Yale Pediatric EBM Journal Club Website

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Yale Pediatric EBM Journal Club Website

• A Web Resource Project
• Rachel L. Chapman, M.D.

Medical Informatics, Summer Quarter
2006 University of Cincinnati College of Education
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Outline

• Background/History
• Project Goal and Scope
• Methods
• Tour of Website
• Future Directions

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Background/History
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What is EBM???

• Evidence based medicine is the integration of
  individual clinical expertise with the best
  available external evidence from systematic
  research
• Sackett D. Evidence based medicine what it is
  and what it isnt. BMJ 1996 31271-72

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EBM and Pediatrics

• Throughout the 1990s the concept and practice of
  EBM flourished within the disciplines of internal
  medicine, family practice, and perinatology
• Over the past 4-5 years, there has been
  increased interest in and practice of EBM within
  in the field of pediatrics

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Applications of EBM Within Pediatrics

• AAP Clinical Practice Guidelines
• CDC and NICHD Consensus Statements
• AAP Grand Rounds
• Archives of Pediatric Adolescent Medicine
  Journal Club
• Pediatric EBM Web Sites
• Pediatric EBM Journal Clubs

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Use of EBM in Clinical Practice

• The Five Steps of EBM
• Ask answerable clinical questions
• Search relevant literature efficiently
• Appraise found data critically
• Apply valid evidence into clinical
  decision-making
• Evaluate and improve the process for future use
• (Onady Raclich, Pediatrics in Review
  September 2002)

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History of the Journal Club

• Historically, journal clubs have been a forum
  where physicians come together to review recent
  articles
• First formal journal club was established at
  McGill University in 1875 by Sir William Osler
  for the purchase and distribution of periodicals
  to which he could ill afford to subscribe
• (Forsen JW Jr, Hartman JM, Neely JG Tutorials
  in clinical research, part VIII creating a
  journal club. Laryngoscope 2003, 113475-483)

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History of the Journal Club

• Journal clubs have evolved over the years, but
  three goals have persisted to keep up with
  current literature, to impact clinical practice,
  and to teach critical reading skills
• (Linzer M The journal club and medical
  education over one hundred years of unrecorded
  history. Postgrad Med J 1987, 63475-478.)
• There has been a recent trend toward the
  development of EBM Journal Clubs, where the
  focus is directed at the process of practicing
  EBM, as well as the article or articles discussed

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EBM Journal Clubs

• Many residency programs have developed EBM
  Journal Clubs as one way of teaching the core
  competency of Practice-Based Learning
• Several of these journal clubs use a web-based
  format for coordinating the club and for
  publishing CATs (Critically Appraised Topics)
  developed by the residents
• http//www.med.umich.edu/pediatrics/ebm/
• http//pedsccm.wustl.edu/EBJournal_Club.html
• http//pediatrics.uchicago.edu/chiefs/journalclu
  b/
• http//www.med.umn.edu/peds/pedsres/current/curri
  culum/journalclub/home.html

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Yale Pediatric EBM Journal Club

• Inaugurated in 2003 with the assistance of a
  dedicated group of chief residents and faculty
  preceptors, with the following goals
• To answer important clinical questions using the
  available medical literature
• To learn and apply basic critical appraisal
  skills based on the type of question being
  answered
• To validate or change your clinical practice or
  institute new practices based on critical
  appraisal of the medical literature
• To practice and teach these skills to each other
  in real clinical situations during morning
  rounds, on-call, during morning report or
  discharge conference, in the clinic, etc.

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Yale Pediatric EBM Journal Club

• Twice a month, one of the senior residents works
  with a faculty mentor to present journal club
• The 5 steps of EBM are incorporated into the
  presentation always beginning with an actual
  patient!

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Yale Pediatric EBM Journal Club

• A 100 page journal club manual was updated and
  distributed to all senior residents and faculty
  annually and included
• Background and instructions for presentation
• Select Users Guide to the Medical Literature
  Articles
• Critical appraisal worksheets
• Copies of sample presentations
• A list of EBM resources

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Project Goal
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• To develop a web resource for the Yale Pediatric
  EBM Journal Club that incorporates the
  information contained in the current manual and
  serves as an EBM resource for all housestaff and
  faculty

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Methods
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Getting Started

• I met with our Chief Residents and Medical
  Librarian to develop a wish-list of
  content/resources for the website
• Hand-drew a general layout for the site and
  collected all resources into one folder on my
  hard-drive
• Obtained access to Macromedia Dreamweaver MX
  via the WebMaster for our Yale Pediatric
  Residency Website
• Obtained familiarity with the program through the
  generous help of our Chief Residents, review of
  the instruction manual, and liberal use of the
  Help function!

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Web Design

• I started with an introductory page, with links
  to the major resource pages
• Direct links to handouts, worksheets, and
  websites were created
• Pictures were added for visual appeal
• E-mail link for questions was created
• Links to sample presentations and a space for
  posting this years presentations was created
• Site was published as a link via the Yale
  Pediatric Residency Website

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Tour of Website
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Future Directions

• The site will updated twice a month, adding new
  journal club presentations, updates, and links to
  new web resources
• Plan to add links to our medical library, PubMed,
  OVID
• Plan to move toward a requirement of a one-page
  CAT (Critically Appraised Topic) for posting on
  the site (in lieu of posting the whole
  presentation)

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Acknowledgements

• Thanks to the Pediatric Chief Residents,
  particularly Mark Zonfrillo, M.D. (Our WebMaster)
  for their assistance with this project!
• Thanks to all of the Yale Pediatric Faculty who
  have served as preceptors for the EBM Journal
  Club
• Thanks to my husband and children for their help
  with this project!