Portal de Periódicos da CAPES

Rethinking Medical Journal Club

2019; Elsevier BV; Volume: 133; Issue: 5 Linguagem: Inglês

10.1016/j.amjmed.2019.10.033

1555-7162

Alec L. Meleger, John Patrick T. Co, Ross Zafonte,

Meta-analysis and systematic reviews

One of the earliest medical journal club references is credited to Cushing's description of Osler's first formal journal club held in 1875 while at McGill: "for the purchase and distribution of periodicals to which he could ill afford to subscribe as an individual."1Linzer M The journal club and medical education: over one hundred years of unrecorded history.Postgrad Med J. 1987; 63: 475-478Crossref PubMed Scopus (206) Google Scholar Over the ensuing decades, the goals and nature of these collegial meetings have evolved and gone on to gain wide professional acceptance, especially within teaching programs, serving as venues of knowledge discovery and its dissemination. Medical journal clubs continue to play an indispensable role in academic life where professional staff and trainees regularly congregate, present, and critically appraise the latest in biomedical research and how it impacts clinical practice. While the classic journal club format has maintained consistency—junior staff present the essence of a chosen article and a senior faculty member facilitates consequent discussion among attendees—the journal club's ability to "keep up" and disseminate new knowledge on a timely basis has become unsustainable due to exponential growth in biomedical publications.2Bornmann L Mutz R Growth rate of modern science: a bibliometric analysis based on the number of publications and cited references.J Assoc Inf Sci Technol. 2015; 66: 2215-2222Crossref Scopus (708) Google Scholar In 2014, there were approximately 28,100 English-language peer-reviewed journals in science, technology, and medicine with a collective publication rate of 2.5 million articles per year and 3%-3.5% annual growth rate in both the number of journals and articles being published.3Ware M Mabe M The STM Report: An Overview of Scientific and Scholarly Journal Publishing.4th ed. International Association of Scientific, Technical and Medical Publishers, The Hague, Netherlands2015https://digitalcommons.unl.edu/scholcom/9/Date accessed: November 20, 2019Google Scholar To quote Fraser and Dunstan's4Fraser AG Dunstan FD On the impossibility of being expert.BMJ. 2010; 341: c6815Crossref PubMed Scopus (64) Google Scholar feature article "On the impossibility of being expert" published in 2010: "To keep up to date, the cardiac imaging specialist needs to read 30 papers a week on echocardiography or 43 a week on multimodality imaging." One can easily infer how much "extra reading," in addition to keeping abreast within one's own field of expertise, would be required to maintain some semblance of clinical well-roundedness while stoking the fire of professional burnout. As the rest of our society has experienced dramatic digital and social media transformation, when it comes to knowledge discovery and its content management, the biomedical community continues to lag behind, while diverse nonmedical websites like GitHub, Goodreads, the Internet Movie Database, and Amazon's "Product Reviews" allow their users to collaborate, comment, and rate respective site content, leaving well-structured digital footprints for the benefit of the society at large. Certainly, sites like Twitter, Facebook, KevinMD, and Medscape do allow for facile sharing of medically related information, with several of the virtual medical journal clubs having also gained some traction over the years: 1) Wiki Journal Club, 2) American College of Physicians Journal Club, 3) Twitter-based #NephJC.5Wiki Journal Club homepage, 2019. Available at: https://www.wikijournalclub.org/wiki/Main_Page. Accessed September 14, 2019.Google Scholar, 6ACP Journal Club homepage, 2019. Available at: https://annals.org/aim/journal-club. Accessed September 14, 2019.Google Scholar, 7The NephJC homepage, 2019. Available at: http://www.nephjc.com/. Accessed September 14, 2019.Google Scholar However, these sites' web architecture is not amenable to inclusion and utilization of multiple institutional journal clubs when crowdsourcing eloquent critiques, quality scores (eg, Jadad, STROBE checklist), strength of evidence, or existence of causation between factor A and B can all be aggregated, leading to tempered bias, plurality of views, and consensus building. Several authors have proposed detailed step-by-step guidelines on developing a virtual journal club, while falling short of discussing facets of robust content management.8Chan TM Thoma B Radecki R et al.Ten steps for setting up an online journal club.J Contin Educ Health Prof. 2015; 35: 148-154Crossref PubMed Scopus (55) Google Scholar,9Lin M Sherbino J Creating a virtual journal club: a community of practice using multiple social media strategies.J Grad Med Educ. 2015; 7: 481-482Crossref PubMed Scopus (21) Google Scholar Yet another attempt at stimulating online literature appraisal, PubMed Commons, part