Narrator - Dr. Abel 00:00 Welcome to HelixTalk, an educational podcast for healthcare students and providers, covering real life clinical pearls, professional pharmacy topics and drug therapy discussions. Narrator - ? 00:11 This podcast is provided by pharmacists and faculty members at Rosalind Franklin University, College of Pharmacy. Narrator - Dr. Abel 00:17 This podcast contains general information for educational purposes only. This is not professional advice, and should not be used in lieu of obtaining advice from a qualified health care provider. Narrator - ? 00:27 And now on to the show. Dr. Sean Kane 00:31 Welcome to HelixTalk episode 122 I'm your co host, Dr. Kane, and I'm Dr. Patel, and the title of today's episode is the first rule of journal club is that we don't talk about Journal Club today. We're talking about, basically from a student perspective, how to excel in your next journal club presentation or discussion, all while avoiding some of those all too common pitfalls that Dr. Patel and I commonly see in students when they do present on their P4 APPE rotations. Dr. Khyati Patel 01:00 So as you said, Dr. Kane, you know, as APPE preceptors, we have these students with us, you know, who do journal clubs. And really, you know, these general clubs are something that we learn off of, too. So we want a to make this a very good learning experience for everyone, but make students successful as well. So in this episode today, we're hoping to kind of focus on, you know, what makes you look like a superstar when you're presenting your journal club? And kind of some of the common pitfalls to avoid that every preceptor or even the audience member who attend would want you to avoid. Dr. Sean Kane 01:32 And Dr. Patel, I'll be honest with you, you know, the word Journal Club, depending on what hospital system you're in, sometimes, is almost a dirty word, because it's synonymous with a student generating a four page Word document and reading every word off of it. That summarizes another article. Historically, I used to bring coffee to these journal clubs that I'd attend because they would get so boring, because the student would just talk and read off of a document for 40 minutes, and there was no discussion, or very little discussion. So one, one thing that I think everyone preceptors and students can do better is making this more of an interactive experience, an active learning experience. And we're going to go through some tips and tricks with respect to that today. Dr. Khyati Patel 02:17 And I love that, and I think the first thing we need to do is making sure we have the right journal article to talk about right and so I usually advise my students to make sure that they kind of try to go with the randomized control trials. It could be either placebo or active control, depending on the disease or the treatment you're dealing with. But these will be the best articles all the other ones, such as, you know, the observational trials or meta analysis are not just the best to discuss in a journal club format. Dr. Sean Kane 02:49 And I found Dr. Patel that with those non randomized observational trials, students sometimes jump to conclusions inappropriately. So because of the lack of randomization. You know, these are intended to be hypothesis generating, and they're not really intended to influence your clinical practice, and students wrongly conclude that association means causation in these trials, and oftentimes, there's so many other limitations to these non randomized trials that students don't pick up on. So it tends to be a little bit more of a minefield. The same is true with meta analyzes, so most of pharmacy schools will emphasize these randomized control trials. And you know, we will talk about meta analyzes, but if you as a student or a preceptor, don't know what you know weighting means, or I squared or random effects models in meta analyzes, then you may not fully understand the methods used in that meta analysis. And again, it's kind of a minefield for a student where you're more prone to having a misunderstanding of the methods of the study or even the conclusions. Dr. Khyati Patel 03:46 And another thing I always try to ask students is to be like, try to pick a topic that you're interested in or you want to learn more about, because this is also an opportunity for the students to grow their knowledge, right? And so pick a topic that would satisfy one of the Netflix studying category, because it's gonna, you know, this presentation is gonna require students to dive into reviewing guidelines, you know, other articles that are similar to the article they're presenting, and obviously, other pertinent literature about the topic in general. So really, they need to pick something that they're interested in. The corollary to Dr. Sean Kane 04:24 that is that you're going to want to pick something that's relevant to your rotation. And also your preceptor. You know, your preceptor wants to learn too, and also your preceptor is going to have a better knowledge base about a topic that they see all of the time. So at least, in my opinion, I really love journal articles, where students will pick an article based on a patient that they've seen in terms of a clinical question that came up, and now they're using an article to answer a question that came up, Dr. Khyati Patel 04:52 and I think this actually increases their time vested and into the rotation as well. They're more eager to learn about that. They may feel a little bit more competent in that knowledge area after actually doing this journal club. So