‘We are all busy’: Journal clubs offer data, connection for rheumatology experts, trainees

Journal clubs in rheumatology are as pervasive as they are useful.

Trainees use them to learn how to read and interpret clinical trials. Longstanding researchers and rheumatologists find them necessary to stay abreast of the never-ending fountain of data that emerges from peer-reviewed literature every day.

However, no matter what stage in their career, all participants use them to connect and fraternize with colleagues.

“We are lucky to live in an era of new targeted therapies for different rheumatic diseases,” Jean W. Liew, MD, assistant professor of medicine and rheumatologist at Boston University, told Healio. “There is too much to keep up with and journal club focuses your attention on one big paper that you read in detail. Even if you have not had the time to read it in detail, the discussion provides enough summary for you to follow along.”

Arthritis & Rheumatology has a monthly journal club. Another can be found online at RheumJC. They are utilized at organizations as far apart geographically as EULAR and the University of California, Davis.

Different groups may select studies and trials based on their particular corner of the specialty. Some may be more social than others. They may be held in person or online. However, the core concept is the same — to examine the methodology, results and conclusions of peer-reviewed data.

Like many experts in the field, Liew has been a longstanding participant in a journal club. She sat down with Healio to discuss the transition from mentee to mentor, strategies for understanding how clinical trials work and how journal clubs can be enjoyable for all participants.

Healio: What is the utility of a journal club for rheumatology residents and fellows, both throughout their training and when they first enter the field?

Liew: Journal clubs are opportunities to discuss recent publications of interest to a group, whether it is from the research or clinical standpoint. Most of us are first introduced to journal clubs during our training, including residency and fellowship. Learning to read, interpret and discuss the scientific literature is a core competency that we must all learn. After training, journal club continues to be an avenue to catch up on the latest publications that could be potentially practice-changing.

Healio: At what point in that timeline might they transition from a mentee to a mentor in these discussions?

Liew: For those of us who remain in academics after the completion of training, we find ourselves transition to a mentor for residents and fellows in journal clubs, particularly if we are at an academic training program where some or all journal clubs are trainee-led. In the rheumatology fellowship program at my institution, we currently have a system where fellows choose which dates and mentors they want to be paired up with.

For half of the monthly journal clubs, fellows choose topics and publications that are the most interesting to them. For the other half, we have structured topics related to study design. Some are focused on basic science and some are focused on clinical epidemiology. The faculty mentor for each topic is familiar with using that method in their own work. The fellow and faculty mentor come up with an appropriate paper together that is related to the topic, and they review the method and how it is used in the paper.

In presenting the journal club to the section, the fellow teaches back what they learned about the method, which further improves their understanding. In medicine, we might call this an example of “see one, do one, teach one.”

Healio: What is the value of participation in a journal club for a practicing rheumatologist?

Liew: We are all busy and new studies are coming out all the time. We are lucky to live in an era of new targeted therapies for different rheumatic diseases. There is too much to keep up with and journal club focuses your attention on one big paper that you read in detail. Even if you have not had the time to read it in detail, the discussion provides enough summary for you to follow along. Journal clubs are a good way for us to keep up with the literature, one paper at a time.

Healio: Please discuss some strategies for interpreting methods and results.

Liew: The best strategy, and one that I acknowledge is not available to everyone, is learning about the study design and analytic methods from an expert who has done them. Although you do not need to learn by doing — and it is also not feasible — you need to have some basic understanding of the methods cemented in your brain before you can fully process the results. Otherwise, the results are just numbers that you might parrot. You need to understand the strengths and limitations of various commonly used methods, and what that means about the results.

This is why in our fellowship program we have gone back to the basics to ensure that everyone is on the same page. You cannot just assume. For clinical epidemiology studies, which is the type of research that I do, we go back to the basics of what is a cohort study, and what is a case-control study. We talk about exposures, outcomes and confounders. We practice interpreting hazard ratios in words — and we do it over and over.

To gain the level of understanding that I have now, I took graduate level coursework in epidemiology and biostatistics as part of my research training during fellowship. I apply this knowledge in my research on a daily basis. This will not be the focus of fellowship for most rheumatology trainees, nor should it be. However, everyone can and should learn the basics in order to understand the studies that we are reading. All clinicians should be able to keep up with the literature, provided they have the time to do so. And we should all be able to understand something more than just superficially.

Healio: Is there also a fun/enjoyment component to these clubs?

Liew: Well, I am in research, so it is part of my personality to find excitement in reading and dissecting new research studies, particularly the methods sections. I did not always feel this way. When I participated in journal clubs before I had formal methodology training, the process felt like a slog because I did not have a deep enough understanding of the methods and how to properly interpret the results. Now it is enjoyable to read the papers myself but also to teach trainees to read the papers and understand them the way that I do.

Healio: How can these clubs build relationships in the rheumatology community?

Liew: Various specialties, not just rheumatology, have tried to do online journal clubs via social media. Some of these efforts have had success and others have fizzled out. I think we preserve a bit of the journal club essence in discussing new publications asynchronously. Being engaged in these discussions can lead a trainee or very junior person to speaking with the senior lead on a big study, which is very cool. We can also hear how the results would or would not change clinical practice in different practice settings around the globe.