A Creative Approach to COVID-Era Journal Clubs
All recipients of the JBJS Robert Bucholz Journal Club Grant are asked to complete an end-of-year survey that includes a question about how they used the grant money. This interesting reply comes from Kyle Morgenstern, MD, an orthopaedic resident at the University of Minnesota.
Resident engagement in journal clubs has been a challenge over the last couple of years. In our hard-working residency it is tough for residents to take time out of their evening every month for journal club. Formerly, we used the JBJS grant funds to purchase food and drinks for attendees. But with the virtual nature of journal club this past year, we saw our attendance start to slide and had to find other ways to recruit residents and boost morale.
So at the beginning of the COVID era, we utilized the grant money to purchase items awarded to attendees for their participation. I figured that if we couldn’t offer food and drink in person, we could at least do it virtually, and we awarded DoorDash gift cards.
Later, we transitioned to awarding a textbook to one presenter at each Journal Club. The winner of the textbook for best presentation was selected via an anonymous Zoom-poll vote of the faculty in attendance. We do Journal Club “Specialty Nights,” so, for example, we awarded Operative Techniques in Shoulder and Elbow Surgery during our shoulder-and-elbow night.
Those who received a textbook were quite thankful, especially those entering their trauma rotations or going into a particular subspecialty. I think this is something we will continue to budget for in the future, as we return to in-person meetings coming out of the pandemic.”
Applications for the 2021-2022 Robert Bucholz Journal Club grant will be available soon. Please stay tuned!
Journal Club Resident Spotlight: Jui-Yo Hsu
JBJS is pleased to highlight the orthopaedic residents who help implement the Robert Bucholz Resident Journal Club Grants at their institutions. The grant program promotes career-long skills in evaluating the orthopaedic literature. Click here for more information.
Name: Jui-Yo Hsu
Affiliation: National Taiwan University Hospital
What was the topic of the most “dynamic” journal club meeting you have had so far this year?
In March 2021, we hosted a spine journal club focusing on adolescent idiopathic scoliosis (AIS). It was our pleasure to have Prof. Andrew J. Schoenfeld, deputy editor of JBJS, join our discussion. His remarkable advice and unique insight inspired in-depth discussion. Our advisor and moderator, Prof. Shu-Hua Yang (楊曙華), chairperson of Taiwan Spine Society, who is also a pioneer in the field of AIS research, also provided great support to our journal club. The paper we presented was “Selecting the ‘Touched Vertebra’ as the Lowest Instrumented Vertebra in Patients with Lenke Type-1 and 2 Curves” (J Bone Joint Surg Am. 2020 Nov 18;102(22):1966-1973.) by Beauchamp, et al. All the faculty and residents were highly involved in the discussion. Due to the high relevance of this topic to clinical decision making in surgical correction of AIS, both Prof. Schoenfeld and Prof. Yang shared their viewpoints and precious clinical and surgical experiences with the audience.
What are the top 3 characteristics of an engaging, enlightening journal club presentation?
First, it’s important to keep the journal club intriguing to the participants. Therefore, choosing a good topic plays a key role. Residents will be more involved if the topic is clinically important, related to a familiar surgery, or connects to their own ongoing research. Second, because knowledge of the topic may vary between senior and junior residents, we assign one of our senior residents to provide background knowledge before the discussion. Reading the article and preparing in advance are required for every participant, and we also encourage everyone to come up with several questions before the journal club. Finally, support and participation from the faculty are crucial to the journal club. They can provide clinical experiences to residents and provoke further discussion. It is even more beneficial if the participants discuss their own cases with both colleagues and instructors.
How has the COVID-19 pandemic affected your journal-club activities?
In Taiwan, fortunately we were able to maintain normal lives and all residents and staff were able to participate in the journal club in person, despite the global pandemic. However, due to a local outbreak in Taiwan in early May 2021, restrictions were imposed on indoor gatherings. We therefore decided to host our journal club online. In fact, residents were more engaged in online journal club. Using the chatroom feature, residents were able to ask question at any time without interrupting the speaker, and supplementary materials could be shared by anyone at any time. I believe online meetings may become mainstream in the post COVID-19 era.
Aside from orthopaedic content, what have you been reading lately?
