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This is for a journal club. That’s my senior’s slides and the article she is presenting on. As a first year, what question can I ask from the presentation itself

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python -m markitdown "/home/daytona/workspace/attachments/c6fcab25-fb4e-49c4-9cb…

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python3 -c " import pdfplumber with pdfplumber.open('/home/daytona/workspace/att…

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python3 -c " from pptx import Presentation prs = Presentation('/home/daytona/wor…

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pip install python-pptx -q && python3 -c " from pptx import Presentation prs = P…

I've now read both the full presentation and the paper. Here are smart, first-year-appropriate questions you can ask directly from the slides - questions that show engagement without needing deep expertise:

Questions You Can Ask at the Journal Club

These are organized from easiest to slightly more advanced - all rooted in things your senior's slides actually cover.

On Study Design (Slides 12-14, 25-26)

1. "Why was the noninferiority margin set at -10 percentage points? How was that number chosen, and how does it translate clinically?"
  • The slides state the margin but don't explain the rationale. This invites a good discussion and your senior will likely know, but it's a fair question for the room.
2. "The trial was open-label, meaning patients knew which treatment they were getting. Could this have introduced performance or expectation bias - particularly with ketamine's known dissociative effects making it easy to guess the treatment arm?"
  • Slide 49 explicitly flags this as a limitation. It's safe to raise because the presenter already acknowledged it.
3. "The study excluded patients with psychosis and bipolar disorder. Since ECT is often considered the gold standard for those very patients, does the noninferiority claim apply only to a subset of the TRD population?"
  • Directly supported by Slides 18 and 43.

On the Results (Slides 28-36)

4. "The primary outcome was a self-reported scale (QIDS-SR-16). The clinician-rated MADRS response showed a smaller difference between the two groups (50.8% vs 41.4%, with a CI crossing zero). Does that affect your confidence in the conclusion?"
  • This is right there in Slide 31 - the MADRS secondary outcome was NOT statistically significant, which is a real tension in the data that the presenter may or may not address.
5. "31 out of 35 pre-treatment dropouts were from the ECT group. How might that differential dropout affect the modified ITT analysis - could it have systematically favored ketamine?"
  • Slide 28 clearly shows this imbalance (31 ECT vs 4 ketamine dropouts). It's a sharp observation for a first-year.
6. "Relapse rates at 6 months were 34.5% for ketamine vs 56.3% for ECT. But during follow-up, patients received treatment at their clinician's discretion - so those numbers are confounded by ongoing treatment. How should we interpret them?"
  • Slide 40 shows these relapse figures; the "as clinically prescribed" follow-up is also a stated limitation (Slide 46).

On Clinical Applicability (Slides 43-44, 53-54)

7. "The slides mention the study population was 88% White. How generalizable are these findings to our patient population in Nepal/South Asia?"
  • Slide 53 says "yes, with caveats" - this opens a genuine local clinical relevance discussion.
8. "Ketamine is a Schedule III controlled substance with abuse potential. Practically speaking, how accessible or feasible is IV ketamine in our setting compared to ECT, which we already have infrastructure for?"
  • Slide 10 mentions the abuse liability. This is a practical, first-year-appropriate question.

One "Safe Star" Question to End With

9. "The paper calls this a 'pragmatic' trial - could you explain what makes a trial pragmatic vs explanatory, and why that distinction matters for applying this study to real practice?"
  • Slide 12 uses the word "pragmatic" and Slide 55 links it to external validity. It's a conceptual question that shows you're thinking about study types, not just results.
The strongest single question to ask if you want to make a good impression: Question 4 about the MADRS secondary outcome not reaching significance while the primary QIDS self-report did - it's data directly in the slides, shows you read carefully, and highlights a genuine interpretive tension in the study.
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