Utilizing journal club to facilitate critical thinking in pre-clinical medical students

Learning and practicing evidence-based medicine (EBM) is vital for all healthcare professionals throughout their careers and requires expert medical knowledge, effective communication skills to uncover patient values, as well as critical thinking skills in appraisal of the scientific literature.1 Integrating EBM training and critical thinking skills into undergraduate medical education programs is required and fully supported by accrediting bodies, such as the Liaison Committee on Medical Education (LCME) and professional organizations.2,3 Specifically, in their 2014 report, Core Entrustable Professional Activities (EPAs) for Entering Residency, the Association of American Medical Colleges (AAMC) named retrieving and applying evidence as a fundamental skill for graduating medical students.3 Core EPAs for entering residency is an initiative to define a “...common core set of behaviors that could/should be expected of all [medical school] graduates”.3 One way to incorporate these fundamental skills into undergraduate medical education is through the use of journal clubs. Journal clubs are already a well-documented instructional method used in residency programs and for continuing medical education.4,5 In that journal clubs focus on critically evaluating current literature and applying it to patient care, they provide the perfect environment for teaching EBM and have been shown to positively impact EBM knowledge and skills.6,7 Effectiveness of these journal clubs has depended on several characteristics including a clear purpose, incentives, and a trained journal club leader.8 Despite extensive use at higher medical education levels, use of journal clubs has been minimally reported in the undergraduate pre-clinical medical education literature. Most studies have implemented journal clubs during medical students’ clinical years.9,10 The purpose of this article is to describe the successes and challenges of, as well as lessons learned in implementing, structured journal club activities in the pre-clinical years in an effort to introduce critical thinking and application skills.