensuring that the key points are addressed. Faculty sponsors also attend the journal club to answer questions, emphasize key elements of the paper, and facilitate the open discussion after the resident’s presentation.

How do you measure impact?

One way to evaluate your journal club is to assess the evidence-based practice skills of the residents before and after the implementation of the journal club with a tool such as the Berlin questionnaire — a validated 15-question survey that assesses evidence-based practice skills. You can also conduct a resident satisfaction survey to evaluate the residents’ perception of the implementation of the journal club and areas for improvement. Finally, you can develop a rubric for evaluation of the resident presenters in each journal club session, and allow faculty to provide feedback on critical assessment of the literature and presentation skills.

Journal clubs are a great tradition in medical training and continue to be a valued educational resource. Set your goal. Consider starting with a primer on study design. Engage and empower residents to be part of the journal club. Enlist faculty involvement for guidance and mentorship. Measure the impact.

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• Jeffrey K Aronson
• Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences , University of Oxford , Oxford OX2 6GG , UK
• Correspondence to Dr Jeffrey K Aronson, Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX26GG, UK; jeffrey.aronson{at}phc.ox.ac.uk

https://doi.org/10.1136/ebmed-2017-110861

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Journal clubs have many functions, including the provision of a forum for developing skills in critical appraisal, an essential part of being a competent clinician.

From early on, journal clubs reported their proceedings in academic journals. The Zoological Journal Club of Michigan , for example, regularly reported its activities in the journal Science (see figure 1 ).  Table 1 lists a selection of other journals that publish journal club articles, showing the wide range of topics covered. Modern methods of conducting journal clubs include the use of online media to encourage interactive discussion, 1 including blogs, 2 twitter, 3 and virtual journal clubs. 4

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The contents page of Science for Friday 7 December 1900, listing the proceedings of the Zoological Journal Club of the University of Michigan .

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Some journals that publish articles under the heading ‘Journal Club’

It is therefore appropriate that Evidence-Based Medicine  (EBM) should feature a regular journal club report.

In order to find out how others run journal clubs and the effects that they have, I searched PubMed for articles on journal clubs, using the search term ‘journal[ti] & (club[ti] OR clubs[ti])’ (1699 hits) and found three types of articles: articles in which authors described a paper that they had discussed at a journal club or thought would be suitable material for a journal club; studies of the effects of running journal clubs; and reviews of various sorts.

I found three systematic reviews. One recommended the journal club as a tool for assessing practice-based competencies that might be difficult to assess by other means 5 ; one reported that journal clubs improve knowledge and critical appraisal skills but that there was no evidence on translation of evidence from journal clubs into clinical practice 6 ; and one reported that journal clubs seemed to be the preferred way of teaching critical appraisal skills but that it was not clear which elements were most important for learning. 7

I have synthesized much of this information and have distilled what I consider to be the important points that arise from the formal studies and reviews and describe the objectives of a journal club and how to run one.  I also give guidance on the preparation of journal club reports that we hope readers will submit for publication. We look forward to hearing from you.

Five reasons for running a journal club

To highlight new findings.

To teach practitioners how to search for interesting articles representing the best evidence to inform clinical practice.

To encourage practitioners to read and appraise publications critically and give them the ability to do so.

To encourage practitioners to do applied clinical research and to show them how.

To improve debating skills, demonstrate leadership skills, and aid peer mentorship.

Sixteen suggestions on how to run a journal club

The members of the club should on the whole have shared or complementary interests, including statisticians, but do not discourage multidisciplinarity, if available; involve everyone, from students down to professors.

Run the club regularly at the same time on the same day of the week, so that it becomes a fixture.

Have at least one designated skilled leader who regularly participates in the club.

Ideally, make attendance mandatory and keep a record.

Ensure that the meetings start and end on time.

Encourage communality; this could be done, for example, by asking everyone at the start of each meeting to give their name and a piece of information about themselves (eg, a movie they have recently seen).

Discuss up to three papers from peer-reviewed journals; develop a theme each time; occasionally include books of interest.

Split presentation and discussion times 50/50.

Try to choose papers that you think may influence clinical practice and discuss why.

Disseminate the chosen articles in advance, with questions that might be asked; the leader should bring spare copies to the meeting.

Keep notes and conduct regular audits (eg, yearly); give feedback on later developments; link it to a Xmas quiz.

Welcome guest speakers from time to time to add expert comment.

Provide free enticing refreshments; have a rota for making the tea/coffee.

Use your imagination to make it fun.

Publish your experience.

Adapt these suggestions to suit your own circumstances.

Ten tips on how to prepare a journal club article for EBM

The article should have proceeded from an actual journal club.

The paper discussed need not have been published in EBM .

At the start, give the full reference (Vancouver style) of the article that you have discussed.

The following framework, adapted from that originally suggested by Riegelman 8 may be useful: aims, methods, results, interpretation, implications for practice, and further research.

Say what the purpose of the study was.

Summarise the important points in the article, paying particular attention to the methods that were used.

Briefly describe the main results.

Highlight the strengths and weaknesses; how could the study have been improved? did the authors achieve what they set out to achieve?

Describe the implications of the results and whether you think they may or may not influence practice beneficially or adversely.

If relevant, say what further research might be carried out.

• Radecki R , et al
• Sparks MA ,
• Phelan PJ , et al
• Chetlen AL ,
• Solberg AO , et al
• Golnik KC , et al
• Deenadayalan Y ,
• Grimmer-Somers K ,
• Prior M , et al
• McKenzie ME ,
• Maclean A , et al
• Riegelman RK

Competing interests JKA is an associate editor for EBM.

Provenance and peer review Commissioned; internally peer reviewed.

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Journal Club: How to Prepare Effectively and Smash Your Presentation

Journal club. It’s so much more than orally dictating a paper to your peers.

It’s an opportunity to get a bunch of intelligent people in one place to share ideas. It’s a means to expand the scientific vocabulary of you and the audience. It’s a way to stimulate inventive research design.

But there are so many ways it can go wrong.

