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About the Curriculum
EBM and Journal Club are combined for 2020-2021. These sessions are meant to develop residents' application of evidence-based medicine and critical appraisal skills. Residents will learn to apply evidence-based practice skills to patient care, close reading in journal clubs or for discussions with peers, and board questions. It is also an opportunity to further the ability to search for high-quality or evidence-based articles relating to a patient case or research project. These sessions will focus on enhancing understanding of research design, biomedical statistics, and clinical reasoning.
Throughout the year, EBM and journal club will be led by teaching residents. Faculty will facilitate. Our learning objectives are the following
- Lead a journal club of no more than 45 minutes in length on the assigned study type that includes teaching on assigned block objectives
Journal Club leaders are expected to:
- Develop an answerable clinical question based on personal clinical experience
- Search for relevant journal article in medical literature to answer clinical question
- Apply critical appraisal concepts to chosen article using a structured approach to evaluate quality of evidence and answer clinical question. Quality of evidence includes, but is not limited to, validity of the study design, confidence of results, and applicability of the study. Frequently asked medical questions include prevention, therapy, harm/causation, diagnosis and prognosis. This should take about 40 minutes
- Select volunteers from the audience (one to play the patient role and one to play the physician role) and have the volunteers participate in a simulated encounter where the physician counsels the patient on the clinical question based on the analysis of the article. The Journal Club (JC) leader should provide feedback to the resident in the physician role on how they counseled the patient (ie did they explain the concepts discussed earlier in layman’s terms at about a high school level)
Preparation & Presentation
- Journal Club (JC) leaders are expected to send a chosen article to the residency’s Critical Literature Appraisal Course Coordinator no later than one week prior to presentation. They will then discuss the article with the JC leader and provide objectives (see below for course).
- Journal Club (JC) leaders are expected to send a chosen article to Academic Chair one to two weeks prior to presentation, in order to be distributed to residents and staff with weekly academic events email.
- JC leaders will create a presentation and lead group discussion. The presentation should include:
- Specific learning objectives which will be assigned by the residency’s Critical Literature Appraisal Course Coordinator
- Brief history of clinical scenario leading to the topic of discussion (no more than one slide)
- Discussion section with 5 A’s of EBM
- Facilitation of a simulated patient encounter (as
Schedule of learning objectives
Article types & learning objectives by block are listed below.
- August: RCT - bias & confounding (and ways to combat them) statistical significance/chance
- September: RCT - sensitivity, specificity, PPV, NPV (what these four mean in plain language), Likelihood ratios, prevalence
- October: RCT - likelihood ratios, prevalence, RR/RRR
- November: RCT - randomization, subgroup analysis, power, post-hoc analysis
- December: Cohort - survival curves, hazard ratio, exposure, relative risk + RRR
- January: Case control - NNT, Odds Ratios
- February: Meta-analysis - forest plots, heterogeneity, chi-square, confidence intervals, weight
- March: Systematic Review - breaking down search methods (and supplementary material)
- April: Compare 2 study types on the same topic (RCT vs Case Control)
- May: Compare 2 study types on the same topic (Case Control vs Cohort - OR and RR, methods)
- June: Compare and contrast different quality articles (focus on h-index, impact factor - what do these mean, how are they calculated, maybe a well known journal vs not, predatory journal info)
Contact the Darnall Medical Library (DML)
For WRNNMC Healthcare Providers
For WRNNMC Patients
- TRICARE Appointment Line: 855-227-6331
- Walter Reed NMMC Main Phone: 301-295-4611
- TRICARE Health Services (includes phone numbers)
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