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Evaluation of Medical Literature and Journal Clubs

Lindsay Davison, PharmD, and Jean Cunningham, PharmD, BCPS

CASE

H.G. is a pharmacy student on an internal medicine APPE rotation. At the end of the month, all students on the rotation are required to participate in the pharmacy’s journal club. H.G. remembers presenting a handful of journal clubs during pharmacy school, but he has never presented to a roomful of pharmacists before.

Why It’s Essential

Discussions about journal clubs and medical literature evaluation have been known to cause rapid heart rate, increased blood pressure, and a host of other unfortunate adverse events in otherwise healthy fi nal-year student pharmacists (please note: these data were derived from observational N of 1 studies). Alas, have no fear! This chapter is here to save you. You may wonder why medical literature evaluation and journal clubs are considered part of The Essentials. Medical literature is what creates the treatment guidelines we rely on as clinicians, and its evaluation is how we can be confi dent (or not so confi dent) in a publication’s fi ndings. Just as you would not drive a car through an intersection with your eyes shut while the passenger concluded that the coast was clear, you should not accept the author’s conclusions of a trial without evaluating the literature. Understandably, you may now be wondering how in the world pharmacists can fi nd the time to evaluate all of the medical literature that impacts their practice. The answer is that they do not. This is where journal clubs come in. A journal club is typically comprised of practitioners who meet to critique and discuss recently published medical literature, distributing among a number of practitioners the diffi cult task of keeping up. While you are on your APPE rotations, you will most likely be asked to become a part of a journal club by reviewing an article and leading the critique—a discussion of the article’s strengths, weaknesses, and potential impact on pharmacy practice.

“Though literature evaluation can be a difficult skill to master, your rotations offer the perfect environment to put your abilities to the test and build a strong foundation for the rest of your career. Use your preceptors to find and fix any areas in need of improvement and start getting into good habits.”—Preceptor

Note: The views expressed in the chapter do not necessarily represent the views of the agency (Food and Drug Administration) or the United States.

59 60 Maximize Your Rotations

Does This Study Matter to Me?

The process of designing a journal club presentation begins with identifying an appropriate article to present. The age-old question “Does this study matt er to me?” is probably the most important one you can ask yourself when surveying the medical literature for an article to present on rotation. If a trial is conducted using a therapy not available to your patients or includes a patient population completely unlike the patients you treat, then reading about it will most likely be a waste of your time. The results of that trial may matt er a great deal to other pharmacists but mean nothing to you. Lesson #1: Do not waste your time. Choosing appropriate journal articles will give you more time to accomplish other tasks and also make your preceptors appreciative that you are providing them with a journal club that they are actually interested in! Interpretations of what matt ers to a practice site can vary, so do not hesitate to ask your preceptors for guidance when choosing an article. On occasion, a preceptor will direct you toward articles in a certain therapeutic area or within a certain class of drugs. Take this advice and run with it! Use PubMed’s medical subject headings (MeSH) terms and limits to your advantage to limit the scope of your search results to match your preceptor’s guidance (see Chapter 5 for a review of PubMed searches). Skim over the two to three articles that seem to be the best fi t, and if they seem like good options, provide your preceptor with copies. Typically, your preceptor will be more than happy to review your short list of articles and tell you if one stands out as most interesting or impactful on his or her practice. Finally, if this route is not eff ective, search the lay press. A general Internet search can help deter- mine if an article you are considering sparked media att ention that may have patients making inquiries to your preceptor. For example, if a trial was published in a major medical journal and the nightly news ran a story about how a commonly prescribed drug may reduce cancer risk, the story is defi nitely going to generate patient interest. Whenever new information is touted to the masses, it represents an opportu- nity to be one step ahead of the questions that will be coming up in patient encounters.

CASE QUESTION

H.G. is having trouble picking an article to present for his journal club. Where can he turn to get some ideas?

Background and Introduction

Now that you have chosen an article, your evaluation begins before you read a single word of the article. First, the audience at your journal club will expect you to be well versed in the current standards of care for the condition treated in the article and where the investigational agent fi ts in. Next, you will need to assess the journal that published the article along with its title and authors. Reviewing this information before you dive in to the trial’s methods and results will build a strong foundation of knowledge and improve your overall journal club presentation.

Study Context Before you begin to evaluate your article in detail, you should perform an appropriate literature search to fi nd supplemental materials for the selected article. The introduction section of your presentation, which includes the relevant background information and previous studies, should be about 15% of the total presentation time. This will allow you to put your article into context and describe relevant back- ground data (guidelines, reviews, existing studies on similar agents, etc.). It will also be imperative to fi nd recent publications preceding this article or that have been published since the article was released.