ABFM Journal Club's Focus on Critical Appraisal of Full Research Articles Is Misplaced

To the Editor: We read with interest the commentary by Drs. Quan and Newton describing the plan of the American Board of Family Medicine (ABFM) to develop a Journal Club as an optional continuing certification activity.¹ They propose to have a national committee select 100 high-quality, potentially practice-changing research articles relevant to family medicine each year and to require Journal Club participants to read the full text of an article and correctly answer 4 multiple-choice questions to earn credit.

Having collectively taught thousands of medical and graduate students how to critically appraise the medical literature, we nonetheless think that it is unrealistic to expect most busy clinicians to learn or even want to learn how to critically appraise full research articles to inform their clinical practices. Rather than trying to stay current by evaluating individual studies, family physicians should pursue Information Mastery,^2,3 which emphasizes selecting good sources of preappraised patient-oriented evidence that matters (POEMs) for foraging (keeping up with new information) and hunting (quickly accessing information at the point of care) purposes.⁴

Although the authors suggest that having Journal Club participants read full research articles will improve shared decision making and personalized care, we are not aware of any empiric evidence or data from the other Boards to support this assumption.⁵ In fact, this approach could create inappropriate expectations and become counterproductive. We and others have found that attempting to teach critical appraisal skills to clinicians results in them concluding (correctly) that it is too time-consuming and difficult to do in the rush of everyday life; instead, they often revert back to relying on questionable information from easily accessible sources (eg, pharmaceutical companies) and “key opinion leaders” with financial conflicts of interest.⁶

As proposed, the ABFM Journal Club will likely self-select a small group of family physicians who are interested and/or have extra time for this intensive activity but will have a minimal impact on the critical thinking and information management skills of the specialty as a whole.

Why can't there be 2 options? There could be a “deep dive” option for those who want to learn to critically evaluate articles as well as a more inclusive option for those who prefer summaries of preappraised POEMs with key take-home points. Several of us have been writing approximately 250 POEMs per year and publishing many of them in family medicine journals for the past 20 years.⁷ In a research study, Canadian family physicians who were given access to an electronic knowledge resource including POEMs reported that their searches resulted in health benefits for their patients.⁸ So, if the Board's goal is to enhance skills that actually improve practice outcomes, they could adopt a similar approach of providing physicians ongoing access to preappraised evidence and teaching information mastery. This proven model is more user friendly than one that tries to teach critical appraisal of individual studies, an approach that we think falls short in terms of relevance and the work involved.²

We agree with Drs. Quan and Newton that family medicine can and should lead the way to better patient care with better information. We disagree, however, that focusing on the appraisal of original research is the best or singular path to realize that goal.