The origins and aspirations of ACP Journal Club
ACP J Club. 1991 Jan-Feb;114:A18. doi:10.7326/ACPJC-1991-114-1-A18
“It is astonishing with how little reading a doctor can practice medicine, but it is not astonishing how badly he may do it.”
—Sir William Osler
If practicing today, Dr. Osler (who grew up about 100 years before and about 100 meters from where this journal club was conceived) would not only be more sympathetic toward his colleagues' reading habits, he'd be in considerable trouble with his own. Even if only 1% of the 4 million articles being added annually to the biomedical literature (1) were pertinent to his clinical practice, he would have to read over 100 articles per day to keep pace.
One proposed solution (1) is “ultraterse communication”: one-sentence messages that give the conclusion, the “bottom line,” from any article. This proposal would ameliorate the problem of volume but exacerbate other problems such as the ability of the reader to verify the validity of the conclusion and to determine the circumstances under which it can be applied. As Spodick (2) has put it: “Thus we must view published experience critically (if not biblically), for too often the 'Conclusion' giveth, but the 'Material and Methods' taketh away.”
Since 1978, a group of us at McMaster University have been teaching evolving versions of “how to read a clinical journal” to students and colleagues (3). The success of this approach for keeping up to date hinges on two actions by clinical readers: assessing applicability and checking validity. That is, as clinical readers attempting to keep up with the literature that bears on patient care, we must select which original journal articles to read both on the basis of applicability to the types of patients we see and on the basis of validity of the methods: the adherence of the study reported in an article to principles of common sense and science. We refer to this process by the unoriginal name of “critical appraisal” of the medical literature. A recent study has shown that critical appraisal skills can be taught to advantage—and that not being taught them leads to diminishing abilities to distinguish good from poor literature (4).
Critical appraisal is an essential skill for clinicians. We also recognize its most important limitation. Few physicians have enough time to apply such skills to a large enough volume of literature to do justice to the concept of keeping up with medical advances as they occur.
ACP Journal Club is our response to this problem. We will scour the literature published in the journals most pertinent to internal medicine and select those articles that meet the specified criteria, including applicability (to the practice of internal medicine broadly defined) and validity (methods sufficiently strong to support direct clinical application). The details of the process of journal and article selection are included in the Purpose and Procedure section. We prepare more informative abstracts (5) for the articles that meet all criteria, so that you, the reader, can verify whether the conclusion is likely to be true and, if so, whether it applies to your own clinical practice. Abstracts are followed by a commentary from a physician with expertise in both critical appraisal and in the clinical content of the article, in order to expand on key features of the methods and to set the article in the context of other key studies in the field. The abstract and commentary are then sent to the author of the article to ensure that we have represented accurately the article and the study on which it is based.
Additional features of ACP Journal Club include authors' addresses for reprint requests and editorials on key methodologic issues.
ACP Journal Club will continue to evolve based on the advice and suggestions of its readers.
R. Brian Haynes, MD, PhD
Hamilton, Ontario, Canada