I have been reading Cribsheet: A Data-Driven Guide to Better, More Relaxed Parenting, from Birth to Preschool, by Emily Oster. It is a remarkable and useful book for first-time parents. I just welcomed my first child in April 2021, and this book provides practical advice in parenting with enormous medical references. Surprisingly, it was written by an economist. I feel more relieved and confident in parenting my son after reading this book.
How has free access to JBJS Clinical Classroom benefitted you and your journal club?
JBJS Clinical Classroom is very helpful in terms of learning orthopaedic knowledge for both junior and senior residents. Its innovative design makes it very easy and efficient to review previously learned concepts. The content is also very neat but with wide coverage across different specialties, which is also very helpful for orthopaedic board exam preparation.
Journal Club Resident Spotlight: Jacob Wilson
JBJS is pleased to highlight the orthopaedic residents who help implement the Robert Bucholz Resident Journal Club Grants at their institutions. The grant program promotes career-long skills in evaluating the orthopaedic literature. Click here for more information.
Name: Jacob Wilson, MD
Affiliation: Emory University School of Medicine, Atlanta
What was the topic of the most “dynamic” journal club meeting you have had so far this year?
We recently held an arthroplasty-themed journal club that was well received. We discussed 4 different papers, but I found the discussion on 2 to be particularly interesting. This included a study on long-term outcomes of cemented versus cementless total knee arthroplasty[1] and a randomized controlled trial on the use of virtual physical therapy visits after total knee arthroplasty.[2] These studies were well-designed and stimulated lively discussion.
- Kim, Y.H., J.W. Park, and Y.S. Jang, The 22 to 25-Year Survival of Cemented and Cementless Total Knee Arthroplasty in Young Patients. J Arthroplasty, 2021. 36(2): p. 566-572.
- Prvu Bettger, J., et al., Effects of Virtual Exercise Rehabilitation In-Home Therapy Compared with Traditional Care After Total Knee Arthroplasty: VERITAS, a Randomized Controlled Trial. J Bone Joint Surg Am, 2020. 102(2): p. 101-109.
What are the top 3 characteristics of an engaging, enlightening journal club presentation?
In my experience, journal club can be one of the better educational opportunities as a resident. There are a few things that are critical to making this the case. 1) Obviously, everyone needs to read the articles that are being discussed. This goes a long way in making the journal club interactive and constructive. 2) Attendance, particularly by faculty, is critical. I have found that when faculty from a variety of subspecialties attend, good discussions are generated. 3) Proper article selection. While landmark papers are important and should be reviewed by all residents, for the purposes of journal club, recent, clinically applicable articles that have the potential to change practice seem to be more interesting to those in attendance.
How has the COVID-19 pandemic affected your journal-club activities?
Like essentially all aspects of our lives, COVID-19 significantly changed our journal-club activities over the past year. Given national, regional, and institutional guidelines, our program moved all educational activities, including journal club, to virtual formats. While different than what we were previously accustomed to, this has made attendance easier for some faculty. That said, we are looking forward to a return to some degree of academic normalcy when we are able.
Aside from orthopaedic content, what have you been reading lately?
I’ve admittedly slacked on reading outside of orthopedics during residency. However, I have always been a fan of narrative nonfiction and am currently reading Dead Wake by Erik Larson.
How has free access to JBJS Clinical Classroom benefited you and your journal club?
I have found JBJS Clinical Classroom to be a good resource. As I prepare for Part I of my board exam, Clinical Classroom has been an easy and nice way to review concepts quickly. The app has made it easy to quickly do a few questions between cases. The content in Clinical Classroom is linked to primary literature, and this has led to some articles being selected for discussion at journal club.
Journal Club Resident Spotlight: Abdulaziz Ahmed
JBJS is pleased to highlight the orthopaedic residents who help implement the Robert Bucholz Resident Journal Club Grants at their institutions. The grant program promotes career-long skills in evaluating the orthopaedic literature. Click here for more information.
Name: Abdulaziz Ahmed, MD
Affiliation: Hamad Medical Corp., Doha, Qatar
What was the topic of the most “dynamic” journal club meeting you have had so far this year?
One distinctive journal club evaluated two Level-I studies that addressed common sports-medicine procedures. One article was a randomized clinical trial (RCT) that evaluated the effectiveness of acromioplasty when added to full-thickness rotator cuff tear repair (Abrams GD, et al. Arthroscopic Repair of Full-Thickness Rotator Cuff Tears with and Without Acromioplasty: Randomized Prospective Trial With 2-Year Follow-up. Am J Sports Med. 2014 Jun;42[6]:1296-303). The second article was a trial that compared hip arthroscopy versus nonoperative treatment for femoroacetabular impingement (Griffin DR, et al. Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome [UK FASHIoN]: a multicentre randomized controlled trial. Lancet. 2018 Jun 2;391[10136]:2225-2235). By completing systematic critical-appraisal forms, the residents were able to dissect and digest complex methodology and statistics. Both articles provided high-value learning points on evaluating the mechanics and limitations of randomized trials.
What are the top 3 characteristics of an engaging, enlightening journal club presentation?
First, audience preparedness is essential to an engaging journal club. Thus, articles should be distributed in advance for prereading. In our program, we circulate articles 4 weeks in advance. In addition, we highlight important educational objectives for each article. This allows residents to concentrate on crucial elements of selected articles, especially when analyzing several articles in one sitting. Second, selected articles have to be pertinent to the residents’ curriculum and clinical exposure. Our journal club articles are hand-picked jointly by senior residents and research-oriented faculty. The senior residents ensure the article’s relevance to residents, while experienced faculty provide oversight and refine article selection. Third, a systematic approach maximizes the beneficial value of the journal club. We provide participants with a systematic critical-appraisal checklist that not only enhances the residents’ critical appraisal, but also helps them adopt efficient lifelong reading tactics.
Aside from orthopaedic content, what have you been reading lately?
I have been reading the book Deep Work by Cal Newport. The book teaches valuable strategies for optimizing productivity and getting the most out of our cognitive abilities—a much-needed skill in our currently fast-paced, distracted world.
How has the COVID-19 pandemic affected your journal-club activities?
The COVID-19 pandemic has profoundly affected residency training around the globe. Although the pandemic limited our in-person journal club format, like many others, we have transitioned to virtual education. Currently, our journal club is conducted through online meetings. As much as we loved the in-person format, the online format made the journal club more accessible to faculty members. Moreover, the virtual setting motivated us to invite experts in the field. Recently, Dr. Bashir Zikria from Johns Hopkins moderated an exciting journal club on the long-term outcomes of matrix-induced autologous chondrocyte implantation.
How has free access to JBJS Clinical Classroom benefited you and your journal club?
JBJS Clinical Classroom has been a useful source for article selection in our journal club. It also provides an exciting opportunity to evaluate our knowledge by strengthening deficient areas and steering us away from mastered topics. The recharge feature provides a time-efficient way to reinforce knowledge. Clinical Classroom presents questions that are based on the best available evidence, and cited references feature both classic and most recent articles.
Journal Club Resident Spotlight: Praharsha Mulpur
JBJS is pleased to highlight the orthopaedic residents who help implement the Robert Bucholz Resident Journal Club Grants at their institutions. The grant program promotes career-long skills in evaluating the orthopaedic literature. Click here for more information.
Name: Praharsha Mulpur, MD
Affiliation: Sunshine Bone and Joint Institute, Hyderabad, India
What was the topic of the most “dynamic” journal club meeting you have had so far this year?
Tuberculosis (TB) of the hip joint is still prevalent in India. We are often faced with situations of advanced destruction of the hip joint requiring total hip replacement (THR), but THR is usually delayed until the disease condition becomes quiescent. However, TB is known to persist subclinically and to reactivate after surgery. One of the journal club articles we discussed was a “practice changer” as far as THR in active TB was concerned: Kim et al. Total hip replacement for patients with active tuberculosis of the hip. Bone Joint J, 2013; 95-B:578-82.
What are the top 3 characteristics of an engaging, enlightening journal club presentation?
The most important characteristics include: (1) Clinical relevance: The article chosen should generate discussion on a topic that is clinically relevant and not one that has already been “settled” or “dismissed.” Not all “historical” articles are clinically relevant in the 21st century. (2) Participation: Participants should be well-versed with the topic prior to the meeting, which allows detailed discussion with different perspectives. (3) Brevity: Presentations of the article(s) being discussed should be clear and concise.
