Letters to the Editor
To the Editor:
There are a number of mistakes that afflict journal clubs in academic medicine. One common mistake is the misalignment of goals and procedures. For example, a journal club focused on teaching clinical appraisal of articles should not rapidly review the entire contents of several journals, whereas that approach may be best if the club seeks to keep its members up-to-date on improving clinical practice.
Another frequent mistake is the use of an overly specific framework to analyze articles, because that may limit the focus to a particular type of study. Journal clubs focused on evidence-based medicine may decide not to review observational or case studies. While such narrowly focused journal clubs may have a specialized role, they also arbitrarily limit their members' view of medical practice and therapeutic advances. Clinicians can sometimes benefit from reading observational and case reports1 as well as scientific bench-research articles, animal studies, review articles, or even literary essays; journal clubs should not automatically exclude such material.
Editors or reviewers often request the participation of biostatisticians for any but the simplest statistical testing in a new submission. In addition, journal clubs have not been consistently effective in teaching physicians about statistics or epidemiologic methods.2,3 It is, then, a mistake to expect nonstatisticians to have expertise with advanced statistical tests, and a journal club's review of articles employing advanced statistical methodologies does not constitute an educational opportunity. In cases where such expertise is essential, the participation of biostatisticians in journal clubs may be useful.
Last, while journal clubs should teach members how to spot weaknesses in published articles, some clubs cross the line from formulating valid criticism to making superficial and arrogant judgments about the quality of an article's research or the review process of the journal that published the research. Recognizing where this line is can be a valuable lesson for a journal club to teach.
John Scott Baird, MD
Assistant professor of clinical pediatrics, Columbia University Medical Center, New York, New York; firstname.lastname@example.org.
1. Black N. Why we need observational studies to evaluate the effectiveness of health care. BMJ. 1996;312:1215–1218.
2. Langkamp DL, Pascoe JM, Nelson DB. The effect of a medical journal club on residents' knowledge of clinical epidemiology and biostatistics. Fam Med. 1992;24:528–530.
3. Alguire PC. A review of journal clubs in postgraduate medical education. J Gen Intern Med. 1998;13:347–353.