journal club literature review

Expert Consult

Journal Club: How to Build One and Why

By Michelle Sharp, MD; Hunter Young, MD, MHS

Published April 6, 2022

Journal clubs are a longstanding tradition in residency training, dating back to William Osler in 1875. The original goal of the journal club in Osler’s day was to share expensive texts and to review literature as a group. Over time, the goals of journal clubs have evolved to include discussion and review of current literature and development of skills for evaluating medical literature. The ultimate goal of a journal club is to improve patient care by incorporating evidence into practice.

Why are journal clubs important?

In 2004, Alper et al . reported that it would take more than 600 hours per month to stay current with the medical literature. That leaves residents with less than 5 hours a day to eat, sleep, and care for patients if they want to stay current, and it’s simply impossible. Journal clubs offer the opportunity for residents to review the literature and stay current. Furthermore, Lee et al . showed that journal clubs improve residents’ critical appraisal of the literature.

How do you get started?

The first step to starting a journal club is to decide on the initial goal. A good initial goal is to lay the foundation for critical thinking skills using literature that is interesting to residents. An introductory lecture series or primer on study design is a valuable way to start the journal club experience. The goal of the primer is not for each resident to become a statistician, but rather to lay the foundation for understanding basic study designs and the strengths and weaknesses of each design.

The next step is to decide on the time, frequency, and duration of the journal club. This depends on the size of your residency program and leadership support. Our journal club at Johns Hopkins is scheduled monthly during the lunch hour instead of a noon conference lecture. It is essential to pick a time when most residents in your program will be available to attend and a frequency that is sustainable.

How do you get residents to come?

Generally, if you feed them, they will come. In a cross-sectional analysis of journal clubs in U.S. internal medicine residencies, Sidorov found that providing food was associated with long-lasting journal clubs. Factors associated with higher resident attendance were fewer house staff, mandatory attendance, formal teaching, and an independent journal club (separate from faculty journal clubs).

The design or format of your journal club is also a key factor for attendance. Not all residents will have time during each rotation to read the assigned article, but you want to encourage these residents to attend nonetheless. One way to engage all residents is to assign one or two residents to lead each journal club, with the goal of assigning every resident at least one journal club during the year. If possible, pick residents who are on lighter rotations, so they have more time outside of clinical duties to dissect the article. To enhance engagement, allow the assigned residents to pick an article on a topic that they find interesting.

Faculty leadership should collaborate with residents on article selection and dissection and preparation of the presentation. Start each journal club with a 10- to 20-minute presentation by the assigned residents to describe the article (as detailed below) to help residents who did not have time to read the article to participate.

What are the nuts and bolts of a journal club?

To prepare a successful journal club presentation, it helps for the structure of the presentation to mirror the structure of the article as follows:

Background: Start by briefly describing the background of the study, prior literature, and the question the paper was intended to address.

Methods: Review the paper’s methods, emphasizing the study design, analysis, and other key points that address the validity and generalizability of the results (e.g., participant selection, treatment of potential confounders, and other issues that are specific to each study design).

Results: Discuss the results, focusing on the paper’s tables and figures.

Discussion: Restate the research question, summarize the key findings, and focus on factors that can affect the validity of the findings. What are potential biases, confounders, and other issues that affect the validity or generalizability of the findings to clinical practice? The study results should also be discussed in the context of prior literature and current clinical practice. Addressing the questions that remain unanswered and potential next steps can also be useful.

Faculty participation: At our institution, the faculty sponsor meets with the assigned residents to address their questions about the paper and guide the development of the presentation, ensuring that the key points are addressed. Faculty sponsors also attend the journal club to answer questions, emphasize key elements of the paper, and facilitate the open discussion after the resident’s presentation.

How do you measure impact?

One way to evaluate your journal club is to assess the evidence-based practice skills of the residents before and after the implementation of the journal club with a tool such as the Berlin questionnaire — a validated 15-question survey that assesses evidence-based practice skills. You can also conduct a resident satisfaction survey to evaluate the residents’ perception of the implementation of the journal club and areas for improvement. Finally, you can develop a rubric for evaluation of the resident presenters in each journal club session, and allow faculty to provide feedback on critical assessment of the literature and presentation skills.

Journal clubs are a great tradition in medical training and continue to be a valued educational resource. Set your goal. Consider starting with a primer on study design. Engage and empower residents to be part of the journal club. Enlist faculty involvement for guidance and mentorship. Measure the impact.

Log in using your username and password

Search More Search for this keyword Advanced search
Latest content
Current issue
BMJ Journals

Jeffrey K Aronson
Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences , University of Oxford , Oxford OX2 6GG , UK
Correspondence to Dr Jeffrey K Aronson, Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX26GG, UK; jeffrey.aronson{at}phc.ox.ac.uk

https://doi.org/10.1136/ebmed-2017-110861

Statistics from Altmetric.com

Request permissions.

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Journal clubs have many functions, including the provision of a forum for developing skills in critical appraisal, an essential part of being a competent clinician.

From early on, journal clubs reported their proceedings in academic journals. The Zoological Journal Club of Michigan , for example, regularly reported its activities in the journal Science (see figure 1 ). Table 1 lists a selection of other journals that publish journal club articles, showing the wide range of topics covered. Modern methods of conducting journal clubs include the use of online media to encourage interactive discussion, 1 including blogs, 2 twitter, 3 and virtual journal clubs. 4

Download figure
Open in new tab
Download powerpoint

The contents page of Science for Friday 7 December 1900, listing the proceedings of the Zoological Journal Club of the University of Michigan .

View inline

Some journals that publish articles under the heading ‘Journal Club’

It is therefore appropriate that Evidence-Based Medicine (EBM) should feature a regular journal club report.

In order to find out how others run journal clubs and the effects that they have, I searched PubMed for articles on journal clubs, using the search term ‘journal[ti] & (club[ti] OR clubs[ti])’ (1699 hits) and found three types of articles: articles in which authors described a paper that they had discussed at a journal club or thought would be suitable material for a journal club; studies of the effects of running journal clubs; and reviews of various sorts.

I found three systematic reviews. One recommended the journal club as a tool for assessing practice-based competencies that might be difficult to assess by other means 5 ; one reported that journal clubs improve knowledge and critical appraisal skills but that there was no evidence on translation of evidence from journal clubs into clinical practice 6 ; and one reported that journal clubs seemed to be the preferred way of teaching critical appraisal skills but that it was not clear which elements were most important for learning. 7

I have synthesized much of this information and have distilled what I consider to be the important points that arise from the formal studies and reviews and describe the objectives of a journal club and how to run one. I also give guidance on the preparation of journal club reports that we hope readers will submit for publication. We look forward to hearing from you.

Five reasons for running a journal club

To highlight new findings.

To teach practitioners how to search for interesting articles representing the best evidence to inform clinical practice.

To encourage practitioners to read and appraise publications critically and give them the ability to do so.

To encourage practitioners to do applied clinical research and to show them how.

To improve debating skills, demonstrate leadership skills, and aid peer mentorship.

Sixteen suggestions on how to run a journal club

The members of the club should on the whole have shared or complementary interests, including statisticians, but do not discourage multidisciplinarity, if available; involve everyone, from students down to professors.

Run the club regularly at the same time on the same day of the week, so that it becomes a fixture.

Have at least one designated skilled leader who regularly participates in the club.

Ideally, make attendance mandatory and keep a record.

Ensure that the meetings start and end on time.

Encourage communality; this could be done, for example, by asking everyone at the start of each meeting to give their name and a piece of information about themselves (eg, a movie they have recently seen).

Discuss up to three papers from peer-reviewed journals; develop a theme each time; occasionally include books of interest.

Split presentation and discussion times 50/50.

Try to choose papers that you think may influence clinical practice and discuss why.

Disseminate the chosen articles in advance, with questions that might be asked; the leader should bring spare copies to the meeting.

Keep notes and conduct regular audits (eg, yearly); give feedback on later developments; link it to a Xmas quiz.

Welcome guest speakers from time to time to add expert comment.

Provide free enticing refreshments; have a rota for making the tea/coffee.

Use your imagination to make it fun.

Publish your experience.

Adapt these suggestions to suit your own circumstances.

Ten tips on how to prepare a journal club article for EBM

The article should have proceeded from an actual journal club.

The paper discussed need not have been published in EBM .

At the start, give the full reference (Vancouver style) of the article that you have discussed.

The following framework, adapted from that originally suggested by Riegelman 8 may be useful: aims, methods, results, interpretation, implications for practice, and further research.

Say what the purpose of the study was.

Summarise the important points in the article, paying particular attention to the methods that were used.

Briefly describe the main results.

Highlight the strengths and weaknesses; how could the study have been improved? did the authors achieve what they set out to achieve?

Describe the implications of the results and whether you think they may or may not influence practice beneficially or adversely.

If relevant, say what further research might be carried out.

Radecki R , et al
Sparks MA ,
Phelan PJ , et al
Chetlen AL ,
Solberg AO , et al
Golnik KC , et al
Deenadayalan Y ,
Grimmer-Somers K ,
Prior M , et al
McKenzie ME ,
Maclean A , et al
Riegelman RK

Competing interests JKA is an associate editor for EBM.

Provenance and peer review Commissioned; internally peer reviewed.

Read the full text or download the PDF:

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Publications
Account settings
My Bibliography
Collections
Citation manager

Save citation to file

Email citation, add to collections.

Create a new collection
Add to an existing collection

Add to My Bibliography

Your saved search, create a file for external citation management software, your rss feed.

Search in PubMed
Search in NLM Catalog
Add to Search

How to run an effective journal club: a systematic review

Affiliation.

1 University of South Australia, City East Campus, Adelaide, Australia.
PMID: 19018924
DOI: 10.1111/j.1365-2753.2008.01050.x

Background: Health-based journal clubs have been in place for over 100 years. Participants meet regularly to critique research articles, to improve their understanding of research design, statistics and critical appraisal. However, there is no standard process of conducting an effective journal club. We conducted a systematic literature review to identify core processes of a successful health journal club.

Method: We searched a range of library databases using established keywords. All research designs were initially considered to establish the body of evidence. Experimental or comparative papers were then critically appraised for methodological quality and information was extracted on effective journal club processes.

Results: We identified 101 articles, of which 21 comprised the body of evidence. Of these, 12 described journal club effectiveness. Methodological quality was moderate. The papers described many processes of effective journal clubs. Over 80% papers reported that journal club intervention was effective in improving knowledge and critical appraisal skills. Few papers reported on the psychometric properties of their outcome instruments. No paper reported on the translation of evidence from journal club into clinical practice.

Conclusion: Characteristics of successful journal clubs included regular and anticipated meetings, mandatory attendance, clear long- and short-term purpose, appropriate meeting timing and incentives, a trained journal club leader to choose papers and lead discussion, circulating papers prior to the meeting, using the internet for wider dissemination and data storage, using established critical appraisal processes and summarizing journal club findings.

PubMed Disclaimer

Publication types

Search in MeSH

LinkOut - more resources

Full text sources.

Ovid Technologies, Inc.

Citation Manager

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

- Google Chrome

Intended for healthcare professionals

My email alerts
BMA member login
Username * Password * Forgot your log in details? Need to activate BMA Member Log In Log in via OpenAthens Log in via your institution

Search form

Advanced search
Search responses
Search blogs

Journal clubs

Related content
Peer review
Martina Esisi , staff grade doctor, psychiatry ( Oritsesemisan{at}btinternet.com )
Warwickshire

Martina Esisi considers how to get the most out of them

Journal clubs are educational meetings where individuals meet regularly to critically evaluate recent articles in the scientific literature. They have often been cited as a bridge between research and practice, as they encourage the application of research in clinical practice. 1

After a literature search, the earliest reference to a journal club I found is described by Sir James Paget who, in the mid-1800s, described a group at St Bartholomew's Hospital in London, as a “kind of club . . . a small room over a baker's shop near the hospital-gate, where we could sit and read the journals.” 2

Why journal clubs?

