Tips on Keeping Up on the Evidence

Earlier today, a resident commented that she just needed me to always be around to keep up on the evidence. While she was joking, it highlighted something that I have not been doing a good job of: showing you my tricks in staying up to date. I actually do not stay at home reading all of the journals. Even if I tried or wanted to, I would have three boys climbing all over me and a very unhappy wife! So how do I keep up to date? Are you ready for the curtain to be pulled back to reveal that it is all a scam? Well then, read on!

I don’t think anyone would find it surprising that my Mac and gadgets play a key role in all of this. Technology has really revolutionized medicine, especially in the area of EBM. Everything is at our fingertips, literally. Utilizing the technology in the most efficient manner is key. It is too easy to be overhwelmed by it all. I have found a system that works extremely well for me. 
Here are my tips for utilizing technology to stay up to date:

1. Utilize the Email Services:
There are multiple services that will email you synopsis of the recent journal articles in particular fields. I subscribe to several, and find them fantastic. The services I use provide a few lines of comments, and sometimes will even have a full commentary on a key article. The comments are often short enough to read while walking to a patient’s room or to the office. This provides me enough information to know whether I want to read the full article, or enough information to keep a mental note of the article if a case comes up related to it. 
The services I find most helpful are: 
a. Journal Watch: Can select which fields to get emailed about. I have about 5-8 fields selected. 
b. Physician First Watch: This is actually a part of Journal Watch. Honestly, this is not always as good as the topic based Journal Watch, but is is still useful.
c. NEJM: NEJM will send you their table of contents, which is nice, but more importantly they send special emails for key articles. These “online first” are often those articles that get the most press later on. 
I have a couple of other places that send me emails (SHM, AFP), but Journal Watch by far is the best.

2. Practice inbox zero:
Ok, so this isn’t actually a service, but it is probably the most important thing I do. Inbox zero is exactly what it sounds like: keep your inbox at 0. We all know how email gets stacked up, and before you know it your inbox is overwhelming. This is incredibly inefficient and creates a great deal of work for you. I am a strong believer of inbox zero.
The way it comes through in keeping up is that I don’t get the stack of medical emails that I plan on reading on a raining day. We all know that is never going to happen! As soon as I get a journal watch email, I read it. If it has an important article, I pull it right away. If there wasn’t an article that I need to pull, I’ll file it in a folder. The beautiful thing about the folder is that it is online, so it is fully searchable with my iPhone, Mac, or iPad. By reading through the email, I find that I retain just enough to be able to put in enough search terms to find it later if needed. You can spot when I am mentioning an article I never read, and only have a vague mental memory about it from reading the synopsis. I will typically say something like “there was just article published on that”, and not follow it up with anything more than some vague comments. The folder system makes it easy for me to pull it up while walking to the next patient, so before rounds even ends I’ve emailed the article. 

3. File the pulled articles in an online folder
You know how it is. You read a great article and feel confident you know the information well. One to two years later you have a patient encounter where you know the article would be really helpful. You remember enough to know you have the article, but not much more. By having all of the articles in a digital format in an online folder, you can access the article at any time. Macs have outstanding search features, so I just search for everything I can remember. I use DropBox to be able to access the folder with any device I have with me, including my iPhone.

4. Use Twitter
If you have never used Twitter, you likely have the wrong impression of it. While it can be used similar to facebook, it is also an amazing resource for keeping up to date on news. All of the major journals, organizations, and even giants in the field use twitter. I follow multiple organizations, journals, and a few doctors. Any cool article, presentation, or really anything is often tweetted about prior to the actual release of the article. It is an incredibly powerful tool. I also tweet about articles that I find, just to return the favor. I went into twitter a little apprehensive, but have found it outstanding. I would encourage you to look into it.

5. Use RSS Feeds
This is my final tip. I’m not sure how many of you are familiar with RSS Feeds. It is actually a little difficult to describe, so bare with me. RSS stands for “Really Simple Syndication”. It is a feed that has the bare bones of the webpage. The power in RSS Feeds comes in when using a RSS Reader. Through Google Reader (free), you can subscribe to multiple RSS Feeds. Every time something new is published on a site with a feed, it will let you know. You can use a reader on your iphone or iPod (I love Feeddler RSS Reader) or on your computer. When I open the app, it checks all of my feeds and lets me know if something new appeared. I can select just a specific journalist, specific journals, or blogs. The NEJM has a blog that is outstanding, along with some well known physicians (Bob Watcher: the father of the hospitalist movement). If you look to the right side of this blog you will see that I have set-up a RSS feed also. 

So, that is my secret. Reading through this blog, you will not find anywhere that I pick up a journal and read it. I find I do not have time for that. I use these services to screen the journals, then I select the articles I want to read. The summaries of the articles I file away incase I need them later, but that is about it. I would be happy to help any of you out with the technical side of things (folder filing, RSS Feeds, and even Twitter). Let me know if you have any tips that you have found helpful!