Creative Education
2012. Vol.3, No.6, 708-711
Published Online October 2012 in SciRes (http://www.SciRP.org/journal/ce) http://dx.doi.org/10.4236/ce.2012.36105
Copyright © 2012 SciR e s .
708
Challenges of E-Journal Club: A Case Study
Nazila Zarghi1,2*, Seyed Reza Mazlom1, Majid Rahban3#
1Department of Nursing, S ch oo l o f Nu rsing and Midwif ery, Mashhad University of Medic al Sciences,
Mashhad, Iran
2Education Development Center (EDC), Mash h ad University of Medical Sciences, Mashhad , Iran
3Department of IT, Sch ool of N ursing and Midwifery Br an ch,
Mashhad University of Medical Sciences, Mashhad, Iran
Received August 14th, 2012; revised September 18th, 2012; accepted September 30th, 2012
Background: Journal clubs, founded by Sir William Osler in 1875, have been used as a teaching format
in academic medicine for over a hundred years. New generation of journal club include EBM format, Au-
dio journal club and the latest, E-journal clubs. This study aimed the challenges of helding E-journal club
in MUMS. Method: For this, a special virtual space was designed for e-journal club and a practical article
was selected for on-line comments. It was possible for participants to register in a 7-day time span. Leader
of journal club sent an e-mail for participants and explained the process for them and asked them to read
the article and leave a comment. As there was impossible for being on-line at the same time for partici-
pants, it was decided to design the second space for leaving comments. Both participants and leader could
access the others’ comments, so the interaction became possible for them. The time for leaving comment
was considered 10 days. Result: Although participants included faculty members and students who were
familiar with e-methods, there was no comment on the space. Conclusion: It seems, other involving fac-
tors should be considered. The other factors apart from educationals, influenced on performing and par-
ticipating in new generation journal clubs which demands further observation.
Keywords: Electronic Journal Club; Journal Club; E-Journal Club
Introduction
Journal club has been defined as “A group of indi viduals who
meet regularly to discuss critically the clinical applicability of
articles in the current medical journals” (Linzer, 1987). Based
on documents, the first recorded journal club was run at Mc
Gill University in 1885, by Sir William Osler aimed to distrib-
ute and pay for journals to which he could not afford to sub-
scribe. Nowadays, the aims have changed, but essentially the
practice remains as an excellent way to remain up to date with
developments in each field. In recent years, the importance of
“evidence based healthcare” has grown and there has been an
inclination to integrate practical evidences into clinical setting
(NHS, 2010). It seems obvious that running journal club could
be a key method for reviewing literature and discussing its
clinical implications. The aims of any journal club should be
critical evaluation of literature and assess the-state-of-the-art
advances for each specialty (Gibbons, 2002). The aims and ob-
jectives of journal club include:
 To provide a bridge between research and practice and fos-
ter an application of research to the clinical setting;
 To locate the best evidence on which to base practice;
 To help research awareness;
 To keep abreast with current research;
 To strengthen critical appraisal skills;
 To understand bio statistical and epidemiological methods;
 To increase confidence in dealing with evidence/research;
 To improve professional reading habits;
 To develop multidisciplinary relationships;
 To fulfill requirements for Continual Professional Develop-
ment;
 To maintain and improve professional knowledge and com-
petence which influence on quality of care;
 To develop local guidelines (Lindquist, Robert, & Treat,
1990).
The structure of successful journal clubs is different. Health-
based journal clubs have been in place for a long time. Partici-
pants meet regularly to critique research papers, improve their
understanding of research design, biostatistics and critical ap-
praisal. However, there is no standard process of conducting an
effective journal club. The main characteristics of successful
journal clubs include regular and anticipated meetings, manda-
tory attendance, clear long- and short-term purpose, appropriate
meeting timing and incentives, a trained journal club leader to
choose papers and lead discussion, circulating papers prior to
the meeting, using the internet for wider dissemination and data
storage, using established critical appraisal processes and sum-
marizing journal club findings (Eval, Deenadayalan, Grimmer-
Somers, Prior, & Kumar, 2008). Face to face journal clubs have
been used as an atmosphere to share knowledge and discuss
research findings relevant to clinical practice. However, atten-
dance at journal club meetings has always been identified as a
barrier to successful and sustainable clubs. One of the possible
solutions to this is the establishment of electronic journal clubs.
