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Medical Student Course Guide: CF3 Journal Club

This guide is specifically designed for UCI medical students. It provides direct links to online key resources and textbooks for the undergraduate medical education curriculum.
URL: https://guides.lib.uci.edu/MS_courseguide

CF3 Journal Club: Prep for Residency

CF3 Journal Club

SDL / EBM Literature Search & Critical Appraisal


Journal Club Goals & Objectives

Clinical clerkship students must be able to search the medical literature, appraise and assimilate scientific evidence, and assess and improve their patient care practices. Clerkship students are expected to:

  • Address clinical questions they may have encountered during their CF3 clerkship rotations.
  • Perform PubMed searches and select a journal article that answers their clinical question.
  • Evaluate the hypothesis, the study design, the method, and the results of the relevant study as well as information on the diagnostic and therapeutic effectiveness.
  • Determine the clinical applicability of the selected study in their clinical clerkship practices.
  • Receive feedback and support from a UCI health sciences librarian, peers, and Dean Scholar. 

Assignment Instructions

The Journal Club EBM assignment is mandatory and involves five steps:

Step 1:

Identify a clinical scenario encountered during one of your clerkship rotations that you would like to further research for the evidence. 

Step 2:

  • Download and complete Worksheet #1 below.  "Asking a Clinical Question & Conducting a PubMed Search."

  • Complete Worksheet #1 and upload it to Canvas. You will receive feedback from a Health Sciences Librarian on your research question, PubMed search strategy, and the article you selected to appraise.
  • Before completing Worksheet #1, you are encouraged to seek guidance from one of the Health Sciences Librarians.  [Note: Worksheet #1 must be completed and uploaded to Canvas by September 1st so that a librarian may provide feedback before you proceed to step 3, which is the critical analysis of the selected study.]

Step 3:

After you have received feedback from the librarian, you need to decide if the selected study is both valid and important before you can apply the evidence to your patients. Download and complete the appropriate worksheet below that match the type of question and study methodology you have selected.  

​​Appraising the Evidence (Critical Appraisal Worksheets)

Step 4: 

  • Upload your completed critical appraisal worksheet and your selected article to Canvas by November 15th.

Step 5:

  • Present your case scenario, search method, and critical analysis to your assigned group during the CF3 intersession. 


Important Note:

  • Upload the completed critical appraisal worksheet and the article you appraised to Canvas by November 1st.
  • You will present your case scenario, clinical question, search methods, and critical appraisal of the selected article to your assigned CF3 group on November 12th.

 

Journal Club Materials & Tutorials

What Needs To Be Done: 

  • Briefly describe a clinical case scenario encountered during one of your clerkship rotations that you would like to further research for the evidence.
  • Construct a well-built, patient-oriented clinical question derived from your case scenario according to the PICO framework.
  • Decide the category of your clinical question (e.g., therapy, diagnosis, etiology/harm) and the ideal study type that contains the best evidence (e.g., randomized controlled trial, cohort study)
  • Identify possible search terms from your PICO question and incorporate them into a PubMed search strategy.

The PICO framework

P = Patients / Population and Problem
I = Intervention: a treatment, a diagnostic test, or an exposure (to a known or presumed risk factor, etc.
C = Comparison: a standard or alternate treatment, placebo, gold standard diagnostic test, absence of risk factor, etc.
O = Outcome of interest
 

The Most Common Types of Clinical Questions

  • Therapy / Prevention
  • Diagnosis / Screening
  • Prognosis
  • Etiology/Harm
  • Cost-benefit Analysis 

Examples of Well-built Clinical Quesitons

  • A question about Therapy:   In females diagnosed with breast cancer suitable for breast conserving surgery, what is the efficacy and safety of partial breast irradiation as compared to whole-breast irradiation?
    • P = Females diagnosed with breast cancer suitable for breast conserving surgery
    • I = Partial breast irradiation
    • C = Whole-breast irradiation
    • O = efficacy and safety of partial breast irradiation
       
  • A questions about Prevention: Does placement of postpartum contraceptive implant decrease rapid repeat pregnancy?
    • P = Postpartum mothers
    • I = Immediate placement of contraceptive implants
    • C = Delayed or no placement of contraceptive implants
    • O = Decrease rapid repeat, unintended pregnancy

  • A question about DiagnosisFor patients with suspicious breast calcification, what is the accuracy and safety of percutaneous ultrasound-guided vs. stereotactic biopsy?
    • P = Patients with nonpalpable breast lesions
    • I = Ultrasound-guided
    • C = Stereotactic
    • O = Sensitivity and specificity of the breast biopsies
       
  • A question about Prognosis: Would secondhand smoke exposure during pregnancy increase the risk of asthma among offspring?
    • P = Pregnancy women
    • I = secondhand smoke exposure
    • C = Smoke-free environment
    • O = increase the risk of asthma among offspring
       
  • A question about Etiology/Harm: Does Estrogen therapy increase the risk of blood clots and strokes in patients with menopausal symptoms?
    • P =Patients with menopausal symptoms
    • I = Estrogen therapy
    • C = No treatment / placebo
    • O = increase the risk of blood clots and strokes
       
  • A question about Cost-benefit Analysis What are the clinical and socioeconomic benefits of increasing access to reproductive health services and supplies for women with substance abuse disorders?
    • P = Reproductive age females with substance abuse disorders
    • I = Contraceptive care & services (family planning program, counseling, contraceptive supplies, patient education programs, etc.)
    • C = Unmet needs for contraception or reproductive health
    • O = Socioeconomic factors (e.g., reduce health care cost, unintended pregnancy, HIV infections, abortion rates, etc.)

