Critically

Appraising a
Journal Article

What is a Journal Club?

An educational meeting in which a group of

individuals read, evaluate and discuss current

articles from the biomedical literature
A collective forum to provide a venue to keep
up with the literature
One of the most effective means by which
students and professionals keep up with
current biomedical literature
Evidence based practice in action

What is a Journal Club?

Classic learning and information sharing

format
Focused on current literature
Just-in-time delivery
Critically appraised information with
commentary and discussion for applicability
and relevance

What is a Journal Club?

The earliest reference to a journal club is found

in a book of memoirs and letters by the late Sir

James Paget, a British surgeon and one of the
founders of modern pathology. He describes a
group at St. Bartholomew's Hospital in London
in the mid-1800s with 'a kind of club ... a small
room over a baker's shop near the Hospitalgate where we could sit and read the journals.
Paget S: Memoirs and Letter of Sir James Paget. London:
Long-mans, Green, and Co., 1901:42

What is a Journal Club?

It is believed that Sir William Osler established

the first formal journal club at McGill

University in Montreal in 1875, though Osler
himself might have been aware of similar
gatherings that were taking place elsewhere.
The purpose of Osler's early journal club was
'for the purchase and distribution of
periodicals to which he could ill afford to
subscribe
Linzer M: The journal club and medical education: over
one hundred years of unrecorded history. Postgrad Med
J 1987,63:475-478.

Successful Journal Clubs include:

A well constructed clinical question
Searching for evidence
A critical appraisal
Commentary and discussion

Successful Journal Clubs include:

A well constructed clinical question
Asking a well-built clinical question will

facilitate your search for and acquisition of the

answer.
The clinical question being investigated is
asked in the PICO format (Patient/population,
intervention, comparison, outcome) More to
come!

Successful Journal Clubs include:

Searching for evidence
Search for articles using your well-built

question.
Identify what type of question you are asking
(therapy, prevention, cost-analysis, etc) and
what type of studies (RCT, cohort, case
reports) are best for evaluating the answer to
your question

Successful Journal Clubs include:

A critical appraisal
Evaluate the articles you have selected
You may use the Critical Appraisal Worksheet

Benefits of Critical
Appraisal
An analytical summary and evaluation of a

research study
Standard approach: recognize important
information
Standard format: easily digested, a quick
read
Usable by professionals in busy practices as
summarized, synthesized evidence

Method of Appraisal
There are a number of methods used to

critically appraise an article.

They all have the same basic format.
The method that we are using is based on one
developed by Duke University.
It is a method that you will see in journal
clubs in your 3rd year clerkships and in your
residency program encounters.

Successful Journal Clubs include:

Commentary and discussion
It is also helpful to look for any accompanying

editorial commentary, which can provide a

unique perspective on the article and
highlight controversial issues.

Anatomy of a Scientific
Article
Abstract
Introduction
Materials and Methods
Results
Discussion
Conclusion

Always Ask Six Things

As you go through the anatomy of the article,

you will always ask six things that will

correspond to the various parts of the article.

Always Ask Six Things

1)
2)
3)
4)
5)

What is the clinical question?

Why was the question asked?
What did they do? Methods
What was the answer ? Results
What did they say about the answer?
Conclusion
6) What do I do with this information? Is this
study of significant enough quality in method
to change my practice one way or the other?
- (Studies done different ways mean different
things) (Look at commentary/discussion)

Always Ask Six Things

1)
2)
3)
4)
5)

What is the clinical question?

Why was the question asked?
What did they do? Methods
What was the answer ? Results
What did they say about the answer?
Conclusion
6) What do I do with this information? Is this
study of significant enough quality in method
to change my practice one way or the other?
- (Studies done different ways mean different
things) (Look at commentary/discussion)

1. What is the Clinical Question?

What type of question is being asked in your

article?
This is typically found in the Introduction
(See Critical Appraisal Checklist based on
Duke Universitys Evidence Based Practice)

Diagnostic Test
For clinicians to use a diagnostic test in

clinical practice, they need to know how well

the test distinguishes between those who
have the suspected disease or condition and
those who do not.
Diagnostic test studies evaluate a test for
diagnosing a disease.

Differential Diagnosis
Differential Diagnosis involves the process of

weighing the probability that one disease

rather than another disease accounts for a
patients illness.
The Differential Diagnosis Study tries to sort
out what proportion of the patients with a
single sign or symptom has various diseases.

Economic Analysis
An economic analysis can provide accurate

values to assess the cost of disease and the

cost-benefit of interventions.

