I had the awesome experience of starting and coordinating the ODU DPT Journal Club over the past year. I started it wanting to know what was being put out there in research (the First Pillar), and that was certainly valuable. I found out, however, that the most valuable aspect of Journal Club is the conversation. Everyone has different perspectives, reads the same line in a different way, asks different questions and can see what you don’t see. I learned a ton from participating in this process and you certainly will too.
So, without further ado, here are my tips on how to start a PT Journal Club (J-Club):
Find Motivation: The best way to progress in life is to develop your skills and interests. The better you become, the more opportunities become available and reading is by far one of the best ways to expand your mental assets. Appraising evidence gives you a great medium to hone your critical thinking skills as well. I mean no maliciousness toward the authors, but try to rip the article apart. See what they missed, how is their study applicable to your patient load? Did they ask the right research question? Is it a high-end synthesis of data from low-end crap sources? Tons of fun ways to get the brain churning. For example: take this tact from Alan J Taylor on the Two Highlighter Approach for filtering out confirmation biases.
Find a Mentor: Find someone who has already been a part of one and ask them how they did it. This is what I did to start the ODU J-Club, I asked Dr. Michael Tamburello, PT, PhD, ATC, ECS, SCS, CSCS. He had started many J-Clubs in his career and he happened to be the go-to guy when you wanted up-to-date research and critical appraisal. Now, you may not have access to someone like this… so you’ve got this blog-post instead, but ask around. Someone in your roll-a-dex (smart phone) likely has some experience.
Find a Seasoned PT: So you want that conversation and discussion, like I mentioned above: well, those that have seen things come and go, and have treated patients with the conditions you are discussing can bring extreme value to the club. Attract them in, ask them to participate. They will be able to expand on that “background” section of the articles and will perhaps have worked with the study authors previously, or interacted with them at conferences. It is always good to have historical context when exploring an issue and the seasoned PT brings that.
Additionally, if you know of someone who has completed and published research (well, published is not a must I suppose!) then ask them to participate. Once you get the J-Club going you can critique their work and they can give you the inside track on the strengths and struggles they encountered. We had this opportunity in our last J-Club of the year, where we reviewed the article COMPARATIVE IMMEDIATE FUNCTIONAL OUTCOMES AMONG CRYOTHERAPEUTIC INTERVENTIONS AT THE ANKLE by our fellow classmate. It was a great meeting and added a lot to the group.
Find Articles: Ok, yes, you do need something to read and appraise! As a J-Club coordinator you can pick the articles/topics, or ask for suggestions from those interested. This can include a new diagnosis that has been showing up in the clinic, or perhaps some hot topic, or that one technique that the old PT does that’s not worth a dang anymore and you want to be passive aggressive about invalidating it… whatever you think would make for good discussion and get people interested. I started out letting my mentor pick the first 3-4 articles, then picked a few myself, then mixed in solicited content from the group.
Now how do you get articles? Well, APTA’s PT Journal, your section Journal, etc should be a few places. Someone in your clinic is a member if you are not. Perhaps your clinic pays to be a member of a a data group and has access to EbscoHost or PubMed or PEDro, PTnow, heck Twitter is a great place! You can also ask your DPT students. They have access to their University servers and can get you all sorts of material. And, lastly, you can email the author of the article; I have heard this is a nice way to get the content and perhaps even start a dialogue.
Don’t have time to find and read articles? Please see this link here from PT Podcast on how to keep up with research. Really… read that post, it’s boss-some. You can make it a habit, no doubt. J-Club takes an hour every two weeks to discuss an article and perhaps an hour reading it beforehand. That’s 4 hours a month. You got that time. Heck, if you can get the manager/boss in on the J-Club, perhaps it’ll be paid time.
Find People: I suppose this should have been mentioned earlier, but reading articles by yourself and talking to the mirror is not what we’re after here. Now, if you have one of those awesome clinic environments where people are pushing the envelope, driving the profession forward and seeking to excel, then this part should be easy; just ask and set an article and date. If you are in Home Health, or in one of those complacent clinics then it can be a bit tougher. First off: try. You could really turn a clinic around and create a fire in your coworkers and be a catalyst.
If this doesn’t work you still have options. You can find potential J-Clubbers at your local PT Association chapter meeting, your old classmates, PT friends at other clinics, etc. Chose those that you like to “talk PT” with, and make the conversation official. All you need is 2+ others to start something.
To add on to this section I’ll mention that these encounters need not occur in the work-place, even when the group is fellow co-workers. Set it on Tuesday nights (every other week) at someone’s house, or at a relaxed bar, or Google Hangout, etc. It can be fun, don’t limit the time or the place or the people.
So, now you’ve found the people, found an interesting looking article, picked a time and a place.
How does the meeting go? First off, arrange yourselves on equal levels (seating wise). No head-of-the-table. You don’t want it to be a seminar or lecture, it’s gotta be a discussion with multiple inputs. I like to follow the general set-up that they use over at PT Inquest. Essentially, start by stating the title, and going over the authors. If anyone knows anything about them, shout it out. Then read out the abstract. This sets the stage well. Then go in to the background information, again if anyone has any additional information at any point, chime it on in! You can learn a lot by just going through the background, so spend some time here if you need to.
Now the Strengths and Weaknesses of the study can be brought up. Not all strengths and weaknesses are statistical. Look to see if the authors address the purpose of their research. See what population they tested, what methods did they use to blind the authors or participants. See here, here or here for steps on how to appraise an article. This part you will certainly get better at as you go along. You will learn to take a critical eye to those statistics too. (that purported “moderate” effect size that is a 0.3 and other such “slip-ups” will start to jump out at you) You will start to see Sample Sizes and Tests Of Differences, etc in a better way, don’t worry about it at first, look up a statistical test per week and soon you’ll have it down. (disclaimer: almost anyone can still get lost in the stats… I get lost all the time).
Now just ask questions. When you are reading before the meeting write in the margins, someone there can help explain it. Try to see if any assumptions are made in the study. Anything you don’t understand, even if it’s just a sentence, ask about it. Likely others have similar questions, or perhaps the answer. If not, BOOM, now you have your next J-Club topic if you want to dig deeper. And so it goes.
After this section, address the clinical application. What does this mean to your daily practice? Will it change anything? Does it re-enforce your current views? Challenge them? Did it persuade that PT to stop doing that invalid technique?
Whatever way you choose to go through the study, try to make it semi-systematic, like any other algorithm. Either way the whole process should make you think. Important note: To make things go best there must be an environment of trust. Everyone is there for the same goal. To learn and discuss and get better. Trust that comments coming from others are not directed at you or your methods. It’s about discussing what we know today… we’ll all be wrong in 20 years, so don’t take it personally.
Ok then. Hope this gave you some direction. It’s really easy to do… get peoples, get articles, get questioning, get appraising, get better.