Efficacy of a novel journal club series at an academic hematology/oncology fellowship program.
Authors: Patel Vivek , Bhaskar Shakthi , Cann Christopher G , Green Jennifer , Mohan Sanjay , Walsh Katherine Jean , Dupuis Megan 
Published: June 2022

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Background: Journal club (JC) is an essential tool in hematology/oncology fellowship to develop critical appraisal skills. The traditional JC format of reviewing an article followed by group discussion may not provide optimal education in appraising literature. We applied a novel JC curriculum and measured impact on fellow comfort with trial design, statistics, and endpoint interpretation. Methods: A novel JC curriculum was implemented for hematology/oncology fellows at Vanderbilt in the 2021-2022 academic year. JC for the prior year utilized the traditional format. We developed five focused learning objectives (LO’s) for each JC and emphasized the goal was to not place the paper in clinical context but to focus on developing the foundational tools for critical appraisal skills. The sessions involved (1) 15 minute introductory lecture from a biostatistician to cover foundations of the LO’s; (2) group discussion led by an upper year fellow to describe the paper in the context of the LO’s; (3) question and answer session from the fellows to both the statistician and a clinical trial expert. We developed anonymous pre and post surveys to understand the impact of the novel JC curriculum on a 5-point Likert scale. Two sample unpaired t-test was used to compare mean differences. Results: A total of 15/22 fellows (68%) completed the pre-survey and 12/22 fellows (55%) completed the post survey. There was an even distribution of fellows by year in the pre survey and 33% first years, 41% second years, and 25% third years in the post survey. There was a statistically significant improvement in pre and post mean fellow comfort in understanding differences in trial types (2.9 vs. 4, p < 0.001), randomization strategy (2.6 vs. 4.25, p < 0.001), endpoints (3 vs. 4.1, p < 0.001), and interpretation of the statistical methodology of represented data (3 vs. 4.3, p < 0.001) on a 1-5 Likert scale (5 being entirely comfortable). In a subset analysis, we did a direct comparison of fellows who had previously participated in both JC formats (n = 9); the new format was rated as a more useful tool for learning data interpretation than prior with a mean of 4.8/5. When comparing fellow perception in the utility of traditional compared to the novel JC, there was a statistically significant mean improvement in utility of JC to prepare fellows to understand differences in trial types (1.9 vs. 4.1, p < 0.001), randomization strategy (1.4 vs. 4.5, p < 0.001), endpoints (2.7 vs. 4.5, p < 0.001), and interpretation of the statistical methodology of represented data (2.33 vs. 4.6, p < 0.001) favoring the novel JC. Conclusions: Fellows’ comfort with trial design and content significantly improved with our novel JC. To our knowledge, this is the first time such a curriculum has been used in hematology/oncology training. Our successfully piloted novel JC model can be adapted to other fellowships to improve foundational skills in the critical appraisal of clinical trials.