The journal club (JC) is an important learning tool in most residency programs, but formats are diverse, with no consistent standards (1–5). Yager et al. reported a survey obtained from 67% of general and 58% of child psychiatry program directors (5). Most had JCs (86%). Higher ratings were associated with mandatory attendance, regular faculty participation, and a focus on research methods (5). Fu et al. investigated the utility of a psychiatry JC, with 12 residents, who participated for 12 weeks, with matched controls (2). The JC was led by a psychiatrist, with one resident selecting and presenting a critical review each week (2). The authors concluded that their format may not be effective in teaching critical appraisal skills (2).

Articles in various specialties report the positive impact of a structured presentation format and a facilitator knowledgeable in research methods and statistics (4, 5). Attributes associated with successful JCs include a small program, perceived importance by the program director, and an active residency research program (5). Successful JCs have regular meetings, mandatory attendance, articles that circulate before the meeting, and food (5, 6). Using established critical appraisal processes, summarizing findings, and having a clear purpose are recommended (1, 4). A limitation was the varied structure of JCs, including educational goals, standards, and formats (1, 3–5).

The use of checklists or reading guides may increase consistency of review, reading speed, and ability to critically review literature (1, 7). Burstein et al. introduced a structured review instrument and determined that it increased resident satisfaction and improved perceived educational value of the JC, without increasing workload (7).

Educational Innovation

Before June 2010, a single M.D. faculty managed a JC with regular meetings, food, and mandatory attendance. Articles were chosen and presented monthly by a resident. However, timelines were not defined; discussion goals were unclear; and explanation of research methods and statistics was limited.

In June 2010, we instituted three major changes to the structure and organization of the JC. First, a Ph.D. facilitator was appointed to increase discussion of research methods and statistics. Second, a self-directed, structured summary format was incorporated to standardize the curriculum, clarify methodology, and increase critical appraisal skills. A resident was assigned to choose an article to be approved by the facilitator and chief resident 6 weeks before presentation. The resident created a one-page, self-directed, structured summary, using a facilitator-designed template to report the background, purpose, research question, hypotheses, data and methods, findings, and conclusion, and report compliments or critiques (Table 1). The resident critiqued the article and presented core concepts in one page. Two weeks before the presentation, the facilitator provided feedback, and the resident revised the summary. The final summary was distributed on the presentation day and was used to facilitate discussion. The resident analyzed the article and described key points with considerable self-directed learning. The expectations for presentation were explained to the residents in the first session. All residents were expected to attend and to have read the article. Lunch is served. Finally, we involved a rotating clinical psychiatrist faculty member to enhance the clinical relevance of the discussion and provide multiple viewpoints.

Once changes were in effect for 1 year, IRB-approved surveys were distributed to residents after they had completed the summary and presented at at least one JC. Likert-type questions measured satisfaction with educational components (Strongly Disagree, Disagree, Agree, Strongly Agree) and effectiveness of participants (Very Ineffective, Somewhat Ineffective, Somewhat Effective, Very Effective). Open-ended suggestions and criticisms were encouraged.

In all, 15 of the 17 residents (88.2%) who completed a self-directed, structured summary and presented from July 2010 to December 2011 completed a survey; 20.0% (N=3) were PGY-IV or PGY-V; 33.3% (N=5) were PGY-III; 40.0% (N=6) were PGY-II; and 6.7% were PGY-I (N=1).

All residents agreed (73.3%; N=11) or strongly agreed (26.7%; N=4) that they gained a stronger understanding of how to critique original research from the JC. Residents agreed (20%; N=3) or strongly agreed (80%; N=12) that their use of articles for evidence-based clinical practice improved. Nearly all agreed or strongly agreed that they understood more about research methods (100%; N=15) and statistics (93.4%; N=14). Most agreed (26.7%; N=4) or strongly agreed (66.7%; N=10) that critical reading skills improved. All agreed or strongly that the JC helped them keep up with current psychiatry literature. The majority also agreed (78.6%; N=12) or strongly agreed (7.1%; N=1) that the self-directed, structured summary is an effective tool for JC teaching. All agreed or strongly agreed that JC enhanced learning. Nearly all (86.7%; N=14) reported that the summary was worth their time and effort.

The Ph.D. facilitator, chief resident, rotating M.D. faculty, and presenters were rated as effective. Comments fell into three categories. First, the summary was extra work, but it enhanced discussion. Second, residents appreciated the usefulness of a dedicated facilitator with clear participation guidelines. Third, residents recognized the usefulness of having one faculty person emphasizing research methods and statistics and another clarifying clinical implications.

We acknowledge several limitations. We are reporting one program, with a small number of trainees. We did not perform an objective pre- and post-test. Results were not stratified to assess potential differences by PGY. There may be recall bias regarding the experience of completing the summary.

With these limitations in mind, we found that JC effectiveness was augmented by the enhanced organization and oversight, including resident accountability. Residents appreciated the consistency and order of the JC, improved with the addition of the self-directed, structured summary. Moreover, the residents reported gains in understanding of research methods, statistics, and critical appraisal. Our results are consistent with previous findings regarding the use of structured review instruments (1, 7). The involvement of varied faculty enhanced the application of research to evidence-based clinical practice. Future research should assess more objective measures to assess resident educational outcomes. Faculty participants should be surveyed to explore perceptions of these changes.

Our study provides educators with a tool to enhance resident accountability and learning. It highlights various factors that encourage the success of JC. Our findings suggest that an organized JC combined with the use of the self-directed, structured summary positively contributes to resident research training.

Research was completed at the Southern Illinois University School of Medicine.

We thankfully acknowledge all residents who participated in the journal club and survey. Preliminary findings were presented as a poster at the 2011 Association for Academic Psychiatry Annual Meeting.

No financial support was provided for this study.

The authors have no financial relationships or conflicts of interest to disclose.