The 50 Most-cited Articles in Orthopaedic Surgery From Mainland China

Background

Citation analysis has been widely used to evaluate the impact of articles in medical and surgical specialties. Although China is the most populous country in the world, and although more than 50,000 orthopaedic surgeons practice there, to our knowledge no formal citation analysis of Chinese orthopaedic articles has been performed.

Questions/purposes

We identified the 50 most-cited orthopaedic articles from mainland China and evaluated these articles in terms of their language of publication, source journals, and topics.

Methods

Science Citation Index Expanded was searched in July 31, 2014 for citations of articles published in 70 selected journals since the inception of the database. The 50 most-cited orthopaedic articles originating in mainland China were identified. Basic information, including title, authors, year of publication, article type, journal in which the work was published, city, institution, number of citations, decade published, and topic or subspecialty of the research were recorded.

Results

The number of citations for the top 50 papers ranged from 181 to 31 (mean, 52). These articles were published between 1981 and 2010. The decade of 2000 to 2009 was the most prolific, with 36 of the top 50 articles published during this time. All articles were written in English and they were published in a total of 16 journals. The journal Spine published the largest number of articles (12), followed by Clinical Orthopaedics and Related Research^® (seven). The journal Lancet had the highest impact factor (39.207 for 2013) among any of the journals that published articles we identified. The top 50 articles originated mainly from Beijing (16) and Shanghai (12), with basic research being the focus of the majority (27 of 50; 54%); the remaining were clinical studies. Bone was the most-investigated topic in basic research; the spine was the most-common topic among the identified clinical studies.

Conclusions

The 50 most-cited articles that we identified should be considered influential, although a large gap remains between mainland China and the global orthopaedic community in terms of citations per article. Nevertheless, insofar as the most-recent decade of our survey generated the most articles in this top-50 list, we would characterize mainland China’s effect on musculoskeletal research as increasing, and as funding increases to programs in mainland China, we anticipate this trend will continue in the future.     

Chiropractic practice in military and veterans health care: The state of the literature

Objective

To summarize scholarly literature that describes practice, utilization, and/or policy of chiropractic services within international active duty and/or veteran health care environments.

Data Sources

PubMed, the Cumulative Index to Nursing and Allied Health Literature, and the Index to Chiropractic Literature were searched from their starting dates through June 2009.

Review Methods

All authors independently reviewed each of the articles to verify that each met the inclusion criteria. Citations of included papers and other pertinent findings were logged in a summary table.

Results

Thirteen articles were included in this study. Integration of chiropractic care into military or veteran health care systems has been described in 3 systems: the United States Department of Defense, the United States Department of Veterans Affairs, and the Canadian Forces.

Conclusion

Chiropractic services seem to be included successfully within military and veteran health care facilities. However, there is a great need for additional written evaluation of the processes, policies, practices, and effectiveness of chiropractic services in these environments.     

Impact factors of orthopaedic journals between 2000 and 2010: trends and comparisons with other surgical specialties

Purpose

The impact factors (IF) of orthopaedic journals is an important component in determining the future of orthopaedic research funding. We aim to characterise the trend in journal IF over the last decade and draw comparisons with other surgical specialties.

Methods

We conducted an analysis of impact factors from Journal Citation Reports between 2000 and 2010.

Results

Between 2000 and 2010 the number of orthopaedic journals increased from 24 to 41, more than any other surgical specialty and the mean IF increased from 0.842 to 1.400. Journals printed in the English language had a significantly higher IF in the year 2010 (1.64 vs. 0.33, p = 0.01) than those printed in other languages. English language journals published in the US had significantly higher mean 2010 IF (1.932 vs. 1.243, p = 0.025) than those published in Europe, and this had changed compared with 2000 mean IF (0.978 Vs. 0.704, p = 0.360). Orthopaedics was ranked sixth out of 11 surgical subspecialties in 2000 but dropped to seventh out of 11 in 2010.

Conclusions

The quality of orthopaedic journals has significantly increased over the last decade and this has been accompanied by a rise in mean IF. It is important that orthopaedics continues to improve the quality of research, which may help orthopaedic researchers secure funding in the future.     

The fifty most cited Latin-American articles in the orthopaedic literature

Purpose

The number of citations of an article is a marker of its academic influence. Several medical specialties, including orthopaedics, have ranked the articles with more citations. We identified the 50 most cited orthopaedic articles from Latin-America and analyzed the characteristics that made them citable.

