There is a new initiative on Twitter: The Twitter Journal Club. It is initiated by Fi Douglas (@fidouglas) a medical student at Cambridge, and Natalie Silvey (@silv24) a junior doctor in the West Midlands.
Fi and Natalie have set up a blog for this event: http://twitjc.wordpress.com/
A Twitter Journal Club operates in the same way as any other journal club, except that the forum is Twitter.
The organizers choose a paper, which they announce at their website (you can make suggestions here or via a tweet). Ideally, people should read the entire paper before the Twitter session. A short summary with key points (i.e. see here) is posted on the website.
The first topic was: Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock [PDF]
It started last Sunday 8 pm (Dutch time) and took almost 2 hours to complete.
@twitjournalclub (the twitter account of the organizers) started with a short introduction. People introduced themselves as they entered the discussion. Each tweet in the discussion was tagged with #TwitJC (a so called hashtag), otherwise it won’t get picked up by people following the hashtag. (Tweetchat automatically provides the hashtag you type in).
Although it was the first session, many people (perhaps almost 100?!) joined the Journal Club, both actively and more passively. That is a terrific achievement. Afterwards it got a very positive Twitter “press”. If you know to engage people like @nothern_doctor, @doctorblogs, @amcunningham and @drgrumble and people like @bengoldacre, @cebmblog and @david_colquhoun find it a terrific concept, then you know that it is a great idea that meets a need. As such, enough reason to continue.
There were also not purely positive voices. @DrVes sees it as a great effort, but added that “we need to go beyond this 1950s model rather than adapt it to social media.” Apparently this tweet was not well received, but I think he made a very sensible statement.
We can (and should) asks ourselves if Twitter is the right medium for such an event.
@DrVes has experience with Twitter Journal Clubs. He participated in the first medical journal club on Twitter at the Allergy and Immunology program of Creighton University back in 2008 and presented a poster at an allergy meeting in 2009.
BUT, as far as I can tell, that Twitter Journal Club was both much more small-scale (7 fellows?) and different in design. It seems that Tweets summarized what was being said at a real journal club teaching session. Ves Dimov:
“The updates were followed in real time by the Allergy and Immunology fellows at the Louisiana State University (Shreveport) and some interested residents at Cleveland Clinic, along with the 309 subscribers of my Twitter account named AllergyNotes“.
So that is the same as tweeting during a conference or a lecture to inform others about the most interesting facts/statements. It is one-way-tweeting (overall there were just 24 updates with links).
I think the present Twitter Journal Club was more like a medical Twitter chat (also the words of Ves).
Is chatting on Twitter effective?
Well that depends on what one wants to achieve.
Apparently for all people participating, it was fun to do and educative.
I joined too late to tell, thus I awaited the transcript. But boy, who wants to read 31 pages of “chaotic tweets”? Because that is what a Twitter chat is if many people join. All tweets are ordered chronologically. Good for the archive, but if the intention is to make the transcribed chat available to people who couldn’t attend, it needs deleting, cutting, pasting and sorting. But that is a lot of work if done manually.
The “remix of tweets” also illustrates that people have their own “mini-chats”, and “off-topic” (but often very relevant) questions.
In addition, the audience is very mixed. Some people seem to have little experience with critical appraisal or concepts like “intention to treat” (ITT) and would perhaps benefit from supplementary information beforehand (i.e. documents at the TwitJC website). Others are experienced doctors with a lot of clinical expertise, who always put theoretical things in perspective. Very valuable, but often they are far ahead in the discussion.
The name of the event is Twitter Journal Club. Journal Club is a somewhat ambiguous term. According to Wikipedia “A journal club is a group of individuals who meet regularly to critically evaluate recent articles in scientific literature”. It can deal with any piece which looks interesting to share, including hypotheses and preclinical papers about mechanisms of actions.
Thus, to me Journal club is not per definition EBM (Evidence Based Medicine).
Other initiatives are a critical appraisal of a study and a CAT, a critical appraisal of a topic (sometimes wrongly called PICO, PICO is only part of it).
The structure of the present journal club was more that of a critical appraisal. It followed the normal checklist for an RCT: What is being studied? Is the paper valid (appropriately allocated, blinded etc ), what are the results (NNT etc) and are the results valid outside of the context of the paper?
