The Impact of Journal Clubs on Postgraduate Medical Education in China

doi:10.21203/rs.3.rs-2452645/v1

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The Impact of Journal Clubs on Postgraduate Medical Education in China

https://doi.org/10.21203/rs.3.rs-2452645/v1

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published 20 Sep, 2023

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Purpose

Journal club plays an essential role in medical education. Studies have revealed its contribution in many countries except China. Chinese medical postgraduates are divided into academic and clinical types. This study aims to investigate their participation, performance, and gains in journal clubs and how student type and study phase influence these aspects.

Method

The authors distributed a survey involving demographic information, participation, performance, and improvements to postgraduates at Tongji Medical College of Huazhong University of Science and Technology, and 232 questionaries were included in further analysis. Mann-Whitney U and Gamma tests were adopted for respective data, and a p-value < 0.05 was considered statistically significant.

Results

The total participation and performance resemble worldwide studies. As for student type, academic postgraduates displayed superior participation and research assistance than clinical postgraduates, while their performances were at the same level. After introducing the study phase, academic-related downward trend and clinical-related upward trend in attendance rate and listening attitude along the senior phase, as well as time-promoting presentation comments, progress after presentation and research assistance were observed.

Conclusions

In this study, the authors revealed academic postgraduates’ fatigue, clinical postgraduates’ enthusiasm, and academic-superior research assistance. We recommend encouraging and supporting scientific research training for clinical postgraduates, helping academic postgraduates establish better time management and less irrelevant work, and promoting critical appraisal skill education.

Journal club

Chinese medical postgraduates

Scientific training

Study phase

Student type.

China has adopted the Soviet model of medical education since 1949 and has experienced reformations during the past decades (Xu et al., 2010). Chinese medical school postgraduates are divided into academic and clinical types; presently, both belong to the clinical medicine major. Academic postgraduates are supposed to conduct scientific research and become clinical scientists in the future, whose jobs comprise study and clinical work. In contrast, clinical postgraduates immerse themselves in clinical work and prepare to be traditional doctors whose careers are occupied by medical affairs. This option is based on the student’s willingness to conduct scientific research.

From the first formal organization in 1875 by William Osler, journal clubs have played an increasingly important role in clinical medical education. They have been established in other disciplines, such as nursing and pharmacy (Burris et al., 2019; Linzer, 1987; Rosen & Ryan, 2019). Various approaches and formats are introduced nowadays, facilitating journal club efficacy, even during the COVID-19 pandemic (Chu, 2020; McGlacken-Byrne et al., 2020; Meleger et al., 2020; Topf et al., 2017). The canonical form consists of regular face-to-face reports of the significance of selected articles by junior members and listening and comments from peers and senior leaders. Chinese journal clubs are usually organized in this format, taking mentors as senior leaders and postgraduates as junior members, and research articles are always the best presentation choices.

Worldwide studies have demonstrated how journal clubs contributions to medical education, including reading habits, lecture methodology, research design, and critical appraisal skills (Lee et al., 2005). Studies focusing on journal clubs in China are rare, even after the reform-and-opening-up boom in medical education (Xu et al., 2010). In this article, we examined Chinese medical postgraduates’ participation, performance, and gains in journal clubs: how they change between clinical and academic types and how the study phase influences them.

1. Survey design

We designated a survey involving participation, performance, and gains in journal clubs. This study was conducted according to the Helsinki Declaration and approved by the Ethics Committee of Union Hospital of Tongji Medical College of Huazhong University of Science and Technology. The announcement of voluntary and anonymous participation lay on the first line. Informed consent was obtained from all respondents at submissions. The main questions were divided into four parts as follows:

(1) Demographic information: gender, age group, student type, present study phase, and grade were collected to categorize the medical postgraduates involved.

(2) Participation: attendance rate and presentation time were collected.

(3) Performance: self-estimated listening attitudes and presentation comments from peers and mentors were collected.

(4) Gains: progress made after the presentation and research assistance acquired were measured in detail. We enumerated the diverse aspects and considered those beyond our knowledge in the two multi-selection questions, although none chose the “other” option.