Methods

Science Citation Index Expanded was searched for citations of articles originated in Latin-America, published in any of the 63 journals in the category “Orthopaedics” from 1988 to 2013. We created a list ranking the 50 most commonly cited articles and determined the citation density (Citations/years since publication). Information noted for each article included authors, year of publication, country of origin, source journal, article type, and field of research.

Results

Latin-American countries were the origin of 1 % of orthopaedic articles. The top 50 most cited articles had between 29 and 150 citations (mean, 44.48); the citation density ranged from 1.43 to 15.5 citations/years (mean, 5.25). The articles were published in 19 of the 63 journals (11 general and eight sub-specialty journals), and all were published in English. Most articles (n = 29) were published in 2000 or later. The majority were clinical articles (n=40), and the most common fields were arthroscopy (n = 15) and hip surgery (n = 13). The top 50 articles originated mainly from Brazil (n = 20) and Argentina (n = 15).

Conclusions

This top 50 list displays articles that have become important references for the orthopaedic scientific community. Researchers may use this work to make their future publications more influential on future investigators.     

What to call spinal cord damage not due to trauma? Implications for literature searching

Objectives

To illustrate the importance of multiple search terms and databases when searching publications on spinal cord damage not due to trauma. To develop comprehensive search filter for this subject, compare the results for 2000–2009 with the Medical Subject Headings (MeSH) and Emtree term ‘spinal cord diseases’ and determine changes in the number of articles over this period.

Design

Literature searches and search filter development.

Setting

Australia.

Interventions

Titles and abstracts searched in MEDLINE and EMBASE (2000–2009) for articles involving humans using search terms ‘non-traumatic spinal cord injury’ and ‘nontraumatic spinal cord injury’ (concise search). Develop comprehensive search filter for ‘spinal cord damage not due to trauma’ and compare the results with the MeSH term ‘spinal cord diseases.’

Outcome measures

Annual publications (2000–2009) identified in MEDLINE and EMBASE literature searches.

Results

Concise search identified 35 articles published during 2000–2009. More publications were identified using the term ‘nontraumatic spinal cord injury’ (n = 20) than ‘non-traumatic spinal cord injury’ (n = 16). Publications increased for both terms ‘spinal cord diseases’ (2000 = 279; 2009 = 415) and ‘spinal cord damage not due to trauma’ identified by the comprehensive search filter (2000 = 1251; 2009 = 1921).

Conclusions

Concise searches using terms ‘non-traumatic spinal cord injury’ and ‘nontraumatic spinal cord injury’ fail to identify relevant articles unless combinations of terms and databases are used. These are inadequate search terms for a comprehensive search. Further research is needed to validate our comprehensive search filter. An international consensus process is required to establish an agreed term for ‘spinal cord damage not due to trauma.’     

Characteristics of highly successful orthopedic surgeons: a survey of orthopedic chairs and editors

Background

Highly successful orthopedic surgeons are a small group of individuals who exert a large influence on the orthopedic field. However, the characteristics of these leaders have not been well-described or studied.

Methods

Orthopedic surgeons who are departmental chairs, journal editors, editorial board members of the Journal of Bone and Joint Surgery (British edition), or current or past presidents of major orthopedic associations were invited to complete a survey designed to provide insight into their motivations, academic backgrounds and accomplishments, emotional and physical health, and job satisfaction.

Results

In all, 152 surgeons completed the questionnaire. We identified several characteristics of highly successful surgeons. Many have contributed prolific numbers of publications and book chapters and obtained considerable funding for research. They were often motivated by a “desire for personal development (interesting challenge, new opportunities),” whereas “relocating to a new institution, financial gain, or lack of alternative candidates” played little to no role in their decisions to take positions of leadership. Most respondents were happy with their specialty choice despite long hours and high levels of stress. Despite challenges to their time, successful orthopedic surgeons made a strong effort to maintain their health; compared with other physicians, they exercise more, are more likely to have a primary care physician and feel better physically.

Conclusion

Departmental chairs, journal editors and presidents of orthopedic associations cope with considerable demands of clinical, administrative, educational and research duties while maintaining a high level of health, happiness and job satisfaction.     

Pitfalls and Important Issues in Testing Reliability Using Intraclass Correlation Coefficients in Orthopaedic Research

Background

Intra-class correlation coefficients (ICCs) provide a statistical means of testing the reliability. However, their interpretation is not well documented in the orthopedic field. The purpose of this study was to investigate the use of ICCs in the orthopedic literature and to demonstrate pitfalls regarding their use.

