HOW A "JOURNAL CLUB" ENHANCES PERFORMANCE


We have looked at Learning Circles in different industries and professions in previous columns, such as "Building Blocks of 'The Learning Organization'", April, l996. This month, let's sit in on one, to get a glimpse of how such a group sparks learning that is both profound and practical.

It is 6:45 on a Thursday morning at North Shore University Hospital in Manhasset, Long Island, adjacent to New York City. Twenty three members of the JAMA Journal Club are seated around a table in the Hospital's main conference room. Some are just starting their day; others have worked all night with the Hospital's most critical, unstable patients. One cardiac surgeon came into the hospital at 2 a.m. to do an emergency operation -- and has chosen to stay on for this meeting.

For the next 50 minutes, these nationally-renowned cardiac surgeons, intensivists, physicians assistants, nurse practitioners and hospital administrators will discuss new findings from the most respected journals in their fields of cardiac surgery, cardiology and intensive care medicine.

This morning, the first item is from a recent issue of the Annals of Thoracic Surgery: a review of the literature and treatment guidelines on the use of a spiral CT scan in patients with suspected pulmonary artery rupture. If unrecognized, this rare complication from the use of an invasive monitoring device can be fatal.

Towards the end of the discussion, Dr. Michael Levy asks Dr. Adel Hanna, an Intensivist (a doctor in charge of an intensive care unit) : "Would a spiral CT work for Mrs. G?" -- a patient upstairs in the Cardiothoracic unit. "Yes," answers the Dr. Hanna. "On the basis of these findings, I'm sure it would."

By 11:00 that morning the CT was underway.

"Something like this happens at virtually every session," says Elizabeth Cohn, the Journal Club's moderator, who is a critical care Nurse Practitioner and research nurse in the department. "It's exciting to see knowledge turn into action that improves patient care. The members tell me that this experience is unique in their continuing medical education. The multiple perspectives of different experts, gives them something they could not get by just reading the journals on their own."

Often, members will be so intrigued or provoked by one of the articles to be discussed, that they will use it as a springboard to provide the group with a much broader view. For example, later in this session Dr. Erfan Hussain presents an article on fluid resuscitation in the ICU. To fully illustrate his point he has researched and read several of the most current medical journals, and logged onto websites designed for critical care physicians.

The Journal Club operates under the direction of Dr. Michael H. Hall, Chief of Cardiothoracic Surgery, and with the guidance of Dr. Vincent Parnell, Jr., Chief of Pediatric Cardiac Surgery. Arrangements have been made with the American Medical Association for the members to receive Category I Continuing Medical Education credits.

But obviously that is incidental to their participation. "What they value is the an opportunity to talk together about treatment options and new developments," says Cohn. "The real motivation is better care of the patients who we are dealing with every day. That tight fit between learning and action is what makes this learning powerful."

The Journal Club is a form of Continuing Professional Education which can help practitioners in any field to keep current with new developments, and improve their performance -- whether it's in medicine, law, insurance, public service, finance, or marketing.

Copyright © 1999 Ronald Gross