Aside from orthopaedic content, what have you been reading lately?
I am following several podcasts, both clinical and nonclinical. I am also reading articles from the Farnam Street blog by Shane Parrish, The New York Times, and a nonfiction book titled Nothing to Envy by Barbara Demick.
How has the COVID-19 pandemic affected your journal-club activities?
Unfortunately, our in-person journal clubs have been halted due to the ongoing risk of COVID transmission, and our institute and department have adopted a completely virtual academic program. This has advantages and disadvantages. On the positive side, we are able to involve senior faculty, both national and international, to participate in the journal club discussions. Apart from our monthly internal journal club, we have an ongoing academic relationship with the department of orthopaedics at the University of Miami for a monthly journal club. With this, our residents and fellows gain international perspectives on topics of clinical significance. On the downside, nothing beats an in-person meeting. Group dynamics and participation are always better in a room than on a Zoom screen.
How has free access to JBJS Clinical Classroom benefited you and your journal club?
JBJS Clinical Classroom is a valuable educational resource and is highly recommended for orthopaedic residents. The content is excellent and helped me cover a lot of topics without having to go back to a reference textbook. The progress meter is useful to assess personal progress. One of the best features is the JBJS Clinical Classroom Library. Every topic has links to the best or most-cited references, which makes studying easy.
Journal Club Resident Spotlight: Agustin Albani Forneris
JBJS is pleased to highlight the orthopaedic residents who help implement the Robert Bucholz Resident Journal Club Grants at their institutions. The grant program promotes career-long skills in evaluating the orthopaedic literature. Click here for more information.
Name: Agustin Albani Forneris, MD
Affiliation: Hospital Italiano de Buenos Aires, Argentina
What was the topic of the most “dynamic” journal club meeting you have had so far this year?
Many articles presented in our journal club ignited debate, not only about their findings but also their design and methodology. One standout was the article by Matsunaga et al. (Minimally Invasive Osteosynthesis with a Bridge Plate Versus a Functional Brace for Humeral Shaft Fractures: A Randomized Controlled Trial. J Bone Joint Surg Am. 2017 Apr 5;99[7]:583-592), which is a prospective randomized study comparing minimally invasive osteosynthesis vs functional bracing for the treatment of humeral shaft fractures. It is quite unusual that a Level-I prospective study like this was designed in Latin America. Our debate focused primarily on identifying which patients in our population would benefit from one treatment or another, in order to apply specific indication criteria to our daily practice. In turn, several hypotheses were raised that stimulated ideas for future projects.
Based on your journal club experiences, what are the top 3 characteristics of an engaging, enlightening journal club presentation?
(1) The commitment of the participants. We encourage all of our 43 residents to not only read the article in advance but also to write a critical review as if they were reviewers of a journal.
(2) Selection of the article. We encourage residents to select controversial studies that trigger debate about results and methodology. It is often valuable to criticize an article whose methodology is controversial to analyze which aspects would make the same study more solid (i.e., selection bias, randomization, data collection, statistical analyses, etc.)
(3) Inviting an experienced faculty surgeon. This is always inspiring to all residents, helping us to write and review articles and transmitting to us their passion for research.
Aside from orthopaedic content, what have you been reading lately?
I am a technology fan, so I usually read specialized magazines on electronic devices and reviews about new gadgets on the market. During holidays, I love to read historical novels that transport me to another place and time. Reading about the achievements of people living at a time when life expectancy did not exceed 30 years amazes me.
How has the COVID-19 pandemic affected your journal-club activities?
Paradoxically, the pandemic empowered our journal-club activities. The substantial decrease in elective surgery to prioritize medical resources for Covid-patients, in addition to the proliferation of virtual applications, gave residents more accessibility to and availability for academic activities. The pandemic also enabled several staff surgeons to join our program, and that enriched the discussions.
How has your free access to JBJS Clinical Classroom benefited you and your journal club?
JBJS Clinical Classroom provides us the opportunity to link one of our most valuable learning tools with the journal club by synchronizing the topics from the resident program classes with the selected journals. JBJS Clinical Classroom also enables us to individualize each resident’s progress and to reinforce the areas that present the greatest difficulty.
