The classic format

The traditional or classic JC format (figure 1) in its most stereotypical form usually occurs face-to-face. Peer-reviewed journal articles of interest are presented by a junior trainee, followed by discussions often led by the more senior members of the clinical hierarchy in attendance. This, or a similar process, is reproduced in many institutions all over the world. It confers distinct educational benefits, including improved critical thinking skills, increased knowledge of research design and enhanced research awareness.8 9 However, the stereotypical format described may have potential pitfalls (which could be, and indeed are, optimised in some institutions) as applied to a contemporary clinical environment. For example, a JC based around a didactic presentation runs the risk of attendees becoming passive listeners.6 JCs led and facilitated by senior clinicians may result in discussions dominated by those with more experienced viewpoints. Face-to-face meetings that adhere to rigid schedules do not suit healthcare professionals who work different shift patterns or who are geographically isolated.10 11

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Figure 1

Examples of journal club (JC) formats. In practice, elements of the classic format can be incorporated into other formats, resulting in multiple potential hybrid approaches to JC that follow the guiding principles of JC design (box 2) and that address the key issues important to consider when setting up a new JC (box 3).

Modern approaches to a classic format

JC has a lot to offer contemporary learners as a medical pedagogy.8 12 13 Educational researchers view the potential of JC through the lens of educational theories that emphasise social learning, communities of practice and distributed leadership.14 The central premise of the JC format can be built on to reflect the principles of contemporary clinical education approaches, which value collaboration, participation and learner engagement (figure 1; box 2).14 15 Although JC design can be approached in a multitude of ways depending on the educational, institutional or departmental context, we consider more recent complementary approaches below, which may promote deeper learning and a wider reach for participants.

Consider who your learners are

Creating a JC from scratch represents an opportunity to design a JC that best suits its learners. A key starting point is carefully considering the individual and collective needs of the attendees, taking into account their career goals and varying clinical and academic experience and mapping learning outcomes accordingly.22 Hospital-based JCs often focus on developing critical appraisal skills, enhancing evidence-based practice and understanding the hierarchy of evidence. Therefore, many JCs in turn reflect ‘Evidence-Based Medicine’ curricula.23 In choosing articles, generally those published in high impact journals that are recent, paradigm changing and have the potential to influence clinical practice make for the bulk of good JC discussion material.

Just as every clinical question, research question or discovery cannot be answered by studies outlined in the typical ‘Evidence Pyramid’ and critical appraisal thereof, JC material may vary depending on context or even week. JCs still help to keep teams and individuals up to speed with topical and important research themes and, for example, material may also include case descriptions, qualitative research, clinical practice guidelines and review articles of major importance (table 2).24 Attendees involved in academia and scientific research may also be interested in translational research approaches. Occasional reviews of recent conferences or discussions around the evidence base for alternative or even controversial approaches in medicine may also appeal to attendees. While attendees ‘rotating through’ general paediatrics and its subspecialties may find these former approaches most relevant, medical JCs also represent an excellent opportunity for interprofessional education and learning, and so can be attended by and tailored towards multidisciplinary professionals.25

Encouraging attendance and engagement

The first step in creating a sustainable, effective JC that engages a learner group is to identify a core team to assist with the design process. This team should consist of genuinely enthusiastic, engaged junior learners and senior clinicians who are willing to act as facilitators of the JC process.8 14 This team can then consider the key ingredients relevant to the learning contexts of their JC group.

The optimal size of journal club has yet to be determined, though at least eight attendees has been suggested for JCs at departmental level. The optimal execution of larger (eg, hospital-wide critical appraisal rounds) may differ, for example, more or less formal boundaries, participant and attendee roles, depending on group size.22 26 Provision of food has been debated and has been associated with increased attendance.8 Mandatory attendance has also been suggested to promote attendance, as has using JC to fulfil continuing medical education or ‘e-portfolio’ requirements. However, being physically present does not equal engagement,8 27 and while these incentives are useful to consider, the emphasis should be placed on actively engaging the target audience so that they realise there is something of value to be learnt during the sessions.