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There has been an explosion of published scientific literature over the past 50 years. The origins of this change can be partly traced back to 1962, when the Kefauver-Harris Drug Amendment was enacted. This law required drug manufacturers to prove the efficacy of their products to the Food and Drug Administration for the first time. As a result, randomized clinical trials became the norm and the amendment encouraged a shift in culture towards applying scientifically obtained evidence in clinical practice.1-3 Currently, PubMed contains more than 24 million citations for biomedical literature.4 Moreover, there are no signs that the influx of scientific submissions is slowing down. The New England Journal of Medicine reports receiving more than 5000 article submissions each year, with an average of 18 submissions each business day.5 One study found that 7,287 articles were published in medical journals associated with primary care within a one month period.6

Given the large quantity of information available at healthcare professionals’ fingertips, as well the increased ease of information dissemination (i.e., via internet, social media, journals, etc.), healthcare professionals must develop the essential skill of keeping up with the literature. This is especially crucial given the profound effect that medical literature has on clinical decision making, therapeutic recommendations, and overall patient care.7-9 However, staying current with the literature has the potential to be a time consuming process; Alper and colleagues estimated that practitioners would need over 600 hours per month to keep up with updated literature.6 New practitioners may struggle with this task due to the fact that they are juggling multiple responsibilities, adjusting to new methods of time management, and transitioning to a full-time career while building their place in practice. By implementing some of the strategies discussed below, new practitioners may find it easier to stay current in practice. 

Focus your efforts on literature relevant to practice

• Set realistic expectations. While new practitioners may feel pressured or tempted to stay on top of every therapeutic advance made in every single disease state, it is simply not feasible. It may also not be in the new practitioners’ best interests to read every single article in a journal. New practitioners should identify and/or prioritize the therapeutic areas that they are most involved in on a daily basis.

Formulate a method to efficiently search for literature

• Identify key journals pertinent to your area of practice. Register to receive monthly email alerts of current issues and tables of contents. Skimming the titles can provide a glimpse of current controversies and help highlight certain articles to further investigate. 

• Utilize RSS (Really Simple Syndication). To minimize the time spent visiting individual websites or joining each site’s email newsletter, consider using RSS.  An RSS feed is a website that contains programming language of contents that users subscribe to, which is translated into user-friendly language through the use of an RSS reader (i.e., Outlook, myYahoo, Pluck). To utilize RSS feed, install an RSS reader and subscribe to various journals such as Journal of American Medical Association (JAMA), New England Journal of Medicine (NEJM), and American Journal of Health-System Pharmacy (AJHP). Additionally, pharmacy organizations, such as ASHP, may offer supplementary feeds such as health-system pharmacy news and current drug shortages to help users stay on top of happenings in various areas of pharmacy.10 With RSS, users are able to keep track of updates from their favorite websites all on one medium without having to visit multiple websites or shift through tons of individual emails. 

• Create search or citation alerts on Web of Science or SciFinder. A search can be run automatically on a weekly or monthly basis with results emailed or sent to an RSS Feeder.  It can be customized to individual preferences such as receiving an alert when a specific article or author is cited.11

• Utilize bibliographic tools such as Mendeley or Endnote. With these programs, one can store and organize notable articles. In many cases, the citation can be exported directly from search engines such as PubMed. Consider sharing the library with colleagues so that other members may contribute to the library, minimizing time spent searching for pertinent literature.

• Subscribe to a pharmacy newsletter. One example is the ASHP Daily Briefing, which compiles updates in medication use, regulatory affairs, health coverage access, health business, and research. Links are provided if additional information is desired. For medical news, consider websites such as MedScape, but be sure to subscribe to clinical areas that are of interest. These resources provide timely clinical and regulatory information.

Devote protected time and preview articles

• Carve out protected time. Keeping up with medical advances in literature requires extensive time. Consider carving out a block of time every week dedicated to emerging practice activities, such as reading articles or attending continuing education sessions. 

• Develop a systematic way to preview articles. Every individual reads and analyzes articles at a different pace. To make the most value of the minutes or hours committed to fully reading an article, consider previewing the article first to determine if is worth checking out. Techniques to consider include reading the abstract, looking carefully over the methodology summary, analyzing the tables in the article, and potentially skimming the authors’ conclusion for insights into the scope of the article. With these methods, one may be able to determine if the article contains clinical significance and is worth further delving into.