it's, it's actually a really good example. And going back to, you know, make it, make sure you make it relevant to your happy rotation. I've had students, you know, on my ambulatory care rotation wanting to present on, for example, vasopressors in septic shock. And I'm like, That's not where we practice in ambulatory care, right? And so try not to do that. And at the same time, when you're on your acute care rotation, Dr. Kane, you wouldn't want student to do a chronic gout treatment, for example, as their, you know, journal club presentation, exactly. Dr. Sean Kane 05:40 And, you know, really for any presentation, but this presentation included, I think it's great at the very beginning that you talk to your audience about why you picked the topic that you picked. You know, even in the didactic years, when you have the option to pick your own journal article or a topic that you're going to present on, it's always nice at the beginning to say why you picked what you picked. There's often a good story behind it. So for example, if you had a patient, let's say Mr. Jones That was a diabetic that had coronary artery disease, you might say something like, you know, I picked this article because, you know, Mr. Jones that we saw last week had CAD and diabetes, and he wasn't on an sglt Two inhibitor. And I wanted to know more about what would the benefit be in a patient like Mr. Jones? That's an awesome way to set up that presentation where people are automatically interested because it's relevant to that rotation, and maybe other people in that room even knew who Mr. Jones was, and this potentially could impact Mr. Jones's care. I think that's a great way to kind of tie everything together before you start that Dr. Khyati Patel 06:39 presentation, and kind of going along with that. Dr. Kane, I think it also helps generate that discussion at the end too. You can use Mr. Jones as a case for those who weren't involved in his care to still engage them in the Q and A's at the end, right? So I think it's very important one thing not to do, even though you might be comfortable with this, is present your didactic years journal club in an APPE rotation; your preceptor will find out. So make sure you're going with a fresher article, fresher topic, something that you can increase your knowledge with. And that being said, I would usually want my students to pick something more recent or things that are still relevant. My recent definition is, you know, no more than three years old, just because, if the article is too old and likely that you know everybody in the audience knows about that article, you're not really adding to that knowledge. It's been presented already, and then you want to make sure it's still relevant. Because if a newer guidelines come out, a new treatment comes out that trumps the standard of care, and the standard of care is no longer a standard of care, then you don't want to present that article. You want to present what's new and what's part of the guideline, or potentially what's new that could change the guidelines, because it's so impactful. Dr. Sean Kane 07:57 I think that's great. And you know, Dr. Patel, once you figure out that perfect article, even if your preceptor doesn't require it, you really should be asking them for permission for that particular article. You know, most rotations, they're going to the Preceptor. If they allow you to pick your own article, they're going to want to approve it. And if they don't, as if I was a student, I would absolutely go to the preceptor and make sure that the article that I picked is consistent with what their expectations are, so that everyone's happy at the end of the day. Dr. Khyati Patel 08:25 Yeah, this is kind of like getting the outline approved before you start your, you know, Article draft, you want to make sure that it's approved, because then all that work is going to be wasted Dr. Sean Kane 08:35 exactly well, you know, once you pick that perfect article, the next step is to likely summarize the article in a journal club template format. You know, different preceptors or different sites may have a template, or they may ask you to use your university's template. And I think the this is where journal clubs start to get their bad rap is that students have this perception that everything needs to go in this template, and you're converting a 10 page PDF manuscript into a five page, Uber small text, Word document that has all of the information that's in the manuscript. And at that point, if you think about it, why wouldn't you just read the manuscript instead of your Word document? So the number one tip here is that in that journal club template, you need to be concise and only include the most pertinent information. You're not taking that article and converting everything comprehensively into a Word document. Dr. Khyati Patel 09:27 You want to make sure that you know you're expecting your audience to have read the article right. And so even though that's the expectation, because it's kind of like the book club, your audience may not have done that right, and so that's where you needing to present or summarizing the article comes from. But summary should actually garner much, much smaller attention, and that critiquing and the discussion at the end, it should be the larger focus of the presentation, yeah. Dr. Sean Kane 09:57 So you're just trying to get everyone on the same page. Were, you know, if they read the article a week ago, they can remember some pertinent details. And if they didn't have the opportunity to read it yet, but they wanted to attend