Poorly explained papers dictated blandly to an unengaged audience. Confusing heaps of data shoehorned into long presentations. Everybody stood awkwardly outside a meeting room you thought would be free.

Whether you are unsure what journal club is, are thinking of starting one, or simply want to up your presentation game—you’ve landed on the ultimate journal club guide.

The whats, the whys, and the hows, all in one place.

What Is a Journal Club in Science?

A journal club is a series of meetings in which somebody is elected to present a research paper, its methods, and findings to a group of colleagues.

The broad goal is to stimulate discussion and ideas that the attendees may apply to their own work. Alternatively, someone may choose a paper because it’s particularly impactful or ingenious.

Usually, the presenter alternates per a rota, and attendance may be optional or compulsory.

The presenter is expected to choose, analyze, and present the paper to the attendees with accompanying slides.

The presentation is then followed by a discussion of the paper by the attendees. This is usually in the form of a series of questions and answers directed toward the presenter. Ergo , the presenter is expected to know and understand the paper and subject area to a moderate extent.

Why Have a Journal Club?

I get it. You’re a busy person. There’s a difficult research problem standing between you and your next tenure.

Why bother spending the time and energy participating in a series of meetings that don’t get you closer to achieving your scientific goals?

The answer: journal club does get you closer to achieving your scientific goals!

But it does this in indirect ways that subtly make you a better scientist. For example:

• It probably takes you out of your comfort zone.
• It makes you a better communicator.
• It makes you better at analyzing data.
• It improves your ability to critique research.
• It makes you survey relevant literature.
• It exposes you and your audience to new concepts.
• It exposes your audience to relevant literature.
• It improves the reading habits of you and your audience.
• It gets clever people talking to each other.
• It gives people a break from practical science.

It also provides a platform for people to share ideas based on their collective scientific experience. And every participant has a unique set of skills. So every participant has the potential to provide valuable insight.

This is what a good journal club should illicit.

Think of journal club as reading a book. It’s going to enrich you and add beneficially to the sum of your mental furniture, but you won’t know how until you’ve read it.

Need empirical evidence to convince you? Okay!

In 1988 a group of medical interns was split into two groups. One received journal club teaching and the other received a series of seminars. Approximately 86% of the journal club group reported improved reading habits. This compares to 0% in the group who received seminar-based teaching. [1]

Journal Club Template Structure

So now you know what journal club is, you might wonder, “how is it organized and structured?”

That’s what the rest of this article delves into. If you’re in a rush and need to head back to the lab, here’s a graphical summary (Figure 1).

Nobody likes meetings that flounder around and run over time. And while I have no data to prove it, I reckon people take less away from such meetings. Here’s a basic journal club template that assumes you are the presenter.

Introduce the Paper, Topic, Journal, and Authors

Let your audience know what you will be talking about before diving right in. Remember that repetition (of the important bits) can be a good thing.

Introducing the journal in which the paper is published will give your audience a rough idea of the prestige of the work.

And introducing the authors and their respective institutes gives your audience the option of stowing this information away and following it up with further reading in their own time.

Provide a Reason Why You Chose the Paper

Have the authors managed to circumvent sacrificing animals to achieve a goal that traditionally necessitated animal harm? Have the authors repurposed a method and applied it to a problem it’s not traditionally associated with? Is it simply a monumental feat of work and success?

People are probably more likely to listen and engage with you if they know why, in all politeness, you have chosen to use their time to talk about a given paper.

It also helps them focus on the relevant bits of your presentation and form cogent questions.

Orally Present Key Findings and Methods of the Paper

Simple. Read the paper. Understand it. Make some slides. Present.

Okay, there are a lot of ways you can get this wrong and make a hash of it. We’ll tell you how to avoid these pitfalls later on.

But for now, acknowledge that a journal club meeting starts with a presentation that sets up the main bit of it—the discussion.

Invite Your Audience to Participate in a Discussion

The discussion is the primary and arguably most beneficial component of journal club since it gives the audience a platform to share ideas. Ideas formulated by their previous experience.

And I’ve said already that these contributions are unique and have the potential to be valuable to your work.

That’s why the discussion element is important.

Their questions might concur and elaborate on the contents of the paper and your presentation of it.

Alternatively, they might disagree with the methods and/or conclusions. They might even disagree with your presentation of technical topics.

Try not to be daunted, however, as all of this ultimately adds to your knowledge, and it should all be conducted in a constructive spirit.

Summarize the Meeting and Thank Your Audience for Attending

There’s no particularly enlightening reason as to why to do these things. Summarizing helps people come away from the meeting feeling like it was a positive and rewarding thing to attend.

And thanking people for their time is a simple courtesy.

How Do You Organize It?

Basic steps if you are the organizer.

Okay, we’ve just learned what goes into speaking at the journal club. But presenter or not, the responsibility of organizing it might fall to you.

So, logistically , how do you prepare a journal club? Simply follow these 5 steps:

• Distribute copies of the research article to potential participants.
• Arrange a meeting time and location.
• Organize a speaker.
• Hold the journal club.
• Seek feedback on the quality of the meeting.

Apart from point 5, these are fairly self-explanatory. Regarding point 5, feedback is essential to growing as a scientist and presenter. The easiest way to seek feedback is simply to ask.

Alternatively, you could create a form for all the meetings in the series and ask the audience to complete and return it to you.

Basic Steps If You Are the Speaker

If somebody has done all the logistics for you, great! Don’t get complacent, however.

Why not use the time to elevate your presentation to make your journal club contribution memorable and beneficial?

Don’t worry about the “hows” because we’re going to elaborate on these points, but here are 5 things you can do to ace your presentation:

• Don’t leave it to the last minute.
• Know your audience.
• Keep your presentation slides simple.
• Keep your audience engaged.
• Be open to questions and critiques.

Regarding point 1, giving yourself sufficient time to thoroughly read the article you have chosen to present ensures you are familiar with the material in it. This is essential because you will be asked questions about it. A confident reply is the foundation of an enlightening discussion.

