Journal Court: A Novel Approach to Incorporate Medicolegal Education into an Emergency Medicine Journal Club.

Audience: The target audience includes health professions students, residents, and fellows who participate in journal clubs.

Introduction: Journal club plays an important role in teaching emergency medicine residents how to critically evaluate medical literature and apply it to their clinical practice. While there is some consensus on the general goals and objectives of journal club, significant variability exists between how different residency programs design and conduct them.1 Papers selected may address similar or disparate topics, highlight specific research applications, or demonstrate diverging evidence on a specific issue.2-5 While numerous approaches have been implemented and described, they do not traditionally entail a trial-based format.More than 7% of practicing physicians have a malpractice claim annually and more than one third will be sued in their lifetime.6,7 Some estimates indicate 75% of emergency medicine physicians will be named in a medical malpractice suit during their career.8 Despite this, the American College of Graduate Medical Education (ACGME) has no specific requirement for medicolegal instruction during emergency medicine training.9 By structuring journal club to encompass a hypothetical medical malpractice lawsuit, our program sought to provide instruction on this topic while also fostering improved resident enthusiasm and participation.

Educational objectives: By the end of this exercise, participants should: 1) identify the four necessary elements for a malpractice claim, 2) understand the basic structure of medical malpractice litigation, and 3) critically analyze medical literature representing diverging viewpoints or conclusions.

Educational methods: Residents read two papers regarding fluid resuscitation in sepsis and a fictional case narrative and associated medical malpractice complaint. The case described a septic patient with a history of congestive heart failure who clinically decompensates after large volume IV fluid administration.10,11 After a brief faculty-led discussion on medical malpractice, a mock trial was conducted. Rather than a more conventional journal club format, the two presenting residents discussed the papers by citing them as evidence in their role as expert witnesses providing testimony on behalf of the plaintiff or defense. Each expert witness explained the strengths of their respective paper and highlighted the weaknesses of the opposing paper. A jury made up of resident attendees then deliberated and rendered a verdict followed by an open discussion among the entire group regarding both papers.

Research methods: At the conclusion of the journal club, residents in attendance were asked to complete a brief and anonymous survey evaluating the activity. Questions utilized a 5-point Likert scale to assess the journal club's utility for teaching about research appraisal and the medical malpractice process.

Results: Among respondents, 14/15 (93.3%) agreed or strongly agreed that the journal club had improved their understanding of clinical research and 14/15 (93.3%) agreed or strongly agreed that the journal club had improved their understanding of medical malpractice litigation. Narrative feedback was limited but uniformly positive and included comments such as "Great journal club" and "This was one of the most engaging journal clubs I have ever been to, love the content as well as the format."

Discussion: Journal club is a novel and effective venue for introducing medicolegal education into an emergency medicine residency curriculum. With a brief presentation and informal mock trial, residents were exposed to the elements of malpractice as well as pertinent state laws regarding medical malpractice. They were able to verbalize understanding of these legal tenets and effectively apply them to a simulated scenario. Additionally, they were able to effectively analyze and compare medical literature and understand implications for clinical practice.The exercise required a little more preparation than the conventional journal club format but was inexpensive, well-received and could be easily replicated.

Topics: Journal club, Emergency Medicine, medical malpractice, litigation, lawsuit, Torts, medical education, legal liability, medical errors.