Many academic training programmes include a journal club. They have long been recognised as a means of keeping up to date with the literature; promoting evidence based medicine; and teaching critical appraisal skills, which I found particularly useful when preparing for the critical review paper to part 2 of the Royal College of Psychiatry's membership exam. In order for trainee doctors to be able to adapt to ever-changing circumstances, in clinical practice, they need to equip themselves with the skills of critical appraisal, and the ability to apply new knowledge. Journal clubs also help to keep permanent staff updated. 3

Advantages of a journal club

Help people to learn and improve their critical appraisal skills

Encourage evidence based medicine

Promote awareness of research skills

Keep abreast with new literature

Encourage use of research

Promote social contact

Provide continuing medical education

Stimulate debate, and improved understanding of current topics.

Unfortunately, in my experience these clubs are often poorly attended. There are various reasons for this, including the way they are organised.

Organising journal club sessions

There is no single ideal format for a journal club. Many variations have been described, and this is influenced by the goals set by the organisers, and the needs and interests of the target participants.

Participants often differ widely in knowledge and skills, and, for example, if part of the goal is to teach critical appraisal skills and thereby help trainees (such as in psychiatry) to prepare for the critical review paper component of the membership exams, the critical appraisal journal clubs will be particularly useful.

In this respect, access to basic and refresher courses are helpful, so that people feel more confident to participate at meetings. Some postgraduate education centres provide this.

If on the other hand the main aim is to contribute to the application of research then it might be more appropriate to structure each meeting to look at specific topics, rather than articles, or perhaps a combination of both will be useful.

Generally, the two main variations are critical appraisal journal clubs and evidence based journal clubs. Even within these broad types, there are variations in the way they are run.

Critical appraisal clubs

Critical appraisal is the process of systematically examining research evidence to assess its validity, results, and relevance before using it to inform a decision. 4 It is thus an essential part of evidence based clinical practice, as it helps close the gap between research and practice. In critical appraisal journal clubs, generally an article is reviewed. Usually, the presenter introduces the paper, which is either a classic paper, or one that has been chosen by the presenter, often using a critical appraisal checklist. The main problem with this sort of club is that participants may not feel confident in their critical appraisal skills and are therefore reluctant to join in.

Evidence based clubs

Evidence based medicine is the process of systematically reviewing, appraising, and using clinical research findings to aid the delivery of optimum clinical patient care. 5 The main elements include posing a question, carrying out a literature search, and then selecting relevant papers, as well as critical appraisal. It may become necessary to spend one session of this journal club finding a relevant paper. and spend another session appraising it. Alternatively, the presenter could select a paper that is then appraised at the club.

Whatever the format, certain factors remain relevant in the structure of a successful journal club. Successful clubs are generally those with a single leader and a mandatory attendance. The environment is also important.

Role of the leader

Having someone who takes overall responsibility for the club is useful. This is usually the leader. Additionally, some clubs have a chairperson who chairs the meeting on different occasions. Usually, as well as organising the meeting the leader decides on the chairperson for each meeting. The advantage of this system is that different people take turns to share experience. Frequently, consultants with interests in medical education, such as tutors, take the role of leaders, and senior trainees such as senior registrars take the role of the chair.

Choosing an article

It is important to consider what you want to achieve in your presentation and then choose a paper accordingly. 6 Think of recent articles that perhaps contradict old truths. Alternatively choose a classic paper in the history of your specialty. You might also want to consider articles of topical issues.

The presentation

Consider the needs of your target audience and remember how long you've got. Use PowerPoint or an equivalent package, with user friendly slides. Bring enough copies of articles for everyone, including multiple copies of a quick (one page) appraisal tool. If an article being reviewed seems only vaguely related to the question, take the opportunity to critically appraise the methodology in a systematic way. 7 It is often useful to include the limitation and clinical implication of an article. Remember to anticipate possible questions you might be asked, and prepare answers.

The environment

The room should suit the group. The larger the group, the larger the room, and vice versa. A large room with a small group of people encourages passivity. On the other hand, a small room with a large number of people discourages attendance. Providing free good food at any educational meeting is only one way of improving attendance; there are others:

Mandatory attendance for trainees (use of registrar)

Bleep-free for trainees not on call

Setting boundaries (strict start and finish time)

Early week rather than late week slots (Mondays, not Fridays)

Distribute time, place, topics, and roles.

Journal clubs can be stimulating and entertaining, but they will only continue to be interesting if they respond to the needs of participants. Although there is no ideal format, the common themes for successful journal clubs seem to be that they are question driven and appraisal focused. 7 They need to be well structured yet flexible and creative within the limitations of a traditional format.

↵ Kleinpell RM. Rediscovering the value of the journal club. American Journal of Critical Care 2002 ; 11 : 42 . OpenUrl
↵ Linzer M. The journal club and medical education; over one hundred years of unrecorded history. Postgraduate Medical Journal 1987 ; 63 : 475 -8. OpenUrl Abstract / FREE Full Text
↵ Swift G. How to make journal clubs interesting. Advances in Psychiatric Treatment 2004 ; 10 : 67 -72. OpenUrl Abstract / FREE Full Text
↵ Hill A, Spittlehouse C. What is critical appraisal? London: Hayward Medical Communications, 2006 . ( www.evidence-based-medicine.co.uk
↵ Rosenberg W, Donald A. Evidence based medicine; an approach to clinical problem solving. BMJ 1995 ; 310 : 1122 -6. OpenUrl FREE Full Text
↵ Hallas P. Tips on—Choosing an interesting paper for the journal club. BMJ Careers 2005 ; 331 : 252 . http://careerfocus.bmj.com/cgi/content/full/331/7529/252 OpenUrl
↵ Phillips R, Glasziou P. What makes evidence based journal clubs succeed? Evidence Based Medicine 2004 ; 9 : 36 -7. OpenUrl FREE Full Text

EMResident Archives
Publications
Submit an Article

Critical Care
Health Policy Journal Club
Program Director Interviews

Journal Club for Dummies: How Not to Be Intimidated by Evidence-Based Medicine

With the advent of the internet, the number of publications readily available has dramatically increased. 1 It has become increasingly important for us to feel confident sorting through what is clinically relevant for our own practice. While this may feel like a tall order, here are a few tips and tricks that will make reading any article easier.

What is the Clinical Question?

All studies begin with a clinical question. This is the most important part of any study because the study was essentially crafted around this query. If you don't comprehend the question, then you will struggle through the entire article. Sometimes, it may be necessary to do some background reading of your own to familiarize yourself with the topic. Typically, you can find it clearly stated in the abstract.

Use the PICO Model

“P” stands for patient, or population: Who is the subject of this conversation?
“I” stands for intervention: How did the study intervene on this subject?
“C” stands for comparison: To what group is the intervention group being compared?
“O” stands for outcome: What is the primary outcome for the study?

There are multiple types of studies, with the gold standard being the randomized controlled trial. In general, you can divide studies into primary vs. secondary literature. Primary literature studies the question directly. Secondary literature involves synthesizing and evaluating the primary literature. Both are necessary to answer a clinical question. Examples include:

Primary Literature: cohort studies, case control, case series, randomized control trials

Secondary Literature: meta-analyses, systematic review, evidence-based practice guidelines, critically appraised topics (CATs).

Of note, there are articles published in the medical literature specifically about how to evaluate an article, such as a meta-analysis. These articles may provide a helpful framework when evaluating the quality of the article that you are reviewing for journal club.

Read the Article in Your Preferred Order

Typically, one starts with the abstract, since this is the study's skeleton. Some people prefer to read the article in its printed order. Others prefer to read the figures or methods first. Table 1 is usually a helpful tabulation of patient characteristics.

Ask Yourself: Would I Apply this to My Clinical Practice?

At the end of your reading, remind yourself of the clinical question. Did the article convince you the authors answered the question well? Was there a confounding variable they did not account for? Do you still have some unanswered questions or doubts? Ultimately, it is up to you to decide if you will change your practice based on this article.

In addition to using these techniques, there are several other resources that may help you digest articles. For example, there are certain apps (like Journal Club) and websites (Wiki Journal Club) that will clearly spell out the clinical question, major points, and bottom line.

You may need to experiment with different methods before you find the one that works best for you. Keep in mind: If you make learning article analysis a priority today, it will serve you for a lifetime.

Walker R, da Silva, PR. Emerging trends in peer review—a survey. Front Neurosci . 2015;9:169.
van Loveren C, Aartman IH. The PICO (Patient-Intervention-Comparison-Outcome) question. Ned Tijdschr Tandheelkd . 2007;114(4):172-178.

ALL ARTICLES

Administration and Operations Committee 2
Critical Care Committee 4
Education Committee 10
Government Services 4
Health Policy Committee 8
Informatics Committee 3
Medical Student Council 7
Pediatrics Committee 4
Research Committee 6
Simulation Committee 3
Social EM Committee 7
Wilderness Committee 5
International Committee 8
Prehospital and Disaster Medicine Committee 5
Simulation Division 2
Sports Medicine Committee 5
Advancement of EM 107
Administration & Operations 55
Admin Ops Literature Review 8
Diversity and Inclusion 17
Research 31
Rapid Research Review 9
Attending 2
Award Winners 20
Educational Courses 2
Residency Leadership 2
Travel Scholarships 3
ACEP Member Benefits 2
Career Planning 78
Board Certification 7
Interviewing 5
Job Search 3
Practice Environments 25
Community 2
International 10
Locum Tenens 2
Clinical 964
Addiction Medicine 4
Surgical Airway 1
Behavioral Health 5
Cardiology 148
ECG Challenge 46
Consult Corner 5
Critical Care 222
Critical Care Alert 100
Critical Care Devices 9
Critical Care Roadblock 3
Critical Care Ultrasound 14
Deep Dive in CritCare 9
Ventilator Management 6
Dermatology 8
Disaster Medicine 12
Prehospital Care 21
Endocrinology 11
Event Medicine 2
Gastroenterology 15
Geriatrics 4
Hematology 18
Immunology 1
Infectious Disease 130
COVID-19 80
Informatics 18
Telemedicine 3
International EM 24
Nephrology 13
Neurology 49
Ophthalmology 15
Orthopedics 26
Osteopathic 3
Pain Management 24
Palliative Care 13
Patient Interactions 16
Pediatric EM 99
Psychiatry 8
Mental Health 3
Pulmonary 17
Radiology 7
Rheumatology 1
Simulation 13
Social EM 52
Space Medicine 3
Sports Medicine 11
Toxicology 96
Medications 11
Recreational Drugs 10
Penetrating 1
Traumatic Brain Injury 2
Ultrasound 83
Guided Procedures 5
POCUS For the Win 7
Undersea and Hyperbaric 2
Visual Diagnosis 20
Wilderness Medicine 25
Editorial 127
Editor's Forum 52
Heart of EM 12
Opinion-Editorial 13
Leadership Reports 77
ACEP Representative 2
ACGME RC-EM 11
President's Message 48
Speaker Report 8
Treasurer's Report 3
Membership 3
Events & Activities 21
ACEP Scientific Assembly 6
CORD Academic Assembly 2
EM Wellness Week 1
EMRA MedWAR 3
Leadership and Advocacy Conference 6
Fellowships 12
Education Fellowships 2
Global EM Fellowships 2
Health Policy Fellowships 1
Pediatric Fellowships 2
Health Equity 3
Health Policy 144
Advocacy 45
Affordable Care Act 7
Health Policy Journal Club 76
Legislation 9
Regulatory 2
Leadership 180
Committees and Divisions 4
EMRA Board of Directors 39
EMRA Spotlight 127
Representative Council 9
Medical Education 79
Board Review 2
Questions 1
Med Ed Fellowship Director Interview Series 10
Medical Students 196
Advising 60
Away Rotations 8
Dual Degree Programs 1
ERAS & Residency Application 3
Military Advising 2
Program Director Interviews 80
Rank List 1
Residents Program Interviews 4
Medical Student Council 29
Mentorship 4
Non Clinical 64
Health Care Administration 35
Otolaryngology 5
Resuscitation 2
Wellness 130
Compassion Fatigue 9
Financial 10
Insurance 2
Loan Refinancing 2
Personal Finance 4
Medico Legal 32
Medical Liability 2
Risk Management Pitfalls 23
Personal 14
Workplace 21
Med Student 46
Advertise with us
Submit an article
Connect with us