Regarding point 3, we’re going to tell you exactly how to prepare effective slides in its own section later. But if you are in a rush, minimize the use of excessive text. And if you provide background information, stick to diagrams that give an overview of results from previous work. Remember: a picture speaks louder than a thousand words.

Regarding point 4, engagement is critical. So carry out a practice run to make sure you are happy with the flow of your presentation and to give you an idea of your timing. It is important to stick to the time that is allotted for you.

This provides good practice for more formal conference settings where you will be stopped if you run over time. It’s also good manners and shows consideration for the attendees.

And regarding point 5, as the presenter, questions are likely to be directed toward you. So anticipate questions from the outset and prepare for the obvious ones to the best of your ability.

There’s a limit to everyone’s knowledge, but being unable to provide any sort of response will be embarrassing and make you seem unprepared.

Anticipate that people might also disagree with any definitions you make and even with your presentation of other people’s data. Whether or not you agree is a different matter, but present your reasons in a calm and professional manner.

If someone is rude, don’t rise to it and respond calmly and courteously. This shouldn’t happen too often, but we all have “those people” around us.

How Do You Choose a Journal Club Paper?

Consider the quality of the journal.

Just to be clear, I don’t mean the paper itself but the journal it’s published in.

An obscure journal is more likely to contain science that’s either boring, sloppy, wrong, or all three.

And people are giving up their time and hope to be stimulated. So oblige them!

Journal impact factor and rejection rate (the ratio of accepted to rejected articles) can help you decide whether a paper is worth discussing.

Consider the Impact and Scope of the Paper

Similar to the above, but remember, dross gets published in high-impact journals too. Hopefully, you’ve read the paper you want to present. But ask yourself what makes this particular paper stand out from the millions of others to be worth presenting.

Keep It Relevant and Keep It Interesting

When choosing a paper to present, keep your audience in mind. Choose something that is relevant to the particular group you are presenting to. If only you and a few other people understand the topic, it can come off as elitist.

How Do You Break Down and Present the Paper?

Know and provide the background material.

Before you dive into the data, spend a few minutes talking about the context of the paper. What did the authors know before they started this work? How did they formulate their hypothesis? Why did they choose to address it in this way?

You may want to reference an earlier paper from the same group if the paper represents a continuation of it, but keep it brief.

Try to explain how this paper tackles an unanswered question in the field.

Understand the Hypothesis and Methods of the Paper

Make a point of stating the  hypothesis  or  main question  of the paper, so everyone understands the goal of the study and has a foundation for the presentation and discussion.

Everyone needs to start on the same foot and remain on the same page as the meeting progresses.

Turn the Paper into a Progression of Scientific Questions

Present the data as a logical series of questions and answers. A well-written paper will already have done the hard work for you. It will be organized carefully so that each figure answers a specific question, and each new question builds on the answer from the previous figure.

If you’re having trouble grasping the flow of the paper, try writing up a brief outline of the main points. Try putting the experiments and conclusions in your own words, too.

Feel free to leave out parts of the figures that you think are unnecessary, or pull extra data from the supplemental figures if it will help you explain the paper better.

Ask Yourself Questions about the Paper Before You Present

We’ve touched on this already. This is to prepare you for any questions that are likely to be asked of you. When you read the paper, what bits didn’t you understand?

Simplify Unfamiliar and Difficult Concepts

Not everyone will be familiar with the same concepts. For example, most biologists will not have a rigorous definition of entropy committed to memory or know its units. The concept of entropy might crop up in a biophysics paper, however.

Put yourself in the audience’s shoes and anticipate what they might not fully understand given their respective backgrounds.

If you are unsure, ask them if they need a definition or include a short definition in your slides.

Sum Up Important Conclusions

After you’ve finished explaining the nitty-gritty details of the paper, conclude your presentation of the data with a list of significant findings.

Every conclusion will tie in directly to proving the major conclusion of the paper. It should be clear at this point how the data answers the main question.

How Do You Present a Journal Club Powerpoint?

Okay, so we’ve just gone through the steps required to break down a paper to present it effectively at journal club. But this needs to be paired with a PowerPoint presentation, and the two bridged orally by your talk. How do you ace this?

Provide Broad Context to the Research

We are all bogged down by minutia and reagents out of necessity.

Being bogged down is research. But it helps to come up for air. Ultimately, how will the research you are about to discuss benefit the Earth and its inhabitants when said research is translated into actual products?

Science can be for its own sake, but funded science rarely is. Reminding the journal club audience of the widest aims of the nominated field provides a clear starting point for the discussion and shows that you understand the efficacy of the research at its most basic level.

The Golden Rule: A Slide per Minute

Remember during lectures when the lecturer would open PowerPoint, and you would see, with dismay, that their slides went up to 90 or something daft? Then the last 20 get rushed through, but that’s what the exam question ends up being based on.

Don’t be that person!

A 10-15 minute talk should be accompanied by? 10-15 slides! Less is more.

Be Judicious about the Information You Choose to Present

If you are present everything in the paper, people might as well just read it in their own time, and we can call journal club off.

Try to abstract only the key findings. Sometimes technical data is necessary for what you are speaking about because their value affects the efficacy of the data and validity of the conclusions.

Most of the time, however, the exact experimental conditions can be left out and given on request. It’s good practice to put all the technical data that you anticipate being asked for in a few slides at the end of your talk.

Use your judgment.

Keep the Amount of Information per Slide Low for Clarity

Your audience is already listening to you and looking at the slides, so they have a limited capacity for what they can absorb. Overwhelming them with visual queues and talking to them will disengage them.

Have only a few clearly related images that apply directly to what you speaking about at the time. Annotate them with the only key facts from your talk and develop the bigger picture verbally.

This will be hard at first because you must be on the ball and confident with your subject area and speaking to an audience.

And definitely use circles, boxes, and arrows to highlight important parts of figures, and add a flowchart or diagram to explain an unfamiliar method.

Keep It Short Overall

The exact length of your meeting is up to you or the organizer. A 15-minute talk followed by a 30-minute discussion is about the right length, Add in tea and coffee and hellos, and you get to an hour.

We tend to speak at 125-150 words per minute. All these words should not be on your slides, however. So, commit a rough script to memory and rehearse it.