Make it count

• Identify opportunities for journal clubs. Attend journal club presentations by students or residents, if possible. Consider utilizing the POEM approach (Patient-Oriented Evidence that Matters) for such sessions. With this method, trainees first describe the case or problem that inspired them to present the paper. Next they state the study design and explain the study using PICO format (Population, Intervention, Comparison/Control, and Outcome). The study outcomes should then be related back to the case or problem originally presented. The POEM approach encourages individuals to think about the implications of the study results on clinical practice and generates meaningful discussion among attendees.12,13 Even if you do not have trainees in your practice setting, consider establishing an informational journal club with other motivated colleagues (held during a lunch or coffee break) or an inter-professional journal club. 

• Identify opportunities that meet career goals and devise strategies that include literature review in order to make the most effective use of time. For example, if job expectations include scholarly activities, consider writing a review article. If teaching is a requirement, offer to provide lectures in emerging areas. If precepting is a responsibility, consider hosting a session on clinical pearls of new guidelines or therapies. Through this mechanism, one can be held accountable, will be able to meet job expectations, and hopefully learn some new data along the way.  

Identify other strategies that do not directly involve reading the literature

• Attend conferences such as the ICHP Annual and Spring Meetings. Many conferences will have presentations dedicated to clinical controversies that review existing evidence as well as practice implications. References are usually provided so practitioners can save time searching for new literature and more time on reading the articles or guidelines.

• Register for continuing education sessions – whether online or live. Many continuing education sessions focus on advances in therapies or updates in guidelines and come with the additional benefit of helping one accrue the hours needed to maintain licensure. Continuing educations are often put forth by residents, pharmacy departments, or local, state, and national organizations. 

Given the pace of scientific advancement and the accessibility of new information, new practitioners are inundated with an avalanche of literature and there is no sign of this slowing down. The key to staying on top of the literature involves efficiently sorting through a large quantity of publications to detect the smaller number of articles that are directly relevant to the practitioner’s area of practice. Additionally, new practitioners should identify and pursue other opportunities that will help him or her stay aware of current trends in the profession.

References:

1. Bastian H, Glasziou P, Chalmers I. Seventy-five trials and eleven systematic reviews a day: how will we ever keep up? PLoS Med. 2010;7:1-6.  

2. McKenzie BE. Guidelines and requirements for the evaluation of contraceptive steroids. Toxicol Pathol. 1989;17(2):377-84.

3. Perucca E. What clinical trial designs have been used to test antiepileptic drugs and do we need to change them? Eplieptic Disord. 2012;14(2):124-31.

4. U.S. National Library of Medicine. PubMed. Available at: www.ncbi.nhm.nih.gov/pubmed. Accessed 2014 Nov 26.

5. New England Journal Medicine. Frequently asked questions. Available at: www.nejm.org. Accessed 2014 Nov 26.

6. Alper BS, Hand JA, Elliott SG, et al. How much effort is needed to keep up with the literature relevant for primary care? J Med Libr Assoc. 2004;92(4):429-37.

7. Michaud G, McGowan JL, van der Jagt R, et al. Are therapeutic decisions supported by evidence from health care research? Arch Intern Med. 1998;158(15):1665-8.

8. Ellist J, Mulligan I, Rowe J, Sackett DL. Inpatient general medicine is evidence based. Lancet. 1995;346:407-10.

9. Nordin-Johansson A, Asplund K. Randomized controlled trials and consensus as a basis for interventions in internal medicine. J Intern Med. 2000;247:94-104.

10. American Society of Health System Pharmacists. RSS Feeds. Available at: http://www.ashp.org. Accessed 2014 Nov 26.

11. Marian Koshland Bioscience and Natural Resource Library. ISI web of knowledge: creating alerts. Available at: http://lib.berkely.edu. Accessed 2014 Nov 26.

12. Slawson DC, Shaughnessy AF. Becoming an information master: using POEMs to change practice with confidence. J Fam Pract. 2000;49(1):63-7.

13. Schwartz MD, Dowell D, Aperi J, Kalet A. Improving journal club presentations, or, I can present that paper in under 10 minutes. ACP J Club. 2007;147(1):A8-9. Editorial.

Originally published in ICHP KeePosted July 2015