The on-line journal club is a useful example of the educational
advantages created by the combination of technology with tra-
ditional journal club methods (Lizarondo, Kumar, & Grimmer-
Somers, 2010). It not only provides an opportunity for asyn-
*Corresponding autho r.
#BSc of Medical Librar
y
and Information Science s.

N. ZARGHI ET AL.
chronous discussion but also allows members to participate in
discussion at a time and place of convenience. To study the
challenges of E-journal club, it was evaluated goal and objec-
tives of journal club by which the challenges will be discovered
through level of achievement.
The purpose of this study is to describe a teaching strategy
that can be used for large numbers of participants, which im-
prove critical appraisal skills for applying in clinical practice
through participation in a university -based journal club. It aim ed
to provide a vi rtua l space for j ourna l club a nd study the c halle ng e s
of E-journal club in Mashhad University of Medical Sciences.
Methods
For performing this study and evaluate goals and objectives,
a special virtual space was designed for e-journal club, and then
a paper was selected to discuss via electronic approach (Figures
1 and 2). Participants were given a 7-day time span for registra-
tion. An e-mail was for them to explain the process of E-journal
club and asked them to read the paper and leave their comments
on the space where was designed for this purpose. As there was
impossible for participants to be on-line at the same time, it was
decided to design the second space for leaving comments. Both
participants and leader could access the others’ comments, so
they could actively interact with each other by their comments.
They had 10 days for making comment. The fina l step was s um-
ming up the comments and makin g hand out for participants. An
evaluation form was designed to obse rve the educational impa c ts
at the end of session both for appraisal skills and knowledge of
the related area.
The following criteria were considered for conducting this st udy
based on journal club goal and objectives:
As CPR (cardiopulmonary resuscitation is one of the most
critical and basic skills among different health care professions
in clinical setting, it was decided to select a paper on this topic
by which the findings could be applied in practice and update
health care professions with current high level of evidence re-
search (Level of Evidence A). The paper was selected from
AHA (American Heart Association) which releases and updates
international guidelines for CPR every five years. It was about
BLS (Basic Life Support) guideline which was updated in 2010.
To help participants’ research awareness and strengthen critical
appraisal skills, understand bio statistical and epidemiological
methods and increase their confidence in dealing with evidence/
research, a critical appraisal tool was sent with paper by which
a standard and strict approach was introduced to participants
both for critique and dealing with new evidence.
It was predictable that participants were working at different
health care professions, so, the selected paper was based on
general critical skills, consequently, inter professional relation-
ship could be made by this virtual space, at the same time they
could develop their reading professional reading during this p roc-
ess which could be considered as a continuing education at the
same time in a friendly use approach. Obviously , improving pr o-
fessional knowledge and competence would be influential on
quality of care, the goal of medical education.
Figure 1.
The designed virtual spaces for electronic journal club: Early explanations and registration.
Copyright © 2012 SciRe s . 709

N. ZARGHI ET AL.
Figure 2.
The designed virtual spaces for electronic journal club: Receiving the paper and making comments.
Results
28 people registered and received the article, i.e. all of them
read the instructions, aims and objectives of the online journal
club and oriented with the process. Surprisingly, although par-
ticipants included faculty members, students and university p hy-
sicians were familiar with e-methods, no comment on the space
was left. It means no journal club and no discussion was oc-
curred but they read the article and got new information. Table
1 demonstrates the result of overall journal club objectives
evaluation.
Discussion
As the body of medical lite rature continues to expand, h ealt h-
care teams especially physicians must develop the necessary
skills to keep up with the vast amount of information. The jour-
nal club provides a forum to allow participants to remain up to
date with the literature and is also teaches them the methods of
critical evaluation. Those readers wishing to start a journal club
or revive an existing one should begin by selecting a leader and
defining the club goals. Formal evaluation will also provide an
objective assessment of the knowledge gained by the house-
staff through participation in journal club (Valentini & Daniels,
1997).
At the start, journal clubs helped participants stay current wi th
Table 1.
Overall evaluation of objectives.
