What makes evidence-based journal clubs succeed?

D o you catch up on valuable rest time once a week at your local journal club? Or doze while somebody presents an article that has been allocated to them, without reference to " question, " " search strategy, " or " assessing performance " ? While the rest may bring health benefits, it is unlikely to advance the quality of care. Evidence-based journal clubs, however, have documented benefits (1). Having made most of the possible " errors, " we'd like to share some tricks and traps that we think make evidence-based journal clubs work or not. We have gathered our information from personal experience, a systematic search of the literature, and stories we have been told by colleagues and members of the evidence-based health care mailing list (see Acknowledgments). One of us (PG) runs an evidence-based journal club in general practice; the other (RSP) runs an evidence-based journal club in the pediatric department of a teaching hospital (2) and facilitates journal club meetings for pharmacists. While running these disparate events, we, quite separately, stumbled on some of the same tricks and traps, many of which are supported by the findings of a large survey of the factors that predict the life span of (any) journal club (3). The structure of successful evidence-based journal clubs varies. Commonly, the clubs run in a cycle. Our own medical journal clubs run over the same 2-session cycle (Figure). The cycle may be weekly, but other time frames are possible. The last 10 to 15 minutes of the session are spent discussing participants' real clinical problems and defining the structured clinical questions that would help address these problems. A process of moderated " voting " on the questions selects the most popular ones, and then someone is assigned the literature search as homework. The first 45 minutes of the next session are spent appraising and applying the studies felt to represent the best answers to the questions raised in the previous session. If there is a wide range of studies, the work may be spread across several sessions. Figure. Alternative sequences for journal club sessions: 2-cycle (upper) and 3-cycle (lower) structures. Initially, we ran the clubs over 3 cycles (question, search, and appraisal) (Figure), and each cycle included a review of the search strategy. However, this led to boredom, particularly if there were problems along the way. Assigning a facilitator to assist with searches …