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.
Orthopaedic Interns Across Chicago Learn and Bond in Journal Club
OrthoBuzz occasionally receives posts from guest bloggers. The following contribution comes from Rob Christian, MD and Maddy Lyons, MD.
Editor’s Note: The application deadline for the 2019-2020 JBJS Robert Bucholz Resident Journal Club Grant Program has been extended to November 1, 2019.
Junior residents often hear attendings, fellows, and senior residents quote landmark studies, but few find the time to track down and read these important papers on their own. So, when the Northwestern University Orthopaedic Residency Program was awarded one of the JBJS Robert Bucholz Resident Journal Club Grants, Haley Smith, MD (PGY-2) and I used the funding to pilot an Intern Journal Club, inviting all the interns in orthopaedic surgery residency programs across Chicago to read and discuss landmark studies.
Over the last decade, several hospitals in Chicago, such as John H. Stroger, Jr. Hospital of Cook County and Ann & Robert H. Lurie Children’s Hospital of Chicago, have trained teams of orthopaedic residents from multiple programs. Working in the hospital with residents from different programs is a great educational experience, and we thought these resident teams could be even more effective if they interacted with one another prior to working together in the hospital.
Our Intern Journal Club met quarterly, and had impressive attendance, especially considering the busy intern work schedule. Each journal club session featured 4 to 5 landmark studies (suitable for PGY-1s), and discussions were led by senior residents selected across the programs. Articles discussed came from all orthopaedic subspecialties. In addition to literature-based discussions, the get-togethers fostered collegial relationships among the different programs.
For me, the most rewarding part of the Intern Journal Club has been meeting the interns as they begin their residencies and guiding discussion to help them think critically about orthopaedic literature. With the continued support of the JBJS Robert Bucholz Resident Journal Club Grant, we look forward to continuing to host the Intern Journal Club for this year’s intern class.
Rob Christian, MD (PGY-5)
McGaw Medical Center of Northwestern University
* * * *
Initially, the JBJS Chicago Intern Journal Club felt like it was adding articles to an endless intern reading list. However, it turned out to be one of the more valuable and fun educational experiences of my intern year.
The meetings provided the unique opportunity to meet residents from the other Chicago programs. Exchanging stories of intern-year trials and tribulations quickly bonded our group. It was interesting to discover the differences and similarities in our programs, our rotations, and even in the ways in which we manage injuries. In addition to building relationships with peers across programs, the journal clubs allowed me to connect with senior residents who have similar career interests and build several new mentorships.
The articles that we read and discussed were landmark studies that shape the practice of orthopaedics on a daily basis. Through morning conferences, OITE practice questions, and clinical care, interns are exposed repeatedly to fundamentals of orthopaedics, such as open fracture management and functional bracing of humeral shaft fractures. However, without our Intern Journal Club, I may not have explored the studies on which these practice-shaping principles are built. An open, discussion-based format with senior residents helped me understand the “whys” of what we are taught.
We are fortunate to have so many great orthopaedic residency programs in Chicago, each with unique strengths. I hope that our Intern Journal Club continues in the years to come to inspire future collaboration in educational, social, and networking events among the local residency programs.
Maddy Lyons, MD (PGY-2)
Loyola University Medical Center
Chicago Orthopaedic Surgery PGY1 Journal Club Commentary
I was pleasantly surprised and excited when I first heard about the citywide Chicago PGY1 journal club. This journal club was funded by the Robert Bucholz Resident Journal Club Grant through The Journal of Bone and Joint Surgery. The premise of this program was for all of the orthopedic surgery PGY1s from around the city to meet and discuss landmark articles specific to a certain orthopedic topic. The event that I attended was the first meeting of the program, and the focus of our discussion revolved around four orthopedic trauma articles. I recognized all of the articles as the guidelines established from these papers are still used in our trauma practice every day.
Although I knew the general principles derived from this literature, I found reading the full text beneficial as it helped provide a more thorough background into the reasoning behind the decisions we make in the management of various fracture patterns. What I found most educational however was the discussions we had with residents at various programs, specifically in regards to our institutions’ management of common orthopedic fractures. We each went around the table and discussed our ED management of injuries including humeral shaft fractures, femoral shaft fractures, open fractures, and our intraoperative technique for intramedullary nailing of tibial shaft fractures.
While there were small differences in our management of these injuries, we all seemed to abide by the general guidelines that were set into motion after the publication of these landmark articles. It brought into focus how influential this literature has been, and also gave me additional insight into possible alternative management algorithms that could produce similar outcomes. When working at one institution throughout your residency, that institutions protocols often become the “normal” for you. I now better recognize that it is important to keep an open mind and that there can be many methods to achieve a desired result.
Our meeting allowed for a low stress environment to both appreciate and constructively criticize how we think about orthopedic trauma. At our specific institution the discussion of articles occurs in a large group setting with attendings and senior residents, and usually focuses on more recent literature. I think it is essential to understand where we came from, and this citywide journal club provides that history while also encouraging open critical discussion. I think any junior resident would benefit from this type of educational open forum with their colleagues.
You can apply for your own Robert Bucholz Resident Journal Club Grant by clicking this link.
Jeremy Adler
Orthopaedic Surgery, PGY-2
University of Chicago
Jeremy.adler@uchospitals.edu
Not Your Grandparent’s Journal Club
OrthoBuzz occasionally receives posts from guest bloggers. The following commentary comes from Matthew R. Schmitz, MD, FAOA.