You’ll find that the main points you need to mention start to stand out and fall into place naturally. Plus, your slides will serve as visual queue cards.

How Do You Ask a Question in Journal Club?

A well-organized journal club will have clear expectations of whether or not questions should be asked only during the discussion, or whether interruptions during the presentation are allowed.

And I don’t mean literally how do you soliloquize, but rather how do you get an effective discussion going.

Presenters: Ask Questions to the Audience

We all know how it goes. “Any questions?” Silence.

Scientists, by their very nature, are usually introverted. Any ideas they might want to contribute to a discussion are typically outweighed by the fear of looking silly in front of their peers. Or they think everyone already knows the item they wish to contribute. Or don’t want to be publicly disproven. And so on.

Prepare some questions to ask the audience in advance. As soon as a few people speak, everyone tends to loosen up. Take advantage of this.

Audience: Think About Topics to Praise or Critique

Aside from seeking clarification on any unclear topics, you could ask questions on:

• Does the data support the conclusions?
• Are the conclusions relevant?
• Are the methods valid?
• What are the drawbacks and limitations of the conclusions?
• Are there better methods to test the hypothesis?
• How will the research be translated into real-world benefits?
• Are there obvious follow-up experiments?
• How well is the burden of proof met?
• Is the data physiologically relevant?
• Do you agree with the conclusions?

How to Keep It Fun

Make it interactive.

Quizzes and polls are a great way to do this! And QR codes make it really easy to do on-the-fly. Remember, scientists, are shy. So why not seek their participation in an anonymized form?

You could poll your audience on the quality of the work. You could make a fun quiz based on the material you’ve covered. You could do a live “what happened next?” You could even get your feedback this way. Here’s what to do:

• Create your quiz or poll using Google forms .
• Make a shareable link.
• Paste the link into a free QR code generator .
• Put the QR code in the appropriate bit of your talk.

Use Multimedia

Talking to your audience without anything to break it up is a guaranteed way of sending them all to sleep.

Consider embedding demonstration videos and animations in your talk. Or even just pausing to interject with your own anecdotes will keep everyone concentrated on you.

Keep It Informal

At the end of the day, we’re all scientists. Perhaps at different stages of our careers, but we’ve all had similar-ish trajectories. So there’s no need for haughtiness.

And research institutes are usually aggressively casual in terms of dress code, coffee breaks, and impromptu chats. Asking everyone to don a suit won’t add any value to a journal club.

Your Journal Club Toolkit in Summary

Anyone can read a paper, but the value lies in understanding it and applying it to your own research and thought process.

Remember, journal club is about extracting wisdom from your colleagues in the form of a discussion while disseminating wisdom to them in a digestible format.

Need some inspiration for your journal club? Check out the online repositories hosted by PNAS and NASPAG to get your juices flowing.

We’ve covered a lot of information, from parsing papers to organizational logistics, and effective presentation. So why not bookmark this page so you can come back to it all when it’s your turn to present?

While you’re here, why not ensure you’re always prepared for your next journal club and download bitesize bio’s free journal club checklist ?

And if you present at journal club and realize we’ve left something obvious out. Get in touch and let us know. We’ll add it to the article!

• Linzer M et al . (1988) Impact of a medical journal club on house-staff reading habits, knowledge, and critical appraisal skills . JAMA 260 :2537–41

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Some departments have journal clubs where everyone takes turns to give a short presentation on a relevant topic or paper. There are numerous books on how to give a presentation, but little advice available on how to choose a good topic or paper. Here are some suggestions.

Consider what you want to achieve with your presentation: do you want to teach, amuse, provoke, or just impress your colleagues? Choose a paper accordingly.

Picking a subject outside your specialty will broaden horizons. Ask colleagues and friends in departments that your specialty is cooperating with about their “hot papers.”

If you have done research, why not boost your image and present the paper? Tell people something other than what they can just read in it, like how you got involved in the particular project, and then briefly outline methods and results. Please constrain yourself—a common mistake is giving too many details and talking for too long.

Try to cross the species-barrier. Veterinarians have developed some unique solutions in all fields of medicine to treat their diverse group of patients. Be inspired.

All doctors have been taught physiology or anatomy but it might be a while back. Updates on basic science subjects are always relevant.

For perspective on daily life routines, try finding a paper on the history of your specialty.

For amusement try the Annals of Improbable Research ( www.improbable.com ) or the Christmas editions of the BMJ .

If you are nervous about giving presentations, choosing an unconventional topic or paper for your talk could actually help you—people will notice what you are saying more than how you are saying it.

Avoid presenting papers on the tautologies and well established routines of your specialty. Only go there if you can present a new paper that contradicts old truths.

Don't think of presenting a paper as just something you have to do. It's your chance to address colleagues without interruption—how often does that happen? ■

Internal Medicine Residency Program

Landmark research series template.

PowerPoint template for Landmark EBM articles. This is a structured format for reviewing and presenting landmark research articles.

Journal Club Template

PowerPoint template for Journal Club. This is a structured format for reviewing and presenting original research articles.

Poster Presentation Template (36×48)

PowerPoint template for poster presentations. The dimensions of this poster are 36 x 48 inches, which can be printed by the Department of Medicine.

Morning Report Template

PowerPoint template for Morning Report

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Effectiveness of Journal Club Presentation as a Learning Modality in the Endocrinology and Endocrine Surgery Module in an Integrative Undergraduate Medical Curriculum

Ahmed hasan alghamdi.

1 Pediatric Department, Faculty of Medicine, Al-Baha University, Al-Aqiq, Al-Baha Province, Saudi Arabia

Associated Data

Data will be made available on request.

Introduction

The journal club is widely used in most postgraduate programs of medical institutes; however, the use of journal clubs in undergraduate medical programs is nearly absent or very rare.

The aim of this work is to document the insertion of the journal club as a method for learning in the undergraduate starting with the endocrinology/endocrine surgery module to be fully implemented in all modules of the MBBS of FMBU. In addition, the study aimed to outline the steps of designing a journal club by following specific procedures and Identification of students’ and faculty satisfaction through 5-years implementation of the journal club.