Resources & Tools

What Needs To Be Done:

  • Provide the PubMed search strategy from the "History" section of the "PubMed Advanced Search Builder" (click "Advanced" under the PubMed main search box).
  • Identify up to three recent and relevant clinical studies from the search results.  
  • Provide the FULL citation of the study you selected to critically appraise.
  • Upload your completed worksheet #1 to Canvas for librarian feedback.

PubMed Search Tips

  • PubMed may add a number of synonyms, spelling variations, MeSH etc. Check the Search Details to see how PubMed translated your search terms. Did it interpret your search how you wanted?
  • Use only “essential” terms. PubMed's simple search box may look the same as Google’s, but PubMed is constructed very differently with a sophisticated search engine. Unlike Google, PubMed has a database of subject headings and key medical terminology through which every search is filtered. When conducting your search, use nouns or MeSH terms with the Boolean search concepts AND, OR, or NOT connecting them. Putting too many words or full sentences will only muddle your search results. PubMed is not Google!
  • Use PubMed Additional Filters to refine your search results to recent publications, Language - English, Species - Human, and Article Types - Clinical trial, Randomized Controlled Trial, etc.
  • Don’t restrict the search results to Free Full-text or Full-text. Very few articles are available free of charge for download.  Most peer-reviewed journals require annual subscriptions. The Full-Text filter option may cause you to miss relevant results from resources that the UCI Libraries own or those that could be requested through UC-eLinks Request It.
  • Avoid using acronyms or other abbreviations as search terms. PubMed is often able to discern the meaning of SOME acronyms and abbreviations, e.g., GERD = gastroesophageal reflux. However, some common abbreviations are NOT recognized by PubMed, e.g., UTI, AOM, ACBE, etc.
  • Do not include “placebo” OR “no treatment” in the search strategy.Avoid using imprecise search words. Some words you might try as search terms may be used inconsistently in published articles or are too imprecise to be useful, e.g., increased, better, greater, less, worse, etc.
  • Display Options – Summary or Abstract.   Sorted by Best match is set as the default display.  Select Sorted by Publication Date or Most Recent.
  • Cite – Allow you to o copy or download a single citation in a specific style format.
  • Similar articles – if you find too few results, the abstract page of a citation provides a pre-calculated set of additional PubMed citations closely related to that article.

PubMed Tutorials

What Needs To Be Done: 

  • After you have completed worksheet #1 and received approval from the librarian, download the appropriate critical appraisal worksheet from Canvas.
  • Download the article you selected to perform the critical appraisal. 
  • Read the selected article and complete the worksheet.
  • Upload the completed worksheet and the article to Canvas by November 1st. 
  • Present your case scenario, search method, and critical appraisal of the selected study to your assigned group during the CF3 intersession. 

 

Example Scenarios Appraisal Worksheets from Evidence-Based Medicine Toolbox

 

Critical Appraisal Mini Videos by Terry Shaneyfelt

Health Sciences Librarian

Profile Photo
Linda Murphy
Contact:
Linda Suk-Ling Murphy, MLIS
Health Sciences Librarian
University of California, Irvine
The UCI Libraries
P.O. Box 19557
Irvine, CA 92623-9557
(949) 824-6419
Website Skype Contact: lmurphy@ad.uci.edu
Subjects: Medicine

Connect from Off Campus

Download the Cisco AnyConnect VPN Software

Watch a short video on VPN download and configuration

  • In the Ready Connect box, enter: vpn.uci.edu
  • In the Group drop-down menu, select UCIFULL 
  • Enter your UCInetID and password 
     

Check My VPN Connection

Relevant Resources and Links

Literature Search Key Databases

PubMed Quiz for Medical Students

After you complete the 20-question PubMed quiz and click submit, you will receive a certification for completion at the end. To begin the quiz, click the image below.

Differential Diagnosis and Clinical Decision Support Tools

Adapted from: 

  1. CEBM: The Centre for Evidence-Based Medicine Develops, promotes and disseminates better evidence for healthcare.  Critical Appraisal Worksheets https://www.cebm.net/2014/06/critical-appraisal/ 
  2. Dartmouth Biomedical Libraries Evidence-Based Medicine Worksheets: https://www.dartmouth.edu/~library/biomed/guides/research/ebm-resources-materials.html
  3. Evidence-Based Medicine Toolbox: Critical Appraisal Worksheets Logbook.  https://ebm-tools.knowledgetranslation.net/worksheet