C3.5 R3(d): Prepare and Facilitate a journal club to pharmacists

For my cardiology rotation, my journal club was on the newly published: Pioneer AF-PCI.

Areas I improved on:

  • Going at an easy to follow pace and leaving enough time/pauses for the audience to absorb information and join in the discussion has been something that I had difficulty with in my previous journal clubs. For this journal club, I was able to slow my pace down and turn the discussion to the group every once in a while to help keep the discussion going.
  • In order to help facilitate discussion, I had prepared questions which I think helped the audience reflect on the information presented on the handout and its implications
    • Another question I could have asked is if the audience agreed with the bottom line before I discussed my opinion on the bottom line, and what kinds of patients the audience would apply this trial on.

Areas to improve on:

  • Continue to work on highlighting pertinent information from the handout, and letting the audience know if we are deviating from the order presented on the handout
  • Especially during the second half, I was reiterating certain points over and over (e.g. one of the limitations of the trial). Another area to improve on is being concise and figuring out and preparing different ways to present the information in advance.
  • Continue to develop my critical appraisal skills and understanding the implications of the study’s design
    • E.g. for this trial: understanding the implications for having a multi-arm study design
  • My handout was very text-heavy and busy. I will continue to work on the spacing of my handout. So far, I have trialed different ways to present each of my journal club and for this journal club, I had attempted to follow the “Rxfiles” style. However, in my attempt to fit everything on two pages, there were certain portions of my handout that were difficult to follow.
  • When preparing for future journal clubs, doing the following:
    • If adherence to the study drug was reported, understand how adherence was measured in the trial
    • Familiarize myself with the protocol under the supplementary appendix and identify any differences between the protocol and the final design/results
    • Understanding and being able to concisely explain the potential implications of the differences in the baseline characteristics of the different treatment arms
    • Be familiar with other guidelines (e.g. European Guidelines for this particular journal club topic), assess the evidence behind their recommendations and rationalize the differences between those recommendations and our local guidelines and current practice
    • Similarly to my preceptor, providing ~ 2 weeks for people to read the trial

My handout: pioneer-af_audience

Resources:

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C3.5 R3(d): Prepare and FACILITATE a journal club to pharmacists

My second journal club is on the following article: Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study

Areas of improvement:

  • Prioritize the most important points I want to get across during the journal club
  • Being concise – highlight the important points and provide the rest of details on paper for the audience to refer to
  • Consider the audience and how to present technical aspects of the trial
    • E.g. Power: The certainty that the study will of detecting a real effect as statistically significant if it truly exists
  • Have a firm understanding of how the drug therapy should fall into guidelines and provide a summary of practical applications
    • Consider dosing in renal impairment, hepatic impairment, in combination with other drugs, interactions with other medical conditions, etc.
      • E.g. ivabradine selectively inhibits the Ifchannel – which is predominantly in the SA node. SA node is dormant in atrial fibrillation; therefore, the theory is that for rate control, ivabradine shouldn’t impact afib
    • Describe the “ideal” patient I would use this medication in, monitoring plan

My journal club handout: SHIFT Audience Handout

C3.5 R3(d): Prepare and FACILITATE a journal club to pharmacists

My first journal club is on the following article: Liraglutide and CV outcomes in T2DM.

My preceptor kindly reviewed my journal club prior to the presentation. He brought up questions and points to consider to better prepare me for my presentation which was very helpful! During the presentation, he also asked questions to help guide and prompt discussion. We had about ~8 pharmacists attend which seemed like a good number as it allowed us to have a good discussion. I was very fortunate to have a very supportive audience for my first journal club – a lot of thought-provoking questions were also asked by the group which made for very good discussion. ☺

What went well:

  • Started prep work early (~1 week prior) for the journal club
  • Increased familiarity with basic principles of different trials (e.g. non-inferiority)
  • Had two different versions of the journal club template: 1 with my notes and things to bring up, and 1 which was a much cleaner version that was easier for my audience to follow
  • Had an opportunity to practice and review my journal club with my preceptor

What I could work on:

  • I think having a good pace is something I still have to work on. When I know I have a lot of information to cover, I tend to go fast and trip on my words. I think slowing down and perhaps turning it to the group every once in a while will help keep the interest and discussion going.
  • Analyzing whether the duration of trial is a limitation and for assessing what outcomes it might a limitation for
    • e.g. retinopathy normally takes 10-15 years to develop…for patients with diabetes for an average of ~12 years, is tx of 3 years enough to assess the efficacy in preventing retinopathy?
  • Answering questions – I think I definitely struggled to answer some of the questions and didn’t answer a lot of them as comprehensively and clearly as I could.
    • Having a clearer idea of the application into practice…specifically into the “timeline”/”steps” of guidelines
  • Need to become more familiar with critical appraisal, statistics, trial designs, etc.

Feedback on reviewing draft:

  • For inclusion/exclusion criteria: don’t only consider whether the patient characteristics are appropriate, but also if such patients would be treated according to current guidelines
    • E.g. Inclusion criteria of T2DM patients with HbA1c > 7% for liraglutide
      –>  If patient’s HbA1c is 7.1%, will you consider liraglutide?
  • What is pre-specified and not?
    • If not pre-specified, may be “looking for” differences
  • When going through template, consider advantages and disadvantages of the trial design?
    • E.g. pros and cons of: multi-centered, international, randomised
  • Be able to identify “specific” bias
  • Consider: How do the results seen compromise blinding?
    • If known SE is weight loss, how will that affect the trial?
  • For withdrawals (before randomization, during trials), know why they withdrew?
    • How does this affect your results
  • Be able to answer: If your family member needed a ___ medication, what would you give? Does the trial change your decision?
    • Be familiar with trials and outcomes of other medications.
  • Think of where you can pose a question to the audience and guide discussion. Provide time for the audience to answer.
  • Put relevant tables/figures in the table

To do for next journal club presentation:

  • Use the NERD-CAT tool
  • Have more questions to guide and prompt discussion
    • Perhaps have someone else answer about background? E.g. what do we know currently about this drug?…and start it off in a more interactive way
    • Don’t just ask “what your thoughts are on the inclusion criteria”…be more specific e.g. what are your thoughts on them including patients with HbA1c > 7%
    • Whenever a pharmacist asked me a question, it might be good to answer but also turn it back to the group at the end so that others have a chance to add in.
  • Have checkpoints throughout the journal club to ask if anyone had any questions
  • Create a more concise and hopefully shorter journal article page
  • Think about what questions could come up and better prepare myself for them
  • *KNOW IF THE DRUG IS ON FORMULARY*
  • *What would you consider clinically signiifcant? Does this agree with the article? Do you agree with the article and their MCID? Be able to justify your answers*
  • Print out about 10 copies of journal club template
  • Print out about 10 copies of journal club article

My journal club review: JC Summary – Liraglutide (Audience)

To end this post off, I’ll leave it with an image that I personally find very relatable: