My Strategy for Keeping Up

One of the central tenets of Clinical Quality Improvement is that we should strive to do our work well and ALSO strive to improve how we do our work. Keeping "up-to-date" with clinical knowledge is a key component of that, but the "journal stack on the bedside table" is a thing of the past.

I've developed a strategy that mostly works for me. If it works for you too, great!

Below, I discuss sources and information that are both free and paid, and I discuss them in terms of the two main "Information Mastery" modes I find myself in - Hunting (seeking an answer to a clinical question) and Foraging (looking for new information to incorporate).

Information sources that require money

DynaMed - This is a workhorse for me - both for hunting and foraging. I would pay for it if I didn't get it through work.

Prescriber's Letter - I do pay for this one. Our main therapeutic tool (other than our relationships and continuity) as family doctors is our medication prescription. It's easy to fall behind on the news about medications. These folks make a great newsletter/reference site with new drug info, comparison charts, patient handouts, etc. - used for both hunting and foraging. Independent of pharma.

Journals I would probably pay for (given what I do):

• JAMA

• Annals of Internal Medicine

• possibly American Journal of Preventive Medicine

Journals for my Job (so I don't have to worry about paying for them):

• Academic Medicine

• Medical Decision Making

Information sources that are free

Journals

• Family Medicine:

  • American Family Physician

  • Annals of Family Medicine

  • Journal of the American Board of Family Practice

• Family Medicine Teaching

  • Family Medicine

  • PRiMER (disclosure: I'm an Associate Editor)

• Other - mostly due to my job in academic medicine

  • CDC's Morbidity & Mortality Weekly Report

  • BMC Family Practice

  • BMC Medical Education

  • Implementation Science

Lots of sources...How to keep up?

Physical Reading: I get physical copies of American Family Physician and Family Medicine. They stack up in my inbox, and I take an hour or so every 2-3 months to go through them. I use AFP for "retracing" - another mode of Information seeking - going over things that I feel generally good about looking for changes - I use the SORT tables as highlights for this, but usually have to look up any new, potentially practice-changing content that isn't included in the SORT tables. I scan Family Medicine for interesting educational topics.

Email: I get Prescribers' Letter and PRiMER by email. I do the CME for Prescribers' Letter reading. I scan PRiMER for interesting educational topics.

RSS: I use The Old Reader - an RSS aggregator - to subscribe to all the other journals' Tables of Contents or Current Issue feeds. The Old Reader has a "river of news" option that lets me organize it by oldest to newest, and scan the articles. I scan the titles and abstracts for POEMs (Patient oriented evidence that matters) and only carefully read the abstracts for the ones that would cause me to change my practice.

If article is worth reading in whole, I use the "star" function in The Old Reader, which I've configured to send that link to Pocket. Pocket is a "read later" service that collects web stuff and holds it for you so you can...well...read it later. Both The Old Reader and Pocket have mobile app versions, so I can catch up when I'm travelling, or during other downtime. It takes some discipline - I do get behind frequently, then have to devote a few hours to cleaning it all out, but that's mainly because I over-subscribe to journals.

Searching for answers

In "hunting" mode, I'll use the following:

• DynaMed - especially if I need more background info, or if I'm in a hurry.

• Prescriber's Letter - the number of times I've referenced their Atypical Antipsychotics Comparison Chart is...a lot.

• PubMed Clinical Queries - Good for finding pertinent original research. A little time investment in using the filters is the key here - the PubMed searches will be much more helpful if you use the filters.

  • There used to be a "systematic reviews" filter on the Clinical Queries page, but now that's integrated into PubMed as it's own filter (along with "meta-analysis", be careful, they are not the same) in the main search page (left hand side on a search).

• Trip Database - this is accessible for free, but some of the content is firewalled, unless you buy a subscription. The doc that produces this site is really thoughtful and is a leader in EBM, but I get overwhelmed on this site easily.

• Google Scholar - I use this for research, mainly.

• Google - yes, I use Google for clinical answers. To paraphrase Professor Dumbledore, "It's not the abilities you have, it's the choices you make." If you apply structured and consistent critical thinking to what you find using Google, there's no reason you can't get helpful resources and answers. But you have to dive deeper than the results page. Same goes for Wikipedia (though it may be harder to trace back to the sources of information there).