E-learning & technology

Early experience of a virtual journal club Raymond Oliphant, Vivienne Blackhall, Susan Moug, Patrick Finn, Mark Vella and Andrew Renwick Department of General Surgery, Royal Alexandra Hospital, Paisley, UK

SUMMARY Background: Traditional journal club models based on didactic presentation sessions followed by group discussion have many limitations. To overcome some of these shortcomings, a virtual journal club (VJC) using social media and e–mail was developed. The aim of this study was to report the initial experience of this novel multimodal e–learning platform to facilitate journal club discussion and promote the development of critical appraisal skills. Methods: Journal articles were discussed monthly via e–mail and social media. After a 3–week

period of discussion, all comments were collated and groupgenerated critical appraisal summaries were fed back to participants. In addition, letters to the journal editors based on the group appraisal were submitted. A questionnaire survey to evaluate the VJC concept was also conducted. Findings: After eight cycles of the VJC, the mean trainee participation rate was 29.6 per cent (range 21.1–42.1%). Senior trainees (≥4 years of postgraduate experience) were more likely to participate than more junior trainees (75.0 versus 21.1%; p = 0.005). The majority of

participants thought that the VJC was educationally valuable, easy to participate in, helpful in keeping up to date with recent papers and useful in developing critical appraisal skills. Barriers to participation were lack of time, motivation and lack of experience in critical appraisal. In addition, the group-generated critical appraisal summaries derived from VJC discussions led to eight published ‘letters to the editor’. Conclusion: This novel VJC model is a feasible and popular method of delivering a journal club in the postgraduate setting.

Traditional journal club models based on didactic presentation sessions followed by group discussion have many limitations

© 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 389–393 389

tct_12357.indd 389

10/26/2015 7:41:36 PM

The delivery of good-quality journal clubs can help develop the critical appraisal skills

INTRODUCTION

T

he delivery of, and participation in, good-quality journal clubs can help develop the critical appraisal skills that are essential for postgraduate doctors in training.1,2 The acquisition of skills to systematically review, assess and critique published evidence enables the medical profession to apply effective treatments and make appropriate health care decisions based on the highest quality evidence available. Critical appraisal skills that are also assessed during postgraduate examinations are becoming increasingly used as part of a global assessment for speciality training recruitment.

The traditional journal club model based on a scheduled meeting of senior and junior clinicians, centred on didactic presentation sessions, and followed by group discussion, has many limitations, however.2,3 For example, traditional journal clubs require protected time during the working week; however, competing clinical demands and shift-based working patterns can make regular attendance difficult. Journal clubs also require a place to meet with adequate IT support for computer-based presentations. In addition, an effective traditional journal club requires an enthusiastic coordinator, well-prepared presenter, and an attentive audience that has had time to read and reflect on the papers under discussion. In our experience these meetings are often poorly attended, with few trainees having prepared sufficiently to enable an informed debate or discussion. In order to overcome some of these limitations, we developed a virtual journal club (VJC). This novel journal club concept is delivered in an electronic format,

with discussion taking place via e–mail and social media. This paper reflects upon our initial experience with this novel concept.

METHODS A VJC was established within our general surgical department in October 2013. Each month a nominated junior doctor took the role of VJC curator and disseminated details of a recently published paper from a peerreviewed journal via e–mail to all doctors in the department. In any month a total of 30 doctors, including permanent consultant staff and rotational junior doctors from foundation year 1 (FY1) to senior specialty registrar (StR) level, were invited to participate. In the UK, junior doctors complete two generic years as foundation doctors before undertaking 4–8 years of specialty training. VJC participants were supplied with details of how to gain access to the full paper via the local library or UK National Health Service (NHS) Knowledge Network (an online e–library resource for NHS staff). All participants were then given 3 weeks to appraise the paper and respond using a simple format (detailing two strengths, two weaknesses, and general comments about the paper under discussion). Participants could reply via e–mail or by leaving comments on dedicated social media sites (Twitter® or Facebook®). After the initial 3–week period, the nominated VJC curator collated all unique comments to generate a critical appraisal summary based on the responses from the group. This was circulated via e–mail back to the whole group. The main themes emerging from this appraisal summary formed the basis of a letter submitted to the editor of the corresponding journal. The VJC curator was

tasked with drafting the letter and all co-authors were then asked to comment prior to submission. A maximum of eight participants who were first to offer unique comments on the paper under discussion were included as co-authors of the letter. After piloting the VJC model for 6 months, a review was undertaken and all invited participants were contacted to complete a short web-based questionnaire. Comparisons of categorical variables were made using the chi-square test, where appropriate; p ≤ 0.05 was considered statistically significant. All quantitative data are presented as percentages, and qualitative data from the freetext questions were analysed by identifying the emergent common themes.4

