Background: Evidence-based medicine (EBM) journal clubs are used by health care practitioners to critique and to keep up-to-date with relevant health literature. Vote cards using three different colored cards (green/yellow/red), allowing participants to express their opinions (agree/doubt/reject) toward the quality, design and possibility of clinical practice regarding to article that was being reviewed. However, the effectiveness of using vote cards in EBM journal clubs has not been well evaluated. Objectives: To assess the overall efficacy of using vote cards in EBM journal clubs. Methods: EBM journal club is held on a weekly basis in Department of Surgery in Taipei Medical University Hospital in Taiwan. The participants include medical students, resident doctors and primary care faculty members. The article is selected based on a clinical based question and it s relevant to participants field. Prior to the session, the moderator helps the presenter to search and decide the best evidence. After the presentation, participants will use the vote cards to critical appraise the article and to decide how the results can be applied in their own practice. After using vote cards for a twelve-week period, the effectiveness of the vote cards is being evaluated based on the survey among participants. Results: Among 66 respondents, 97.0% agreed that vote cards can improve overall quality, 97.0% agreed it has encouraged active participation, 93.9% agreed it helped to stimulate critical appraisal skills, and 93.9% rated the vote cards more favorably than traditional hand voting. For future implementation, 93.9% of them agreed that vote cards should be used in future EBM journal clubs. Conclusion: Using vote cards in EBM journal clubs was appreciated by most of the participants and may encourage active participation and improve critical appraisal skills. Thus, we suggest the use of vote cards regularly in EBM journal clubs.