How are internal medicine residency journal clubs organized, and what makes them successful?

BACKGROUND While there has been extensive research on interventions designed to increase knowledge of research methods in the setting of journal clubs, little is known regarding other features that are of potential importance. To my knowledge, no research to date has described the attributes of journal clubs associated with high resident attendance and the avoidance of periodic abandonment. I sought to determine how journal clubs in postgraduate programs in internal medicine are organized and to identify the features associated with high attendance and continuous existence. METHODS Mailed cross-sectional survey of the 208 accredited residency programs in internal medicine in the eastern United States. The surveys were mailed to the chief resident in internal medicine in August 1992. RESULTS Data from 131 residency programs were available (response rate, 64.5%). Mean estimated attendance at the 124 programs with an active journal club was 58.5% (range, 7% to 100%); 86 (65.6%) of the clubs were in continuous existence for 2 years or longer. Fifty-two journal clubs (41.9%) were described as independent of any faculty clubs, and 62 (50.0%) emphasized original research. The number of articles reviewed per session ranged from one to six, but the majority reviewed two articles, usually during a 1-hour period, most often during the lunch hour. Seventy-two programs (58.1%) described club attendance as mandatory. The provision of food was a regular feature of 83 (66.9%) of the journal clubs, and the majority of clubs with food regularly rely on funding support for the food from pharmaceutical companies. Participation of faculty in the scheduling of the club, assigning articles, and overall coordination varied, but in 29 (22.1%) of the clubs, faculty provided formal teaching of critical appraisal skills, clinical epidemiology, and biostatistics. Fewer house staff, a mandatory attendance requirement, being independent of a faculty journal club, and formal teaching were associated with high attendance. The regular provision of food was associated with long, continuous existence. Reviewing only original research articles was associated with long, continuous existence but was negatively associated with high attendance. Journal clubs with both long, continuous existence and high attendance were associated with mandatory attendance, the provision of food, and fewer house staff. CONCLUSIONS If residency journal club success is defined as having high attendance or long, continuous existence, then success is associated with smaller residency programs, making attendance mandatory, promoting a journal club independent of faculty, providing formal teaching of critical appraisal skills, making food available, and emphasizing original research articles. Residency programs in internal medicine seeking to establish journal clubs with long, continuous existence or high attendance should focus on these attributes.