Information Overload: Fighting the Tide to Stay Up-To-Date in Emergency Medicine at RCEM15

Editor's Notes

1. 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.
2. 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.
3. 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 since 2003 and that 1% of those 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. PMCID: PMC1250328
4. 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 since 2013 and that 1% of those 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. PMCID: PMC1250328
5. 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 since 2013 and that 1% of those 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. PMCID: PMC1250328
6. 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 since 2013 and that 1% of those 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. PMCID: PMC1250328
7. 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 since 2013 and that 1% of those 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. PMCID: PMC1250328
8. 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.
9. Traditional Journal Club 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.
10. Thorough critical appraisal, people you trust and can quiz and argue with. Get to make up your own mind and translate to your practice.
11. Usually one paper per week at most. Many EDs don’t have journal club at all. Attendance, frequency, volume.
12. Alerts, TOCs, First Watch etc PubMed alerts – tell it how often to email you with the titles and/or abstracts of articles in journals you’re interested in. NEJM alerts (First Watch) TOCs from individual journals (librarians can help)
13. Get it all when it’s published electronically. Have it all in one place (your inbox).
14. You have to choose the right journals. No control over timing. No access to the full article if behind a paywall.
15. Online Review (LITFL R&R, Critical Care Reviews) Collaboration of clinicians scouring the literature to highlight interesting and relevant articles with a mini-appraisal and a link.
16. Quick and easy access to relevant papers with a first level filter.
17. Numbers of actual papers still small – weekly (6 this week). Only minimal review so still have paywall issues. Some are critical care focused (not necessarily a bad thing)
18. RSS Feeds You sign up to an aggregator eg 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
19. Get it all Sort, save, share Access it when the time is right for you
20. Can be overwhelming, sterile Impersonal, you still need to do the appraisal part May still have access issues if behind paywall
21. Online Critical Appraisals (SGEM, EMLitofNote, St Emlyns, PEMLit, Resus.Me, TheBottomLine Various FOAM sites pick out relevant articles and appraise them for you. Different approaches between them.
22. Overcomes some of paywall problems – more of paper shared than just abstract. Journal club feel (you may be able to contact the blog authors to get the paper), comments and discussion welcome
23. Appraisal not totally objective Still need to read article
24. Twitter People you follow tweet links to interesting articles they’ve found – and may discuss the impact in real time
25. Conversation happens Real time review Rapid response (may even include authors of the paper)
26. It’s twitter! Restricted to 140characters. You may need to be obsessive about your timeline to ensure you don’t miss anything. Quality depends on who you follow (and what else they tweet)
27. The answer? 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.
28. Lots of info out there Social media and FOAM can help
29. But you have to know what you want and what works for you
30. One size doesn’t fit all – find something that suits you