Imo, official critical appraisal of the paper costs a lot of time and is not the most interesting. Looking at my edited transcript you see that half of the people are answering the question and they all say the same: “Clearly focused question” is answer to first question (but even in the edited transcript this takes 3 pages), “clear interventions (helpful flowcharts) is the answer to the second question.
Half of the people have their own questions. Very legitimate and good questions, but not in line with the questions of @twitjournalclub. Talking about the NNT and about whether the results are really revolutionary, is VERY relevant, but should be left till the end.
A twitter chat with appr. 100 people needs a tight structure.
However, I wonder whether this approach of critical appraisal is the most interesting. Even more so, because this part didn’t evoke much discussion.
Plus it has already been done!!
I searched the TRIP database and with the title of the paper, to find critical appraisals or synopses of the paper. I found 3 synopses, 2 of which follow more or less the structure of this journal club here, here (and this older one). They answer all the questions about validity.
Wouldn’t it have better with this older key paper (2001) to just use the existing critical appraisals as background information and discuss the implications? Or discuss new supporting or contradictory findings?
The very limited search in TRIP (title of paper only) showed some new interesting papers on the topic (external validation, cost effectiveness, implementation, antibiotics) and I am sure there are many more.
A CAT may also be more interesting than a synopsis, because “other pieces of evidence” are also taken into consideration and one discusses a topic not one single paper. But perhaps this is too difficult to do, because one has to do a thorough search as well and has too much to discuss. Alternatively one could choose a recent systematic review, which summarizes the existing RCT’s.
Anyway, I think the journal club could improve by not following the entire checklist (boring! done!), but use this as a background. Furthermore I think there should be 3-5 questions that are very relevant to discuss. Like in the #HSCMEU discussions, people could pose those questions beforehand. In this way it is easier to adhere to the structure.
As to the medium Twitter for this journal club. I am not fond of long Twitter chats, because it tends to be chaotic, there is a lot of reiteration, people tend to tweet not to “listen” and there is a constriction of 140 characters. Personally I would prefer a webinar, where people discuss the topic and you can pose questions via Twitter or otherwise.
Other alternatives wouldn’t work for me either. A Facebook journal club (described by of Neil Mehta) looks more static (commenting to a short summary of a paper), and Skyping is difficult with more than 10 people and not easy to transcribe.
But as said there is a lot of enthusiasm for this Twitter Journal Club. Even outside the medical world. This “convincing effort” inspired others to start a Astronomy Twitter Journal Club.
Perhaps a little modification of goals and structure could make it even more interesting. I will try to attend the next event, which is about Geoffrey Rose’s ‘Prevention Paradox’ paper, officially titled ”Strategy of prevention: lessons from cardiovascular disease”, available here.
 A summary of the first Twitter journal club is just posted. This is really valuable and takes away the disadvantages of reading an entire transcript (but one misses a lot of interesting aspects too)!
 This is the immediate response of one of the organizers at Twitter. I’m very pleased to notice that they will put more emphasis on implications of the Journal. That would take away much of my critic.
(Read tweets from bottom to top).
- Welcome (twitjc.wordpress.com)
- An important topic for the first Twitter Journal Club (twitjc.wordpress.com)
- Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M; Early Goal-Directed Therapy Collaborative Group. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001 Nov 8;345(19):1368-77. PubMed PMID: 11794169. (PDF).
- The First Journal Club on Twitter – Then and Now (casesblog.blogspot.com)
- Allergy and Immunologyclub on Twitter (allergynotes.blogspot.com)
- The Utility of a Real-time Microblogging Service for Journal Club in Allergy and Immunology. Dimov, V.; Randhawa, S.; Auron, M.; Casale, T. American College of Allergy, Asthma & Immunology (ACAAI) 2009 Annual Meeting. Ann Allergy Asthma Immunol., Vol 103:5, Suppl. 3, A126, Nov 2009.
- https://docs.google.com/document/pub?id=1qzk1WzjNO5fbWd0PAax6cIDdUGGg1sDn86FPT1li-sQ (short remix of the transcript)
- Model for a Journal Club using Google Reader and Facebook OR if the prophet does not go to the Mountain…. bring the journal club to FB! (blogedutech.blogspot.com)
- Astronomy Twitter Journal Club/ (sarahaskew.net)
- A summary of week one: Rivers et al (twitjc.wordpress.com)