In “How to Write Peer-Reviewed Journal Articles,” Henry D. Jampel, MD, MHS, provided insight into how residents can engage in evaluating published research via writing a manuscript and submitting it to a professional journal. This month, YO Info turns its sights on the journal club and the peer review process.
Most ophthalmologists would agree that young physicians interested in participating in the advancement of clinical research have an obligation to understand, if not actively participate in, the review process. Two possible ways to do that include hosting a journal club and becoming a peer reviewer.
The Journal Club
Why should I join the club? Simply put, a journal club is a group of residents, oftentimes led by a faculty member, who come prepared to discuss and share their thoughts and opinions on any number of manuscripts. This usually takes place in academia, where it’s used as a tool to develop analytic skills in trainees and possibly highlight gaps in scientific literature. However, journal clubs are also commonplace in many private practices. Regardless of the setting, Janice C. Law, MD, associate director for residency education at Vanderbilt Eye Institute, said the purpose of the activity is to get participants to think critically about the articles and discuss whether the information is reliable and relevant and to what degree it will impact clinical practice.
“Through an analytical exercise like a journal club,” Dr. Law said, “the trainee will gain a systematic approach to reading and analyzing scientific literature, as well as a stronger understanding of research methodologies, study designs and statistical reporting.” Questions that residents should be prepared to discuss usually include: What is the conclusion of the research? Do the data support this conclusion? Was the study designed and powered appropriately to reach this conclusion? What limitations should be factored into the results?
Ophthalmology professor Anne L. Coleman, MD, PhD, who teaches at UCLA’s Jules Stein Eye Institute, said the main goal of the journal club is to learn to think critically about ophthalmic research: “When you are done with your training, you have to be reading the literature and deciding whether the material is applicable to your patients and whether it offers a clinical direction that I want to pursue in practice.” As such, a journal club is an integral part of a resident’s continuing education. “As a resident, you have to be a savvy learner,” added Dr. Coleman, who also serves as executive editor of the American Journal of Ophthalmology.
“When you are in training, your professors are guiding you through that process, filtering information, telling you why certain research findings are important. But when you are out there by yourself, you have to do the filtering on your own. A journal club will teach you how to do that and how to be a critical reader so that you continue providing great quality care to your patients.”
Is it required? Most ophthalmology training programs incorporate journal clubs into their curriculum; however, there is no official residency-program mandate from the Accreditation Council for Graduate Medical Education (ACGME). The ACGME does require programs to involve residents in practice-based learning and improvement (PBL&I) activities. The requirement states that residents must be able to demonstrate the ability to analyze practice performance and carry out needed improvements. “One critical aspect of this is being able to locate and apply scientific evidence to the care of patients by critically appraising the scientific literature,” Dr. Law said. “Therefore, a residency training program may use a tool such as a journal club to actively engage residents in evidence-based medicine activities with faculty direction.”
Joining the club. Because most institutions have some form of a journal club already in place, a resident may not need to create his or her own. However, Dr. Law said some journal clubs might need a bit of a makeover. “In these cases, I would recommend that the residents approach the activity with a little creativity,” she said.
“For example, divide the resident group in half and have one half read and analyze the article in such a way as to support the conclusions the authors have published. Then, have the other half of the group focus on why they should refute the conclusions. If they apply this to a specific patient case scenario, the exercise comes full circle.” An activity like this can teach one of the more valuable lessons for a resident: no research is perfect. “Our journal clubs at Vanderbilt almost always involve food as well,” added Dr. Law, “another way to get residents excited about evidence-based medicine!”
Whether or not your program offers a journal club, residents and faculty should always look for areas of potential improvement and effective new ways to learn, as with any other institutional component. “It might be possible to Skype in a faculty member from a different university if you don’t have a certain expertise at your institution,” Dr. Coleman said. Because of advances in video conferencing, a group of residents who are far afield, for example, might try to connect with an existing journal club at an established institution. “I think it’s really all about being actively engaged in your own education,” she added, “and making sure that you are getting the education, the exposure and the knowledge to succeed.”
The Peer Reviewer
A lot in common. Participating in a journal club can also teach residents effective peer-review skills: the approach you would take in a journal club is the same approach that a peer reviewer would take when determining whether a manuscript is publishable or not. “They are almost one and the same,” Dr. Law said. “One additional component in peer reviewing, however, includes needing to be well versed in that subject’s literature to be able to see how an article can add to that body of literature and vice versa.”
In addition to the process, the benefits are similar as well. “What a peer reviewer gains is an insight into the literature,” Dr. Coleman said. “Like a journal club, you are taking more time to read the manuscript and formulate your critical thoughts. A lot of times you might read it and think, ‘Well, I don’t believe these findings,’ but if you are a peer reviewer or in a journal club, you have to substantiate that and write down why and what could be done to improve the research.” As such, participation in both a journal club and the peer-review process become very much a part of improving residents’ knowledge and grasp of the literature that will then help to improve the care they give to their patients.
Is there a clear-cut path to become a peer reviewer? “I wish there was,” said Dr. Coleman. “There is a skill to learn in order to become a peer reviewer, however, and a lot of those skills are learned in a journal club, where you are presenting the same information that needs to be presented in an evaluation of a manuscript for the peer-review process.” She recommends interested residents contact journals directly, identifying if there are any members on the editorial board with whom they are familiar and asking if there are any available opportunities. “It’s very rare that residents have ever contacted me to be a peer reviewer,” Dr. Coleman noted. “If one of them did, however, I’d definitely have them do it; what a great opportunity it is.”
Dr. Law also suggested that faculty peer reviewers who are actively engaged in the review process invite a resident for a tryout of sorts. “Training programs would have to initiate a course of action that asks faculty to do this formally and mentor residents through the process,” she said. “The residents could submit their final written review and scoring of the article and see how it matches with the faculty’s response. This would generate valuable discussion between faculty and trainee and would be a great educational tool on many levels.”
Never fear. Although few residents end up participating in the actual peer review process, past Ophthalmology editor-in-chief Andrew Schachat, MD, said you should not feel discouraged about playing a larger role. He said he frequently used the services of residents during his tenure, all of whom generally performed excellent reviews. “I was very pleased to have their insight and assistance,” said Dr. Schachat. “Wider participation is of course better, and we are always looking for more reviewers.” (Like Dr. Coleman, he suggests that interested residents contact Ophthalmology directly and register online.) The current editor-in-chief of Ophthalmology, George B. Bartley, MD, agreed, noting that many residents already have degrees in complementary fields like statistics, public health, physiology, biochemistry and immunology, which are highly valuable as a peer reviewer.
In the end, make an impact. Ultimately, peer reviewing allows residents to peer behind the curtain for a sneak peek into the latest research and make an impact on what is being published. It’s a pursuit that also gains importance later on in one’s career as an avenue to mentor other physicians less familiar with the process. Together with the journal club, the skills learned are nothing less than the indispensable components of scholarly communication and can really fortify a continued sense of belonging in the scientific community.
“These are essential learning experiences,” Dr. Coleman said, “that can be expected to pay dividends throughout an ophthalmologist's career if they take advantage of these opportunities during their training.”
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About the author: Mike Mott is a former assistant editor for EyeNet Magazine and contributing writer for YO Info.