FINDINGS Each month a total of 30 individuals, including 11 consultant general surgeons and 19 trainee doctors, were e–mailed details of the paper to be discussed. The trainee group comprised surgical StRs, core trainees, clinical fellows, and a rotating group of general practice (GP) trainees and FY1 and FY2 doctors. To date since its launch, the VJC has reviewed eight peer-reviewed papers. The mean participation rate for trainee doctors was 29.6 per cent (range 21.1–42.1%) and 10.2 per cent among consultant staff (range 0–18.2%) (Table 1). Overall, senior trainees (StR3 and above) were more likely to participate than junior trainees (75.0 versus 21.1%; p = 0.005). The groupgenerated critical appraisal derived from the VJC discussions has led to the submission of eight letters to the editor, all of which have been accepted for publication. This has led to 22 medical staff becoming published authors, generating an

390 © 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 389–393

tct_12357.indd 390

10/26/2015 7:41:37 PM

Table 1. Response rates for papers discussed by the virtual journal club Paper

Overall response n = 30

Consultant response n = 11

Trainee response n = 19

1

8 (26.7%)

2 (18.2%)

6 (31.6%)

2

5 (16.6%)

1 (9.1%)

4 (21.1%)

3

6 (20.0%)

2 (18.2%)

4 (21.1%)

4

8 (26.7%)

1 (9.1%)

7 (36.8%)

5

8 (26.7%)

2 (18.2%)

6 (31.6%)

6

7 (23.3%)

1 (9.1%)

6 (31.6%)

7

4 (13.3%)

0

4 (21.1%)

8

8 (26.7%)

0

8 (42.1%)

additional 52 cumulative lines on the curricula vitae (résumés) of the participating junior medical staff. In total, 58 people have been invited to participate in the VJC since its launch (including permanent and rotational staff), and all were invited to complete the questionnaire survey. A total of 22 of 58 people (37.9%) completed the survey, the results of which are shown in Table 2. Of those who responded, 21 (95.5%) had read at least one VJC paper, 12 (54.6%) had contributed to the VJC discussions, 19 (86.4%) thought the VJC was educationally valuable, 17 (77.3%) found it helpful in keeping up to date with recent papers, and 14 (63.6%) stated that it led to an improvement in their critical appraisal skills. In order to identify barriers to participation, the respondents were asked ‘if you have not participated or contributed to the VJC discussions, what has prevented you from taking part?’ From the free-text responses, common themes to emerge were a lack of time and poor motivation to participate. In addition, more junior staff felt inhibited to take part because of their own

inexperience of contributing critical comments in an open forum.

Initially it seemed quite daunting to put forward any sort of critical appraisal given a lack of experience in doing so and being aware of senior trainees’ contributions. FY1 doctor To identify areas where the VJC had been successful, respondents were asked ‘is there anything about the VJC that you feel is particularly good?’ Common emergent themes from the free-text responses included: the VJC was easy to participate in, was informal and enabled juniors to contribute to discussion using social media, with the opportunity to become involved with the publication of letters to the editor.

Modern forum, flexible to the trainees’ timetable, incredibly successful. StR doctor The VJC format was also preferred to a traditional journal club format.

Much more interesting than traditional journal clubs…

good idea to involve young and inexperienced trainees in a non-threatening environment. Consultant surgeon Finally, respondents were asked ‘what aspects of the VJC do you feel could be improved?’ From the free-text responses, the major theme to emerge was that junior staff felt that a more formal teaching session on critical appraisal could help them to become better equipped to get involved in group discussions.

This VJC model affords participants time to read, critique and debate recently published peerreviewed papers

The provision of some sort of basic critical appraisal training to more junior staff to help support them. FY1 doctor DISCUSSION This paper presents a unique model for the delivery of a successful journal club using an e–learning environment incorporating the use of e–mail and social media. This VJC model affords participants time to read, critique and debate recently published peer-reviewed papers via a multimodal e–learning platform. Overall, the majority of participants found this model to be easy to use, informal and gave trainees the opportunity to participate at a time that suited them. In addition, this VJC model has also been successful in generating publications in the form of letters to the editor. The addition of letter submission has also given more junior trainees a useful insight into the publication process. There were a number of barriers, however, that led to a lower than anticipated participation rate, and which will require this VJC model to be modified

© 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 389–393 391

tct_12357.indd 391

10/26/2015 7:41:37 PM

Junior doctors felt inhibited to participate by their own limited experience

Table 2. Virtual journal club (VJC) questionnaire responses (n = 22) VJC questionnaire results What grade of doctor are you?

