This might be a familiar sight to you – this is the mail tray of one of my colleagues. I usually get my EMJs out of the wrapper but only about 24h before the next one falls through the letterbox onto the floor.
There’s a real problem with information overload in medicine. Keeping up to date can feel like trying to hold back the sea – you get through the big wave and there’s another right behind.
Let’s look at the size of the problem – no-one is really sure how many journal articles are published each year, let alone how many are relevant to Emergency Medicine. What we do know is that there are a lot; a study published in 2005 looked at medline published articles up to 2003 and found the annual number of MEDLINE articles increased 46%, from an average of 272,344 to 442,756 per year, and the total number of pages increased from 1.88 million pages per year during 1978 to 1985 to 2.79 million pages per year between 1994 to 2001.
Now, assuming that there has been no increase in the number of annual publications since 2003 and that 1% of articles are relevant to EM that would mean 85 articles per week which, on a consultant 8/2 contract where 4hrs CPD time are paid, that would mean 21 articles per hour or an article every 2.8mins to stay up-to-date during work time.
But the numbers aren’t static – it’s estimated that the volume of published scientific research is currently doubling every 9 years.
That sounds like a lot to me.
So we need help. We can’t do it alone. And there are a couple of strategies we can employ to get the balance. The first point I want to make on that front is this – social media and FOAM resources can help you with this BUT you need to know what you want and what suits you. So this isn’t a straightforward “do this and everything will be brilliant” talk but I’m going to outline the options for you and hopefully you might find something that works for you.
Option 1 – Traditional Journal Club
How It Works
Traditionally your department picks a paper you think is relevant and you get together with your colleagues to pick it apart and appraise it together, to work out whether it really is relevant and how it’s going to change practice. Many journal clubs are well established and very successful.
You get thorough critical appraisal alongside people you trust and can quiz about their opinions and (respectfully) argue with. It’s a great way for trainees to learn critical appraisal skills in order to prepare for FCEM. You can also make up your own mind about study findings and decide how you will, individually and as a department, translate them to your clinical practice.
Most journal clubs cover one paper per week at most and the process is time-consuming (more so if people haven’t read the paper in advance). Many EDs don’t have a journal club at all.
In Virchester the Journal Club is well established but we’ve struggled over the years to maintain a steady attendance. There are challenges of disseminating important learning to people who can’t attend (in Virchester a summary of the appraisal and discussion is emailed out, or blogged about – or both) and the amount of effort invested overall means this isn’t ideal for keeping up to date with the EM literature as a whole.
Option 2 – Alerts, Table of Contents, Physicians’ First Watch
How It Works
There are similarities between these approaches in that you are delegating out the task of collecting the published literature to another party, although there are slight differences in how each works.
PubMed alerts – you can create a pubmed login and tell it how often to email you with the titles and/or abstracts of articles in journals you’re interested in. We’ve covered the how-to of this in greater depth here.
NEJM alerts (First Watch) – NEJM will email you with snippet summaries of recently published papers in your area of interest. Sign up and select your mail types here.
TOCs – each journal produces a table of contents which you can have emailed directly to you when the print journal is published. The EMJ signup option is here.
QxMD – there’s an online version and an app. I haven’t quite gotten to grips with this myself but from what I can see it acts like an RSS feed aggregator (see below) for the journals you select but incorporates your institutional access to bring you the full articles without the annoying login screens. Some people love this!
You get all the articles you might be interested in when they are published, online before print versions if you sign up for pubmed alerts as it informs you of when citations are generated rather than the paper publication.
These methods allow you to keep it all in one place (your inbox) and you can use inbox rules and folders to separate them from the rest of your email.
You have to choose the right journals to subscribe to. Occasionally there’s something trauma-related and interesting in the Bone & Joint journal but my interest in the finer points of cement choice in hip replacement is limited (sorry).
