Reprinted from the summer 2023 issue of The Ohio Family Physician
By: Sohail Merchant, MD; Alexandra Prosser, MD, CLC; Eric Mast, DO, Firelands Physician Group; and Kari Ketvertis, MD, NOMS Health Care Firelands Regional Medical Center, Department of Medical Education
My eyes welled with tears as I laughed hysterically at my co-resident. He was singing a 20-second bit from his favorite Taylor Swift song, and after a rough week filled with long days, our early morning desperately needed the lightheartedness. My off-pitch-but-tryinghis- hardest co-resident had been randomly handed an orange popsicle stick when he arrived at Journal Club (JC). “Truth or dare?” he was asked, instead of what the dependent and independent variables of the study were. Fearlessly, he always chose the dare.
When we inherited the inaugural co-chief title, JC had low engagement, uninspiring discussion, and limited clinical relevance. So, we set out to inject new life into our monthly meetings. We both independently brainstormed and proposed the same fun way to spice things up: Why not add an iteration of a classic childhood game, “Truth or Dare?” Our idea revitalized JC; it has since been engaging, interactive, enjoyable, and impactful.
Several reviews highlight some of the challenges of JCs in medical education including poor attendance, low engagement, and the vast amount of ever-changing medical knowledge.1-3 Fortunately, these reviews also share common recommendations about how to improve the JC experience: 1) designate a leader, 2) select relevant articles, and 3) use a structured approach.2,4-6 We propose a fourth element: FUN!
- Chief Residents Lead
In years past, JC was led by a different resident each month, and that resident was assigned to choose a journal article, distribute it to attendees, and facilitate discussion. Although equitable, this approach produced variability in structure, organization, passion, educational value, and audience interest. For consistency’s sake, we proposed that the co-chief residents alternate leading the sessions. - American Board of Family Medicine (ABFM) National Journal Club
To ensure that our discussions are clinically relevant, co-chiefs select articles from the new ABFM National Journal Club. These articles have been pre-vetted for quality and clinical relevance, ensuring our discussions are meaningful and impactful to our clinical practice. - Our Structured Approach
Each meeting, we consolidate a list of 12 discussion questions designed to systematically analyze our article. Similarly, Xiong et al. and Schwartz et al. recommend a series of guiding questions.2,5 Residents are tasked to read the journal article prior to the JC session and come prepared to answer any of the predefined discussion questions. We have a collection of popsicle sticks painted 16 different colors, and each resident randomly selects one at the beginning of the session. Each color corresponds to a discussion question that the resident will answer, but only the leader knows which question corresponds with which color. Reference our discussion questions and a PowerPoint template for our JC approach. - The Fun Part: Truth or Dare!
Most notable of our changes is our integration of “Truth or Dare,” which definitely adds a flavor of fun and unpredictability! Here’s how it works: Four of the popsicle sticks/colors are randomly assigned a “truth” or “dare” instead of a discussion question.
The addition of “Truth or Dare” created a lot of excitement and laughter, and thus JC has been more enjoyable and interactive. The game serves as an opportunity for us to learn and team-build. Along with delighting in an enthusiastic and off-key Taylor Swift performance, we have witnessed embarrassing hairstyles, relived the memory of a peer tripping on stage at their high school graduation, and watched a colleague try to stand on their head for five minutes.
For Trainees: Critical Appraisal Skills
We also integrate a short biostatistics review within each JC session, referencing statistics and experimental designs featured in each respective article. This spurs thoughtful discussion while improving understanding and interpretation. Further, it helps review for both licensing and board certification exams. Templates for these short reviews are featured in our PowerPoint template viewable via the QR code.
Discussion
We are not alone in our pursuit to improve JCs. Gonzales demonstrated a debate-based approach which increased participation, educational value, and fun.4 Dzara et al. demonstrated success using an active learning approach in which participants analyzed articles without any advanced reading or preparation.7 Combe et al. encouraged imagination and creativity in an innovative JC model which “transformed [their] JC into an enjoyable event.”8
Indeed, our simple game increased enthusiasm, engagement, and satisfaction in our JC. With more attention on attaining a work-life balance, it’s worth noting that our modified JC doubles as an enjoyable way to simultaneously attain medical knowledge and build relationships. Anonymous feedback from residents this year has included “Fun way to do journal club,” “Sparked good discussion,” and “Best JC this year!” We encourage other family medicine residency programs to consider implementing creative and innovative changes that promote lightheartedness, fun, and learning!
References available on the Ohio Academy of Family Physicians website.