2. Survey administration

We input the survey into “Wenjuanxing” at https://www.wjx.cn/, which specializes in questionnaire service, and distributed electronic questionnaires to postgraduates at Tongji Medical College of Huazhong University of Science and Technology by “WeChat” in April 2021. From April 2021 to January 2022, we received a total of 275questionnaires and excluded sixteen undergraduates, three without study phase, twenty without academic or clinical type, and Four incomplete. The remaining 232 were included in the analysis.

3. Statistical analysis

We input results from the 232 responders in “Microsoft Office Excel Professional Plus 2019” and conducted statistical analysis in “IBM SPSS Statistics 26”. Mann-Whitney U test was adopted to identify whether there is an increase or decrease in ranked data, including attendance rate, presentation time, listening attitude, and ranked presentation comment (only not well, common and good), between student types, divided or undivided by study phase. Gamma test was utilized in these ranked data between study phases in both student types. A p-value < 0.05 was considered statistically significant in the analyses mentioned above.

1. Characteristics of involved medical postgraduates

We revealed high participation in the journal club of Chinese postgraduates. Full-attending students constituted 36% (n=84) of the total, and 82% (n=151) of attendees had presentation experience (Figure 1a&b). Conversely, only 43% (n=79) of attendees showed a positive listening attitude, and 34% (n=51) of presented postgraduates received good comments (Figure 1c&d). As for gains, of 151 presented postgraduates, more than half made progress in searching (Figure 1e); reading speed improvement, research designation ability obtainment, and better retrieval skills were highlighted by the majority of 177 attendees approving of scientific support (Figure 1f).

Considering our similarities in participation and performance with worldwide studies (Lee et al., 2005), we were of keen interest in whether grouping by features would lead to extraordinary impact and selected student type and study phase as grouping factors. Of 232 postgraduates, 143 (62%) belonged to the academic type, and 89 (38%) were clinical type. Given the limited indication of degree, we employed the age group to distinguish study phases and defined those younger than 25 as junior students and others as senior students, representing master candidates, doctoral and postdoctoral students, respectively. Accordingly, 112 (48%) junior and 120 (52%) senior students were distinguished.

2. Academic-superior participation and acquired research assistance

Dividing our respondents into academic and clinical postgraduates, we observed a better attendance rate and presentation frequency of academic postgraduates (Figure 2a&b). Despite this inferior participation of clinical postgraduates, there was no statistically significant difference in listening attitudes and presentation comments between student types (Figure 2c&d). Furthermore, progress after the presentation in reading, preparation, and PPT making shared similar proportions between student types. As for discrepancies, clinical postgraduates obtained more progress in searching, while academic postgraduates made more progress in lecturing skills (Figure 2e). Regarding research assistance, academic postgraduates experienced a general overtaking of clinical postgraduates, particularly in being rigorous and meticulous (Figure 2f). Herein, Chinese medical postgraduates displayed academic-superior participation and research assistance, although the performance in journal clubs were at the same level between student types.

3. Enthusiastic clinical postgraduates, fatigued academic postgraduates, time-promoted presentation comments, progress after the presentation and research assistance acquired

To evaluate the influence of the study phase, we introduced it to both student types. We identified an intriguing phenomenon: the attendance rate witnessed an upward trend in clinical postgraduates and a downward trend in academic postgraduates (Figure 3a). Notably, the overall attendance rate of junior academic postgraduates was higher than that of junior clinical postgraduates, whereas there was no statistically significant difference between senior academic and clinical postgraduates (Figure 3a). Similarly, there is a declining tendency in academic postgraduates and an increasing trend in clinical postgraduates in terms of listening attitude (Figure 3c). These findings suggested decreasing participation and performance of academic postgraduates and growing participation and performance of clinical postgraduates along with higher study phase. However, academic postgraduates exhibited a moderate study-phase-related increase in presentation frequency; senior academic postgraduates showed higher presentation frequency than senior clinical postgraduates (Figure 3b). Clinical postgraduates underwent a slightly study-phase-related downward trend in presentation frequency (Figure 3b). Consistent with this, after excluding the “non or general” option in the presentation comment, we revealed strong positive correlations between junior and senior academic students and at the comment level (data not shown). A significant difference in the comment was not identified between junior and senior clinical students or between junior and senior postgraduates of different types (Figure 3d). As to gains, junior academic postgraduates made less progress after the presentation in all aspects, while more junior clinical postgraduates declared progress in preparing than senior ones; and in research assistance, junior academic postgraduates were surpassed by senior academic postgraduates except for English level, and more junior clinical postgraduates declared improvement on writing skills and technology understand but less on innovation and exploration compared to senior clinical ones(Figure 3e&f). Thus, we deduced that while reaching the higher study phase, academic postgraduates became less interested in journal clubs, yet clinical postgraduates were more willing to participate and get involved. Although progress after the presentation displayed study phase-related improvement without student type-related superiority, research assistance and presentation comment acquired still exhibited academic-superior and time-promoting properties.