Methods

First, orthopedic articles that used ICCs were retrieved from the Pubmed database, and journal demography, ICC models and concurrent statistics used were evaluated. Second, reliability test was performed on three common physical examinations in cerebral palsy, namely, the Thomas test, the Staheli test, and popliteal angle measurement. Thirty patients were assessed by three orthopedic surgeons to explore the statistical methods testing reliability. Third, the factors affecting the ICC values were examined by simulating the data sets based on the physical examination data where the ranges, slopes, and interobserver variability were modified.

Results

Of the 92 orthopedic articles identified, 58 articles (63%) did not clarify the ICC model used, and only 5 articles (5%) described all models, types, and measures. In reliability testing, although the popliteal angle showed a larger mean absolute difference than the Thomas test and the Staheli test, the ICC of popliteal angle was higher, which was believed to be contrary to the context of measurement. In addition, the ICC values were affected by the model, type, and measures used. In simulated data sets, the ICC showed higher values when the range of data sets were larger, the slopes of the data sets were parallel, and the interobserver variability was smaller.

Conclusions

Care should be taken when interpreting the absolute ICC values, i.e., a higher ICC does not necessarily mean less variability because the ICC values can also be affected by various factors. The authors recommend that researchers clarify ICC models used and ICC values are interpreted in the context of measurement.     

Chiropractic care for patients with asthma: A systematic review of the literature

Objective:

To provide a review of the literature and rate the quality of published studies regarding chiropractic care, including spinal manipulation, for asthmatic patients.

Methods:

A multimodal search strategy was conducted, including multiple database searches, along with reference and journal hand-searching. Studies were limited to those published in English and in peer-reviewed journals or conference proceedings between January 1980 and March 2009. All study designs were considered except personal narratives or reviews. Retrieved articles that met the inclusion criteria were rated for quality by using the Downs and Black checklist. A brief summary was also written for each retrieved study.

Results:

Eight articles met the inclusion criteria of this review in the form of one case series, one case study, one survey, two randomized controlled trials (RCTs), one randomized patient and observer blinded cross-over trial, one single blind cross study design, and one self-reported impairment questionnaire. Their quality scores ranged from 5 to 22 out of 27.

Conclusion:

Results of the eight retrieved studies indicated that chiropractic care showed improvements in subjective measures and, to a lesser degree objective measures, none of which were statistically significant. It is evident that some asthmatic patients may benefit from this treatment approach; however, at this time, the evidence suggests chiropractic care should be used as an adjunct, not a replacement, to traditional medical therapy.     

Demographic analysis: an update of randomized controlled studies in prostatic oncology

Introduction:

Results from randomized trials are least prone to systematic bias and represent the highest level of evidence in medical practice. We carried out a demographic analysis examining randomized controlled trials (RCTs) in prostate cancer. Particular emphasis was placed on newly conducted phase II/III RCTs between January 1997 and March 2006.

Methods:

We searched the MEDLINE database using the heading “prostate neoplasms” between January 1997 and March 2006. The results were then crossed with the MeSHs “Clinical trial.mp. OR clinical trial.pt. OR random:.mp. OR tu.xs;” this cross-checking is considered an optimal search strategy for detecting RCTs in MEDLINE® literature. The search yielded 7831 articles in total for the defined period. Of this total number, 7314 articles were manually analyzed and excluded as they did not represent RCTs. The qualifying 517 articles were then analyzed with emphasis on modality of therapy, cohort size, principal author, participating country and journal type.

Results:

Among the 517 randomized trials, most trials investigated medical therapies (42.7%). This was followed by diagnostic studies (13.2%), while the remaining categories made up 44.1%. A trend towards more completed RCTs is noted in the later years of the cohort. Cohort sizes were generally greater than 100 participants (63.1%). Urologists were the lead investigators in 48.2% of the trials. Trials were largely conducted in Europe and the United States (43.1% and 38.3%, respectively). About 7% of studies were based in Canada. Articles were generally published in surgical journals (48.4%), followed by medical journals (36.9%).

Conclusions:

Given that initial searches yielded nearly 8000 articles listed as RCTs in prostatic oncology, only a small percentage (5.4% to 8.6%) of these were actually RCTs which reported novel results. Most of the published data were either review articles or commentaries. It is abundantly clear that new recruitment strategies need to be developed to encourage patients to enrol in RCTs and that such studies need to be undertaken in urologic oncology to provide definitive answers to the abundant and unanswered questions in urologic oncology.     

Improving journal clubs through the use of positive deviance: A mixed-methods study

BACKGROUND:

Plastic surgery journal clubs are often unsatisfactory for both surgeons and residents, leading to frustration and poor surgeon attendance.