About NEOMED Library
About Our Collections
Library Location & Hours
Associated Hospital Libraries
Copyright & Privacy Statements
NEOMED University Homepage

COLLECTIONS BY FORMAT:

Search for Journal Articles
Search for Books, Journals & E-Books
Library Databases & Clinical Tools
Library Catalog

KEY RESOURCES:

Cochrane Library
NEOMED Bibliography Database
More About Our Collections . . .
Services for Students
Services for Faculty & Staff
Borrow, Renew & ILL
Instruction & Curriculum Support
Literature Search Services
More Research Services . . .
Study Spaces
Printing & Copying
24-hour Silent Area
Guides by Subject
Course Guides
Database Search Tips
All Guides A-Z
Logins for Students
Logins for Faculty/Staff
My Library Account
Interlibrary Loan Account
Off-Campus Access
Library Login
Get Full-Text Articles
Reserve a Study Room
Request an Article
More FAQs . . .

Journal Club Presentation Resources (Statistics Help): Meta-Analyses & Systematic Reviews

Introduction
Level of Evidence / EBM Calculators
Library Resources
Types of Research Studies
ANOVA / Misc. Statistics Resources
Confidence Intervals/ Type I & II Errors/ Statistical Power
Bias / Validity & Clinical Significance / Outcomes
Confounders / Placebo Control or Other Control
Blinding / Randomization / Subgroup Analysis
Meta-Analyses & Systematic Reviews
Regression, Correlation / Survival Analysis
Diagnostic Tests & Nonparametric Tests
ITT, Per Protocol, etc. / Non-inferiority Trials, etc.

Evaluation Tools

AHRQ: Spotting a Bad Meta-Analysis AHRQ YouTube video
Are Network Meta-Analysis More Prone to Unreliable Conclusions? Improving Medical Statistics and the Interpretation of Clinical Trials
Development of AMSTAR: A Measurement Tool to Assess the Methodological Quality of Systematic Reviews BMC Medical Research Methodology article
How to Review a Meta-analysis Article Russo MW. How to review a meta-analysis. Gastroenterol Hepatol (N Y). 2007;3(8):637-42.

Jadad Score Berger VW, Alperson SY. A general framework for the evaluation of clinical trial quality. Rev Recent Clin Trials. 2009;4(2):79-88. doi:10.2174/157488709788186021
Limitations of Meta-analysis: Overview Improving Medical Statistics and the Interpretation of Clinical Trials
Living Systematic Reviews: Towards Real-time Evidence for Health-care Decision-making BMJ Blog By Chris Mavergames and Julian Elliott
Meta-Analysis: Principles and Procedures article Egger M. Meta-analysis: principles and procedures. BMJ 1997;315:1533.

The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-analyses GA Wells, B Shea, D O'Connell, J Peterson, V Welch, M Losos, P Tugwell. Department of Epidemiology and Commuunity Medicine, University of Ottawa
Overview of Meta-Analysis and Methods greatdoctorstv YouTube video of Gordon Guyatt, M.D., M.Sc.

Resource for NEOMED students, faculty, staff, and clinical faculty.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement Annals of Internal Medicine article
Problems with Meta-Analysis Methods greatdoctorstv YouTube video of Gordon Guyatt, M.D., M.Sc.
Tips for Learners of Evidence-Based Medicine: 4. Assessing Heterogeneity of Primary Studies in Systematic Reviews and Whether to Combine their Results Hatala R, Keitz S, Wyer P, Guyatt G. Tips for learners of evidence-based medicine: 4. Assessing heterogeneity of primary studies in systematic reviews and whether to combine their results. CMAJ. 2005;172(5):661-5.
Traditional Reviews vs. Systematic Reviews tutorial Students 4 Best Evidence

Understanding the Statistics

5 Key Things to Know About Meta-Analysis Hilda Bastian - Absolutely Maybe
Another 5 Things to Know About Meta-Analysis Bastian H. Absolutely Maybe : Evidence and Uncertainties about Medicine and Life PLOS blog.
Forest Plot at a Glance tutorial Students 4 Best Evidence
Funnel Plots
Heterogeneity: Assessing Heterogeneity in Meta-Analysis: Q Statistic or I2 Index? University of Connecticut - Tania Huedo-Medina, et al.
How to Read a Forest Plot in a Meta-analysis Sedgwick P. How to read a forest plot in a meta-analysis. BMJ 2015;351:h4028
Living Systematic Reviews The Cochrane Library
Measuring Inconsistency in Meta-Analyses Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557-60.
Meta-analyses: Heterogeneity and Subgroup Analysis Sedgwick P. Meta-analyses: heterogeneity and subgroup analysis. BMJ. 2013;346:f4040.
Meta-analyses: How to Read a Funnel Plot Sedgwick P. Meta-analyses: how to read a funnel plot. BMJ. 2013;346:f1342.
Meta-analyses: Tests of Heterogeneity Sedgwick P. Sample size: how many participants are needed in a trial?. BMJ. 2012;344:e3971.
Meta-Analysis Handbook of Biological Statistics John H. McDonald
What is Heterogeneity? YouTube video by Terry Shaneyfelt, M.D.

Other Resources

The Story of the Cochrane Logo Cochrane Community (beta)
What are Systematic Reviews? video Cochrane Collaboration
<< Previous: NNT/NNH
Next: Regression, Correlation / Survival Analysis >>
Last Updated: May 22, 2024 10:51 AM
URL: https://libraryguides.neomed.edu/journalclub

Northeast Ohio Medical University is an Equal Education and Employment Institution ADA Compliance | Title IX

NEOMED Library - 4209 St, OH-44, Rootstown, OH 44272 - "A Building" Second Floor

330-325-6600

[email protected]

Except where otherwise noted, content on the NEOMED LibGuides is licensed for reuse under a Creative Commons 3.0 Attribution-NonCommercial license (CC BY-NC)

PROVIDE FEEDBACK

COLLECTIONS

LOCATION & HOURS

MAKE A FINANCIAL DONATION

OFF-CAMPUS ACCESS

HELP & GENERAL INFO

HOSPITAL LIBRARIES

Loading metrics

Open Access

Peer-reviewed

Research Article

Functional connectivity changes in the brain of adolescents with internet addiction: A systematic literature review of imaging studies

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Software, Validation, Visualization, Writing – original draft, Writing – review & editing

Affiliation Child and Adolescent Mental Health, Department of Brain Sciences, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom

Roles Conceptualization, Supervision, Validation, Writing – review & editing

* E-mail: [email protected]

Affiliation Behavioural Brain Sciences Unit, Population Policy Practice Programme, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom

Max L. Y. Chang,
Irene O. Lee

Published: June 4, 2024
https://doi.org/10.1371/journal.pmen.0000022
Peer Review
Reader Comments

Internet usage has seen a stark global rise over the last few decades, particularly among adolescents and young people, who have also been diagnosed increasingly with internet addiction (IA). IA impacts several neural networks that influence an adolescent’s behaviour and development. This article issued a literature review on the resting-state and task-based functional magnetic resonance imaging (fMRI) studies to inspect the consequences of IA on the functional connectivity (FC) in the adolescent brain and its subsequent effects on their behaviour and development. A systematic search was conducted from two databases, PubMed and PsycINFO, to select eligible articles according to the inclusion and exclusion criteria. Eligibility criteria was especially stringent regarding the adolescent age range (10–19) and formal diagnosis of IA. Bias and quality of individual studies were evaluated. The fMRI results from 12 articles demonstrated that the effects of IA were seen throughout multiple neural networks: a mix of increases/decreases in FC in the default mode network; an overall decrease in FC in the executive control network; and no clear increase or decrease in FC within the salience network and reward pathway. The FC changes led to addictive behaviour and tendencies in adolescents. The subsequent behavioural changes are associated with the mechanisms relating to the areas of cognitive control, reward valuation, motor coordination, and the developing adolescent brain. Our results presented the FC alterations in numerous brain regions of adolescents with IA leading to the behavioural and developmental changes. Research on this topic had a low frequency with adolescent samples and were primarily produced in Asian countries. Future research studies of comparing results from Western adolescent samples provide more insight on therapeutic intervention.

Citation: Chang MLY, Lee IO (2024) Functional connectivity changes in the brain of adolescents with internet addiction: A systematic literature review of imaging studies. PLOS Ment Health 1(1): e0000022. https://doi.org/10.1371/journal.pmen.0000022

Editor: Kizito Omona, Uganda Martyrs University, UGANDA

Received: December 29, 2023; Accepted: March 18, 2024; Published: June 4, 2024

Copyright: © 2024 Chang, Lee. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting information files.

Funding: The authors received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Introduction

The behavioural addiction brought on by excessive internet use has become a rising source of concern [ 1 ] since the last decade. According to clinical studies, individuals with Internet Addiction (IA) or Internet Gaming Disorder (IGD) may have a range of biopsychosocial effects and is classified as an impulse-control disorder owing to its resemblance to pathological gambling and substance addiction [ 2 , 3 ]. IA has been defined by researchers as a person’s inability to resist the urge to use the internet, which has negative effects on their psychological well-being as well as their social, academic, and professional lives [ 4 ]. The symptoms can have serious physical and interpersonal repercussions and are linked to mood modification, salience, tolerance, impulsivity, and conflict [ 5 ]. In severe circumstances, people may experience severe pain in their bodies or health issues like carpal tunnel syndrome, dry eyes, irregular eating and disrupted sleep [ 6 ]. Additionally, IA is significantly linked to comorbidities with other psychiatric disorders [ 7 ].

Stevens et al (2021) reviewed 53 studies including 17 countries and reported the global prevalence of IA was 3.05% [ 8 ]. Asian countries had a higher prevalence (5.1%) than European countries (2.7%) [ 8 ]. Strikingly, adolescents and young adults had a global IGD prevalence rate of 9.9% which matches previous literature that reported historically higher prevalence among adolescent populations compared to adults [ 8 , 9 ]. Over 80% of adolescent population in the UK, the USA, and Asia have direct access to the internet [ 10 ]. Children and adolescents frequently spend more time on media (possibly 7 hours and 22 minutes per day) than at school or sleeping [ 11 ]. Developing nations have also shown a sharp rise in teenage internet usage despite having lower internet penetration rates [ 10 ]. Concerns regarding the possible harms that overt internet use could do to adolescents and their development have arisen because of this surge, especially the significant impacts by the COVID-19 pandemic [ 12 ]. The growing prevalence and neurocognitive consequences of IA among adolescents makes this population a vital area of study [ 13 ].