Journal Club Resident Spotlight: Brian Goh
JBJS is pleased to highlight the orthopaedic residents who help implement the Robert Bucholz Resident Journal Club Grants at their institutions. The purpose of this program is to promote career-long skills in evaluating the orthopaedic literature as it relates to practice decision making among orthopaedic residents. Click here for more information about the grant program.
Name: Brian Goh, MD
Affiliation: Harvard Combined Orthopaedic Residency Program, Boston, MA
What was the topic of the most “dynamic” journal club meeting you have had so far this year?
One of the most dynamic and engaging journal clubs we have had centered around both residency [1] and fellowship [2] selection – a topic of universal interest for both residents and faculty. This journal club was particularly interesting in the setting of the recent changes to the USMLE Step 1 and how the assessment of medical students will change in the future. We analyzed the merits of these manuscripts, and our discussion led to commentary on the current state of the residency and fellowship selection process.
[1] Trikha R, Keswani A, Ishmael CR, Greig D, Kelley BV, Bernthal NM. Current Trends in Orthopaedic Surgery Residency Applications and Match Rates. J Bone Joint Surg Am. 2020 Jan 6:10.2106/JBJS.19.00930. doi: 10.2106/JBJS.19.00930. PMID: 31904608.
[2] Krueger CA, Helms JR, Bell AJ, Israel H, Cannada LK. How the Reputation of Orthopaedic Residency Programs Is Associated with Orthopaedic Fellowship Match Results. J Bone Joint Surg Am. 2020 Jan 8:10.2106/JBJS.19.00750. doi: 10.2106/JBJS.19.00750. PMID: 31913867.
Based on your journal club experiences, what are the top 3 characteristics of an engaging, enlightening journal club presentation?
Our journal clubs usually consist of manuscript topics that directly impact clinical practice and demonstrate clear, foreseeable patient application. Another characteristic is inviting faculty who are engaged in similar areas of research and can comment on the merits of the manuscripts discussed. Lastly, our journal clubs have been fortunate to receive visits from JBJS Editor-in-Chief, Dr. Marc Swiontkowski. He provides unique insight into the review process of manuscripts and how these articles have contributed to the broader musculoskeletal literature.
What advice about running a top-notch journal club program do you have for residents who will manage a Robert Bucholz Resident Journal Club Grant next year?
Our journal clubs are structured so that each article is jointly presented by a junior and senior resident. The junior resident presents the article and study design, while the senior resident provides context of the research and the strengths and weaknesses of the manuscript. Our discussions typically follow Dr. Seth Leopold’s framework [1] on thoughtful analysis of orthopaedic literature. To allow more residents to participate, we also have our journal clubs streamed to our off-site residents. As residency training evolves to include more off-site rotations, finding a mutual time and place is increasingly difficult. We have found videoconferencing to be immensely beneficial to include all of our residents, near and far. Good food and beverage also help maximize attendance!
[1] Leopold SS. Editorial: Getting the Most from What You Read in Orthopaedic Journals. Clin Orthop Relat Res. 2017;475(7):1757–1761. doi:10.1007/s11999-017-5371-0
Aside from orthopaedic content (journals and otherwise), what have you been reading lately?
I recently took a course in Value-Based Health Care Delivery at Harvard Business School that is based on the research of Dr. Michael Porter. I am now reading Redefining Health Care: Creating Value-Based Competition on Results by Drs. Michael Porter and Elizabeth Teisberg to better understand how health care delivery is changing and how we can maximize value in patient care.
Journal Club Resident Spotlight: Elizabeth Scott
JBJS is pleased to highlight the orthopaedic residents who help implement the Robert Bucholz Resident Journal Club Grants at their institutions. The purpose of this program is to promote career-long skills in evaluating the orthopaedic literature as it relates to practice decision making among orthopaedic residents. Click here for more information about the grant program.
Name: Elizabeth Scott, MD
Affiliation: University of Iowa
What was the topic of the most “dynamic” journal club meeting you have had so far this year?
We were fortunate to host this year’s Arthur Steindler Award recipient, Dr. Margaret McQueen at our journal club when she visited our department earlier this year. We had a lively discussion regarding the diagnosis of compartment syndrome, and the use of continuous compartment pressure monitoring. We discussed the pros and cons of our current practices and how they could be improved. Having the original author present was extraordinarily valuable!
