The Role of a “Holistic” Journal Club

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Residency training and plastic surgical practice today take place in a complex medical environment. Changes in access to health care, regulatory body policy updates, and federal and state legislative actions are all critical aspects affecting the plastic surgeon’s medical atmosphere. Medical, behavioral, and psychological studies are continually updated and present relevant information crucial to the plastic surgeon’s understanding of his or her patient population and his or her own decision-making. An awareness of broader media coverage of surgical topics is essential to understanding the dynamic relationship of plastic surgery to the broader public community.
We recognized a need to address some of these issues of fundamentally relevant information in a journal club format at our plastic surgery program at the University of Wisconsin–Madison. In addition to the traditional plastic surgical literature–focused journal club, a second form of literature we call the “holistic journal club” was developed to permit critical review of a more extended body of knowledge.
Quarterly, the Division of Plastic and Reconstructive Surgery meets to discuss articles ranging from regulatory body policy updates to news editorials in a journal club format. As many as four articles are selected, and each is presented and facilitated by a resident, permitting a short introduction to the article and critical review of the topic, with the majority of the time reserved for discussion with faculty, residents, and medical students. This meeting is in addition to our currently monthly plastic surgery journal club.
Prior subjects have included the public and regulatory scrutiny placed on the common practice of concurrent operations as featured in the Boston Globe1 and The New York Times articles investigating the phenomenon of deferring reconstruction2 or dissatisfaction after reconstruction.3 Regulatory topics include updated American Association of Medical Colleges best practice guidelines on residency interviews and Association of Perioperative Registered Nurses/American College of Surgeons recommendations and evidence regarding surgical attire. Scientific, non–plastic surgery studies consisted of a Proceedings of the National Academy of Sciences investigation of the concept of “decision fatigue” during lengthy decision-making sessions,4 and a New England Journal of Medicine comparison of hospital mortality/readmission rates for patients treated by male versus female physicians.5 Each has led to valuable discussion enriching the everyday practice of our residents and faculty.
Although subject matter presented in this and other plastic surgery–related journals is undoubtedly fundamental to plastic surgery training and practice, we believe that optimized training and practice necessitates a knowledge base that extends beyond the plastic surgical literature. The role of a broader journal club is the promotion and critical appraisal of relevant information outside of plastic surgery, and to encourage participants to continue the quest to becoming a truly informed surgeon and citizen. We recommend that plastic surgery residencies adopt such a holistic approach to resident and physician education.
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