Each student group will be assigned the role of moderating

Each student group will be assigned the role of moderating one of the journal club sessions.  In order to give you an example of how to do this, your instructor will moderate the first journal club.  Presenters should use a PowerPoint presentation to aid their directing of the journal club.

Journal club participation represents 20% of your course grade and is assessed based on your participation during each journal club and your leading of one manuscript’s discussion. Students that routinely meet the standard expectations for participation will receive a journal club grade of 75%. Those that exceed those expectations on a regular basis will receive a higher score and those that do not meet expectations on one or more occasion may receive a score below 75%.

Note:  Your grade for journal club will be dependent on both your job as a single session’s moderator as well as your participation within the discussions held within other sessions.

Non-moderators must:

1. read the publication prior to class
2. bring a copy of the publication to class (digital copy OK)
3. engage in the discussion

Moderators:

You will provide a big picture review of the publication, however, as moderators of a journal club you are not expected to simply present a summary of a journal manuscript (i.e. regurgitate what was written).  As moderators you are to direct an interactive discussion among your classmates which critically appraises the publication.  Although your primary role should be to initiate discussion within your fellow students, you should be prepared to provide your critical appraisal of the piece.   Below is a general break down for how you should organize the journal club.  You should cover each of the 6 sections below; however, it is up to you to use your discretion to select (as well as create your own) questions to be used for initiating discussion.

1. Authors, Title, Journal (1 Slide: ~2 minutes)
2. Consider the source. Tell us something about the authors that provides insight regarding the credibility of the authors / article (no more than 3 authors in articles with many authors). The following are some factors that may impact credibility of the study (this list is not exhaustive and you may come up with your own factors).
   1. Any potential conflict of interest (COI) for the authors
   2. Academic credentials (do they support or detract from credibility of the manuscript)
   3. Number of publications in the field (how does this relate to authors credibility)
   4. Grant history (Funded or unfunded research, corporate sponsored research, etc)
   5. Pertinent leadership positions
   6. Role in the present study (e.g., data analysis, PI, Sub-I, Fellow, dissertation work)
3. Tell us something about the institution(s) involved in the study.
4. What is the level of evidence of the research (see: http://www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/)?
5. Tell us the Journal Impact Factor for the journal in which your manuscript appears.

1. Introduction / Background (1 – 2 Slides)

The introduction should set the stage for journal club:

1. Briefly review the pertinent historic, anatomic, pathophysiologic and technical information that is necessary for understanding the context of this manuscript/research. Introduce any supplemental information that may be necessary for understanding the context, limitations and significance of the article’s findings. This information is often in the introduction section of a paper however many introductions are poorly written or are incomplete so you are not solely limited to relying upon the introduction given in the journal manuscript.
2. What is the specific experimental question, goal, or aim to be addressed? e.
   1. To compare two treatment approaches or (two surgical procedures or conservative vs surgical care)
   2. To test an intervention (Characterize, outcome assess, refine a treatment or algorithm of care)
   3. To characterize a condition
   4. To introduce a new concept or technique
   5. To evaluate a diagnostic technique / therapeutic approach
3. Potential questions for discussion-
   1. Are important findings from previous studies omitted or misrepresented?
   2. Is the functional, biological, and/or clinical significance of the topic established?
   3. Are previous experimental observations linked together in a logical manner to establish a formally stated and testable working hypothesis? Does the hypothesis clearly indicate the direction of the postulated effect?
   4. If previous studies have covered the same topic:
      1. Are the strengths/limitations of those studies used to establish the need for further investigation?
      2. Is it clear how the present study will improve upon or advance the knowledge gained from previous ones?

III.  Materials & Methods (~2 slides)

1. Provide an overview of subjects utilized
   1. Review some (or all) of inclusion/exclusion criteria; review sample size estimate if used
   2. Recruitment methods
   3. Treatment assignment
   4. Review important demographics
2. Provide an overview of the protocol/methods/tools & instruments used
3. Analysis plan (this could potentially be addressed in your results section)
4. Potential questions:
   1. Is the subject population appropriate for the question posed?
   2. Were the assumptions of the sample size estimate reasonable/appropriate?
   3. Was ethical oversight appropriate (use of IRB, safety monitoring board…)?
   4. How will the study sample/methods impact the internal/external validity of the results? There is often a tradeoff between internal vs. external validity.  Generally the more tightly controlled a study is, the better confidence one will have as to whether the intervention actually made a difference, however, the difference may be more difficult to obtain if the intervention is utilized in a less restrictive setting (general practice).
   5. Are the methods appropriate for answering the initial question? If a better design could have been used, were there practical limitations that prevented this?
   6. Do the experimental design and the protocols employed control for all potential confounding factors? Stated another way, does the experimental approach effectively isolate the mechanism or factor of interest?
   7. Areas of bias to consider that can skew presentation of data and conclusions
      1. Convenience samples vs. random controlled sampling
      2. Pooled data from multiple surgeons vs. a single surgeon

• Patient drop out

1. Populations with unique characteristics that introduce bias when making comparisons
   1. Military cadets more likely healthier than the general population
   2. Comparing military training to general fitness
   3. Comparing compliance with therapy in institutional settings (military/incarceration) to less structured settings (homeless shelters/community centers)
2. Were the statistical techniques used appropriate for the research question and study design?

1. Results (~1-3 slides)

1. Summarize statistical analysis (if already covered sufficiently in methods this may not be necessary)
2. Summarize key study results relating to the following:
   1. Demonstrate differences between study populations, treatment groups, disease states.
   2. Highlight key results that relate to major and minor conclusions or recommendations from the study
3. Potential questions:
   1. Are data presented in a clear concise manner?
   2. Where appropriate, were measures of variability (standard deviation, standard errors…) provided? Was there excessive variability in one or more measurement?
   3. Are data presented on any measurement that was not described in the methods and vice versa?
   4. Are data presented in appropriate units and are adjustments (statistical adjustments for baseline differences) appropriate?
   5. Is scaling/presentation of figures/graphs appropriate and unbiased? Changes in scale can over or under-emphasize the practical difference between outcomes.

1. Discussion/Conclusion (~2-4 slides)

1. Provide a “quick” review of what the authors include in their discussion/conclusion. Then proceed to questions for class.
2. Potential questions:
   1. Are the major new findings of the study clearly described and properly emphasized?
   2. Are the key conclusions adequately supported by the data?
   3. How do the findings relate to previous work (circle back to references from intro and discussion sections of manuscript)?
   4. Were the conclusions/recommendations based on primary data and results from the paper or is it based on indirect evidence?
   5. Are there other ways to interpret the data than the way in which in the authors did?
   6. Are the significance and implications of the results appropriately addressed or do the authors over (or less likely under) state meaning of the results?
   7. What does the journal club believe is the next step in progressing this line of research?
   8. What experimental limitations were there? The authors should present some and the journal club should be able to come up with some as well.
3. Final Question: Do you (journal club members) care? Some possible factors to consider in answering this are: Will the paper impact your provision of care, understanding of illness/injury…?  Does it support or refute current Dogma?