OBJECTIVE:

To assess and modify journal clubs using the principles of positive deviance.

METHODS:

Surgeons and residents were surveyed across five domains before and after journal club modification. These included perception of the quality of articles chosen, the quality of the presentations, postpresentation discussions, educational benefit and overall satisfaction.

RESULTS:

Using the principles of positive deviance, the authors were able to identify points of concern with journal clubs and make suggestions for improvement. Postintervention surveys demonstrated a statistically significant improvement in journal clubs across all five domains assessed.

CONCLUSIONS:

Using the principles of positive deviance, journal club satisfaction was improved. The interventions presented could be used to improve journal clubs at other institutions. In addition, the principles of positive deviance can be used to address a variety of administrative and educational challenges faced by plastic surgery programs.     

The top 100 cited articles in urology

Background

We identified and analyzed the characteristics of the 100 most frequently cited articles published between 1965 and 2007 in journals pertaining to urology and related fields.

Methods

We selected 69 of the highest impact urology and sub-specialty journals and 22 of the highest impact general medical and medical research journals from the 2006 edition of Journal Citation Reports: Science edition. We identified the 100 most frequently cited urological articles published in these 91 journals using the Science Citation Index Expanded (1965–present). We reviewed and analyzed the articles.

Results

The top 100 articles were cited a mean of 629 times (range 418–1435) and published between 1965 and 2003, with 89% published after 1979 and 54% published in the 1990s. Fifteen journals were represented, led by The New England Journal of Medicine (30), The Journal of Urology (22) and Lancet (11). Ninety publications originated from North America (81) or the United Kingdom (9). Johns Hopkins University (13), Harvard University (5), Stanford University (5) and University of California, Los Angeles (5) published the most articles. Five urologists were first authors of 2 or more of the articles. Fifty-six articles reported observational studies. Oncology (51) and transplantation (20) were the most commonly represented urological subfields.

Conclusion

These top-cited articles in urology identify topics and authors that contributed to major advances in urology. Observational studies and randomized controlled trials in oncology published in high-impact urological or medical journals constitute the most common type of highly cited publications.     

Non-pharmacological interventions for sleep quality and insomnia during pregnancy: A systematic review

Objective:

To systematically review the literature regarding non-pharmacological inteventions for improving sleep quality and insomnia during pregnancy.

Methods:

An electronic search strategy was conducted using several online databases (CINAHL, PubMed, Medline, Index to Chiropractic Literature) from inception to March 2013. Inclusion criteria consisted of studies evaluating non-pharmacological interventions, published in English in a peer reviewed journal, and assessed sleep quality or insomnia. The full text of suitable articles was reviewed by the authors, and scored using a risk of bias assessment.

Results:

160 articles were screened and seven studies met the inclusion criteria in the form of three prospective RCTs, one prospective longitudinal trial, one experimental pilot study, and two prospective quasi-randomized trials. Quality scores ranged from five to eight out of twelve on the risk of bias scoring criteria.

Conclusions:

Exercise, massage, and acupuncture may be associated with improved sleep quality during pregnancy, however, due to the low quality and heterogeneity of the studies yielded, a definitive recommendation cannot be made. Further higher quality research is indicated.     

Association of scientific and nonscientific factors to citation rates of articles of renowned orthopedic journals

Purpose

The physician often relies on the prestige of a journal to identify the most relevant articles to be read in his field. This investigation studied associations of scientific and nonscientific criteria with the citation frequency of articles in two top-ranked international orthopedic journals.

Methods

The 100 most (mean, 88 citations/5 years for cases) and 100 least (mean, two citations/5 years for controls) cited articles published between 2000 and 2004 in the Journal of Bone and Joint Surgery and the Bone & Joint Journal (formerly known as JBJS (Br)), two of the most distributed general orthopedic journals, were identified. The association of scientific and nonscientific factors on their citation rate was quantified.

Results

Randomized controlled trials, as well as multicenter studies with large sample sizes, were significantly more frequent in the high citation rate group. The unadjusted odds of a highly cited article to be supported by industry were 2.8 (95 % confidence interval 1.5, 5.6; p?<?0.05) if compared with a lowly cited article.

Conclusion

Beside scientific factors, nonscientific factors such as industrial support seem associated to the citation rate of published articles. This, together with publication bias, questions whether scientific facts reach the readers in a balanced fashion. Level of Evidence 3     

Peer-reviewed publications by CUA members: then and now

Objective:

The objective of this study was to assess the characteristics of publications by members of the Canadian Urological Association (CUA) over a 10-year period.