You also have no control over timing so this can be a nightmare if you’re an inbox-zero obsessive. I have pubmed alerts and, although I make an effort to read them when they arrive, if it’s an inconvenient time they often end up ignored.
You may also still struggle with access to the full article if behind a paywall, depending on your institution’s subscriptions.
Option 3 – Online Review
How It Works
A couple of FOAM sites specifically exist to draw your attention to relevant recently published literature. Notable examples are Life in the Fast Lane’s weekly Research & Reviews post and the site Critical Care Reviews, which collates critical-care relevant articles and includes a newsletter signup option.
These sites are reliant on collaboration of a team of clinicians scouring the literature to highlight interesting and relevant articles with a mini-appraisal (LITFL R&R) and a link.
These sites offer quick and easy access to relevant papers with a first level filter. Someone with more time than you is wading through the literature so you don’t have to!
Numbers of actual papers is still small – edition 99 only includes 5 papers. R&R only includes a minimal review, shorter than the abstract, so you may still have paywall issues.
There is also a heavy critical care focus – not necessarily a bad thing, but also not a fair reflection of the bulk of EM patient workload.
Option 4 – RSS Feeds
How It Works
You sign up to an aggregator (I use Feedly). Tell it what you want it to collect for you (journals and blogs) and when you log in everything published since last login is there.
You can get all the content you’re looking for in a single place at a time that suits you. There are also options to bookmark, save, and share articles of interest (including social media sharing and emailing), and you can add both RSS feeds from journals and all the FOAM blogs so you can access everything at once. Some journals release titles only, others include the abstract so you can skim through and identify articles of interest and relevance to you.
The video below runs you through the previous feedly interface – it’s changed a little but it’s close enough that it wasn’t worth the effort of remaking the video!
If you don’t login regularly the amount you are faced with when you do login can be overwhelming. It’s a little sterile and impersonal without having some sort of interactive appraisal and as you are accessing the articles directly you’ll still need to do the appraisal part. Similarly to above, you may still have access issues if behind paywall.
Option 5 – Online Appraisals
How It Works
Various FOAM websites offer online critical appraisals of literature they think will be of interest to you; some are written, some in podcast format. Notable examples include the Skeptics Guide to Emergency Medicine, EMLitofNote, PEMLit, Resus.Me, TheBottomLine and of course St Emlyns 🙂
Each site has a slightly different approach.
The FOAM appraisal overcomes some of paywall problems – most sites include a summary of the paper so you’ll have more of paper shared than just the abstract. Many take a Journal club feel and if you want to read the article but can’t access it you may be able to contact the blog authors to get the paper (this is often permissable under journal licensing agreements if you consider your appraisal as part of an online journal club – individual journals have different agreements). Comments on the blog and discussion are welcome so if you have strong thoughts in support or contradiction – share them!
Someone else’s appraisal is not totally objective and we would always advise that in addition to reading our thoughts and comments you need to read the original article too.
Option 6 – Twitter
How It Works
People you follow tweet links to interesting articles they’ve found and they appear in your timeline – some of them may discuss the impact of the paper on their practice in real time.
Conversation happens more organically on twitter; if you read the paper after someone has shared it you can engage in a real time review similar to an online journal club. In fact, some journals actively encourage this through facilitated online journal club discussions with the chosen paper shared in advance and sometimes made open access for this purpose.
You can get rapid responses to your questions and you may even be able to communicate directly with the authors of the paper.
Yes – it’s twitter! (Although it’s really not that bad. You should try it. Go on :-))
As with all tweets, your comments and questions are restricted to 140characters and you may need to be obsessive about your timeline to ensure you don’t miss anything. The quality of the relevant articles shared depends on who you follow (and what else they tweet). For example, Minh Le Cong is great at sharing relevant articles but he does tweet at a superhuman pace.
No one-size-fits-all. Need some balance and maybe have one core method with others supplementing regularly e.g. feedly with TOCs or twitter & pubmed alerts with feedly follow up regularly.
If there’s something else that works for you – let us know.