Previous Chinese research concentrated on English improvement and organizational experience (Tsui et al., 2016; Tucker et al., 2004; Yu et al., 2017). Our findings were based on quantitative data instead of qualitative analysis and experience sharing. We investigated how student type and study phase influence journal club scientific training in Chinese medical postgraduates for the first time.

We revealed resemblances in participation and performance between our and worldwide studies(Lee et al., 2005), which covered student type and study phase influences. For instance, both types displayed different attendance rates, and academic postgraduates gain unambiguous superiority in overall attendance rate over clinical postgraduates. Indeed, an academic-related downward trend and a clinical-related upward trend in attendance rate, along with a higher study phase, were observed. Although the overall attendance rate of junior academic postgraduates was higher than that of junior clinical postgraduates, senior academic and clinical postgraduates exhibited similar overall attendance rates. Together, we demonstrated that, reaching the senior phase, academic postgraduates were indisposed to join the journal club, wherein clinical postgraduates preferred attending. A similar phenomenon also manifested in listening attitude: academic and clinical postgraduates experienced a slightly downward and upward trend along with higher study phases respectively, despite the same overall and study-phase-divided levels between student types. Why did the preference for journal clubs from academic and clinical postgraduates display an opposite trend while reaching a higher study phase? Generally, academic postgraduates were supposed to conduct scientific research and would be under more pressure when approaching graduation (Zhu et al., 2014). Experiments and other work might crowd out the time reserved for the journal club, leading to decreased attendance rate. In contrast, clinical postgraduates developed an increasing awareness of the essence of research in their future careers. They became more willing to attend journal clubs, although clinical work was their principal duty(Yuan et al., 2013; Zhang et al., 2019). These findings altered the bias in scientific awareness of clinical postgraduates (Yuan et al., 2013; Zhang et al., 2019).

As opposed to these, academic postgraduates showed higher overall presentation frequency than clinical postgraduates, and their presentation frequency increased throughout the study phase. However, The presentation frequency of clinical postgraduates witnessed a slightly downward trend. We thus speculated that this academic-superior presentation frequency resulted from its moderate increase following the study phase since there was no statistically significant difference between junior academic and clinical postgraduates. Likewise, although there was no statistically significant difference in presentation comments received between different grades of clinical postgraduates or total academic and clinical postgraduates, the comment level underwent substantial increases along the study phase in academic student types. Clinical postgraduates received comments at the same level as academic postgraduates, given their inferior overall presentation time. This surprising finding might be because clinical postgraduates were required to communicate with and explain medical information to patients and their companies, which could facilitate the improvement of their presentation. In terms of progress after the display, academic-superior lecturing and clinical-superior searching were substantiated by comparing both student types at the senior phase. We inferred that clinical postgraduates were engaged with clinical work and unfamiliar with searching for research information. In contrast, academic postgraduates were occupied with experiments and not skilled in giving lectures. Furthermore, compared to senior students, junior academic students obtained inferior progress in all aspects except for a slight superiority in searching, and junior clinical postgraduates got more improvement in preparation. Academic postgraduates received better comments and made more progress in lecturing, PPT making and preparing while reaching the senior phase. More clinical postgraduates received progress on searching and reading along with study phase rises.