Adolescence is a crucial developmental stage during which people go through significant changes in their biology, cognition, and personalities [ 14 ]. Adolescents’ emotional-behavioural functioning is hyperactivated, which creates risk of psychopathological vulnerability [ 15 ]. In accordance with clinical study results [ 16 ], this emotional hyperactivity is supported by a high level of neuronal plasticity. This plasticity enables teenagers to adapt to the numerous physical and emotional changes that occur during puberty as well as develop communication techniques and gain independence [ 16 ]. However, the strong neuronal plasticity is also associated with risk-taking and sensation seeking [ 17 ] which may lead to IA.

Despite the fact that the precise neuronal mechanisms underlying IA are still largely unclear, functional magnetic resonance imaging (fMRI) method has been used by scientists as an important framework to examine the neuropathological changes occurring in IA, particularly in the form of functional connectivity (FC) [ 18 ]. fMRI research study has shown that IA alters both the functional and structural makeup of the brain [ 3 ].

We hypothesise that IA has widespread neurological alteration effects rather than being limited to a few specific brain regions. Further hypothesis holds that according to these alterations of FC between the brain regions or certain neural networks, adolescents with IA would experience behavioural changes. An investigation of these domains could be useful for creating better procedures and standards as well as minimising the negative effects of overt internet use. This literature review aims to summarise and analyse the evidence of various imaging studies that have investigated the effects of IA on the FC in adolescents. This will be addressed through two research questions:

How does internet addiction affect the functional connectivity in the adolescent brain?
How is adolescent behaviour and development impacted by functional connectivity changes due to internet addiction?

The review protocol was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (see S1 Checklist ).

Search strategy and selection process

A systematic search was conducted up until April 2023 from two sources of database, PubMed and PsycINFO, using a range of terms relevant to the title and research questions (see full list of search terms in S1 Appendix ). All the searched articles can be accessed in the S1 Data . The eligible articles were selected according to the inclusion and exclusion criteria. Inclusion criteria used for the present review were: (i) participants in the studies with clinical diagnosis of IA; (ii) participants between the ages of 10 and 19; (iii) imaging research investigations; (iv) works published between January 2013 and April 2023; (v) written in English language; (vi) peer-reviewed papers and (vii) full text. The numbers of articles excluded due to not meeting the inclusion criteria are shown in Fig 1 . Each study’s title and abstract were screened for eligibility.

PPT PowerPoint slide
PNG larger image
TIFF original image

https://doi.org/10.1371/journal.pmen.0000022.g001

Quality appraisal

Full texts of all potentially relevant studies were then retrieved and further appraised for eligibility. Furthermore, articles were critically appraised based on the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework to evaluate the individual study for both quality and bias. The subsequent quality levels were then appraised to each article and listed as either low, moderate, or high.

Data collection process

Data that satisfied the inclusion requirements was entered into an excel sheet for data extraction and further selection. An article’s author, publication year, country, age range, participant sample size, sex, area of interest, measures, outcome and article quality were all included in the data extraction spreadsheet. Studies looking at FC, for instance, were grouped, while studies looking at FC in specific area were further divided into sub-groups.

Data synthesis and analysis

Articles were classified according to their location in the brain as well as the network or pathway they were a part of to create a coherent narrative between the selected studies. Conclusions concerning various research trends relevant to particular groupings were drawn from these groupings and subgroupings. To maintain the offered information in a prominent manner, these assertions were entered into the data extraction excel spreadsheet.

With the search performed on the selected databases, 238 articles in total were identified (see Fig 1 ). 15 duplicated articles were eliminated, and another 6 items were removed for various other reasons. Title and abstract screening eliminated 184 articles because they were not in English (number of article, n, = 7), did not include imaging components (n = 47), had adult participants (n = 53), did not have a clinical diagnosis of IA (n = 19), did not address FC in the brain (n = 20), and were published outside the desired timeframe (n = 38). A further 21 papers were eliminated for failing to meet inclusion requirements after the remaining 33 articles underwent full-text eligibility screening. A total of 12 papers were deemed eligible for this review analysis.

Characteristics of the included studies, as depicted in the data extraction sheet in Table 1 provide information of the author(s), publication year, sample size, study location, age range, gender, area of interest, outcome, measures used and quality appraisal. Most of the studies in this review utilised resting state functional magnetic resonance imaging techniques (n = 7), with several studies demonstrating task-based fMRI procedures (n = 3), and the remaining studies utilising whole-brain imaging measures (n = 2). The studies were all conducted in Asiatic countries, specifically coming from China (8), Korea (3), and Indonesia (1). Sample sizes ranged from 12 to 31 participants with most of the imaging studies having comparable sample sizes. Majority of the studies included a mix of male and female participants (n = 8) with several studies having a male only participant pool (n = 3). All except one of the mixed gender studies had a majority male participant pool. One study did not disclose their data on the gender demographics of their experiment. Study years ranged from 2013–2022, with 2 studies in 2013, 3 studies in 2014, 3 studies in 2015, 1 study in 2017, 1 study in 2020, 1 study in 2021, and 1 study in 2022.

https://doi.org/10.1371/journal.pmen.0000022.t001

(1) How does internet addiction affect the functional connectivity in the adolescent brain?

The included studies were organised according to the brain region or network that they were observing. The specific networks affected by IA were the default mode network, executive control system, salience network and reward pathway. These networks are vital components of adolescent behaviour and development [ 31 ]. The studies in each section were then grouped into subsections according to their specific brain regions within their network.

Default mode network (DMN)/reward network.

Out of the 12 studies, 3 have specifically studied the default mode network (DMN), and 3 observed whole-brain FC that partially included components of the DMN. The effect of IA on the various centres of the DMN was not unilaterally the same. The findings illustrate a complex mix of increases and decreases in FC depending on the specific region in the DMN (see Table 2 and Fig 2 ). The alteration of FC in posterior cingulate cortex (PCC) in the DMN was the most frequently reported area in adolescents with IA, which involved in attentional processes [ 32 ], but Lee et al. (2020) additionally found alterations of FC in other brain regions, such as anterior insula cortex, a node in the DMN that controls the integration of motivational and cognitive processes [ 20 ].

https://doi.org/10.1371/journal.pmen.0000022.g002

The overall changes of functional connectivity in the brain network including default mode network (DMN), executive control network (ECN), salience network (SN) and reward network. IA = Internet Addiction, FC = Functional Connectivity.

https://doi.org/10.1371/journal.pmen.0000022.t002

Ding et al. (2013) revealed altered FC in the cerebellum, the middle temporal gyrus, and the medial prefrontal cortex (mPFC) [ 22 ]. They found that the bilateral inferior parietal lobule, left superior parietal lobule, and right inferior temporal gyrus had decreased FC, while the bilateral posterior lobe of the cerebellum and the medial temporal gyrus had increased FC [ 22 ]. The right middle temporal gyrus was found to have 111 cluster voxels (t = 3.52, p<0.05) and the right inferior parietal lobule was found to have 324 cluster voxels (t = -4.07, p<0.05) with an extent threshold of 54 voxels (figures above this threshold are deemed significant) [ 22 ]. Additionally, there was a negative correlation, with 95 cluster voxels (p<0.05) between the FC of the left superior parietal lobule and the PCC with the Chen Internet Addiction Scores (CIAS) which are used to determine the severity of IA [ 22 ]. On the other hand, in regions of the reward system, connection with the PCC was positively connected with CIAS scores [ 22 ]. The most significant was the right praecuneus with 219 cluster voxels (p<0.05) [ 22 ]. Wang et al. (2017) also discovered that adolescents with IA had 33% less FC in the left inferior parietal lobule and 20% less FC in the dorsal mPFC [ 24 ]. A potential connection between the effects of substance use and overt internet use is revealed by the generally decreased FC in these areas of the DMN of teenagers with drug addiction and IA [ 35 ].

The putamen was one of the main regions of reduced FC in adolescents with IA [ 19 ]. The putamen and the insula-operculum demonstrated significant group differences regarding functional connectivity with a cluster size of 251 and an extent threshold of 250 (Z = 3.40, p<0.05) [ 19 ]. The molecular mechanisms behind addiction disorders have been intimately connected to decreased striatal dopaminergic function [ 19 ], making this function crucial.

Executive Control Network (ECN).

5 studies out of 12 have specifically viewed parts of the executive control network (ECN) and 3 studies observed whole-brain FC. The effects of IA on the ECN’s constituent parts were consistent across all the studies examined for this analysis (see Table 2 and Fig 3 ). The results showed a notable decline in all the ECN’s major centres. Li et al. (2014) used fMRI imaging and a behavioural task to study response inhibition in adolescents with IA [ 25 ] and found decreased activation at the striatum and frontal gyrus, particularly a reduction in FC at inferior frontal gyrus, in the IA group compared to controls [ 25 ]. The inferior frontal gyrus showed a reduction in FC in comparison to the controls with a cluster size of 71 (t = 4.18, p<0.05) [ 25 ]. In addition, the frontal-basal ganglia pathways in the adolescents with IA showed little effective connection between areas and increased degrees of response inhibition [ 25 ].

https://doi.org/10.1371/journal.pmen.0000022.g003

Lin et al. (2015) found that adolescents with IA demonstrated disrupted corticostriatal FC compared to controls [ 33 ]. The corticostriatal circuitry experienced decreased connectivity with the caudate, bilateral anterior cingulate cortex (ACC), as well as the striatum and frontal gyrus [ 33 ]. The inferior ventral striatum showed significantly reduced FC with the subcallosal ACC and caudate head with cluster size of 101 (t = -4.64, p<0.05) [ 33 ]. Decreased FC in the caudate implies dysfunction of the corticostriatal-limbic circuitry involved in cognitive and emotional control [ 36 ]. The decrease in FC in both the striatum and frontal gyrus is related to inhibitory control, a common deficit seen with disruptions with the ECN [ 33 ].

The dorsolateral prefrontal cortex (DLPFC), ACC, and right supplementary motor area (SMA) of the prefrontal cortex were all found to have significantly decreased grey matter volume [ 29 ]. In addition, the DLPFC, insula, temporal cortices, as well as significant subcortical regions like the striatum and thalamus, showed decreased FC [ 29 ]. According to Tremblay (2009), the striatum plays a significant role in the processing of rewards, decision-making, and motivation [ 37 ]. Chen et al. (2020) reported that the IA group demonstrated increased impulsivity as well as decreased reaction inhibition using a Stroop colour-word task [ 26 ]. Furthermore, Chen et al. (2020) observed that the left DLPFC and dorsal striatum experienced a negative connection efficiency value, specifically demonstrating that the dorsal striatum activity suppressed the left DLPFC [ 27 ].

Salience network (SN).

Out of the 12 chosen studies, 3 studies specifically looked at the salience network (SN) and 3 studies have observed whole-brain FC. Relative to the DMN and ECN, the findings on the SN were slightly sparser. Despite this, adolescents with IA demonstrated a moderate decrease in FC, as well as other measures like fibre connectivity and cognitive control, when compared to healthy control (see Table 2 and Fig 4 ).

https://doi.org/10.1371/journal.pmen.0000022.g004

Xing et al. (2014) used both dorsal anterior cingulate cortex (dACC) and insula to test FC changes in the SN of adolescents with IA and found decreased structural connectivity in the SN as well as decreased fractional anisotropy (FA) that correlated to behaviour performance in the Stroop colour word-task [ 21 ]. They examined the dACC and insula to determine whether the SN’s disrupted connectivity may be linked to the SN’s disruption of regulation, which would explain the impaired cognitive control seen in adolescents with IA. However, researchers did not find significant FC differences in the SN when compared to the controls [ 21 ]. These results provided evidence for the structural changes in the interconnectivity within SN in adolescents with IA.

