Setting and Problem

Prior to academic year 2015, the journal club components of the San Antonio Uniformed Services Health Education Consortium (SAUSHEC) internal medicine residency curriculum had typically been in the format where 1 article was sent out each month to the residents, with 1 or 2 residents assigned to review the article. The limitations of this format included the fact that only those who were presenting were actively involved; others may not participate and/or may not have read the article; and the article was provided by the program, decreasing trainee motivation to learn how to search the medical literature for an appropriate article to answer a clinical question. The benefit of this typical journal club format was the presence of an in-depth review of a single article.

Intervention and Outcomes

To revamp the journal club of the SAUSHEC Internal Medicine Residency Program, a change was suggested by a core faculty member to make the experience more engaging for millennial learners, and encourage them to learn how to answer clinical questions using the medical literature. The 94 residents were divided into 4 teams for the academic year and were tasked with selecting a journal article that best answered the clinical question of the month. The new format had several advantages: it required active participation by a larger number of residents, as it was team driven; there were 4 articles to be discussed; it taught residents how to search the medical literature and variable online professional resources to answer the clinical question; and it fostered team building through friendly competition. One limitation of this format was that each article was summarized and was not discussed in full detail.

Journal club was lined up with academic half-day conferences' “Specialty of the Month.” The chief resident, who is a staff physician, ensured that each team had a different article and that meta-analysis and guideline articles were not selected. The journal club judge was a faculty member from the specialty department, who determined which team had the best article to answer the clinical question. Points were given to the winning team each month. Cumulative points throughout the year resulted in recognition of the winning journal club team with a trophy. A post–academic year survey of the residents regarding the new format revealed a majority preferred the new journal club format with an overwhelming majority wanting to continue with the new format for the next academic year; 75% of respondents increased the number of articles they read. Comments from resident participants included:

“Residents are more vested in the team atmosphere . . . We are learning how to research and answer clinical questions.”

“I like being more actively engaged in choosing an article that best answers a clinical question, which is more realistic to how I will use articles in the future. Also, the competitive atmosphere keeps people more engaged.”

“The problem with the old system was that in each group, only the group leader would have read the paper and typically without much discussion beforehand as to what key points should be discussed. Then we would circle up and simply answer questions about how to critically evaluate the article, usually ending the session without a good discussion of the theme of the paper. Very few people were ever prepared and even fewer took it seriously. The new format condenses 4 papers into highlights with a rapid presentation allowing a broader evaluation of the clinical question and how one might approach answering it. The different perspectives and take-away points from the articles are a nice way to pique interest in the topic and the final word from the guest judge usually puts everything into context. I like that more people are involved . . .”

The journal club format at SAUSHEC was revamped for the millennial learner by creating teams and fostering a competition-style format to answer a clinical question. This format can be easily adopted by other graduate medical education training programs.

Author notes

The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, US Army Medical Department, US Army Office of the Surgeon General, Department of the Army, Uniformed Services University of the Health Sciences, US Air Force, Department of Defense, or the US government.