A journal club can be defined as a group of individuals who meet regularly to discuss articles in current medical literature . The earliest reference to a journal club is found in Sir James Paget's memoirs and letters (1835–1854) in which he described how a small group of students near St. Bartholomew's Hospital London met in a room over a baker's shop to read journals. Evidence of the first formal journal club comes from McGill University Montréal where, in 1875, William Osler found a way to make expensive periodicals affordable by organizing with fellow students to purchase expensive journals at a group rate .
At the start journal clubs helped students stay current with medical literature. Later, they improved acquisition of knowledge in clinical epidemiology, biostatistics, research design, and more recently in teaching critical appraisal skills [3–8]. Studies show that journal clubs promote critical thinking, reading habits and strengthening of collegial relationships. [3, 6, 9–11]. The journal club also has been advocated as a bridge between research and practice, hence facilitating better practice of evidence based medicine [12–17]. Current internet technology has added another dimension to traditional journal club, where online discussions are the main stay of journal club [18, 19].
Many clinical disciplines report using journal clubs to train postgraduate trainees in relevant specialties. At present journal clubs are found in Medicine (and allied fields of Internal Medicine, Palliative Care, Family Medicine, Emergency Medicine and Critical Care, Cardiology, Paediatrics, Ophthalmology, Physical Medicine and Rehabilitation), Surgery (and allied fields of Obstetrics and Gyneacology, Orthopeadics, Neurosurgery, Hand surgery), Psychiatry, Geriatrics, Nursing, and Health Care Management [16, 20–29]. Benefits of a journal club exercise are even documented at medical undergraduate level .
While a 1999 article from the Royal College of Physicians London illustrates the popularity of journal clubs in public health medicine related to clinical practice,  the existence of journal clubs in the discipline of Community Medicine (Public Health) has been documented sparsely. In Pakistan, the effectiveness of journal clubs has so far not been evaluated in any postgraduate medical education program.
In order to find criteria of effective journal clubs, articles were identified through electronic searches using PubMed, and Cochrane retrieval systems. Search terms used were "journal club", "effectiveness", "public health" and "post graduate medical education". Reference lists of known systematic reviews were also searched in this connection besides hand search of library periodicals [1, 32–36].
The following criteria and associated factors of effective journal clubs were found:
Criteria for effective journal club
Factors associated with effective journal club (listed in random order)
Explicit written learning objectives
Having a designated club leader
Formal teaching of critical appraisal skills
Journal club independent of faculty journal club
Regular attendance by faculty
High value given by program director
Smaller residency programme (12 or less residents)
Incorporation of adult learning principles
Provision of free food
Use of a structured checklist for article review
The purpose of this study was to determine the effectiveness of the CMR-JC currently conducted in a Pakistan medical university by:
Comparing the criteria of effective journal clubs in the international literature with that of the CMR-JC
Seeking evidence of resident and alumni satisfaction with CMR-JC
Community Medicine resident journal club (CMR-JC)
CMR-JC is offered by the Community Medicine Residency Program (Community Health Sciences Department) of a Pakistan medical university. The target audience is Community Medicine Residents (equivalent to post graduate trainees in Public Health). These trainees already have a MBBS degree.
The goals of CMR-JC are to:
increase awareness of residents regarding important national and international public health issues
teach residents critical appraisal skills
meet core competencies required by the College of Physicians and Surgeons Pakistan, the program accreditation body
assess residents' knowledge and expertise over time in raising public health issues, utilizing public health tools and developing strategies to address issues.
Format and environment
The CMR-JC began in September 1999. It is conducted once every week for one hour. Attendance is mandatory for all Community Medicine Residents but students and faculty from other departments may also attend. On average there are 12 residents in the program, thus each resident is required to present every twelfth week. A presentation is followed by an interactive discussion. After the session, the presenting resident hosts a breakfast for participants.
Senior residents of the program act as journal club coordinator on a rotational basis. Their responsibilities include helping other residents in article selection, preparing presentations, organizing mock presentations before the actual presentation day, ensuring the selected article reaches every one in the department at least two days prior to the meeting, and maintaining a record of journal club presentations. The journal club coordinator (resident) is guided by the coordinator and director of residency program.
Selection of presentation topic
The residents choose original articles of public health importance published within the past three years in indexed journals. Residents can also present their research work and experiences of placement done or training attended. Sometimes alumni of the program are invited to share important research they have conducted.
Structure of presentation
The resident first presents the rationale for choosing a particular topic by summarizing a background search indicating the global and local burden of the problem. Then the article is discussed according to Introduction, Methodology, Results, Discussion and Conclusion. Finally, a critique of the article is presented. The journal club coordinator facilitates discussion of strengths and weakness of the study. The issue is then related to the local context and possible solutions discussed. Residency faculty supervises the session and provides feedback.
The presenting resident is evaluated by the faculty and senior residents on a standard evaluation form containing ten areas including the degree to which problem background relevant to Pakistan was provided, whether the resident was able to apply the article's information to a relevant context, and whether responses to queries were answered satisfactorily. Evaluations are compiled quarterly and are included in the overall evaluation of the resident.