The aims an d o bjectives o f journal c lub Overall
evaluation
Provide a bridge between research and practice and foster
an applicat ion of research to the clinical se t t i ng +
Locate the best evidence on which to base practice +
Help research awareness –
Keep abreast with current research +
Strengthen critical appraisal skills –
Understand bio statistical and epidemiological methods –
Increase confidence in dealing with evidence/research –
Improving professional reading habits +
Develop multi disciplinary relationships +
Fulfill requirements for Continual Professional Development ±
Maintain and improve profess ional knowledge and
competence which influence on quality of care ±
Develop loc al guidelines ±
Note: ±: Doubtful; +: Achieved; –: Not achieved (main challenges).
Copyright © 2012 SciR es .
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N. ZARGHI ET AL.
medical literature. Later, they improved acquisition of knowl-
edge in clinical epidemiology, biostatistics, research design, and
more recently in teaching critical appraisal skills. Journal clubs
could develop critical thinking, reading habits and strengthen-
ing of collegial relationships. The journal club also has been
advocated as a bridge between research and practice, hence
facilitating better practice of evidence based medicine. Current
internet technology has added another dimension to traditional
journal club, where electronic even online discussions are the
main stay of journal club. Many clinical disciplines report using
journal clubs to train postgraduate trainees in relevant special-
ties. At present, benefits of a journal club exercise are reported
not only in postgraduate programs, but also even documented at
undergraduate level (Akhund & Kadir, 2006).
As to the results, no journal club was conducted. A possible
reason may be that the participants were in different Depart-
ments; participants were a mixed group of postgraduate stu-
dents, nurses and physicians. Of the study limitations include
the small sample size. Although the Mashhad University of
Medical Sciences has one of the largest postgraduate programs
and number of staffs in Iran, it was hypothesized that partici-
pants would discuss the article. The most optimistic explanation
could be that the participants read the paper and got the new
points, but they did not contribute to critical appraisal due to
either lack of motivation or lack of knowledge about the way of
participating in club despite of explanations. It seems, it was
not considered as a priority for them. An alternative explanation
would have been a significant interaction through shared duties
and seminars among sites i.e. lack of time and they would lik ely
have stopped attending. It was believed the best compromise
was to be honest about the study. Nonetheless, the journal club
in present study would not be conducted better than the others
if it held. The results suggested that the journal club, as shown
in this study, cannot be considered as an effective method for
an electronic approach. In addition, the journal club did not
describe an increased use of the literature, which corresponds to
the earlier study findings. The format of a journal club is highly
regarded as a way to teach skills for critical appraisal. However,
this study corroborates the literature that journal clubs were not
effective at the electronic approach especially in interactive off-
line versions. Perhaps participants have already acquired some
skills, and further teaching produces diminishing returns. The
effectiveness of journal clubs may root in other facets, such as
improving collegiality and communicating ne w lit erature as w e ll.
Perhaps a wait-list group, may be feasible. Finally, it seems that
the learning critical appraisal skills were promoted by the de-
gree of personal importance to participants, and this factor is
often in a form that affects on their evaluations.
Conclusion
Based on the results, it seems the main challenges were allo-
cated to the objectives such as help research awareness, streng then
critical appraisal skills, understand bio statistical and epidemi-
ological methods and increase confidence in dealing with evi-
dence/research which need further education in non-virtual or
even blended atmosphere. Some objectives were planned and
supervised by leader/supervisor: provide a bridge between re-
search and practice and foster an application of research to the
clinical setting, locate the best evidence on which to base prac-
tice, improving professional reading habits, develop multidisci-
plinary relationships, fulfill requirements for Continual Profes-
sional Development and maintain and improve professional
knowledge and competence which influence on quality of care.
It should be said that evaluation of these objectives required
specific methods and the results of this study just have pre-
sented overall evaluation. As the paper was not discussed elec-
tronically, the evaluation of the last three objectives, i.e. fulfill
requirements for Continual Professional Development, maintain
and improve professional knowledge and competence which in-
fluence on quality of care and develop local guidelines were in
doubt.
As to the findings, it could be concluded that although par-
ticipants were oriented with electronic methods and approaches,
they did not participate in these sessions unless they gain some
incentive points. Providing infrastructural factors such as allo-
cating special time for participation and teaching them to run
journal club, both educational and critical structure before par-
ticipating in virtual ones and performing blended form of jour-
nal club before virtual ones could be helpful. Supervising clini-
cal setting for applying them in practice is could be effective as
well.
Acknowledgements
Special thanks to authorities of School of Nursing and Mid-
wifery for their kind cooperation.
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