• Robin S McLeod, Helen M MacRae, Margaret E McKenzie, J Charles Victor, Karen J Brasel, and Evidence Based Reviews in Surgery Steering Committee.
• Division of General Surgery, Mount Sinai Hospital, Toronto, ON, Canada. rmcleod@mtsinai.on.ca
• J. Am. Coll. Surg. 2010 Dec 1;211(6):769-76.

BackgroundEvidence Based Reviews in Surgery (EBRS) is an Internet journal club that is effective in teaching critical appraisal skills to practicing surgeons. The objective of this randomized controlled trial was to determine whether teaching critical appraisal skills to surgical residents through the Internet is as effective as a moderated in-person journal club.Study DesignTwelve general surgery programs were cluster-randomized to an Internet group (6 programs; 227 residents; 23 to 47 residents/program) or a moderated journal club (6 programs, 216 residents, 21 to 72 residents/program). Each EBRS package includes a clinical and methodological article plus clinical and methodological reviews. Residents in the Internet group were required to complete 8 EBRS packages online plus participate in an online discussion group. Residents in the moderated group were required to attend 8 journal clubs moderated by a faculty member. All residents completed a validated test assessing expertise in critical appraisal.ResultsIn the Internet group, only 18% of residents completed at least 1 EBRS package compared with 96% in the moderated group. One hundred and thirty (57.8%) residents in the Internet group completed the test compared with 157 (72.7%) in the moderated group. The residents in the moderated group scored considerably better on the critical appraisal test, with a mean score of 42.1 compared with 37.4 in the Internet group (p = 0.05), with a moderate effect size of 0.6 SD.ConclusionsA moderated journal club is considerably better in teaching critical appraisal skills to surgical residents. This is likely because of the low participation in the Internet journal club.Copyright © 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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