Nutrition Support Blog: Just Do It
September 21, 2012
When I first became interested in nutrition I was a bit over-enthusiastic about healthy eating. My friends quickly learned not to bring up nutrition, because once I got started, it was hard to get me to stop talking. While I eventually learned to constrain my desire to teach everyone every single thing I know about nutrition, there are still nutrition topics I am very passionate about.
One topic that gets me “fired up” is presenting about the benefits for clinical nutrition professionals to read and critically evaluate original research on a regular basis. Every time I speak about critical appraisal, I remind myself to present it in an objective manner and at a reasonable pace and volume. Inevitably, I end up a bit more passionate than intended, because it is something I feel strongly about.
My experience is that nutrition professionals who attain some degree of evidence mastery achieve a new level of empowerment, respect and appreciation in the clinical setting. Even more important than having specific recommendations readily embraced by other healthcare professionals, there are also opportunities to change how the whole profession of nutrition/nutrition support is viewed.
Some clinicians that I have talked with have been unsure how to get started with critical evaluation of research articles. Others were intimidated because they did not understand some aspects of studies. One of the best ways that we have found to make sure all of us are reading articles on a regular basis is to start a Journal Club. Your co-workers will notice aspects of some articles that you miss, and reviewing an article together makes sure all of the staff is on the same page regarding the merits (or lack thereof) of new research. There is no absolutely wrong way to have a journal club – the important part is that you have one, and do it on a regular basis.
We try to have one per month, but we drop a month here and there when people are all on vacation in August, and in December, and if things are abnormally busy. However, it is important to not postpone them every time someone is a bit busy or they just won’t happen often enough to be meaningful.
We rotate who is the primary presenter, and the presenter gets to choose the article. Our guidelines are that the article be a human study and not a review article (you would have to critique every article used in the review to do that correctly). We prefer interventional over observational studies. However, some observational studies can be potentially groundbreaking or frequently cited, and it is important to understand the study limitations of the data. There does not have to be a handout or written notes, unless the presenter wants them for themselves. We do ask that everyone read the article and try to contribute something.
Sometimes doing a journal club at lunch is efficient, so that it does not take up too much time from your day, but whenever it is best for the majority usually works. Some groups do them over coffee/second breakfast in the morning, at a restaurant once a month, etc.
It goes without saying that people should be respectful of everyone else's opinion, or the journal club will be short-lived. Some of our discussions have gotten a bit “lively”, but this just reflects our level of interest in the truth about the data. I think it should be a casual atmosphere and people should feel comfortable jumping in.
We have guidelines for critiquing the literature on our "Resources for the Nutrition Support Clinician" page of our website ( click here to go to the Resources page)
I have found that reading new research is a bit like exercise - what exercise, how long, and what time of day are far less important - as long as you do something on a regular basis. Just like exercise you will find what works best for your schedule. There will be times you miss, but it's important to get back into the swing of things as soon as you can, or it just gets harder to get started again. And, if you avoid it altogether, eventually it catches up with you.
“Half my life's in books' written pages
Lived and learned from fools and from sages
You know it's true
All these things come back to you”
- Aerosmith, Dream On, 1973