of PubMed database maintained by the National Library of Medicine, was introduced in the fall of 2013 to allow commenting on indexed citations for biomedical literature. However, due to minimal usage, with comments submitted on only 6000 of the 28 million articles indexed in PubMed, PubMed Commons was discontinued in the spring of 2018.10NCBI Insights. PubMed Commons to be discontinued (updated on February 27, 2018). Available at: https://ncbiinsights.ncbi.nlm.nih.gov/2018/02/01/pubmed-commons-to-be-discontinued/. Accessed September 14, 2019.Google Scholar ResearchGate, a networking site for scientists to promote collaboration, paper sharing, and discussion has not gained significant traction among the medical community. A quick search (June 2, 2019) for the recently published and consequential ARRIVE trial, which examines the role of aspirin in primary prevention of vascular events in patients at moderate risk for cardiovascular disease, showed zero comments from the ResearchGate community, while it can be said, with a great amount of certainty, that it has been and is being discussed in multiple medical journal clubs around the country and the world.11Gaziano JM Brotons C Coppolecchia R et al.Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial.Lancet. 2018; 392: 1036-1046Abstract Full Text Full Text PDF PubMed Scopus (467) Google Scholar Regrettably, these peer reviews will not be digitized and aggregated for the benefit of the medical community, and as it currently stands, widespread adoption of a robust, user-friendly, and interactive biomedical knowledge discovery and management gateway does not exist. A comprehensive, web-based platform can remarkably enrich journal club experience, facilitate knowledge discovery, crowdsource critique, and optimize content management. The potential benefits of such a gateway are numerous, for both trainees and professional staff, and can have profound downstream effect by enhancing competence of critical literature appraisal and subsequent erudite refinement of current medical practice for the benefit of the clinical community at large. PubMed Commons and ResearchGate have not been able to gain meaningful traction because their web interface and site architecture were not specifically developed for journal club experience, and current virtual journal clubs either lack interactive capability or have not been engineered for facile content management. A well-designed application would afford a fluid segue in helping to create a digital footprint of discussions already taking place across multiple academic institutions. Critical requirements for such an interactive application would be the same as for any other popular "app"—intuitive user interface, accessibility across multiple platforms (ie, desktop, smartphone, tablet), offline capability, powerful search engine, well-styled comments section, synchronous and asynchronous participation, utilization of voting and quality scoring tools, etc. Journal club preceptors, in addition to moderating conversation and integrity of digital content, would also be able to gauge residents' engagement, topic comprehension, and critical appraisal based on the caliber of comment generation, as well as allow off-site clinicians, researchers, and statisticians to additionally facilitate with literature assessment. Enhanced content tagging generated by users and text mining software would allow for more powerful literature search—imagine being able to search for specific studies based on particular inclusion criteria, sample size, geographical locale, drug dose, placebo type, outcome measure, or statistical test applied. While registered users would also be able to rate individual journal clubs on the quality of their content, which can enhance academic visibility, gain online followers, and push content creators toward progressive excellence—exhibited by disciplined assessment of research questions being asked, while commenting on such elements as adequacy of sample size, randomization, blinding, appropriateness of statistical tools used, and admissibility of results attained. Quality control of digital content creation will be overseen by journal club preceptors as well as the community of registered users, where registration can be limited to members of academic institutions and well-recognized sites (ie, Doximity, ResearchGate). Additionally, quality of critique, comments, and voting by registered members can further be weighted by member reputation scores generated by fellow users or by using analogous metrics such as RG Score from ResearchGate, which is based on one's peer-reviewed publishing history. In conclusion, and as importantly, access to such a trove of peer-reviewed literature summations would markedly enhance both clinical knowledge and critical appraisal, as well as decrease the reading burden for a majority of clinicians, and will lead to improved care for our patients. The time has come to crowdsource biomedical knowledge—a robust, well-designed journal club-style gateway would yield the strongest results.