Methods:

All publications by active CUA members during the periods January 1993-December 1994 and January 2003-December 2004 were reviewed.

Results:

Of the 487 active members in 1993–1994, 130 (26.7%) were authors a total of 649 times in 641 publications. External funding was acknowledged in 195 (30.4%). There were 131 observational studies (20.4%), 127 review articles (19.8%), 58 case reports (9.0%), 37 case series (5.8%), and 21 randomized controlled trials (RCTs) (3.3%). Of the 454 active member in 2003–2004, 139 (30.6%) were authors a total of 748 times in 705 publications. External funding was acknowledged in 237 (33.6%). There were 153 observational studies (21.7%), 124 review articles (17.6%), 52 case reports (7.4%), 49 case series (7.0%), and 46 RCTs (6.5%). There were significantly more RCTs and clinical trials in 2003–2004. The most common journal was The Journal of Urology in both eras. There were significantly more publications in The Canadian Journal of Urology, the British Journal of Urology International and the Journal of Endourology in 2003–2004. There were significantly more publications acknowledging industry funding and more publications citing more than 1 CUA member in 2003–2004. Publication intensity increased significantly from 0.67 to 0.82 publications per member, per year for the CUA as a whole.

Interpretation:

Scholarly activity has remained robust over the last decade with over 30% of active CUA members contributing to peer-reviewed literature. Higher levels of evidence are now observed with a greater number of RCTs. CUA members should be proud of their academic productivity.     

Reporting disclosures to the reader in plastic surgery journal publications

BACKGROUND:

With the associations between investigators and funding sources becoming increasingly complicated, conflicts of interest may arise that could potentially cause biases in the reporting of results.

OBJECTIVE:

To determine the number of published plastic surgery articles that lack reporting of disclosures.

METHODS:

An online review of four major North American plastic surgery journal publications from January 1, 2007 to December 31, 2007, was performed. For identification and to provide anonymity, journals were assigned a letter from A to D.

RESULTS:

Of the 1759 articles reviewed, 726 (41%) were included. Disclosure was not reported in 368 (51%) articles: Journal A (n=10, 3%), Journal B (n=153, 85%), Journal C (n=193, 93%) and Journal D (n=12, 32%). Journals differed significantly in their reporting of disclosure (P<0.01).

CONCLUSION:

In the plastic surgery journals reviewed, the lack of documentation of disclosures was frequent. To ensure identification of bias in plastic surgery publications, a section dedicated to disclosure statements is recommended for each published article.     

Disclosure of Funding Sources and Conflicts of Interest in Phase III Surgical Trials: Survey of Ten General Surgery Journals

Background

Discussions regarding disclosure of funding sources and conflicts of interest (COI) in published peer-reviewed journal articles are becoming increasingly more common and intense. The aim of the present study was to examine whether randomized controlled trials (RCTs) published in leading surgery journals report funding sources and COI.

Methods

All articles reporting randomized controlled phase III trials published January 2005 through December 2010 were chosen for review from ten international journals. We evaluated the number of disclosed funding sources and COI, and the factors associated with such disclosures.

Results

From a review of 657 RCT from the ten journals, we discovered that presence or absence of a funding source and COI was disclosed by 47 % (309) and 25.1 % (165), respectively. Most articles in “International Committee of Medical Journal Editors (ICMJE)-affiliated journals” did not disclose COI. Disclosure of funding was associated with a journal impact factor >3 (51.7 vs 41.6 %; p < 0.01), statistician/epidemiologist involvement (64.2 vs 43.7 %; p < 0.001), publication after 2008 (52.9 vs 41.1 %; p < 0.01), and the journal being ICMJE-affiliated (49.3 vs 40 %; p < 0.05). Conflict of interest disclosure was associated with publication after 2008 (38.7 vs 11.3 %; p < 0.001), and with the journal not being affiliated with ICMJE (36.9 vs 21.3 %; p < 0.001).

Conclusions

Of the published studies we investigated, over half did not disclose funding sources (i.e., whether or not there was a funding source), and almost three quarters did not disclose whether COI existed. Our findings suggest the need to adopt best current practices regarding disclosure of competing interests to fulfill responsibilities to readers and, ultimately, to patients.     