Material and Methods

A total of 453 students representing the five consecutive batches of medical students from 2019 to 2023 who studied the endocrinology/endocrine surgery module were entered into the study. Following guidelines for implementation of the journal clubs that were adopted by the quality and accreditation committee, the faculty select the types of papers from the articles chosen by students. The papers discussed were case reports, original research, and review articles. The students were asked to formulate critical appraisal topics, PICO, for each paper. A 20-question test was applied to all participants. The students’ attendance, scores, and students/faculty satisfaction were estimated.

A total of 50 papers were discussed in the 5-year journal club 15 case reports (30%), 26 original research (52%), and 9 review articles (18%). The student’s attendance ranged from 72.53±3.74 to 98.07±3.15. The students and faculty’s satisfaction were 3.52 and 3.82 respectively. The mean Students’ score in A 20-question test in a 5-year journal club was 76.93 ± 9.78 and the lowest score was in the 2nd batch (online batch).

The insertion of a well-structured journal club in the undergraduate medical program is necessary to improve the knowledge including knowledge among students. In addition, journal clubs inspire students to be lifelong learners.

Faculty of Medicine, Al-Baha University (FMBU) follows the integrative approach of teaching in the medical Bachelor of Medicine, Bachelor of Surgery program (MBBS) program. 1 , 2 The integration was adopted not only in the basic and preclinical years but also in the clinical years. 3 , 4 Therefore, many learning and teaching strategies were adopted such. 4–6 The introduction of a journal club in the undergraduate medical program is an innovative learning tool as most journal clubs are applied to the postgraduate programs in most institutes.

A journal club is simply defined as a regular devoted meeting where healthcare practitioners gather to converse about different types of published articles from indexed peer-reviewed journals. 7 These regular meetings have many advantages such as helping healthcare providers as fellows and residents to be in contact with recent research updates, promoting and alleviating their critical thinking skills, and enhancing their presentation and arguing abilities. A journal club is considered a fundamental element in the training program for internship, residency, and fellowship in virtually all medical and healthcare provider institutes. 8–10

Deenadayalan et al suggested some features for journal clubs to be effective that include encompassed even and anticipated meetings, mandatory attendance, strong and well-structured objectives, proper meeting timing and motivations, a well-trained journal club leader to select papers and lead conversation, distributing papers previous to the onset of the meeting, availability of the internet for broader distribution and information storing, application of recognized critical appraisal procedures and succinct journal club conclusions. 11

Many forms of journal clubs have been developed over the years. The most identified formats include a traditional format and an evidence-based format. 12 , 13 The traditional format describes one presenter portraying formerly selected articles, and the attendees discuss and debate the results and findings followed by comments from the senior faculty founded on their experience. The evidence-based journal club is suitable for solving clinical queries, debates, and questions evolving from clinical situations. The discussions comprise the critical assessment of methodological views and whether the results would alter the clinical practice. 14–16 An additional forms of journal club are the online type, 17–19 and flipped journal club. These formats join large groups, keeps learners responsible, and pushes greater participation among learners and faculty. 20 , 21

After assessment of the current situation, the program committee found that the ratio of student-centered learning is low compared to the internal benchmark ratio and suggested some learning modalities to be newly introduced. The program committee in association with quality and accreditation unit decided to introduce the journal club in the curriculum starting with the endocrinology module. Many challenges were faced such as it is the first time to use this learning tool in the undergraduate integrative curriculum, how to select the topics and how to prepare the faculty in performing the journal club ideally.

The aim of this work is to document the insertion of the journal club as a method for learning in the undergraduate medical curriculum starting with the endocrinology/endocrine surgery module to be fully implemented in all modules of the MBBS of FMBU. In addition, the study aimed to outline the steps of designing a journal club by following specific procedures adopted by the quality and accreditation committee and finally, identifying student and faculty satisfaction through the 5-year implementation of the journal club.

Materials and Methods

This article is approved by the Scientific Research Ethical Committee of Al-Baha University-Faculty of Medicine (SRECFM-BU) under REC/PEA/BU-FM/2023/71. This study is a retrospective study in which a total of 453 students in the fourth academic year studied the endocrine/endocrine surgery module. These students were representing the 5 batches of the successive 5 years starting from 2019 to 2023. All students registered in the endocrinology/endocrine surgery module were entered in the study including male and female sections. A variety of teaching and learning tools were adopted in the endocrinology module besides the journal club. The evidence-based, and online journal clubs (during the Covid-19 pandemic) were introduced. Four journal clubs were implemented in the endocrinology module each year. In each academic year, the students were oriented about the importance of journal clubs as a student, learner, doctor, professional and scholar. In addition, the students were educated about the steps of journal clubs and optimal requirements that should the students prepare for it. The students were subdivided into main 4 groups: 22–24 students per each, which was further subdivided into small subgroups ranging from 5 to 8 students. The students in each subgroup were asked to search for special papers, either case studies, original articles, or review articles that serve in achieving the learning outcomes of the module. From the obtained articles, two papers were selected by the module committee for each group and the total number of papers discussed in each batch was about 10. Each group was responsible for preparing and introducing the journal club as a Ppt presentation. Each session has 2–3 assessors using a checklist for evaluation. Before starting the module activities, orientation about the preparation and judgment of a journal club was introduced and a handout was distributed containing the instructions and procedures for implementing a journal club. The students should follow the procedures for the journal club which were adopted by the quality/accreditation unit. These procedures consisted of 11 steps as follows:

Describe the Major Interest That is Involved in This Article

The students were starting the presentation with a brief case presentation, or briefly clarifying how the article is appropriate to applied learning outcomes. This helps attendees to be more fully participant in the presentation and attracts them to the end of the story.

Explain How the Participants Came Across This Article

For more benefit and student training, the presenter must explain the strategy of searching to catch this specific article such as using keywords, using a mesh of PubMed/Medline, Scopus, and others. In addition, describe how many articles he found dealing with and close to this subject.

