Instructions for Authors
During the course of the year, each first-year CCM fellow will be responsible for presenting and writing-up an Evidence-Based Medicine Journal Club on a topic related to Critical Care. This experience fulfils several goals of the research curriculum such that at its conclusion each fellow will be able to:
- Conduct structured critical appraisal
- Understand the limitations of the application of evidence
- Recognize and understand basic study design, distinguishing weak from strong methodology
- Gain familiarity with basic statistical tests
- Gain insight into a specific clinical problem
- Hone skills related to oral and written presentations
Journal Club Responsibilities
The success of the EBM Journal Club depends on participation of fellows and faculty. Each presentation will involve a presenting fellow and a faculty preceptor. Additionally, each presenting fellow may wish to ask one of his or her colleagues to serve as a "referee", an assistant who makes note of important discussion points during the presentation, which can then be used in the final write-up.
Presenting Fellow
You will be assigned a date and a preceptor. Except under extraordinary circumstances, these will not be changed. Any problems with either assignment (date or preceptor) should be brought to Dr. Milbrandt's attention as early as possible. The primary responsibility for the EBM Journal Club rests with the presenting fellow and the faculty preceptor. This is a joint responsibility and any problems should be brought to Dr Milbrandt's attention.
Responsibilities:
- Agree on a primary article with the faculty preceptor 6 weeks prior to your presentation (see criteria for articles below). If you are having trouble finding a relevant article, check first with your preceptor. If you are still having trouble, Dr. Milbrandt has a list of recent important articles that may help.
- Once you have selected an article, "claim" it by sending an email to Dr. Milbrandt (milbeb@ccm.upmc.edu) with the title, reference, and a PDF of the article. Dr. Milbrandt will verify that the article has not been previously selected and that it is appropriate for journal club. You will receive an email verifying this.
- Read the article and decide what type it is (Therapy, Diagnosis, Prognosis, Harm/Etiology, Economic Analysis, or Decision Analysis). This is an important step and you should discuss your decision with your preceptor. Most articles will fall into the first three categories.
- Fill out the worksheet that corresponds to the type of article you are appraising. Meet with your preceptor to go over you answers. You will use this document as a guide/outline for your presentation. Worksheets are available here
- Develop your presentation and produce a final critique (see below).
Preceptors
The primary responsibility for the EBM Journal Club rests with the presenting fellow and the faculty preceptor. Although this is a joint responsibility, faculty preceptors are expected to take the initiative to solve problems and to ensure that deadlines are met. Any problems with the fellow's performance should be addressed with Drs. Milbrandt and Rogers.
Responsibilities:
- Ensure that the primary article meets the criteria for Journal Club (see criteria for articles below). If the fellow does not have an acceptable topic/article, assign one.
- Schedule frequent meetings with fellow well in advance. Treat this like you would a book chapter that is overdue.
- Read the article and review the worksheets with the fellow.
- Review an outline of their presentation and make changes where necessary.
- Attend the presentation. If not possible to do so, review the taped presentation (see Dr. Reiker).
- Meet with the presenting fellow and the referee as soon after the presentation as possible (the same day is ideal) for a debriefing.
- Review drafts of the fellow's final critique (abstract and commentary) and ensure that they follow procedures and keep deadlines (see procedure below).
- Remember, the final product will bear your name.
Journal Club Procedures
Article Selection
Agree on an article with your preceptor at least 6 weeks before your scheduled presentation. The main article must fulfill the following criteria:
- The results of the study, if valid, must impact clinical practice in some way.
- For articles describing therapy, diagnosis, or harm, the methods of the study must fulfill the following basic validity criteria:
- Therapy : randomized, all patients accounted for.
- Diagnosis : independent blind comparison with a "gold" standard, patient sample included a reasonable mix of patients with and without disease similar to the population the test will be used on in practice.
- Harm: the comparison group was similar except for the "exposure" of interest, exposure and outcome were measured the same way in both groups.
- The study contains no other major flaws of methodology
- The primary article should be recent (last 2 years).
- The article (or one just like it) should not have been reviewed in the last 2 years.
Review
Critique the article with your preceptor according to the appropriate guideline worksheet provided:
Therapy Worksheet
Diagnosis Worksheet
Prognosis Worksheet
Harm/etiology Worksheet
Economic Analysis Worksheet
Decision Analysis Worksheet
- Download or view the worksheet using Adobe Acrobat. If you do not have Acrobat installed on your machine, the software is available free from Adobe.
- Fill these out online and print them for your preceptor.
- Revise them as needed.
Drs. Kellum, Angus and Milbrandt are available for specific help regarding evidence appraisal. Drs. Rotondi and Kellum are available for help regarding statistics. Dr. Rieker is available for help with your presentation, including software assistance.
Presentation
Your presentation will be done in PowerPoint. Dr. Rieker is available to guide you. Your presentation should be roughly organized as follows:
- Topic Background (state why this is important) 5-10 min
- Outline a hypothetical (or real) case (one slide, keep it brief) 2 min
- Present the paper (its helpful to make slides of the figures and tables) 10-15 min
- Present the critical appraisal (this is best done with a slide for each 1-3 questions and your answers for each). 15-20 min
- Sum up. Include your conclusion and how YOU will put these results into practice. 5 min
Aim to finish in 40 minutes or less to save time for discussion. Try not to get too bogged down in one aspect (i.e., was the measurement tool valid?). If this cannot be settled quickly, it's your job to say so and move on.
Final Critique
This is the most important part of EBM Journal Club, since it summarizes the discussion in a concise format that will be featured on Critical Care Forum, the website of Critical Care, a leading critical care medicine journal edited by Prof. Jean Louis Vincent. This final report will literally be viewed by the world, so it needs to be sharp. The report is mandatory for all fellows and due 2 weeks after the presentation. The following criteria should be met:
- The report will take the form of an expanded abstract with a 3-5 paragraph commentary, which summarizes the journal club discussion using the ACP Journal Club format (see attached example).
- Use your worksheet and the summary from your Referee to produce the critique.
- As a general guide, you should mention at least 3 strengths and 3 weakness of the study.
- You should conclude by answering the following question: "Based on the findings of this study, should we change our practice?"
All reports will be featured on Critical Care Forum. However, Critical Care reserves the right to reject poorly written reports.
Turn in your completed write-up to Dr. Milbrandt for editorial review. He may ask you to make a few changes to strengthen it. These changes must be completed within one week of their request so that we can meet the publication deadlines of Critical Care Forum.
Your write-up should be included in your CV as a publication. For instructions on how to cite an online publication, please see http://www.apastyle.org/elecref.html.
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