Analysis of Orthopaedic Research Produced During the Wars in Iraq and Afghanistan

Background

Military orthopaedic surgeons have published a substantial amount of original research based on our care of combat-wounded service members and related studies during the wars in Iraq and Afghanistan. However, to our knowledge, the influence of this body of work has not been evaluated bibliometrically, and doing so is important to determine the modern impact of combat casualty research in the wider medical community.

Questions/purposes

We sought to identify the 20 most commonly cited works from military surgeons published during the Iraq and Afghanistan conflicts and analyze them to answer the following questions: (1) What were the subject areas of these 20 articles and what was the 2013 Impact Factor of each journal that published them? (2) How many citations did they receive and what were the characteristics of the journals that cited them? (3) Do the citation analysis results obtained from Google Scholar mirror the results obtained from Thompson-Reuters’ Web of Science?

Methods

We searched the Web of Science Citation Index Expanded for relevant original research performed by US military orthopaedic surgeons related to Operation Iraqi Freedom and Operation Enduring Freedom between 2001 and 2014. Articles citing these studies were reviewed using both Web of Science and Google Scholar data. The 20 most cited articles meeting inclusion criteria were identified and analyzed by content domain, frequency of citation, and sources in which they were cited.

Results

Nine of these studies examined the epidemiology and outcome of combat injury. Six studies dealt with wound management, wound dehiscence, and formation of heterotopic ossification. Five studies examined infectious complications of combat trauma. The median number of citations garnered by these 20 articles was 41 (range, 28–264) in Web of Science. Other research citing these studies has appeared in 279 different journals, covering 26 different medical and surgical subspecialties, from authors in 31 different countries. Google Scholar contained 97% of the Web of Science citations, but also had 31 duplicate entries and 29 citations with defective links.

Conclusions

Modern combat casualty research by military orthopaedic surgeons is widely cited by researchers in a diverse range of subspecialties and geographic locales. This suggests that the military continues to be a source of innovation that is broadly applicable to civilian medical and surgical practice and should encourage expansion of military-civilian collaboration to maximize the utility of the knowledge gained in the treatment of war trauma.

Level of Evidence

Level IV, therapeutic study.     

The use and abuse of abbreviations in orthopaedic literature

INTRODUCTION

Abbreviations are commonly used in medical literature. Their use has been associated with medical errors and they can be a source of irritation and misunderstanding. There are strict guidelines for their use. This study analysed the use of abbreviations in orthopaedic literature and compared adherence with guidelines in a general orthopaedic and spinal journal. It also examined orthopaedic professionals& understanding of abbreviations.

SUBJECTS AND METHODS

The use of abbreviations in articles over a 3-month period in a general orthopaedic and spinal journal was analysed. The number of abbreviations and adherence with guidelines was recorded. A group of orthopaedic healthcare professionals were tested for their understanding of abbreviations.

RESULTS

Almost half of all abbreviations were not properly used and 30% of abbreviations were never defined. Abbreviations were used significantly more often in the spinal journal. Only 40% of abbreviations were correctly defined by the orthopaedic professionals tested.

CONCLUSIONS

Guidelines regarding the use of abbreviations are not being adhered to by authors or editors. The poor understanding of abbreviations underlines the importance of minimising their use and defining abbreviations when they are used.     

Role of Evidence-Based Reviews in Surgery in teaching critical appraisal skills and in journal clubs

Background

Evidence-Based Reviews in Surgery (EBRS) is a program developed to teach critical appraisal skills to general surgeons and residents. The purpose of this study was to assess the use of EBRS by general surgery residents across Canada and to assess residents’ opinions regarding EBRS and journal clubs.

Methods

We surveyed postgraduate year 2–5 residents from 15 general surgery programs. Data are presented as percentages and means.

Results

A total of 231 residents (58%, mean 56% per program, range 0%–100%) responded: 172 (75%) residents indicated that they know about EBRS and that it is used in their programs. More than 75% of residents who use EBRS agreed or strongly agreed that the EBRS clinical and methodological articles and reviews are relevant. Only 55 residents (24%) indicated that they used EBRS online. Most residents (198 [86%]) attend journal clubs. The most common format is a mandatory meeting held at a special time every month with faculty members with epidemiological and clinical expertise. Residents stated that EBRS articles were used exclusively (13%) or in conjunction with other articles (57%) in their journal clubs. Most respondents (176 of 193 [91%]) stated that journal clubs are very or somewhat valuable to their education.

Conclusion

The EBRS program is widely used among general surgery residents across Canada. Although most residents who use EBRS rate it highly, a large proportion are unaware of EBRS online features. Thus, future efforts to increase awareness of EBRS online features and increase its accessibility are required.