Brief Description or Introduction of the Study

The presenter should describe in brief the study and its type such as cross-sectional, descriptive, prospective, retrospective, cohort, case study, case series, randomized, controlled trial of therapy. Furthermore, the presenter should describe whether the study is diagnostic, therapeutic, or prognostic. In addition, the presenter should illustrate the site of conducting the research.

In a case presentation, the presenter should start with some universal forms of the patient followed by the chief complaint.

The Presenter Should Illustrate the Research Question

Richardson et al illustrated the main basic components of the research question and the presenter should answer all these components: these include the population studied, exposure or intervention including therapy, tests, risk factors, and others, comparison, or control (alternatives to exposure or intervention) and outcomes. 22

Brief Description of the Importance, and Setting of This Question

This data is mainly found in the introduction of an article where the author places the current study in the setting of other literature and stresses the importance of the current study.

Describe the Methods by Giving More Detail on the Question Components Either Critical Appraised Topics (CAT) or PICO Format Questions

Following this succinct introduction, more details on the Patients (as the number, age, sex, and others), Intervention or exposure, Comparison with others, and Outcome and fate (PICO) related to the research question should be given. 23

Respond to the Criticism and Critically Appraised Topics (CAT) About Study Validity

The presenter should briefly respond to the assumed critical appraisal questions on the validity. The idea is how to translate clinical research into evidence-based decisions to improve patient care. 24

Summarize the Obtained Results

The presenter can report the results after the research question. The summary of the obtained results should be focused mainly on the primary question and just present the secondary results if they are appropriate and relevant.

Explain the Ability to the Application of These Results to the Current Case or Patient

The presenter can assess the study’s validity by the ability to apply these results to the presenting case. This is determined by making a comparison between the presenting case and the presented study according to similarities and differences.

Conclude with the Final Decision About the Effectiveness of the Study in Clinical Practice

The presenter can do a brief short summary of the case and in one statement can end the question by deciding the utilization of the results in the current case.

A Succinct Handout Summarizing the Article Should Be Prepared

The summary will serve as notes for the presentation and will guide the group’s attention.

Following these steps, both the presentation and critical appraisal skills of the students will be enhanced.

At the end of each journal club session, the students’ satisfaction was evaluated using a Likert scale questionnaire ranging from 5 to 1: highly satisfied to highly dissatisfied. In addition, the evaluation of the level of satisfaction among the assessors and supervisors, and attendant faculty was done using the same instrument as the Likert scale questionnaire.

Several variables were measured including the students’ attendance, students’ achievement, and students/faculty’ satisfaction.

Statistical Analysis

Descriptive and parametric tests such as Analysis of Variance (ANOVA) were used in the study. The result is significant at p < 0.05. SPSS version 17 was used in the current study.

The study was designed to estimate the effectiveness of journal clubs among medical students. The study was carried out on 453 medical students of the endocrinology and endocrine surgery module representing the five batches starting from 2019 to 2023. A total of 75 papers were obtained by students, and only 50 papers were selected and discussed in the 5-year journal club. These papers included case reports, original research, and review articles. Following the steps adopted by quality accreditation committee in collaboration with the module committee of FMBU, CAT and PICO format were done by students in each journal club session. Examples of CAT and PICO formats formulated by students are represented in Table 1 ( Table 1 ).

Shows Examples of Selected CAT and PICO Formats Prepared by Students in the Journal Club

The papers discussed in the 5-year journal clubs included 15 case reports/studies (30%), 26 original research (52%) and 9 review articles (18%). More details about types of paper in each batch are presented in Table 2 ( Table 2 ). Variable measures are estimated including attendance, students’ scores, and students/faculty’ satisfaction in the current study.

Shows the Number and Type of Articles Selected (Case Report, Original Research, and Review Article) for Each Batch in the 5-Year Journal Club

In general, students’ attendance was good for all the 5-year journal club with the exception for the 2nd batch which was related to Covid-19 pandemic. The attendance ranged from 68.1% to 100%. The lowest attendance was recorded during Covid-19 pandemic in which the attendance was obtained from data of allocated special system in our institute (RAFID). The low attendance during pandemic was due to multiple factors including reported cases among students and their families, weak internet, and inappropriate timing, loss of interest among some students and social factors. More details of the students’ attendance are represented in Table 3 including mean ± SD for each batch ( Table 3 ).

Shows the Students’ Attendance in the Journal Clubs in Each Batch of the 5-Year Journal Club

Regarding students’ scores, the mean score for all batches was 76.93±9.78. The 2nd batch revealed the lowest mean among all batches. Pairwise comparison revealed significant differences between the 2nd batch vs 1st batch ( p = 0.00437), 2nd batch vs 4th batch ( p = 0.00132), and 3rd batch vs. 5th batch ( p = 0.00215). However, no significant differences were obtained between other batches. In addition, a significant difference was obtained on comparison of all batches ( p = 0.00034). More details are presented in Table 4 ( Table 4 ).

Shows the Students’ Scores in the 20-Question Test Applied for Topics Learned by Journal Clubs for Each Batch in the 5-Year Journal Club

Regarding students’ satisfactions, pairwise comparison between the students’ satisfaction revealed that there are significant differences between 1st batch vs the 2nd batch ( p = 0.0001), between 2nd batch vs 3rd batch ( p = 0.0000), 2nd vs 4th batch ( p = 0.0000), and 2nd vs 5th batch ( p = 0.0000). In addition, there is a significant difference among all batches ( p = 0.0001). However, no significant differences between other groups were obtained. More details are presented in Table 4 ( Table 5 ).

Shows the Students’ Satisfaction with the Journal Clubs for Each Batch in the 5-Year Journal Club

Regarding faculty’s satisfaction, pairwise comparison between the faculty’s satisfaction revealed that there are significant differences between 1st batch vs the 2nd batch ( p = 0.00259), between 2nd batch vs 3rd batch ( p = 0.00353), 2nd vs 4th batch ( p = 0.00005), and 2nd vs 5th batch ( p = 0.00002). In addition, there is a significant difference among all batches ( p = 0.0001). However, no significant differences between other groups were obtained. All these data are shown in Table 5 ( Table 6 ). No significant results were obtained between satisfactions and the type of paper. The questionnaire instrument used in this study is presented in table ( Table 7 ).