Wang et al. (2017) investigated network interactions between the DMN, ECN, SN and reward pathway in IA subjects [ 24 ] (see Fig 5 ), and found 40% reduction of FC between the DMN and specific regions of the SN, such as the insula, in comparison to the controls (p = 0.008) [ 24 ]. The anterior insula and dACC are two areas that are impacted by this altered FC [ 24 ]. This finding supports the idea that IA has similar neurobiological abnormalities with other addictive illnesses, which is in line with a study that discovered disruptive changes in the SN and DMN’s interaction in cocaine addiction [ 38 ]. The insula has also been linked to the intensity of symptoms and has been implicated in the development of IA [ 39 ].

“+” indicates an increase in behaivour; “-”indicates a decrease in behaviour; solid arrows indicate a direct network interaction; and the dotted arrows indicates a reduction in network interaction. This diagram depicts network interactions juxtaposed with engaging in internet related behaviours. Through the neural interactions, the diagram illustrates how the networks inhibit or amplify internet usage and vice versa. Furthermore, it demonstrates how the SN mediates both the DMN and ECN.

https://doi.org/10.1371/journal.pmen.0000022.g005

(2) How is adolescent behaviour and development impacted by functional connectivity changes due to internet addiction?

The findings that IA individuals demonstrate an overall decrease in FC in the DMN is supported by numerous research [ 24 ]. Drug addict populations also exhibited similar decline in FC in the DMN [ 40 ]. The disruption of attentional orientation and self-referential processing for both substance and behavioural addiction was then hypothesised to be caused by DMN anomalies in FC [ 41 ].

In adolescents with IA, decline of FC in the parietal lobule affects visuospatial task-related behaviour [ 22 ], short-term memory [ 42 ], and the ability of controlling attention or restraining motor responses during response inhibition tests [ 42 ]. Cue-induced gaming cravings are influenced by the DMN [ 43 ]. A visual processing area called the praecuneus links gaming cues to internal information [ 22 ]. A meta-analysis found that the posterior cingulate cortex activity of individuals with IA during cue-reactivity tasks was connected with their gaming time [ 44 ], suggesting that excessive gaming may impair DMN function and that individuals with IA exert more cognitive effort to control it. Findings for the behavioural consequences of FC changes in the DMN illustrate its underlying role in regulating impulsivity, self-monitoring, and cognitive control.

Furthermore, Ding et al. (2013) reported an activation of components of the reward pathway, including areas like the nucleus accumbens, praecuneus, SMA, caudate, and thalamus, in connection to the DMN [ 22 ]. The increased FC of the limbic and reward networks have been confirmed to be a major biomarker for IA [ 45 , 46 ]. The increased reinforcement in these networks increases the strength of reward stimuli and makes it more difficult for other networks, namely the ECN, to down-regulate the increased attention [ 29 ] (See Fig 5 ).

Executive control network (ECN).

The numerous IA-affected components in the ECN have a role in a variety of behaviours that are connected to both response inhibition and emotional regulation [ 47 ]. For instance, brain regions like the striatum, which are linked to impulsivity and the reward system, are heavily involved in the act of playing online games [ 47 ]. Online game play activates the striatum, which suppresses the left DLPFC in ECN [ 48 ]. As a result, people with IA may find it difficult to control their want to play online games [ 48 ]. This system thus causes impulsive and protracted gaming conduct, lack of inhibitory control leading to the continued use of internet in an overt manner despite a variety of negative effects, personal distress, and signs of psychological dependence [ 33 ] (See Fig 5 ).

Wang et al. (2017) report that disruptions in cognitive control networks within the ECN are frequently linked to characteristics of substance addiction [ 24 ]. With samples that were addicted to heroin and cocaine, previous studies discovered abnormal FC in the ECN and the PFC [ 49 ]. Electronic gaming is known to promote striatal dopamine release, similar to drug addiction [ 50 ]. According to Drgonova and Walther (2016), it is hypothesised that dopamine could stimulate the reward system of the striatum in the brain, leading to a loss of impulse control and a failure of prefrontal lobe executive inhibitory control [ 51 ]. In the end, IA’s resemblance to drug use disorders may point to vital biomarkers or underlying mechanisms that explain how cognitive control and impulsive behaviour are related.

A task-related fMRI study found that the decrease in FC between the left DLPFC and dorsal striatum was congruent with an increase in impulsivity in adolescents with IA [ 26 ]. The lack of response inhibition from the ECN results in a loss of control over internet usage and a reduced capacity to display goal-directed behaviour [ 33 ]. Previous studies have linked the alteration of the ECN in IA with higher cue reactivity and impaired ability to self-regulate internet specific stimuli [ 52 ].

Salience network (SN)/ other networks.

Xing et al. (2014) investigated the significance of the SN regarding cognitive control in teenagers with IA [ 21 ]. The SN, which is composed of the ACC and insula, has been demonstrated to control dynamic changes in other networks to modify cognitive performance [ 21 ]. The ACC is engaged in conflict monitoring and cognitive control, according to previous neuroimaging research [ 53 ]. The insula is a region that integrates interoceptive states into conscious feelings [ 54 ]. The results from Xing et al. (2014) showed declines in the SN regarding its structural connectivity and fractional anisotropy, even though they did not observe any appreciable change in FC in the IA participants [ 21 ]. Due to the small sample size, the results may have indicated that FC methods are not sensitive enough to detect the significant functional changes [ 21 ]. However, task performance behaviours associated with impaired cognitive control in adolescents with IA were correlated with these findings [ 21 ]. Our comprehension of the SN’s broader function in IA can be enhanced by this relationship.

Research study supports the idea that different psychological issues are caused by the functional reorganisation of expansive brain networks, such that strong association between SN and DMN may provide neurological underpinnings at the system level for the uncontrollable character of internet-using behaviours [ 24 ]. In the study by Wang et al. (2017), the decreased interconnectivity between the SN and DMN, comprising regions such the DLPFC and the insula, suggests that adolescents with IA may struggle to effectively inhibit DMN activity during internally focused processing, leading to poorly managed desires or preoccupations to use the internet [ 24 ] (See Fig 5 ). Subsequently, this may cause a failure to inhibit DMN activity as well as a restriction of ECN functionality [ 55 ]. As a result, the adolescent experiences an increased salience and sensitivity towards internet addicting cues making it difficult to avoid these triggers [ 56 ].

The primary aim of this review was to present a summary of how internet addiction impacts on the functional connectivity of adolescent brain. Subsequently, the influence of IA on the adolescent brain was compartmentalised into three sections: alterations of FC at various brain regions, specific FC relationships, and behavioural/developmental changes. Overall, the specific effects of IA on the adolescent brain were not completely clear, given the variety of FC changes. However, there were overarching behavioural, network and developmental trends that were supported that provided insight on adolescent development.

The first hypothesis that was held about this question was that IA was widespread and would be regionally similar to substance-use and gambling addiction. After conducting a review of the information in the chosen articles, the hypothesis was predictably supported. The regions of the brain affected by IA are widespread and influence multiple networks, mainly DMN, ECN, SN and reward pathway. In the DMN, there was a complex mix of increases and decreases within the network. However, in the ECN, the alterations of FC were more unilaterally decreased, but the findings of SN and reward pathway were not quite clear. Overall, the FC changes within adolescents with IA are very much network specific and lay a solid foundation from which to understand the subsequent behaviour changes that arise from the disorder.

The second hypothesis placed emphasis on the importance of between network interactions and within network interactions in the continuation of IA and the development of its behavioural symptoms. The results from the findings involving the networks, DMN, SN, ECN and reward system, support this hypothesis (see Fig 5 ). Studies confirm the influence of all these neural networks on reward valuation, impulsivity, salience to stimuli, cue reactivity and other changes that alter behaviour towards the internet use. Many of these changes are connected to the inherent nature of the adolescent brain.

There are multiple explanations that underlie the vulnerability of the adolescent brain towards IA related urges. Several of them have to do with the inherent nature and underlying mechanisms of the adolescent brain. Children’s emotional, social, and cognitive capacities grow exponentially during childhood and adolescence [ 57 ]. Early teenagers go through a process called “social reorientation” that is characterised by heightened sensitivity to social cues and peer connections [ 58 ]. Adolescents’ improvements in their social skills coincide with changes in their brains’ anatomical and functional organisation [ 59 ]. Functional hubs exhibit growing connectivity strength [ 60 ], suggesting increased functional integration during development. During this time, the brain’s functional networks change from an anatomically dominant structure to a scattered architecture [ 60 ].

The adolescent brain is very responsive to synaptic reorganisation and experience cues [ 61 ]. As a result, one of the distinguishing traits of the maturation of adolescent brains is the variation in neural network trajectory [ 62 ]. Important weaknesses of the adolescent brain that may explain the neurobiological change brought on by external stimuli are illustrated by features like the functional gaps between networks and the inadequate segregation of networks [ 62 ].

The implications of these findings towards adolescent behaviour are significant. Although the exact changes and mechanisms are not fully clear, the observed changes in functional connectivity have the capacity of influencing several aspects of adolescent development. For example, functional connectivity has been utilised to investigate attachment styles in adolescents [ 63 ]. It was observed that adolescent attachment styles were negatively associated with caudate-prefrontal connectivity, but positively with the putamen-visual area connectivity [ 63 ]. Both named areas were also influenced by the onset of internet addiction, possibly providing a connection between the two. Another study associated neighbourhood/socioeconomic disadvantage with functional connectivity alterations in the DMN and dorsal attention network [ 64 ]. The study also found multivariate brain behaviour relationships between the altered/disadvantaged functional connectivity and mental health and cognition [ 64 ]. This conclusion supports the notion that the functional connectivity alterations observed in IA are associated with specific adolescent behaviours as well as the fact that functional connectivity can be utilised as a platform onto which to compare various neurologic conditions.

Limitations/strengths

There were several limitations that were related to the conduction of the review as well as the data extracted from the articles. Firstly, the study followed a systematic literature review design when analysing the fMRI studies. The data pulled from these imaging studies were namely qualitative and were subject to bias contrasting the quantitative nature of statistical analysis. Components of the study, such as sample sizes, effect sizes, and demographics were not weighted or controlled. The second limitation brought up by a similar review was the lack of a universal consensus of terminology given IA [ 47 ]. Globally, authors writing about this topic use an array of terminology including online gaming addiction, internet addiction, internet gaming disorder, and problematic internet use. Often, authors use multiple terms interchangeably which makes it difficult to depict the subtle similarities and differences between the terms.

Reviewing the explicit limitations in each of the included studies, two major limitations were brought up in many of the articles. One was relating to the cross-sectional nature of the included studies. Due to the inherent qualities of a cross-sectional study, the studies did not provide clear evidence that IA played a causal role towards the development of the adolescent brain. While several biopsychosocial factors mediate these interactions, task-based measures that combine executive functions with imaging results reinforce the assumed connection between the two that is utilised by the papers studying IA. Another limitation regarded the small sample size of the included studies, which averaged to around 20 participants. The small sample size can influence the generalisation of the results as well as the effectiveness of statistical analyses. Ultimately, both included study specific limitations illustrate the need for future studies to clarify the causal relationship between the alterations of FC and the development of IA.

Another vital limitation was the limited number of studies applying imaging techniques for investigations on IA in adolescents were a uniformly Far East collection of studies. The reason for this was because the studies included in this review were the only fMRI studies that were found that adhered to the strict adolescent age restriction. The adolescent age range given by the WHO (10–19 years old) [ 65 ] was strictly followed. It is important to note that a multitude of studies found in the initial search utilised an older adolescent demographic that was slightly higher than the WHO age range and had a mean age that was outside of the limitations. As a result, the results of this review are biased and based on the 12 studies that met the inclusion and exclusion criteria.