your presentation, then they can be up to speed in terms of what was the core stuff about the article, in terms of methods, results, things like that. So you're not trying to be comprehensive. You're just trying to get everyone on the same page so that everyone can participate in that really high quality discussion that you're going to have later. So again, just to re emphasize the common pitfall here is that you have way too much stuff in that journal club document. So Dr, tell what are some things that tend to be like, excessive in the journal clubs that you have on your rotation? Dr. Khyati Patel 10:36 Yeah, I think that journal articles are actually doing a better job of like, including only the need to know in in the actual the article, the you know, the treatment article, or the randomized control trial, for example, and then everything else that's extra. It's part of the supplement. So that's nice, but if you're not picking one of those mainstream journals that do that, then you'll have a laundry list of inclusion and exclusion criteria. You don't have to include all of them. Only the pertinent ones include, or should be included. Baseline characteristics is another one. You know. You don't have to write out every single one of them. You can point the audience to the actual table in the article, or print out the page that has the table and give it to the audience so they can refer to it while you're pointing those things out. Another common issue where too much information is included is, you know, secondary end points, or like the subgroup analysis, while some of those may be pertinent to what you're discussing, lot of focus should be on the primary endpoints and outcomes. Dr. Sean Kane 11:43 And you know, if you think about it, you as the presenter, you are the expert on the articles, and you get to decide what is the most pertinent details that you want to include in your journal club template. So no one's going to fault you if you decide not to include race as a baseline characteristic, if you don't think that race is pertinent to that discussion, but maybe you think that you know baseline meds are important or pertinent, then you choose to include that you will always be able to reference it if someone has a question, because hopefully you'd print out that the full manuscript and maybe even the supplement, so you could potentially pull it up if you had to. But again, you are the expert. Part of the activity is to decide what do you want to talk about, what is pertinent to you? Dr. Khyati Patel 12:25 Yeah, and as a student and a resident, this is what I did when I presented my journal clubs. I created two versions because I was afraid that I was going to miss out some information. I always had that detailed version for myself, and I kind of highlighted things that were similar to what the audience had. So audience version was a little bit lighter version, so it didn't look too information heavy, but I had more information on my handout, just if I needed to refer to those or if I got any questions asked. So that could also help avoid the perception of kind of like reading off if you kind of have your own version for yourself, I Dr. Sean Kane 13:06 think that's a great tip. And, you know, even on your detailed document, try to avoid having big paragraphs of text. You know, bullet points are great, so that you can kind of skim a little bit more. You know, it's natural. Humans naturally, when you see big chunks of text, you're going to start reading it. And people can tell when you're can tell when you're just reading verbatim off of a document. So try to summarize, try to have these bullet points. And you know, even on the the document, to give the the audience, if the Journal did a really good job on a graph, it's okay to reference that graph. You don't have to necessarily put it in your document, although you could, but you can always say, referring to figure two, you can see blah, blah, blah, blah, blah of that the article that you're presenting. So you know, when appropriate, you can leverage what is already in that article to get a point across or to show a result for the audience. Dr. Khyati Patel 13:57 Yeah, and also summarizing the results to like you don't have to write the entire statements of the result. Just put a little table. You know, as we said, you don't have to go into each and every secondary endpoint or outcome, but like, at least the primary ones, you can put them in a table format, and it's a little bit more visually appealing, and it won't look like you're reading them off, because you're actually explaining the results. Dr. Sean Kane 14:21 So Dr. Patel, the next step is, you know, as students are talking about the methods and things like that, it's very common that biostatistics come up, and I know that students absolutely hate talking about the section because they aren't confident in terms of what the different terms mean. And it's also a very common area where preceptors ask questions of the students about the method section or interpretation of certain biostatistics that are presented in the manuscript. So, you know, we don't have time to have a full scope review of Biostatistics and literature evaluation, but I think we can probably cover a couple common elements that most journal clubs will at least touch on. So that the audience can have a better sense of those common pitfalls. Dr. Khyati Patel 15:04 And Dr. Kane, I completely relate to this segment, because I used to be one of those students. You know, obviously, as a preceptor, I'm in a much better place, but we can