American researchers revealed that journal clubs electively provided pharmacy doctoral students with better potential in clinical science (Burris et al., 2019). Consistent with this, general overtaking in research assistance by academic postgraduates to clinical postgraduates and by senior academic postgraduates to junior clinical postgraduates or senior clinical postgraduates were revealed in our study. Time-promoting research assistance acquired was comprehensible, whereas differences between senior academic and clinical postgraduates need explaining. Apart from involving in a journal club, research practice and related time spent were also essential for assistance obtainment. However, the cultivation of clinical postgraduates made them inclined to clinical expertise rather than research, leading to this inferior assistance obtainment.

Based on our findings, we propose that encouraging and support for fundamental and advanced scientific research training to clinical postgraduates, such as basic experiments, study designation and scientific English writing, should be emphasized more in China. As for academic postgraduates, training regarding better time management and less irrelevant work in the senior phase should be highlighted to guarantee their stable attendance rate. They shall be emboldened to give presentations to peers and teachers for lecturing improvement. Moreover, worldwide studies shed light on critical appraisal skill promotion by journal club (Ahmadi et al., 2012; Alguire, 1998; Honey & Baker, 2011; Lee et al., 2005; Lee et al., 2006; Sanchez-Mendiola et al., 2015), which is crucial in almost every step of a particular research project. In contrast, merely a few postgraduates acquired this assistance from the journal club. We hereby recommend that additional training for critical appraisal skills, besides the journal club, be established in China.

Our limitations were as follows. First, the small sample size of clinical postgraduates restricted our analysis, especially in progress after the presentation and research assistance acquired. Second, the low completion of study phase labeling in questionnaires compelled us to divide respondents by age group, which might result in possibly unknown deviation. Third, as an observational and cross-sectional study, we explained the phenomenon based on our experiences and knowledge of Chinese medical postgraduate education. Fourth, all postgraduates involved belonged to Tongji Medical College of Huazhong University of Science and Technology, leading to possibly unknown divergence while generalizing our conclusions to Chinese medical postgraduates. Future multi-center studies are required to elucidate these limitations.

Reaching the higher study phase, academic postgraduates became averse to journal clubs, yet clinical postgraduates were more willing to participate and get involved. Although academic postgraduates presented more times than clinical postgraduates, both received same-level comments and made progress after the presentation in their respective vulnerable spot. Presentation comment, progress after the presentation and research assistance acquired witnessed time-promoting growths, whereas academic postgraduates always occupied the overwhelming superiority in research assistance against clinical postgraduates. We recommended encouraging and supporting scientific research training for clinical postgraduates, helping academic postgraduates establish better time management and less irrelevant work, and promoting critical appraisal skill education.

Acknowledgments

The authors wish to thank all volunteers involved in this work.

Availability of data and materials

All data generated or analyzed during this study are included in this published article.

Authors' contributions

Jing Xiong and Yi Hao designed and oversaw the study; Yue Zhang performed the survey; Yi Hao supervised and provided the expertise in survey design and data interpretation; Yue Zhang and Yujuan Li wrote the manuscript and performed data analysis; Jing Xiong and Yi Hao commented on the manuscript. All the authors gave final approval to the submitted manuscript.

Declaration of interests

The authors declare no competing interests.

Ethics approval and consent to participate

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Union Hospital of Tongji Medical College of Huazhong University of Science and Technology (approve number: UHCT-IEC-SOP-015-03-01). Informed consent was obtained from all participants. Participation was voluntary and anonymous.

Consent for publication

Not applicable.

Funding

This work was supported by the Education Research Funds for Huazhong University of Science and Technology (Project no. 2017020, 2018135, 2022132) and teaching Research Project of Colleges and Universities of Hubei Province(Project no. 2021059 ).

Previous presentations

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Glossary terms

Academic medical postgraduates: A type of Chinese medical postgraduate major in clinical medicine and focus on scientific research during their postgraduate period.

Clinical medical postgraduates: A type of Chinese medical postgraduate major in clinical medicine, mainly do clinical work and must accomplish rotation during their postgraduate period.

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No competing interests reported.

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The Impact of Journal Clubs on Postgraduate Medical Education in China

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