Harm / Etiology
A Harm/Etiology study addresses how to

identify causes for disease (including

iatrogenic forms ie caused by the healthcare
system)

Prognostic
A prognostic study addresses how to estimate

the patients likely clinical course over time

and anticipate likely complications of disease.

Practice Guideline
A practice guideline study is a systematically

developed statement on medical practice that

assists a practitioner and a patient in making
decisions about appropriate health care for
specific medical conditions.

Qualitative Study
A qualitative study deals with phenomena

that are difficult or impossible to quantify

mathematically, such as beliefs, meanings,
attributes, and symbols

Systematic Review
A systematic review is a literature review focused on a single

question that tries to identify, appraise, select and synthesize all

high quality research evidence relevant to that question.
A meta-analysis is a survey in which the results of all of the

included studies are similar enough statistically that the results

are combined and analyzed as if they were one study.

Therapy
A therapy study addresses how to select

treatments to offer patients that do more

good than harm and that are worth the efforts
and costs of using them.

Question!
Students participate in PollEverywhere

Question

Always Ask Six Things

1)
2)
3)
4)
5)

What is the clinical question?

Why was the question asked?
What did they do? Methods
What was the answer ? Results
What did they say about the answer?
Conclusion
6) What do I do with this information? Is this
study of significant enough quality in method
to change my practice one way or the other?
- (Studies done different ways mean different
things) (Look at commentary/discussion)

2. Why was the question asked?

What did the author/s want to know?
This is typically found in the Introduction

Always Ask Six Things

1)
2)
3)
4)
5)

What is the clinical question?

Why was the question asked?
What did they do? Methods
What was the answer ? Results
What did they say about the answer?
Conclusion
6) What do I do with this information? Is this
study of significant enough quality in method
to change my practice one way or the other?
- (Studies done different ways mean different
things) (Look at commentary/discussion)

3. What did they do?

(Methods)
You look for the validity of the study by

checking the way it was carried out.

3. What did they do?

(Methods)
Validity
The degree to which the results of a study are

likely to be true, believable and free of bias.

3. What did they do?

(Methods)
Bias
Deviation of results or inferences from the

truth, or processes leading to such deviation.

Recall
Selection
Cultural
Conflict of Interest
Economic
Lead Time
Length Time

Types of Studies
There are various types of studies for

evaluating the answer to your question

TYPES OF STUDIES

Activity
Students participate in a group activity.

Always Ask Six Things

1)
2)
3)
4)
5)

What is the clinical question?

Why was the question asked?
What did they do? Methods
What was the answer ? Results
What did they say about the answer?
Conclusion
6) What do I do with this information? Is this
study of significant enough quality in method
to change my practice one way or the other?
- (Studies done different ways mean different
things) (Look at commentary/discussion)

4. What was the answer? (Results)

What was the consequence, effect, or

outcome of the study?

This is found in the Results

Always Ask Six Things

1)
2)
3)
4)
5)

What is the clinical question?

Why was the question asked?
What did they do? Methods
What was the answer ? Results
What did they say about the answer?
Conclusion
6) What do I do with this information? Is this
study of significant enough quality in method
to change my practice one way or the other? (Studies done different ways mean different
things) (Look at commentary/discussion)

5. What did they say about the answer? Conclusion

What was the decision reached?

This is typically in the Conclusion

Always Ask Six Things

1)
2)
3)
4)
5)

What is the clinical question?

Why was the question asked?
What did they do? Methods
What was the answer ? Results
What did they say about the answer?
Conclusion
6) What do I do with this information? Is this
study of significant enough quality in method
to change my practice one way or the other?
- (Studies done different ways mean different
things) (Look at commentary/discussion)

6. What do I do with this

information?
Is this study of significant enough quality in

method to change my practice one way or the

other?
Look at the commentary and discussion that
has been provided by the author/s in the
journal article.

Commentary and
Discussion
After you have appraised the

commentary/discussion part of the article,

your Journal Club will end with the journal club
participants engaging in commentary and
discussion about the article.
It is also helpful to look for any accompanying
editorial commentary, which can provide a
unique perspective on the article and
highlight controversial issues.
Look up your article and see if there are any
comments affiliated with your article.

Where to find
Commentary
PubMed
http://www.ncbi.nlm.nih.gov/pubmed/?otool=musmlib
Google Scholar
http://scholar.google.com.medlib-proxy.mercer.edu/
ACP Journal Club
http://annals.org.medlib-proxy.mercer.edu/journalclub

.aspx
Cochrane Journal Club
http://www.cochranejournalclub.com.medlib-proxy.mer
cer.edu/
Evidence Based Medicine
http://ebm.bmj.com.medlib-proxy.mercer.edu/