understand that students are generally nervous about this area. So if you if you know that that's your weaker area. You want to be ahead of it, and you want to make sure what you're presenting and what the article includes. You have a good handle of those biostatistics methods. Yeah. Dr. Sean Kane 15:32 So for example, Dr. Patel, a common thing that comes up is type one and type two error. No matter what you are, always at risk for one or the other. A type one error is where you have a significant P value, typically less than point 05 and you're concluding that there is a difference, like the treatment is better than placebo, but it actually isn't meaning that you had a false positive result, that you think there's a difference, but there's not that is called a type one error, Dr. Khyati Patel 15:59 and on the opposite there is this type two error. So that basically happens if you fail to see the difference. So if your P value is above that, cut off of point, oh, five. You don't think the drug actually works, because it's not statistically significant, but it could actually work. And so that's something called type two error. So as Dr. Kane mentioned, you know, we're always at a risk of one of these types of errors, and it's a guaranteed question that you're going to have from a preceptor. Dr. Sean Kane 16:29 And you know, focusing on type two error as an example, the most common reason for a type two error is that you don't have enough statistical power. Statistical power refers to the probability that you'll be able to see a difference if one actually exists, or in other words, the percent chance that if the drug works, that you'll have a significant P value showing that the drug works. Most of the time, studies will use 80% power. So that means that most studies will try to have about 80% chance of seeing that a drug works if it truly does work. Dr. Khyati Patel 17:00 And you know, most of these studies are going to kind of have a power statement that talks about, you know, how many patients would they need to show the difference? So, like, that's the capital and, and then also, another part of that statement is incident rate. So, you know, they were looking for X many events to occur as their primary endpoint. And then the last, but not the least, is the treatment effect, how big of a difference the treatment will actually make. And so all of those three things are important to consider as considering the power for the study. Dr. Sean Kane 17:39 And a common pitfall I see Dr. Patel is that when you have an article that shows a difference, so you're at risk of type one error because you had a significant P value. We basically don't care about statistical power at that point. So commonly, when you have a trial, you're presenting a trial, and you say that the drug is better than placebo, you don't need to spend that much time talking about power? Did they meet power? Did they have whatever incidence rate? You just don't need to, because you're not you're not concerned about power because you observe the difference. Instead, you're concerned about, was this a clinically relevant difference? You could talk about number needed to treat, or number needed to harm, things like that, but we don't care about power if we observed a difference in our trial, because we're not at risk for type two error, right? Dr. Khyati Patel 18:23 And so it kind of concludes that power is basically our ability to see the difference. Dr. Sean Kane 18:29 Yeah, and you know, if you don't show a difference, so if your P value is high, then we definitely care about power. And we really want to look at that power statement to see, did the trial have enough people and enough of the thing that they were looking at to have had a good shot again, like 80% shot at seeing a difference if one truly was there. I can tell you, very commonly in critical care literature, it comes up a lot where they enroll the right number of people so they hit their enrollment target, but the incidence rate is way less common, therefore they actually don't have statistical power. And the pitfall here is that students assume that as long as you have the right end the right number of patients, that you must be adequately powered. And that's not the case. An example here would be, let's say a sepsis trial wanted to enroll 5000 patients, and they thought half of them would die 50% mortality if they enrolled 5000 patients, but the actual mortality rate wasn't 50% but it was lower, like 30% they would be underpowered, and they would be at risk for type two error if they failed to show a difference, because they were expecting 50% death and the incidence rate was a lot lower. Therefore they would have had to enroll more people to be able to have that same 80% shot at seeing a difference. So you have to look at both the N and also the incidence rate to determine if they're adequately powered when they have a high P value and they conclude that there is no difference. Dr. Khyati Patel 19:57 And in addition to, you know, looking at these air. Errors. The other common statistical misinterpretation is that confidence interval right? So the 95% confidence interval doesn't mean that you're 95% confident, but it's these confident intervals are usually provided with either a relative risk or has a ratio. So let's say you have a study that looked at mortality differences between statin and placebo and found that the relative risk was point eight, the 95% confident interval was point seven to point nine. And what this really means that patients who are on statins were point eight