Shows the Faculty’s Satisfaction with the Journal Clubs for Each Batch in the 5-Year Journal Club

Questionnaire Used in the Present Study to Illustrate the Satisfactions of Both Students and Faculty Members

Medical students and health professionals need to acquire the necessary skills to be life-long learners and practice evidence-based medicine. Some recommended skills should be learned to achieve these goals such as the ability to formulate a question, perform systematic searches of the literature, critically appraise articles, and formulate their own conclusion and experience following allocating the evidence. 28 All these skills will be achieved through well-designed journal club. 29–32

In the present work, the attendance of students ranged from 68.1% to 100%. However, the lowest attendance was observed in online sessions during the Covid-19 pandemic. These low student attendances are associated with low student scores. This observation is compatible with that observed in McLeod et al study. 33 McLeod compared 2 types of journal clubs: online versus traditional journal clubs regulated by faculty. They revealed that the attendance rate for online journal clubs was 18% compared to 96% for the traditional format. Furthermore, the mean scores of participants in the online group were significantly lower compared to that in traditional journal clubs.

The present study revealed that the level of student satisfaction with the journal club in the endocrinology module in all 5 successive academic years was 92% (satisfied 30%, highly satisfied 62%). This result is compatible with many studies 31 , 32 , 34 in which the percentage of satisfied to highly satisfied ranged from 31% to 55%, however, these studies were carried out on the residents, not on undergraduates. No studies were done to estimate the level of satisfaction among undergraduates. This may be due to the inadequate representation of the journal club in most integrative undergraduate medical programs, or the journal club is not considered one of the learning tools in most of the undergraduate curricula.

In addition, the identification of satisfaction is recommended by Taverna et al 35 who stated that journal club experiences are greatly valued by applicants and trainees and could be a beneficial selection for the training of convinced soft skills.

The students’ satisfaction regarding types of journal clubs (traditional, or online) revealed that the students’ satisfaction was higher in traditional classes than in online or virtual classes with significant differences. In addition, the student’s attendance was low in virtual classes compared to that of traditional classes with significant differences. This coincides with the study of McLeod et al 33 on a randomized controlled experiment in which participants were grouped in a random fashion into a traditional journal club and a virtual journal club. The involvement in the virtual journal club was observed to be inadequate even though it was a general elective learning requirement for those residents. In addition, the participants of the traditional class attained significantly higher scores in the validated critical appraisal test. However, Hammond and Whelan 34 revealed that participation in an online journal club showed a higher degree of satisfaction than in a traditional format.

In the present study, no significant results were obtained between satisfactions and type of paper. This coincides with McLeod study 33 which no significant differences were observed among participants. However, students’ satisfaction was reported to be higher in articles covering both professional and socioeconomic aspects, and effective instruments for teaching all domains as well as critical appraisal skills and advancing reading habits. 34 , 36 , 37

In the present study, the 4 sessions of journal club in the short endocrinology module revealed that the student acquired knowledge and skills despite the time of the module being short. This is compatible with short courses of other studies. 38–40 So, this indicates that short courses including journal clubs are valuable in improving knowledge and skills among the participants. 29 , 41

In addition, this result is compatible with the study of Cheatham 38 about the effectiveness of a one-year journal club curriculum in general surgery and revealed improvement in knowledge, test scores, and achievement of learning outcomes at the end of the curriculum. In addition, Lee et al 42 revealed the effectiveness of the short course journal club in ophthalmology using critique checklist and found that about 86% of residents showed improvements in various skills.

Regarding journal club and knowledge acquisition, the obtained results revealed that most of the students attained high scores on the 20-question test applied to topics learned by the journal club. This is matched with the results of Hammond and Whelan 34 who revealed that the participating residents in the journal club achieved good scores in the educational program. However, there is no evidence that supports the keeping of knowledge retention for a long period as most evaluating processes occur at the end of the curriculum. 31 , 32

In addition, Thurnau and Fishburne 43 described a regular journal club in an obstetrics and gynecology program. The goals of the journal club were to induce and foster critical thinking about medical reports, deliberate experimental design, and attain knowledge of current literature. The outcome was that all participating residents assessed and critiqued 119 medical articles, designed 42 study proposals, and published 12 papers. The knowledge and skills acquisitions were of utmost high, and all participating residents revealed high achievement.

Lee et al 44 confirmed that the journal club is considered an effective tool for evaluating and supporting teaching, particularly practice-based medicine and it has a major role in improving the educational outcomes.

In the current study, critical appraisal training (CAT) was a part of the objectives of the journal club. This coincides with many studies. 29 , 30 , 33 Other studies designed critique checklists to judge the quality of the papers. 32 , 44

In the present study, two papers were discussed in each journal club session that have been selected by students and the faculty did selection from the chosen papers, this coincides with many reports, in which 2–3 articles were reviewed in each session. However, these reports revealed that the faculty only elected the articles from the start and headed the sessions. 29 , 30 , 33

Finally, for journal clubs to be more effective, some of the conditions have been listed that include continuous and regular manner, high rate of attendance, compulsory participation, and availability of well-prepared meeting for journal clubs that includes drinks and food, understanding of the learning goals of the participants, sensible article selection, and prominence in promoting the commitment of participant learners. 12 , 45

In the present study, the questionnaire was anonymous, and the students responded freely with no consequences. In addition, the effectiveness of the journal club as a learning modality is not based only on the questionnaire but also on the question applied and the achievement of learning outcomes of the journal club.

In addition, the role of students in integrated-based teaching is increased to a degree close to that of faculty, this role has been suggested by Harden “The changing role of medical students; students as assessor, curriculum collaborator, information processor, facilitator of learning, professional, scholar and teacher” 46 and accordingly, the students can give their feedback freely without any pressure. From this point, the questionnaire used for the students is the same for faculty to facilitate the identification of areas of weakness and compare the results between students and faculty. In addition, some closed questions were applied to faculty, but we did not find any of these responses for the closed questions were important to enrich the study.