Regarding the global nature of the research, although the journals that the studies were published in were all established western journals, the collection of studies were found to all originate from Asian countries, namely China and Korea. Subsequently, it pulls into question if the results and measures from these studies are generalisable towards a western population. As stated previously, Asian countries have a higher prevalence of IA, which may be the reasoning to why the majority of studies are from there [ 8 ]. However, in an additional search including other age groups, it was found that a high majority of all FC studies on IA were done in Asian countries. Interestingly, western papers studying fMRI FC were primarily focused on gambling and substance-use addiction disorders. The western papers on IA were less focused on fMRI FC but more on other components of IA such as sleep, game-genre, and other non-imaging related factors. This demonstrated an overall lack of western fMRI studies on IA. It is important to note that both western and eastern fMRI studies on IA presented an overall lack on children and adolescents in general.

Despite the several limitations, this review provided a clear reflection on the state of the data. The strengths of the review include the strict inclusion/exclusion criteria that filtered through studies and only included ones that contained a purely adolescent sample. As a result, the information presented in this review was specific to the review’s aims. Given the sparse nature of adolescent specific fMRI studies on the FC changes in IA, this review successfully provided a much-needed niche representation of adolescent specific results. Furthermore, the review provided a thorough functional explanation of the DMN, ECN, SN and reward pathway making it accessible to readers new to the topic.

Future directions and implications

Through the search process of the review, there were more imaging studies focused on older adolescence and adulthood. Furthermore, finding a review that covered a strictly adolescent population, focused on FC changes, and was specifically depicting IA, was proven difficult. Many related reviews, such as Tereshchenko and Kasparov (2019), looked at risk factors related to the biopsychosocial model, but did not tackle specific alterations in specific structural or functional changes in the brain [ 66 ]. Weinstein (2017) found similar structural and functional results as well as the role IA has in altering response inhibition and reward valuation in adolescents with IA [ 47 ]. Overall, the accumulated findings only paint an emerging pattern which aligns with similar substance-use and gambling disorders. Future studies require more specificity in depicting the interactions between neural networks, as well as more literature on adolescent and comorbid populations. One future field of interest is the incorporation of more task-based fMRI data. Advances in resting-state fMRI methods have yet to be reflected or confirmed in task-based fMRI methods [ 62 ]. Due to the fact that network connectivity is shaped by different tasks, it is critical to confirm that the findings of the resting state fMRI studies also apply to the task based ones [ 62 ]. Subsequently, work in this area will confirm if intrinsic connectivity networks function in resting state will function similarly during goal directed behaviour [ 62 ]. An elevated focus on adolescent populations as well as task-based fMRI methodology will help uncover to what extent adolescent network connectivity maturation facilitates behavioural and cognitive development [ 62 ].

A treatment implication is the potential usage of bupropion for the treatment of IA. Bupropion has been previously used to treat patients with gambling disorder and has been effective in decreasing overall gambling behaviour as well as money spent while gambling [ 67 ]. Bae et al. (2018) found a decrease in clinical symptoms of IA in line with a 12-week bupropion treatment [ 31 ]. The study found that bupropion altered the FC of both the DMN and ECN which in turn decreased impulsivity and attentional deficits for the individuals with IA [ 31 ]. Interventions like bupropion illustrate the importance of understanding the fundamental mechanisms that underlie disorders like IA.

The goal for this review was to summarise the current literature on functional connectivity changes in adolescents with internet addiction. The findings answered the primary research questions that were directed at FC alterations within several networks of the adolescent brain and how that influenced their behaviour and development. Overall, the research demonstrated several wide-ranging effects that influenced the DMN, SN, ECN, and reward centres. Additionally, the findings gave ground to important details such as the maturation of the adolescent brain, the high prevalence of Asian originated studies, and the importance of task-based studies in this field. The process of making this review allowed for a thorough understanding IA and adolescent brain interactions.

Given the influx of technology and media in the lives and education of children and adolescents, an increase in prevalence and focus on internet related behavioural changes is imperative towards future children/adolescent mental health. Events such as COVID-19 act to expose the consequences of extended internet usage on the development and lifestyle of specifically young people. While it is important for parents and older generations to be wary of these changes, it is important for them to develop a base understanding of the issue and not dismiss it as an all-bad or all-good scenario. Future research on IA will aim to better understand the causal relationship between IA and psychological symptoms that coincide with it. The current literature regarding functional connectivity changes in adolescents is limited and requires future studies to test with larger sample sizes, comorbid populations, and populations outside Far East Asia.

This review aimed to demonstrate the inner workings of how IA alters the connection between the primary behavioural networks in the adolescent brain. Predictably, the present answers merely paint an unfinished picture that does not necessarily depict internet usage as overwhelmingly positive or negative. Alternatively, the research points towards emerging patterns that can direct individuals on the consequences of certain variables or risk factors. A clearer depiction of the mechanisms of IA would allow physicians to screen and treat the onset of IA more effectively. Clinically, this could be in the form of more streamlined and accurate sessions of CBT or family therapy, targeting key symptoms of IA. Alternatively clinicians could potentially prescribe treatment such as bupropion to target FC in certain regions of the brain. Furthermore, parental education on IA is another possible avenue of prevention from a public health standpoint. Parents who are aware of the early signs and onset of IA will more effectively handle screen time, impulsivity, and minimize the risk factors surrounding IA.

Additionally, an increased attention towards internet related fMRI research is needed in the West, as mentioned previously. Despite cultural differences, Western countries may hold similarities to the eastern countries with a high prevalence of IA, like China and Korea, regarding the implications of the internet and IA. The increasing influence of the internet on the world may contribute to an overall increase in the global prevalence of IA. Nonetheless, the high saturation of eastern studies in this field should be replicated with a Western sample to determine if the same FC alterations occur. A growing interest in internet related research and education within the West will hopefully lead to the knowledge of healthier internet habits and coping strategies among parents with children and adolescents. Furthermore, IA research has the potential to become a crucial proxy for which to study adolescent brain maturation and development.

Supporting information

S1 checklist. prisma checklist..

https://doi.org/10.1371/journal.pmen.0000022.s001

S1 Appendix. Search strategies with all the terms.

https://doi.org/10.1371/journal.pmen.0000022.s002

S1 Data. Article screening records with details of categorized content.

https://doi.org/10.1371/journal.pmen.0000022.s003

Acknowledgments

The authors thank https://www.stockio.com/free-clipart/brain-01 (with attribution to Stockio.com); and https://www.rawpixel.com/image/6442258/png-sticker-vintage for the free images used to create Figs 2 – 4 .

View Article
PubMed/NCBI
Google Scholar
2. Association AP. Diagnostic and statistical manual of mental disorders: DSM-5. 5 ed. Washington, D.C.: American Psychiatric Publishing; 2013.
10. Stats IW. World Internet Users Statistics and World Population Stats 2013 [ http://www.internetworldstats.com/stats.htm .
11. Rideout VJR M. B. The common sense census: media use by tweens and teens. San Francisco, CA: Common Sense Media; 2019.
37. Tremblay L. The Ventral Striatum. Handbook of Reward and Decision Making: Academic Press; 2009.
57. Bhana A. Middle childhood and pre-adolescence. Promoting mental health in scarce-resource contexts: emerging evidence and practice. Cape Town: HSRC Press; 2010. p. 124–42.
65. Organization WH. Adolescent Health 2023 [ https://www.who.int/health-topics/adolescent-health#tab=tab_1 .

Advanced Search

Unpacking the process of conceptual leaping in the conduct of literature reviews

New citation alert added.

This alert has been successfully added and will be sent to:

You will be notified whenever a record that you have chosen has been cited.

To manage your alert preferences, click on the button below.

New Citation Alert!

Please log in to your account

Information & Contributors

Bibliometrics & citations, view options, recommendations, literature reviews in hci: a review of reviews.

This paper analyses Human-Computer Interaction (HCI) literature reviews to provide a clear conceptual basis for authors, reviewers, and readers. HCI is multidisciplinary and various types of literature reviews exist, from systematic to critical reviews ...

An overview of systematic literature reviews in social media marketing

Systematic literature reviews (SLRs) adopt a specified and transparent approach in order to scope the literature in a field or sub-field. However, there has been little critical comment on their purpose and processes in practice. By undertaking an ...

The need for multivocal literature reviews in software engineering: complementing systematic literature reviews with grey literature

Systematic Literature Reviews (SLR) may not provide insight into the "state of the practice" in SE, as they do not typically include the "grey" (non-published) literature. A Multivocal Literature Review (MLR) is a form of a SLR which includes grey ...

Information

Published in.

Butterworth-Heinemann

United States

Publication History

Author tags.

Literature review
Theoretical contribution
Conceptual leap
Conceptual leaping
Review process
Research-article

Contributors

Other metrics, bibliometrics, article metrics.

0 Total Citations
0 Total Downloads
Downloads (Last 12 months) 0
Downloads (Last 6 weeks) 0

View options

Check if you have access through your login credentials or your institution to get full access on this article.

Full Access

Share this publication link.

Copying failed.

Share on social media

Affiliations, export citations.

Please download or close your previous search result export first before starting a new bulk export. Preview is not available. By clicking download, a status dialog will open to start the export process. The process may take a few minutes but once it finishes a file will be downloadable from your browser. You may continue to browse the DL while the export process is in progress. Download
Download citation
Copy citation

We are preparing your search results for download ...

We will inform you here when the file is ready.

Your file of search results citations is now ready.

Your search export query has expired. Please try again.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Publications
Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

Advanced Search
Journal List
Am J Pharm Educ
v.71(4); 2007 Aug 15

A Rubric to Assess Critical Literature Evaluation Skills

To develop and describe the use of a rubric for reinforcing critical literature evaluation skills and assessing journal article critiques presented by pharmacy students during journal club exercises.

A rubric was developed, tested, and revised as needed to guide students in presenting a published study critique during the second through fourth years of a first-professional doctor of pharmacy degree curriculum and to help faculty members assess student performance and provide formative feedback. Through each rubric iteration, the ease of use and clarity for both evaluators and students were determined with modifications made as indicated. Student feedback was obtained after using the rubric for journal article exercises, and interrater reliability of the rubric was determined.

Student feedback regarding rubric use for preparing a clinical study critique was positive across years. Intraclass correlation coefficients were high for each rubric section. The rubric was modified a total of 5 times based upon student feedback and faculty discussions.

A properly designed and tested rubric can be a useful tool for evaluating student performance during a journal article presentation; however, a rubric can take considerable time to develop. A rubric can also be a valuable student learning aid for applying literature evaluation concepts to the critique of a published study.

INTRODUCTION

There has been increased interest over the past decade in using evidence-based medicine (EBM) as a basis for clinical decision making. Introduced in 1992 by the McMaster University-based Evidence-Based Medicine Working Group, EBM has been defined as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” 1 Current best evidence is disseminated via original contributions to the biomedical literature. However, the medical literature has expanded greatly over time. Medline, a biomedical database, indexes over 5000 biomedical journals and contains more than 15 million records. 2 With this abundance of new medical information, keeping up with the literature and properly utilizing EBM techniques are difficult tasks. A journal club in which a published study is reviewed and critiqued for others can be used to help keep abreast of the literature. A properly designed journal club can also be a useful educational tool to teach and reinforce literature evaluation skills. Three common goals of journal clubs are to teach critical appraisal skills, to have an impact on clinical practice, and to keep up with the current literature. 3 , 4 Journal clubs are a recognized part of many educational experiences for medical and pharmacy students in didactic and experiential settings, as well as for clinicians. Journal clubs have also been described as a means of teaching EBM and critical literature evaluation skills to various types of medical residents.