times more likely to die compared to placebo. That's what your relative risk really means. And really that 95% confidence, it basically means that it has that much more reproducibility. And so if the study was repeated or reproduced 100 times exactly the same design, the relative risk would be between point seven and point 990, 5% of the time. So really, it gives us the surety of the reproducibility of the finding. That's what the 95% confidence interval really means. That gives 5% chance that range, or the item you're looking at could fall outside of the confidence interval. And a lot Dr. Sean Kane 21:27 of times, you know depending, it depends on your endpoint. But if you're looking at a relative risk or hazard ratio, if your 95% confidence interval crosses 1.0 that usually means that it's a statistically insignificant finding equivalent to a p value that's more than point oh five. And the reason for that deals with whether there's benefit or harm, and benefit or harm is above or below that 1.0 relative risk or hazard ratio. And another common statistical term that comes up is intention to treat and for superiority trials, where we're trying to prove that drug A is better than drug B or versus placebo, we want to see intention to treat. And that basically means that whatever you were assigned to, initially randomized to initially you stay in that group, even if you don't do the thing that we told you to do. So, you know, if you were randomized to take a statin, but you didn't take the statin, we're still going to count you as a statin arm patient, or if we randomize you to placebo, but for whatever reason you ended up taking a statin later on, we still count you as a placebo patient, now at face value. Dr. Patel, this sounds bad, right? It sounds like you're kind of muddying the waters a little bit. Dr. Khyati Patel 22:36 Yeah, it does look like that. But hey, how many times in a real life patient does that? How many times in a real life patient is started on a statin and doesn't complete it, and we still have to account for whatever that decision resulted into the outcome, right? And so really, studies that incorporate intention to treat analysis represent more of that real world scenario. And so these studies tend to have a little bit better or the results tend to have a little bit better external validity. And last, but not the least, you know, students tend to point out to these fancy graphs or plots such as Cox hazard model or the forest plot in the article, but then they fail to really understand what the model really means, or, you know, implies, or the forest plot really implies. And so if you're willing to point it out, make sure that you know what these tests mean and how you would interpret it, because likely you're going to get a question by a preceptor. Dr. Sean Kane 23:37 And I actually feel like that's a good rule of thumb for any presentation you do ever if you don't know what it is, don't put it on your slide, or don't put it on your document, because if you get a question about it, you look really bad if you included a term that you have no clue what it actually means, but you included it because you felt obligated to. It's very, very poor form. It doesn't make you look like a superstar, so you're better off not including it and then potentially filling a question later than to include it and have no clue what it means. Moving on, Dr. Khyati Patel 24:07 just to, you know, from statistical analyzes, kind of talking about the results, right? I think one of the biggest pitfall is just reading it straight off of handout. And I know we talked about it earlier. You know, you don't want to read from the handout you want to maybe lead the audience to the page, or summarize your results in a table form within your you know, handout in itself, but try not to read every single number you know you could summarize it in a shorter term. So like for example, instead of saying that describing your baseline characteristics. Instead of saying mean age in treatment arm was 67.5 years and the placebo arm was 66.4 years more likely, your audience can see that in the table. You can just say the mean age in the trial was, you know, somewhere mid to late 60s. And that would be succinct, and Dr. Sean Kane 24:59 just keep. In mind, like, as long as the document is in front of people, they're going to be reading while you're talking. So your job is to highlight certain sections of your document and supplement what is on there. Your job is to not read what their eyes can read on their own, right? Because they're going to read it, whether you want them to or not. So you you want to kind of summarize and work through the document so that you're highlighting pertinent parts of that document Dr. Khyati Patel 25:25 right, and then also kind of nitty gritty of how to present the results. You want to always make sure that you have the percentage along with the P value. You can't just include a p value, because it doesn't really indicate any magnitude. It just shows whether the results were significant in terms of statistics or not. But it really doesn't give us the magnitude of effect. And magnitude of effect really comes from the percentage and not from the n. So don't say, you know, X, many people died versus why many people died in the other group, you need to actually have percent, because a lot of people don't complete the study, the denominator is different. And so we need to make sure that we look at the percentages. Dr. Sean Kane 26:15 And even if you think about it, if I told you 10 fewer people died in treatment A