Pulse
Too Much Information
With new studies and guidelines coming out by the minute, how can docs keep up with the latest in their field?
By Kim Kiser
In an article published in the British Medical Journal last December about the impossibility of keeping up with published medical reports, a cardiology professor and statistician from Cardiff University in Wales cited daunting statistics: there are now 25,400 science, technology, and medical journals, and their number is increasing by 3.5 percent a year; 1.5 million articles were published in those journals in 2009 alone; and the National Library of Medicine’s PubMed database now cites more than 20 million articles. They noted that a trainee in cardiac imaging reading 40 papers a day, five days a week, would need 11 years to get up to speed, during which time another 82,000 relevant articles would have been published. With new information coming out at breakneck speed, how can docs keep from falling behind?
We asked Don Deye, M.D., an internal medicine physician in Cambridge, Minnesota, who has long been involved in sharing relevant information with fellow physicians about what it takes to cope with medicine’s information tsunami and whether technology is helping us manage the deluge or contributing to it. Deye serves as medical director for Oakstone Medical Publishing, which produces continuing education materials for health care professionals. In that role, he has been recording audio versions of the American College of Physicians’ (ACP) Medical Knowledge Self-Assessment Program (MKSAP) for 15 years. He also compiles a “medical news of the weird” segment about unusual things hospitalists should know for Practical Reviews in Hospital Medicine, an electronic journal club. And he runs Allina Medical Group’s journal club.
Q:What’s behind the information explosion?
The number of journals and the quantity of data has exploded because, as a global culture, we have developed research, and most of these articles come out of research. Now, medical companies are developing drugs and devices, which leads to more studies. There is also NIH and government-sponsored research. Plus medical knowledge has become specialized and subspecialized. Each specialty has a universe of knowledge and researchers. All those things together have created a huge explosion of information. It has gone up exponentially and shows no signs of stopping.
Q:You’ve been using the ACP’s MKSAP since you finished residency in 1979, long before you got involved in recording audio versions for Oakstone. Why do you feel this is a good way to keep up? And what else do you do to stay on top of your game?
I do general internal medicine, which, alarmingly, covers all specialties of primary care medicine aside from pediatrics and obstetrics. The self-assessment program comes out every three years. The ACP forms committees—one for each specialty within internal medicine. They spend a year figuring out what’s new that’s clinically relevant and important to know and then write chapters on each topic. Because three years is a long time, the ACP comes out with updates every six months These are a good way to keep up with what’s generally accepted as current practice.
Many of us also use UpToDate. Every four months, they come out with a revision and each revision has a chapter on what’s new for each specialty—cardiology, gastroenterology, etc.. Another is ACP Medicine, an electronic medical reference that helps physicians keep up with new guidelines and treatment recommendations. I also go to meetings, including the ACP Minnesota Chapter’s meeting, and internal medicine review courses at the University of Minnesota and Mayo Clinic.
The other thing I use that has been around forever is the journal club. These started in medical schools and residency programs. They would meet monthly and each person was assigned specific journals to review for landmark or unusually interesting or clinically relevant articles. But if you’re out in the middle of nowhere, there may not be a journal club.
Q:Practical Reviews started out as a journal club at the University of Alabama Birmingham. How has it changed the concept of what a journal club is?
These days, it’s all computerized and you can do searches. Oakstone has a database from journal clubs in nearly all specialties. All these journal clubs have a team of docs around the country reviewing the current literature. It’s like local journal clubs used to do. But there are now 450 docs doing this every month. So if you imagine 450 docs individually looking with a critical eye at the current literature as a group, they cover virtually all the relevant journals. It’s like you took Medline and the incredible amount of data there and put it through an intelligent filter. But the intelligent filter isn’t some algorithm, it’s the brains of all these docs. So now you can go online and search all of these journal clubs at once. Instead of coming up with a couple thousand hits like you would on Google or Medline, you come up with maybe eight or 15, but they’re ones you’re looking for. Journal Watch is similar, but they don’t have as many specialties.
Q: What do you do to prepare for your 15-minute segment for Practical Reviews in Hospital Medicine?
I go through the content of all the Oakstone journal clubs—the ones that have anything to do with primary care medicine or hospital medicine. I pull out articles that grab my attention as being really interesting or really important. Then I rate them on a scale of 1 to 5. The ones that have the highest ratings, I use as content for my segment.
Q: How do you prepare to lead Allina Medical Group’s journal club?
In the process of doing research for the segment, I create this document with 70 to 100 of the best articles with the reviewers’ abstracts and critiques of each article. I share those with the docs in the club.
Q: What else might be done to help us with information overload?
Electronic medical records create very searchable data. At the clinic level, we’re being tracked for patients who have an A1c less than 7, blood pressure that’s under control, lipids that are under control, and we get score cards. It does change behavior, but it’s primitive. Third-party payers are working on logic rules for analyzing medical claims data. These include rules that grade or measure a physician’s quality. I’m working on a project called ASAP, Automated Self-Assessment Program, that would use this data to point out what physicians don’t know they don’t know. The idea is to close the loop—to take the data these rules generate and create a profile for each individual and feed print, audio, or video information to that individual to address their learning needs. The idea is to create a curriculum for you as an individual. I think this is the next big wave for CME. But right now, it’s a pipe dream.
Q: What else is on the horizon?
One idea we’re working on is doing something similar to what happens when you shop online. If you order a CD, a message will pop up saying ‘Buyers who bought this also bought that.’ The idea is to do the same thing as it relates to the interests of physicians. If you search for a term, you can pull up what you get in the search engine but also pull up related items. Another way to do this is for the person to choose from a list of terms that he or she would like to have monitored and have print articles, MP3 audio downloads, video downloads, or any combination sent to their iPad, smartphone, or even emailed to them.
Q:What advice do you have for busy physicians who are trying to stay current?
Use electronic medical references, and be aware of new products coming out that will be helpful in meeting your information needs without taking time way from your work or home. For a physician, time is your only salable commodity, and it’s your most limited resource. Things that save time are critical.