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Viewpoint: Reimagining Journal Club in Resident Education

Reynolds, Catie MS IV; Ostermayer, Daniel MD

doi: 10.1097/01.EEM.0000480773.37727.4e
Viewpoint

Ms. Reynoldsis a fourth-year medical student at the University of Texas-Houston, andDr. Ostermayeris an EMS fellow and clinical instructor at the University of Texas-Houston Department of Emergency Medicine.

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Journal clubs have served as a way for the local medical community to appraise and dissect medical literature for more than two centuries. (Postgrad Med J 1987;63[740]:475.) The first journal clubs date back to the early 1800s, and involved cards, smoky rooms, and late-night discussion. Sir William Osler organized a formal meeting at McGill University in 1875, and since then, residents and attendings have discussed classic and new research in settings ranging from resident conferences to local bars.

The traditional format of a local journal club is undoubtedly successful, but it has significant constraints. Only physicians in attendance gain from the discussion. Even fantastic local clubs have little global impact, and documentation for knowledge translation and recall is often absent. Online tools offer opportunities for local emergency medicine journal clubs to reimagine their place within the global EM community, increase engagement, and enhance knowledge translation.

Many journal clubs struggle to achieve maximum attendance because of busy resident and attending schedules. An innovative solution to this dilemma has been demonstrated by the Global EM Journal Club Series hosted by Academic Life in Emergency Medicine. (www.ALiEM.com; Ann Emerg Med 2014;63[4]:490.) The blog picks a journal article to discuss and allows its followers to contribute talking points on Twitter using the hashtag #ALiEMJC until a specific closing date. They then host a discussion of experts on Google+, with an accompanying blog post that includes a summary of the Twitter discussion. The Global EMJC Series using social media eliminates attendance stress by allowing everyone to contribute through Twitter and comments on the blog asynchronously. This setup, however, can make the contributions difficult to navigate because some comments are made on the video Google+ hangout while others are hidden within the Twitter summary. This format also lacks integration with local existing clubs that may not read the scheduled paper during the assigned time frame.

The emergency medicine journal club at Washington University in St. Louis has enhanced recall and knowledge translation through online documentation. Recording a session makes a journal club much more valuable for members because they can later review discussions and teaching points.

Many residency programs accomplish this goal privately by distributing minutes via emails to members. Documentation provides a permanent source for reviewing findings and recalling discussions, but the content is static. New literature cannot be added to older journal reviews, and these reviews are typically impossible to locate on a busy shift.

WikEM's Journal Club offers a novel approach to an accessible, dynamic journal club with ongoing discussion and contributions. (www.WikEM.org.) By using a wiki exactly like Wikipedia, any member from any journal club at any time can contribute knowledge gained from local discussion. The system augments the already-existing residency-sponsored in-person meetings. The material is highly integrated with core emergency medicine content linked between pages, and all content is expandable for future contributions. More importantly, the format allows local groups to set their own club schedule while also contributing relevant material to the wiki for the benefit of the global EM community.

Because WikEM.org is open access and user-generated, any journal club blog post, paper, online calculator, or podcast can be referenced and linked to a discussion to curate the best related content. Pages never close or disappear, allowing participants to build on historical knowledge, validate previous studies, or refute old evidence.

Most importantly, all of the content is available offline on a mobile device using the WikEM app. Journal club discussions directly translate into bedside knowledge because of this tool. Just as we use new meaningful technologies for patient care, it is imperative that we also bring Osler's journal club into the 21st century by making it more accessible and dynamic with online resources.

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