versus in treatment B, you have to know the other numbers, like the denominator, to even interpret that in your brain in terms of, is 10, a lot or a little? Is that 0.01% improvement, or is it like a 5% improvement? So the percentages, or something like that, are really important. Dr. Khyati Patel 26:36 And then talking about the percentages, you know, something more to be focused on is to include the ratios, as we talked about, so those relative risk hazard ratio or the odds ratio, along with that 95% confidence interval. Dr. Sean Kane 26:51 And then, of course, you can also calculate a number needed to treat or a number needed to harm, as long as you know what that those terms mean, and you can interpret them if asked. But oftentimes you have to actually calculate these on your own. You know, some articles will present this in the discussion section, but if they don't, you should be able to calculate it. And it looks good if you include that, to put it into perspective in terms of the how many patients you'd have to give your drug to for one patient to benefit. Dr. Khyati Patel 27:18 And then, you know, kind of the number needed to harm is a similar concept as you're looking at maybe in the secondary endpoints, you know, the side effect of the drug or the ADRs. You know, if it's alarming, we really would like to see if the number needed to harm, if it's, you know, too small, then likelihood of having that side effect, it's higher too, and that might be something pertinent to your patient or the population you are working with. Dr. Sean Kane 27:46 So Dr. Patel, really the last part, and arguably the most important part, of that journal club, is to have a discussion. That's why we call it journal club discussion. You know, this is why we evaluate primary literature, is to figure out how to improve our practice, and that comes from discussion among people who read the article and decide whether this should be implemented in their practice or not. You know, just because an article is published doesn't mean that you must accept the results and do whatever the trial did. You know that comes from discussion and thinking about the other body of literature out there and guidelines and things like that. Dr. Khyati Patel 28:20 Absolutely, and again, if you are including the summary of the art parent article, make sure it's very small and succinct, to bring everybody on the same page, to carry out the actual discussion. And what you're focusing really on is critiquing the article. You know you're focusing on, what was the study population? What was the design and the interventions? What were the statistics, as we talked about earlier, and what were the end points, and how would the findings of this article would make an impact to your clinical practice? Dr. Sean Kane 28:53 And you know, one of the jobs of the person presenting is to be the person to MC the discussion. So to figure out, how do you elicit a good discussion among the group? And oftentimes, people in the group aren't just going to, you know, raise their hand and have a thought provoking statement that they provide to you. Oftentimes you have to ask questions that gets them to think, and then that is what prompts a really high quality discussion. The challenge here is that you want to ask questions that are opinion based questions as opposed to fact based questions. So you don't want to ask Can anyone define what intention to treat means? Because you're not quizzing the audience, you're trying to ask an opinion based question for people to weigh in on how they feel. There's no right or wrong answer for these questions, and that's how a good discussion happens. Dr. Khyati Patel 29:43 And some of the examples of these thought provoking questions are going to be things like weighing out the risk versus benefit of the therapy. Right? Are the results applicable to your clinical practice? Would you use this. Drug in, you know, patient, x, y and z. If you were, for example, an employee at FDA approving committee or body, would you approve this drug? Those will be the questions to kind of really discuss and generate opinions. Dr. Sean Kane 30:16 Dr. Patel, I feel like this is the section that students don't focus on enough, and they don't even think about getting the audience to participate. And oftentimes preceptors will, because we want to have the discussion to kind of test the knowledge of the student as well. But this is where a student can really shine, to have people really think hard about that article, and by having these questions prepared ahead of time on your kind of secret document that you have on your own, that's a great opportunity to really make this a high quality journal article. Dr. Khyati Patel 30:47 Yeah, I agree. Dr. Kane, most of the time it's my job as a preceptor to ask this question, to engage the discussion, but students usually are very, you know, straightforward, focused and focusing so much on just summarizing the article and kind of critiquing the article that they failed to focus on, how can they use the time to really engage audience in the discussion? Dr. Sean Kane 31:11 So, you know, we've covered kind of the core components, everything from picking your article to understanding the methods, bio, stats, results, kind of wrapping up with a really high quality discussion. Dr. Patel, are there any other kind of last minute thoughts that you want to leave the audience with in terms of ways to really drive home a really good journal club discussion for primarily a P for app irritation, right? Dr. Khyati Patel 31:33 And these are kind