June 2020

Time To Talk A Little Nerdy: How to Read a Paper

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Carp27 -

Ken & Swami:

This is a fabulous segment that I intend to share with my residents every July as we begin a new year of Journal Club! A couple of questions/challenges and additional resources on this topic.

Question #1 (Existential, Philosophical)
You state that your approach to finding the literature does not include subscribing to journals. If everyone followed this approach, how would journals like Academic Emergency Medicine (with zero advertisement revenue) survive? Secondary peer review services like EM:RAP are not free and exist because basic operational costs are covered by subscription fees. How can journals with basic expenses not have the same benefit of subscription fees? I understand that low income nations often lack resources for these fees and we recently provided a litany of free resources to learn these EM critical appraisal skills in the African Journal of Emergency Medicine https://www.sciencedirect.com/science/article/pii/S2211419X20300264

Question #2 (Big Picture)
You both noted how abysmal your residency Journal Club experiences were. Members of the SAEM EBM Interest Group surveyed emergency medicine residency program directors via CORD in 2010 to describe their current state with EBM curriculum and expectations for faculty & residents in terms of EBM proficiency (including critical appraisal - see https://onlinelibrary.wiley.com/doi/full/10.1111/j.1553-2712.2010.00889.x). At Washington University we have tried to incorporate those principles into Journal Club for nearly 20 years (see https://emergencymedicine.wustl.edu/journal-club/archive/ ). In your opinions, why have Journal Club experiences been slow to provide their learners with these experiences?

Thanks for your thoughts and kudos on another wonderful episode!

Chris Carpenter, MD, MSc
Washington University in St. Louis School of Medicine
Department of Emergency Medicine

Anand S. -

Chris - love these questions. We should add this as a discussion for TTALN down the line
Short answer:
Journals: we simply can't subscribe to all of them. From my understanding, far more revenue comes from library subscriptions but, I could be flawed in that belief. For the individual, some subscriptions come with professional dues and that makes sense. What if journals went all on-line with no hard copy produced? Think of the savings in addition to the environmental impact. I would be more likely to subscribe at a reduced cost with electronic only. EMRAP has recently abandoned CDs so now there's no non-electronic version decreasing our impact and saving money.
Journal Club - need a champion to drive it. Someone who believes in it and invests time in creating a structured, cycled approach.

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