Cramer described use of a journal club to reinforce and evaluate family medicine residents' understanding and use of EBM concepts. 5 Pre- and posttests were used during each journal club to assess the residents' understanding of key EBM concepts related to the article discussed. Pretest scores improved over the year from 54.5% to 78.9% ( p < 0.001) and posttest scores improved from 63.6% to 81.6% ( p < 0.001), demonstrating the journal club's ability to help residents utilize EBM techniques. Linzer and colleagues compared a journal club to a control seminar series with regard to medical interns' reading habits, epidemiology and biostatistics knowledge, and ability to read and incorporate the medical literature into their practice of medicine. 6 Forty-four interns were randomized to participate in the journal club or a seminar series. After a mean of 5 journal club sessions, 86% of the journal club group improved their reading habits compared to none in the seminar group. Knowledge scores increased more with the journal club and there was a trend toward more knowledge gained with sessions attended. Eighty percent of the journal club participants reported improvement in their ability to incorporate the literature into medical practice compared to 44% of the seminar group.

Journal clubs have also been used extensively to aid in the education and training of pharmacy students and residents. The journal club was a major component in 90% and 83% of drug information practice experiences offered by first professional pharmacy degree programs and nontraditional PharmD degree programs, respectively. 7

When a journal club presentation is used to promote learning, it is important that an appropriate method exists for assessing performance and providing the presenter with recommendations for improvement. Several articles have listed important questions and criteria to use when evaluating published clinical studies. 8 - 11 However, using such questions or criteria in the form of a simple checklist (ie, indicating present or absent) does not provide judgments of the quality or depth of coverage of each item. 12 A rubric is a scoring tool that contains criteria for performance with descriptions of the levels of performance that can be used for performance assessments. 12 , 13 Performance assessments are used when students are required to demonstrate application of knowledge, particularly for tasks that resemble “real-life” situations. 14 This report describes the development and use of a rubric for performance assessments of “journal club” study critiques by students in the didactic curriculum and during an advanced pharmacy practice experience (APPE).

Two journal article presentations have been a required part of the elective drug information APPE at the West Virginia Center for Drug and Health Information for many years. For these presentations, students select a recent clinical study to evaluate and present their study overview and critique to the 2 primary drug information preceptors. Prior to rubric development, these presentations were evaluated using a brief checklist based upon the CONSORT criteria for reporting of randomized controlled trials. 15 Work on a scoring rubric for the student presentations began in 2002. The first step in its development involved identifying the broad categories and specific criteria that were expected from the journal club presentation. The broad categories selected were those deemed important for a journal club presentation and included: “Content and Description,” “Study Analysis,” “Conclusion,” “Presentation Style,” and “Questions.” The criteria in “Content and Description” involved accurate and complete presentation of the study's objective(s), rationale, methods, results, and author(s)' conclusion. Other criteria within the rubric categories included important elements of statistical analyses, analysis of study strengths and weaknesses, the study drug's role in therapy, communication skills, and ability to handle questions appropriately and provide correct answers. The first version of the rubric was tested in 2003 during the drug information APPE, and several rubric deficiencies were identified. Some sections were difficult to consistently interpret or complete, other criteria did not follow a logical presentation sequence, and a few of the levels of performance were based on numbers that were difficult to quantitate during the presentation. For example, the criteria under “Content and Description” were too broad; students could miss one aspect of a study's design such as blinding but correctly identify the rest, making it difficult to accurately evaluate using the rubric.

Version 2 of the rubric was reformatted to remedy the problems. The description and content categories were expanded to make it easier to identify the specific parts of the study that the students should describe, and the “Study Overview” category was divided into distinct parts that included introduction, study design, patients/subjects, treatment regimens, outcome measures, data handling method, dropouts per group, statistics, results, and conclusion. To facilitate ease of use by evaluators, a check box was placed next to each item within the individual parts. This format also allowed the student to see in advance exactly which criteria they needed to include during their presentation, as well as any that were later missed. The use of a checklist also aided evaluators when determining the overall score assigned to the subsections within this category. “Study Analysis and Critique” directed students to refer to the “Study Overview” category as a guide to the parts of the study they should critically analyze. “Study Conclusion” divided the scoring criteria into an enumeration of key strengths, key limitations, and the conclusion of the group/individual student. “Preparedness” included criteria for knowledge of study details and handling of questions. The “Presentation” category included criteria for desired communication skills. This rubric version was tested during 8 journal club presentations during the drug information rotation, and on a larger scale in 2003 in the required medical literature evaluation course for second-professional year students. During the second-professional year journal club assignment, groups of 2 or 3 students were each given 1 published clinical study to evaluate, which they later presented to 2 evaluators consisting of a faculty member plus either a fourth-professional year drug information rotation student or a pharmacy resident. The faculty members evaluating students included the 2 rubric developers as well as 2 additional faculty evaluators. The evaluators first completed the rubric independently to assess student performance; evaluators then discussed their scores and jointly completed a rubric that was used for the grade. The rubric was given to the students in advance to serve as a guide when preparing their journal club presentation. In addition, to provide students with actual experience in using the rubric, 2 fourth-professional year drug information APPE students each presented a journal article critique to the second-professional year class. The fourth-professional year students first gave their presentations to the drug information preceptors as practice and to ensure that complete and accurate information would be relayed to the second-professional year class. The second-professional year students then used the rubric to evaluate the fourth-professional year students' presentations; the completed rubrics were shared with the fourth-professional year students as feedback.

Based on student and evaluator feedback at the end of the journal club assignment, additional revisions to the rubric were needed. Students stated they had difficulty determining the difference between the “Study Analysis and Critique” category and the key strengths and weaknesses parts of the rubric; they felt they were simply restating the same strengths and weaknesses. Students also felt there was insufficient time to discuss their article. The evaluators had difficulty arriving at a score for the “Study Analysis and Critique” category, and students often did not know the important aspects to focus on when critiquing a study. Revisions to the rubric included expanding the presentation time from a maximum of 12 to a maximum of 15 minutes, explaining that the strengths and weaknesses should relate to the areas listed under “Study Overview,” and stating that only the key limitations that impacted the study findings should be summarized as part of the conclusion.

Version 3 of the rubric was tested during the 2004 journal club assignment for the second-professional year students. A brief survey was used to obtain student feedback about the rubric and the assignment as a tool for learning to apply literature evaluation skills. The rubric was revised once again based on the feedback plus evaluator observations. Through use of the first 3 versions of the rubric, the evaluators continually noted that students skipped key areas of the analysis/critique section when presenting their journal articles. Thus, for version 4, a list of questions was developed by the drug information faculty members to aid students in identifying the key considerations that should be included in their analysis (Appendix 1 ). To prepare this list, several sources were located that detailed questions or issues to take into account when evaluating a published study. 8 - 11 Specific questions were also added based upon areas that were consistently overlooked or inappropriately discussed during the journal club presentations. Version 4 of the rubric was used by the 2 primary drug information preceptors to evaluate the fourth-professional year student journal club presentations during the drug information rotation. Following each fourth-professional year student's journal club presentation, each evaluator independently completed the rubric. The evaluators then met together to briefly review their scores, discuss discrepancies, and modify their individual scores if desired. This was important because one evaluator would occasionally miss a correct or incorrect statement made by a student and score the student inappropriately lower or higher for a particular section. Based upon further feedback from students and evaluators, final revisions were made to the rubric. The final and current version (Appendix 2 ) was used for all subsequent fourth-professional year journal club presentations, for the second-professional year students' journal club assignments during 2005 and 2006, and for a new, similar journal club assignment added to the curriculum for third-professional year students in 2006. Feedback about the finalized rubric was obtained from the second- and third-professional year students.

To evaluate the rubric's reliability, 3 drug information faculty members used the final rubric to evaluate the journal club presentations by 9 consecutive fourth-professional year drug information experiential students. Intraclass correlation coefficients were calculated for each rubric section and the total score.

Five versions of the rubric were developed over a 3-year time period. The majority of the revisions involved formatting changes, clarifications in wording, and additions to the criteria. However, the change that appeared to have the greatest positive impact on the student presentations was the addition of the specific questions that should be considered during the study analysis and critique. Second- and third-professional year student feedback from the final version of the rubric is shown in Table Table1 1 and is very positive overall. Representative comments from the students included: “Very helpful for putting the class info to use,” “Great technique for putting all concepts together,” and “This assignment helped me to become more comfortable with understanding medical studies.” The suggestions for change primarily involved providing points for the assignment (it was graded pass/fail for the second-professional year students), better scheduling (the journal club assignment was due at the end of the semester when several other assignments or tests were scheduled), and providing more pre-journal club assistance and guidance to students. A small number of students indicated they still found it confusing to critique a study after the journal club assignment, which was expected since literature evaluation skills take considerable practice and experience to master.

Pharmacy Students Feedback Concerning a Journal Club Assignment in Which the Rubric Was Used for Evaluation

An external file that holds a picture, illustration, etc.
Object name is ajpe63tbl1.jpg

*Items specific to rubric

† Based on a 5-point Likert scale ranging from 1 = strongly disagree to 5 = strongly agree

‡ Positive response = agree or strongly agree

A survey of 7 recent fourth-professional year students who used the rubric to prepare for journal club presentations and who were also evaluated using the rubric found that all of the students agreed or strongly agreed with each item shown in Table Table1. 1 . One representative comment was, “I was surprised at how articles appear to be good when I first read them but then after going through them again and using the form, I was able to find so many more limitations than I expected. I definitely feel that journal club has helped me to interpret studies better than I had been able to in the past.” Several fourth-professional year students took the rubric with them to use during other rotations that required a journal club presentation. After establishing that the rubric was user-friendly to evaluators and that students could clearly follow and differentiate the various sections, the reliability of the rubric in each of the 12 rating areas was determined (Table (Table2). 2 ). The intra-class correlation coefficient demonstrated a high level of correlation between evaluators for each student for 11 of the 12 areas. A score of 0.618 was found for the section involving the students' response to questions. This was still considered acceptable; however, given that a fairly low variability in ratings affected the intra-class correlation coefficient due to the small scale (0-3 points) used in the rubric, with a relatively small number of observations. The intra-class correlation coefficient was calculated using the fourth-professional year students' journal club evaluations from the drug information rotation. Thus, by necessity, the evaluators consisted of the 2 primary faculty drug information preceptors and a drug information resident. These evaluators had previously used the rubric and the 2 faculty evaluators worked to develop the rubric. This may have increased the level of correlation between evaluators due to their familiarity with the sections of the rubric.

Rubric Intraclass Correlation Coefficients (N = 9)

An external file that holds a picture, illustration, etc.
Object name is ajpe63tbl2.jpg

*95% confidence interval

About 5 minutes are required for an individual evaluator to complete the rubric, with an additional 5 minutes needed for score comparison and discussion. In almost all cases, the reasons for any differences were easily identified through discussion and resulted from an evaluator simply missing or not correctly hearing what was said during the presentation. In general, evaluators found the rubric easy to use and did not require an extensive amount of time to consistently assess literature evaluation skills.

A rubric can be a useful tool for evaluating student performance in presenting and critiquing published clinical studies, as well as a valuable learning aid for students. However, developing a rubric that appropriately guides students in achieving the targeted performance, provides proper student feedback, and is user-friendly and reliable for evaluators requires a significant initial investment of time and effort. Multiple pilot tests of the rubric are generally required, with subsequent modifications needed to improve and refine the rubric's utility as an evaluation and learning tool. Once the rubric is developed, though, it can be used to quickly evaluate student performance in a more consistent manner.

As part of the development and use of a rubric, it is important that the rubric's criteria be thoroughly reviewed with students and they are provided the opportunity to observe examples of desired performance. Once a rubric is used to evaluate student performance, the completed rubric should be shared with students so they can identify areas of deficiency. This feedback will help enable students to appropriately modify their performance.