of like those, you know, small tidbits that I hone in on and provide feedback on to the students is first and foremost. Please, please, please, make sure you can pronounce the name of the drug or the drugs involved in your studies correctly. As a presenter and as the person who knows everything about the article who's presenting it, you owe it to yourself you know and you can go on YouTube or reputable video of the drug or the drug site, because sometimes they'll have the website of the drug company, will have small videos for teaching and stuff, and they all pronounce the drug itself. So you can pick up the pronunciations from there. And this pronunciation tip applies to some of the hard to pronounce words on your presentation as well, some of the statistics, methods, some of the, you know, pathophysiology, or, you know, an enzymes and things like that. I've had students present those and pronounce them incorrectly. It just doesn't look good. And I Dr. Sean Kane 32:37 can tell you, Dr. Patel, even when I was a student, and, you know, worked as a technician, I dreaded the prescription where I was trying to say the name of a drug and I had no clue how to pronounce it. And, you know, obviously you give it your best shot, but from the patient perspective, in that circumstance, it makes you look less professional and less polished, like you don't know what you're talking about when you say metoprolol instead of metoprolol or something to that effect. So this is such a low hanging fruit to just make sure that you can remain polished and, you know, pronounce everything correctly, right? Dr. Khyati Patel 33:11 And couple other points that I'm about to make are kind of pertinent to our role as the gatekeeper of the cost and healthcare, right? And so we're always thinking about whether this treatment we're talking about is good enough to be included on the formulary, or is it cost effective to be used in our patient population. And so kind of always have a knowledge about, you know, the cost of the drug, a WP, if there are any kind of cost effective utility analysis done your pharmacoeconomic study data. Make sure you kind of have reviewed those, because a question may come, and a common question sometimes is about, shall we add this drug to our formulary or not? Right? So doing a rotation on a hospital side, you probably should be aware of what where the formulary is, what are the other alternative agents on the formulary? If you're ever asked a question to compare them and Dr. Sean Kane 34:08 kind of going along with that, you know, if an item is restricted where it's on formulary, but you have to meet certain criteria, you probably should know what those criteria are. Or if it's part of an order set, where other things have to happen within that order set, you probably should know about that as well. So this is where talking to your preceptor is really important, where you can say, you know, is this on formulary? Do you know what the cost is? Are there alternative agents? If it's not on formulary, if it's restricted, what criteria do you have to meet your preceptor? Can fill in those details so that when you present and someone who isn't your preceptor asks you, you know, how is Keppra used at our facility? You can actually respond to that, as opposed to being informed the day of your presentation how the drug is used at that particular institution, right? Dr. Khyati Patel 34:53 And then finally, last nitty gritty things is make sure you have enough copies for your. Audience, you know, so make sure you have printed them earlier, enough to please make sure you also review, maybe like triple check for any errors, typographical errors, spelling grammar errors, and then, whenever possible, include the references. That's one of the things that you know. It just kind of goes along with professional presentation and writing in general. Dr. Sean Kane 35:21 And hopefully it goes without saying, but if you don't have the references you depending on how you're using your document, potentially, you're at risk for plagiarism. And of course, you know, you can't, you know, copy paste something from wiki journal club or from an editorial about your article and just kind of plop it in as your own. That's Frank plagiarism at that point. So absolutely, you need those references at a minimum for the article that you're presenting on and any other you know, additional things like guidelines or whatever that you reference within that journal club template. So I think that wraps up today's discussion nicely. If you would like to follow us on Twitter, we're at HelixTalk. You can see show notes for today's episode, which is episode 122 at HelixTalk.com where you can also see show notes from all of our other episodes as well. And we still love the five star reviews and iTunes and other podcast directories, so keep those coming. And we love to hear from our audience if there's certain topics that you'd love to hear more of in the future. So you can contact us at our website, HelixTalk.com with that, I'm Dr. Kane Dr. Khyati Patel 36:21 and I'm Dr. Patel, and as always, study and journal club hard. Narrator - Dr. Abel 36:26 If you enjoyed the show, please help us climb the iTunes rankings for medical podcasts by giving us a five star review in the iTunes Store. Search for HelixTalk and place your review there Narrator - ? 36:37 to suggest an episode or contact us. We're online at HelixTalk.com thank you for listening to this episode of HelixTalk. This is an educational production copyright Rosalind Franklin University of Medicine and Science.