Limitation of the Study

No control group in our study. In the integrated medical program, the learning tools are selected and unified for all students. So, the selected topics for journal clubs must be delivered by journal clubs to ensure justice among students.

The second limitation is the shortage of journal club data for the undergraduates, most of the literature focused mainly on the residency in their workplace. So, comparative studies with previous studies are difficult to obtain.

The insertion of a journal club in the integrated endocrinology/endocrine surgery module showed high levels of satisfaction among students and faculty. Journal club initiates, promotes enhances the acquisition of knowledge among the students. As most integrative medical programs give more attention to student-centered learning, the insertion of a journal club widely in the curriculum will expose the students early to be lifelong learners and to remain contemporary with the literature.

Acknowledgment

The author acknowledges Associate Prof Ihab Shafek Atta for his valuable contribution throughout this work. In addition, the author acknowledges all students and faculty who share in this study.

Data Sharing Statement

Author contributions.

The author made a full contribution in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

No funds were received at all. No conflict of interest to declare.

Safety, Tolerability and efficacy of Rapid Optimization, helped by NT-proBNP and GDF-15, of Heart Failure therapies (STRONG-HF): rationale and design for a multicentre, randomized, parallel-group study

Affiliations.

• 1 INSERM UMR-S 942, St. Louis and Lariboisère University Hospitals, Paris University, Paris, France.
• 2 Momentum Research Inc., Durham, NC, USA.
• 3 Department of Cardiology, Abderrahmen Mami University hospital, Ariana, Tunisia.
• 4 Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
• 5 Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine 'Carol Davila', Bucharest, Romania.
• 6 Department of Cardiology, Lariboisère University Hospital, Paris, France.
• 7 Estudios Clínicos Latinoamérica, Instituto Cardiovascular de Rosario, Rosario, Argentina.
• 8 Eduardo Mondlane University Hospital, Maputo, Mozambique.
• 9 Department of Internal Medicine - Cardiology, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.
• 10 Heart Failure Unit, Attikon University Hospital, National and Kapodistrian University of Athens, Greece; School of Medicine, University of Cyprus, Nicosia, Cyprus.
• 11 Department of Heart Failure and Transplantation, National Institute of Cardiovascular Diseases, Bratislava, Slovak Republic.
• 12 Cardiac Care Unit, Moscow City Hospital, Moscow, Russia.
• 13 Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
• 14 Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.
• 15 Critical Cardiac Unit, City Clinical Hospital, Moscow, Russia.
• 16 Division of Cardiology, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
• 17 Department of Medicine, Bayero University Kano, Kano, Nigeria.
• 18 Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
• 19 Moscow SHI, City Clinical Hospital, Moscow, Russia.
• 20 Department of Anesthesiology and Critical Care Medicine, St. Louis and Lariboisère University Hospitals, Paris, France.
• PMID: 31423712
• DOI: 10.1002/ejhf.1575

Aims: Patients admitted for acute heart failure (HF) are at high risk of readmission and death, especially in the 90 days following discharge. We aimed to assess the safety and efficacy of early optimization of oral HF therapy with beta-blockers (BB), angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) or angiotensin receptor-neprilysin inhibitors (ARNi), and mineralocorticoid receptor antagonists (MRA) on 90-day clinical outcomes in patients admitted for acute HF.

Methods: In a multicentre, randomized, open-label, parallel-group study, a total of 900 patients will be randomized in a 1:1 ratio to either 'usual care' or 'high-intensity care'. Patients enrolled in the usual care arm will be discharged and managed according to usual clinical practice at the site. In the high-intensity care arm, doses of oral HF medications - including a BB, ACEi or ARB, and MRA - will be up-titrated to 50% of recommended doses before discharge and to 100% of recommended doses within 2 weeks of discharge. Up-titration will be delayed if the patients develop worsening symptoms and signs of congestion, hyperkalaemia, hypotension, bradycardia, worsening of renal function or significant increase in N-terminal pro-B-type natriuretic peptide between visits. The primary endpoint is 90-day all-cause mortality or HF readmission.

Conclusions: STRONG-HF is the first study to assess whether rapid up-titration of evidence-based guideline-recommended therapies with close follow-up in a large cohort of patients discharged from an acute HF admission is safe and can affect adverse outcomes during the first 90 days after discharge.

Clinical trial registration: ClinicalTrials.gov Identifier NCT03412201 .

Keywords: Acute heart failure; Biomarker; Cardiovascular mortality; Rehospitalization.

© 2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiology.

Publication types

• Comparative Study
• Multicenter Study
• Randomized Controlled Trial
• Research Support, Non-U.S. Gov't
• Acute Disease
• Adrenergic beta-Antagonists / adverse effects
• Adrenergic beta-Antagonists / therapeutic use*
• Angiotensin Receptor Antagonists / adverse effects
• Angiotensin Receptor Antagonists / therapeutic use*
• Angiotensin-Converting Enzyme Inhibitors / adverse effects
• Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
• Biomarkers / blood
• Cause of Death
• Growth Differentiation Factor 15 / blood
• Guideline Adherence
• Heart Failure / blood
• Heart Failure / drug therapy*
• Heart Failure / mortality
• Middle Aged
• Mineralocorticoid Receptor Antagonists / adverse effects
• Mineralocorticoid Receptor Antagonists / therapeutic use*
• Natriuretic Peptide, Brain / blood
• Neprilysin / antagonists & inhibitors*
• Patient Admission
• Patient Readmission
• Patient Safety
• Peptide Fragments / blood
• Survival Rate
• Treatment Outcome
• Adrenergic beta-Antagonists
• Angiotensin Receptor Antagonists
• Angiotensin-Converting Enzyme Inhibitors
• GDF15 protein, human
• Growth Differentiation Factor 15
• Mineralocorticoid Receptor Antagonists
• Peptide Fragments
• pro-brain natriuretic peptide (1-76)
• Natriuretic Peptide, Brain

Associated data

• ClinicalTrials.gov/NCT03412201