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Using vote cards to encourage active participation and to improve critical appraisal skills in evidence-based medicine journal clubs


  • This article was presented at the Joint Colloquium of the Cochrane and Campbell Collaborations, Keystone, Colorado, USA, October 2010.

Dr Ka-Wai Tam, Department of Surgery and Evidence-Based Medicine Center, Taipei Medical University Hospital, 252 Wuxing Street, Taipei 11031, Taiwan. E-mail:


Rationale, aims and objectives  Evidence-based medicine (EBM) journal clubs are used by health care practitioners to critique and remain updated on relevant health literature. Vote cards, in three different colours (green/yellow/red), allow participants to express their opinions (agree/doubt/reject) on the quality and possibility of clinical application regarding the article being reviewed. Our aim is to assess the efficacy of using vote cards in EBM journal clubs.

Methods  Evidence-based medicine journal club is held on a weekly basis in the Department of Surgery in Taipei Medical University Hospital, Taiwan. The participants of EBM journal clubs include medical students, resident doctors and primary care faculty members. After the presentation, participants use their vote cards to critically appraise the literature and decide if the rationales could be applied in their own practice. After a 12-week period, we evaluated the effectiveness of the vote cards based on survey findings of the participants.

Results  The majority of 66 respondents agreed that vote cards can improve the overall quality of EBM journal clubs, may encourage active participation and improve critical appraisal skills. They also rated the vote cards more favourably than traditional hand voting and agree that vote cards should be used in future EBM journal clubs.

Conclusion  We suggest the regular and routine use of vote cards in EBM journal clubs.