The journal club evaluation rubric can be used when teaching literature evaluation skills throughout all levels of education and training. Students early in their education will probably need to extensively refer to and rely upon the supplemental questions to help them identify key considerations when analyzing a study. However, as students progress with practice and experience and their literature evaluation skills are reinforced in actual clinical situations, their need to consult the supplemental questions should diminish.

Despite the considerable time and effort invested, the evaluation rubric has proven to be a valuable and ultimately timesaving tool for evaluating student performance when presenting a published study review and critique. More importantly, the rubric has provided students with clear expectations and a guide for desired performance.

Appendix 1. Study Analysis and Critique – Supplement

An external file that holds a picture, illustration, etc.
Object name is ajpe63app1.jpg

Appendix 2. Final evaluation rubric for journal club presentations

An external file that holds a picture, illustration, etc.
Object name is ajpe63app2a.jpg

COMMENTS

Journal Club: How to Build One and Why
The original goal of the journal club in Osler's day was to share expensive texts and to review literature as a group. Over time, the goals of journal clubs have evolved to include discussion and review of current literature and development of skills for evaluating medical literature. The ultimate goal of a journal club is to improve patient ...
Establishing and sustaining an effective journal club
A journal club is a group that meets regularly to review and critique scientific literature. It is thought that Sir William Osler set up the first discussion-based healthcare journal club at McGill University in 1875, after which he encouraged attendees to apply their updated knowledge in practice. 1 There is debate over whether the main goal of a journal club should be for attendees to keep ...
A systematic review of the effectiveness of journal clubs in
One popular mechanism to facilitate this is the Journal Club (JC)—a structured gathering of medical trainees and professionals who review, discuss, and debate the contemporary medical literature. Journal clubs have been around since the second half of the 19th century and promote critical thinking amongst doctors, an essential skill for both ...
Establishing and sustaining an effective journal club
A journal club is a group that meets regularly to review and critique scientific literature. It is thought that Sir William Osler set up the first discussion-based healthcare journal club at McGill University in 1875, after which he encouraged attendees to apply their updated knowledge in practice.1
Exploring the impact of journal clubs: A systematic review
The literature search was formulated initially using the broad parameters of the 'Participants, Interventions, Comparisons and Outcomes' ... The successful features of a journal club, evidenced by this review, have been summarised in Table 2. Table 2. The component parts of the proposed journal club based upon selected successful features.
Sixteen suggestions on how to run a journal club
Journal clubs have many functions, including the provision of a forum for developing skills in critical appraisal, an essential part of being a competent clinician. From early on, journal clubs reported their proceedings in academic journals. The Zoological Journal Club of Michigan , for example, regularly reported its activities in the journal Science (see figure 1). Table 1 lists a selection ...
How to run an effective journal club: a systematic review
However, there is no standard process of conducting an effective journal club. We conducted a systematic literature review to identify core processes of a successful health journal club. Method: We searched a range of library databases using established keywords. All research designs were initially considered to establish the body of evidence.
Promoting evidence-based nursing through journal clubs: an integrative
The purpose of the nursing journal club is to review existing literature, discuss the latest information and evidence and identify practical changes required to ultimately improve patient outcomes. ... Lachance C. (2014) Nursing journal clubs: A literature review on the effective teaching strategy for continuing education and evidence-based ...
How to run an effective journal club: a systematic review
We conducted a systematic literature review to identify core processes of a successful health journal club. Method We searched a range of library databases using established keywords. All research designs were initially considered to establish the body of evidence. Experimental or comparative papers were then critically appraised for ...
Establishing and sustaining an effective journal club
How to run an effective journal club: a systematic review. J Eval Clin Pract 2009; 14: 898e911 6. Ahmadi N, McKenzie ME, Maclean A et al. Evidence-based reviews in surgery steering group. Teaching evidence based medicine to surgery residentsdis journal club the best format? A systematic review of the literature. J Surg Educ 2012; 69:91e100 7 ...
Promoting evidence-based nursing through journal clubs: an integrative
The purpose of the nursing journal club is to review existing literature, discuss the latest information and evidence and identify practical changes required to ultimately improve patient outcomes. ... Lachance C (2014) Nursing journal clubs: A literature review on the effective teaching strategy for continuing education and evidence-based ...
How to run an effective journal club: a systematic review
We conducted a systematic literature review to identify core processes of a successful health journal club. Method We searched a range of library databases using established keywords. All research designs were initially considered to establish the body of evidence. Experimental or comparative papers were then critically appraised for ...
Journal clubs
Journal clubs are educational meetings where individuals meet regularly to critically evaluate recent articles in the scientific literature. They have often been cited as a bridge between research and practice, as they encourage the application of research in clinical practice.1 After a literature search, the earliest reference to a journal club I found is described by Sir James Paget who, in ...
How to run an effective Journal Club: a systemic review
Conclusions The purpose of the nursing journal club is to review existing literature, discuss the latest information and evidence and identify practical changes required to ultimately improve ...
How to Prepare an Outstanding Journal Club Presentation
The foundation of an outstanding journal club presentation rests on the choice of an interesting and well-written paper for discussion. Several resources are available to help you select important and timely research, including the American College of Physicians (ACP) Journal Club and the Diffusion section of The Hematologist.McMaster University has created the McMaster Online Rating of ...
PDF A Guide to Leading a Journal Club
This guide aims to help you to lead a journal club. It will introduce the principles of evidence- ... Evidence-based practice does not mean being dictated to by the literature nor is it an attempt by journal publishers to take over the clinical world. ... Systematic review Meta -analysis Meta -synthesis . 9 2. Study design
PDF How to run an effective journal club: a systematic review
REVIEW How to run an effective journal club: a systematic review Y. Deenadayalan BPT IMMP BEHM (MBA),1 K. Grimmer-Somers PhD MMedSci BPhty,2 M. Prior BPhty (Hons)1 and S. Kumar PhD MPT BPT3 1Researcher, Centre for Allied Health Evidence, University of South Australia, City East Campus, Adelaide, Australia 2Director, Centre for Allied Health Evidence, University of South Australia, City East ...
LibGuides: Journal Clubs: Evaluation and Critique
How to Critique a Journal Article. Once you have found your article, the next step in preparing for a journal club is analyzing the study's methodology, data gathering, and statistical analysis. Use the resources below to help you in your critical review. Basically, you will be looking at these general areas:
Journal Club in Residency Education: An Evidence-based Guide to Best
Journal clubs are an important tool for critically appraising articles and keeping up-to-date with the current literature. This paper provides a critical review of the literature on the design and structure of journal clubs in residency education with a focus on preparation, topic selection, implementation, and integration of technology.
Journal Club for Dummies: How Not to Be Intimidated by Evidence ...
Secondary Literature: meta-analyses, systematic review, evidence-based practice guidelines, critically appraised topics (CATs). ... For example, there are certain apps (like Journal Club) and websites (Wiki Journal Club) that will clearly spell out the clinical question, major points, and bottom line. ...
Meta-Analyses & Systematic Reviews
Shamseer L, Moher D, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. 2015;349:g7647. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement
Functional connectivity changes in the brain of adolescents with
Internet usage has seen a stark global rise over the last few decades, particularly among adolescents and young people, who have also been diagnosed increasingly with internet addiction (IA). IA impacts several neural networks that influence an adolescent's behaviour and development. This article issued a literature review on the resting-state and task-based functional magnetic resonance ...
Edge to cloud tools: : A Multivocal Literature Review: Journal of
For this purpose, we conducted a Multivocal Literature Review (MLR) by analyzing 40 tools from 1073 primary studies (220 PS from the white literature and 853 PS from the grey literature). We categorized the tools based on their characteristics and targeted environments.
Unpacking the process of conceptual leaping in the conduct of
International Journal of Management Reviews. 15 (2), 149-166.), I unpack the process of conceptual leaping in the conduct of literature reviews. This process involves navigating dialectic tensions between knowing and not knowing , engagement and detachment , deliberation and serendipity , and self-expression and social connection .
How to run an effective journal club: a systematic review
We conducted a systematic literature review to identify core processes of a successful health journal club. Method We searched a range of library databases using established keywords. All research designs were initially considered to establish the body of evidence. Experimental or comparative papers were then critically appraised for ...
Remote Sensing
Recent advancements in deep learning have spurred the development of numerous novel semantic segmentation models for land cover mapping, showcasing exceptional performance in delineating precise boundaries and producing highly accurate land cover maps. However, to date, no systematic literature review has comprehensively examined semantic segmentation models in the context of land cover mapping.
Inside CVS's Strategy to Improve the Pharmacy Experience
Reviews. Architecture Review. Art Reviews. Book Reviews. Film Reviews. Television Reviews. ... Expert recommendations on products and services, independent from The Wall Street Journal newsroom.
A Rubric to Assess Critical Literature Evaluation Skills
A journal club in which a published study is reviewed and critiqued for others can be used to help keep abreast of the literature. A properly designed journal club can also be a useful educational tool to teach and reinforce literature evaluation skills. ... A checklist system for critical review of medical literature. Med Educ. 1985; 19:392 ...
'The Friday Afternoon Club' Review: Growing Up Dunne
In the mid-1950s, the "Today" show ran a segment on the daily life of a young family: Dominick Dunne, who worked on the TV series "Playhouse 90"; his wife, Lenny; and their baby son, Griffin.

Journal Club: How to Build One and Why

Why are journal clubs important?

How do you get started?

How do you get residents to come?

What are the nuts and bolts of a journal club?

How do you measure impact?

Log in using your username and password

You are here

Statistics from Altmetric.com

Five reasons for running a journal club

Sixteen suggestions on how to run a journal club

Ten tips on how to prepare a journal club article for EBM

Read the full text or download the PDF:

Save citation to file

Add to My Bibliography

How to run an effective journal club: a systematic review

Similar articles

Publication types

LinkOut - more resources

Search form

Journal clubs

Why journal clubs?

Advantages of a journal club

Organising journal club sessions

Critical appraisal clubs

Evidence based clubs

Role of the leader

Choosing an article

The presentation

The environment

Journal Club for Dummies: How Not to Be Intimidated by Evidence-Based Medicine

ALL ARTICLES

COLLECTIONS BY FORMAT:

KEY RESOURCES:

Journal Club Presentation Resources (Statistics Help): Meta-Analyses & Systematic Reviews

Evaluation Tools

Understanding the Statistics

Other Resources

Functional connectivity changes in the brain of adolescents with internet addiction: A systematic literature review of imaging studies

Introduction

Search strategy and selection process

Quality appraisal

Data collection process

Data synthesis and analysis

(1) How does internet addiction affect the functional connectivity in the adolescent brain?

Default mode network (DMN)/reward network.

Executive Control Network (ECN).

Salience network (SN).

(2) How is adolescent behaviour and development impacted by functional connectivity changes due to internet addiction?

Executive control network (ECN).

Salience network (SN)/ other networks.

Limitations/strengths

Future directions and implications

Supporting information

S1 Appendix. Search strategies with all the terms.

S1 Data. Article screening records with details of categorized content.

Acknowledgments

Unpacking the process of conceptual leaping in the conduct of literature reviews

New Citation Alert!

Information & Contributors

An overview of systematic literature reviews in social media marketing

The need for multivocal literature reviews in software engineering: complementing systematic literature reviews with grey literature

Information

Publication History

Contributors

View options

Full Access

Share on social media

A Rubric to Assess Critical Literature Evaluation Skills

INTRODUCTION

Appendix 1. Study Analysis and Critique – Supplement

Appendix 2. Final evaluation rubric for journal club presentations

COMMENTS