McQueen MM, Duckworth AD, Aitken SA, Court-Brown CM. The estimated sensitivity and specificity of compartment pressure monitoring for acute compartment syndrome. J Bone Joint Surg Am. 2013;95(8):673–677. doi:10.2106/JBJS.K.01731
Based on your journal club experiences, what are the top 3 characteristics of an engaging, enlightening journal club presentation?
There are a few characteristics of a good journal club. The first is the most obvious – attendees actually have to read the articles in advance. Limit the number of articles you choose, and send them out well in advance so everyone has time to prepare. The second is a clear structure – we allot a certain amount of time to each article and guide junior residents on how to present an article succinctly. Lastly, you must have faculty commitment. Letting faculty approve or suggest articles, as well as the meeting venue, can help.
What advice about running a top-notch journal club program do you have for residents who will manage a Robert Bucholz Resident Journal Club Grant next year?
Come up with a system for how things are done, and stick to it! Everyone (staff, residents, students) should know exactly what to expect and feel prepared. Avoid pressured “pimp sessions” and focus on group learning and discussion. Journal club should be something residents and staff look forward to.
Aside from orthopaedic content (journals and otherwise), what have you been reading lately?
I’m a fan of audiobooks – easy to listen to in the car or walking home – and particularly nonfiction. If you’re looking for some motivation, check out “Can’t Hurt Me” by David Goggins, a Navy Seal and elite ultramarathoner. I’m currently listening to Greg McKeown’s “The Disciplined Pursuit of Less,” which tackles the idea of essentialism.
Journal Club Resident Spotlight: Carl Herndon
JBJS is pleased to highlight the orthopaedic residents who help implement the Robert Bucholz Resident Journal Club Grants at their institutions. The purpose of this program is to promote career-long skills in evaluating the orthopaedic literature as it relates to practice decision making among orthopaedic residents. Click here for more information about the grant program.
Name: Carl Herndon, MD
Affiliation: Columbia University Medical Center, New York, NY
What was the topic of the most “dynamic” journal club meeting you have had so far this year?
We recently had a journal club focusing on adult joint reconstruction, and discussed different fixation strategies of implants (broadly cement vs cementless fixation). We evaluated the following 3 studies:
Stea S, Comfort T, Sedrakyan A, Havelin L, Marinelli M, Barber T, Paxton E, Banerjee S, Isaacs AJ, Graves S. Multinational comprehensive evaluation of the fixation method used in hip replacement: interaction with age in context. The Journal of bone and joint surgery. American volume. 2014 Dec;96(Suppl 1):42-51.
Khanuja HS, Vakil JJ, Goddard MS, Mont MA. Cementless femoral fixation in total hip arthroplasty. JBJS. 2011 Mar 2;93(5):500-9.
Nam D, Lawrie CM, Salih R, Nahhas CR, Barrack RL, Nunley RM. Cemented versus cementless total knee arthroplasty of the same modern design: a prospective, randomized trial. The Journal of bone and joint surgery. American volume. 2019 Jul 3;101(13):1185.
Based on your journal club experiences, what are the top 3 characteristics of an engaging, enlightening journal club presentation?
1. Hand-on activities: We always lead off our journal club with a sawbones exercise where senior residents, fellows, and attendings lead junior residents through a topical saw bones. Great to get everyone thinking and a chance for everyone to learn.
2. Multilevel involvement: Having everyone there from interns all the way to senior attendings is critical as we evaluate the literature with different biases and can all learn together.
3. Atmosphere: Reading these articles and discussing them doesn’t have to be boring! Having food or snacks and scheduling it at the end of the day allows for a more laid-back vibe to learning that is conducive to discussion.
What advice about running a top-notch journal club program do you have for residents who will manage a Robert Bucholz Resident Journal Club Grant next year?
Plan it out in advance, and put dates on the calendar for everyone to know when it’s happening. Nothing worse than trying to do all this work and having no one show up!
Aside from orthopaedic content (journals and otherwise), what have you been reading lately?
Once a Runner by John L. Parker Jr. One of my favorite books.
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