Medical education is a constant need, but how it’s delivered is always changing. When my grandfather was a surgeon, medical trainees brought their dusty textbooks and print journals to “fireside chats” at an attending’s home. Today, we have online journals, tablets and smartphones, podcasts, and “virtual” discussions on social media platforms. Although the technologies evolve, the need to discuss present and past literature remains constant.
These discussions often taken place nowadays through journal clubs. Medical residents across the continent routinely get together in formal or informal settings to discuss journal articles, not only to acquire the knowledge contained in the articles themselves, but also to learn how to properly read, critique, and digest the information.
JBJS provides medical education across multiple platforms, several of which I participate in. I strongly encourage residency programs to submit an application for the 2019-2020 JBJS Robert Bucholz Resident Journal Club Grant Program before the deadline of September 30, 2019. The grant allows medical educators to support their journal clubs in many ways:
- Investigating new and innovative alternatives to the traditional journal club.
- Bringing an author to your institution to discuss his or her articles.
- Hosting a virtual journal club with multiple authors via teleconference or social media.
- Purchasing food and refreshments within the “old school” method of a fireside chat at an attending’s home.
No matter the platform or methodology, journal clubs are a vital part of orthopaedic education, not only for interpreting literature, but also for incorporating knowledge into future clinical practice and for the joy and excitement of lifelong learning.
Matthew R. Schmitz, MD, FAOA is an orthopaedic surgeon specializing in adolescent sports and young adult hip preservation at the San Antonio Military Medical Center in San Antonio, TX. He is also a member of the JBJS Social Media Advisory Board.
Journal Club Grant Brings Bhandari to UChicago
Editor’s Note: The Journal of Bone and Joint Surgery’s Robert Bucholz Resident Journal Club Grant provides selected orthopaedic surgery residency programs with funds that facilitate career-long skills in evaluating orthopaedic literature and its impact on clinical decision-making. The Journal is always interested in hearing how those funds have been used to enhance orthopaedic education. Here, Michael Perrone, MD describes how the University of Chicago’s Department of Orthopaedic Surgery and Rehabilitation Medicine used its grant this past academic year.
Our residency hosted Dr. Mohit Bhandari for two days. Dr. Bhandari is widely recognized as the world’s foremost authority in the translation of orthopaedic research into clinical practice. On the first day, he joined us for dinner at a local Chicago pizzeria, where we had a “Deep Dish-cussion” about several landmark articles within the orthopaedic literature. He provided his insights on the design, merits, and limitations of each paper, while also discussing each study’s clinical impact. Both residents and faculty alike found the discussion enlightening and educational.
The following morning, Dr. Bhandari delivered Grand Rounds to the entire department. His talk, “Fear Less, Do More,” gave us an inside look at the trials and tribulations of conducting large, multicenter studies and bringing them to publication. Throughout the talk, he encouraged residents and faculty to be ambitious in their pursuit of research and evidence-based practice.
There are few people with more experience or expertise within orthopaedic research than Dr. Bhandari, and his visit to our residency program was inspirational and enlightening. Such an experience would not have been possible without the generous support from JBJS.
Michael Perrone, MD
PGY-5
University of Chicago
New Frontiers in Journal Clubs
Depending on which historical account you read, journal clubs have been a staple of medical education since around 1875. Still ubiquitous within medical education today, journal clubs help educators and students alike stay current on medical literature, provide a vehicle for teaching how to critically appraise medical studies, and convene a forum in which respectful debate can occur among colleagues. Journal clubs constitute a medical-education practice that almost no one questions, probably because they are so effective.
But that doesn’t mean journal clubs can’t be improved. As the September 30, 2018 deadline approaches to submit applications for the JBJS Robert Bucholz Journal Club Grant Program (click here for the application form), I encourage medical-education leaders to envision new ways in which journal clubs could further orthopaedic education. That might include various iterations of “virtual” journal clubs over the internet. For example, the Journal of Hand Surgery recently hosted a journal club on Twitter. Another intriguing possibility would be to invite authors of journal articles with conflicting conclusions about the same research question to discuss their findings in a point/counterpoint format over teleconference. (Today’s teleconferencing platforms are not hard to set up, are relatively low-cost, and could broaden journal-club participation to anyone with a suitable device and a high-speed internet connection.)
The traditional face-to-face journal club provides many unique benefits, but creating new, innovative platforms for using departmental or grant-based journal-club funds could increase their impact and help ensure the sustainability of these educational programs. It will also be important for everyone to share their experiences with alternative journal-club formats. It behooves the orthopaedic community to continually envision how to integrate the journal-club component of medical education into new technologies as they evolve.
Chad A. Krueger, MD
JBJS Deputy Editor for Social Media
JBJS: Aiding and Abetting Orthopaedic Residents
No matter how you look at it, orthopaedic residency is a relentlessly challenging five or six years. The Journal of Bone & Joint Surgery offers the following special services to make life and learning a little easier for orthopaedists in training:
- Complimentary access to all JBJS journals via the AOA’s Council of Orthopaedic Residency Directors (CORD)
- Guidance for getting the most out of your Journal Club
- Annual grants ($2,500) to support Journal Club activities
- Free access to JBJS Podcasts, Videos, and Webinars
- Opportunities to participate in the JBJS blog, OrthoBuzz
Residents who connect now with JBJS establish a solid foundation for a career of lifetime orthopaedic learning. Click on the “Residents” button under “Editorial Resources” at www.jbjs.org to find out more.
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