n (%) Consultant

6 (27.3%)

Specialty registrar

4 (18.2%)

Clinical fellow

1 (4.6%)

Core trainee

1 (4.6%)

GP trainee

1 (4.6%)

FY2

2 (9.1%)

FY1

7 (31.8%)

0

1 (4.6%)

1–2

7 (31.8%)

3–4

9 (40.9%)

5–6

2 (9.1%)

≥7

3 (13.6%)

Have you contributed to the VJC discussions

Yes

12 (54.6%)

No

10 (45.5%)

Do you think that the VJC is educationally valuable?

Strongly agree

11 (50.0%)

How many of the VJC papers have you read (out of a total of 8)?

Do you think that the VJC is helpful in keeping up to date with recent papers?

Do you think that the VJC has improved your critical appraisal skills?

over time. In particular, junior doctors felt inhibited to participate by their own limited experience and lack of understanding as to the process of critical appraisal. This has led to the development of an interactive basic critical appraisal workshop aimed at junior trainees. Future developments also include the use of a webbased e–learning critical

Agree

8 (36.4%)

Neutral

1 (4.6%)

Disagree

0

Strongly disagree

2 (9.1%)

Strongly agree

2 (9.1%)

Agree

15 (68.2%)

Neutral

5 (22.7%)

Disagree

0

Strongly disagree

0

Strongly agree

5 (22.7%)

Agree

9 (40.9%

Neutral

6 (27.3%)

Disagree

2 (9.1%)

Strongly disagree

0

appraisal tutorial. Therefore, we aim to increase future VJC participation rates by improving junior trainees’ understanding of critical appraisal skills through interactive teaching sessions supported by e–learning tutorials. Few similar methods of journal club delivery via an e–learning environment have

been published. These previously published models reported similar findings to this present paper in that VJCs were educationally useful, improved critical appraisal skills, but also suffered from low participation rates.5,6 In summary, the delivery of a VJC using social media and e–mail is simple, educationally valuable, and well regarded by junior medical staff. This multimodal e–learning platform has also been useful in overcoming some of the limitations associated with traditional journal clubs. The delivery of the VJC can easily be replicated across all medical and surgical subspecialties. Barriers to participation, such as lack of basic critical appraisal skills, are likely to be overcome with the addition of specific teaching strategies. REFERENCES 1.

Cave MT, Clandinin J. Revisiting the journal club. Med Teach 2007;29:365–370.

2.

Swift G. How to make journal clubs interesting. Advances in Psychiatric Treatment: Journal of Continuing Professional Development 2004;10:67–72.

3.

Deenadayalan Y, Grimmer-Somers K, Prior M, Kumar S. How to run an effective journal club: a systematic review. J Eval Clin Pract 2008;14:898–911.

4.

Peräkylä A, Ruusuvuori J. Analyzing talk and text. In: The SAGE handbook of qualitative research. Denzin NK, Lincoln YS (eds). Thousand Oaks: SAGE; 2011: pp. 529–544.

5.

Kawar E, Garcia-Sayan E, BakerGenaw K, Drake S, Kaatz S. Journal Club 102: Enhancing EvidenceBased Medicine Learning Using a Virtual Journal Club. Journal of Graduate Medical Education 2012;4:116.

6.

Berger J, Hardin H, Topp R. Implementation of a Virtual Journal Club in a Clinical Nursing Setting. Journal for Nurses in Staff Development 2011;27:116–120.

392 © 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 389–393

tct_12357.indd 392

10/26/2015 7:41:37 PM

Corresponding author’s contact details: Raymond Oliphant, Department of General Surgery, Royal Alexandra Hospital, Paisley, UK. E-mail: [email protected]

Funding: None. Conflict of interest: None. Acknowledgements: None. Ethical approval: No formal ethical approval was sought. This study reflects the description of a teaching method and not a piece of research, and therefore does not require formal ethical approval. Participation in the VJC was voluntary. All responses to the questionnaire were anonymised. All persons invited to complete the VJC questionnaire were informed prior to completion that their responses would contribute to a subsequent publication. Therefore, by completing the questionnaire, all participants gave implied consent for their anonymised responses to be published. doi: 10.1111/tct.12357

© 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 389–393 393

tct_12357.indd 393

10/26/2015 7:41:37 PM

Early experience of a virtual journal club.

Traditional journal club models based on didactic presentation sessions followed by group discussion have many limitations. To overcome some of these ...
229KB Sizes 0 Downloads 15 Views