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How does Martin Izakovic, MD, medical director of the hospitalist program at Mercy Hospital in Iowa City, Iowa, suggest keeping current with medical literature?

“Let your journals pile up in your office, including the free ones you never subscribed to, feel guilty about throwing any away, tell yourself you will get to them one day, and then watch as it almost never happens.”

Dr. Izakovic is kidding, of course, but it’s no joke trying to read the wealth of medical information published daily. In fact, some people call it impossible. So to stay afloat, many hospitalists go electronic or turn to journal clubs.

Electronic Resources to the Rescue

It’s not for lack of trying that you can’t get through all the literature out there. Most hospitalists we queried say they only skim through the major internal medicine-related journals, including the Annals of Internal Medicine, the Journal of the American Medical Association (JAMA), The New England Journal of Medicine, Lancet, the Journal of General Internal Medicine, and the Journal of Hospital Medicine.

What really keeps hospitalists apprised of the latest medical news and research, they say, comes to them by way of the World Wide Web—straight to their inboxes. To start, many register for e-mails of journal tables of contents. Others subscribe to the American College of Physicians Journal Club, which reviews and critiques journal articles, rates the relevance of each article on a five-point scale, offers a customized literature updating service, and bundles mailings with the Annals.

Some physicians, like Leora Horwitz, MD, assistant professor in the division of General Internal Medicine at Yale School of Medicine, New Haven, only wish to receive information pertinent to specific topics. To make this happen, Dr. Horwitz sets up a search through Ovid or PubMed that runs about every two weeks and flags new articles that match her criteria.

“I only do this for absolutely key areas and I make the search criteria very restrictive so I only get one to two hits a month at most,” she says. “Then I set up an alert for one or two major articles in each field I am interested in.”

Dr. Horwitz also sets up alerts for her own published articles.

Hospitalists who work at academic institutions, in particular, are inundated with information via grand rounds, lectures, and formats for topics related to hospital medicine.

Team Hospitalist Weighs In

“I am pretty rigorous about organization now, but it’s taken me several years to get it down,” says R. Neal Axon, MD, assistant professor in the departments of Internal Medicine and Pediatrics, Medical University of South Carolina, Charleston, and member of Team Hospitalist (hospitalist editorial advisors for this publication). “Few things are more frustrating than not being able to find the fact or article you want to reference in a convenient way.”

Dr. Axon subscribes to several journals at his home address (a favorite is the Annals of Internal Medicine, particularly the “Update in …” sections) and to two journals relevant to his research area, hypertension. “Over the years I’ve become much more selective in what I read,” he says. He marks articles of interest and culls through a stack in his office at least twice a month.

Dr. Axon also subscribes to The Hospitalist (“most useful by leaps and bounds, and the ‘In the Literature’ section is better than ever”) as well as Today’s Hospitalist and ACP Hospitalist (“the MKSAP review questions are useful”), which he browses and tends to read at night with the TV on in the background.

In the “Fund of Knowledge” folder on his computer he’s created subfolders organized by topic (“for example, Pulmonary, Renal, GI, Heme/Onc, Peri-op, Research, and Statistics”) and he keeps PDFs of useful articles for teaching, research, and publication. He uses EndNote to organize his bibliography.

Also, “my partners are pretty good about sharing articles of interest with the group by emailing pdf’s, and everyone has their own interest,” says Dr. Axon. “For instance, one of my partners has a particular interest in perioperative medicine, and his institution’s CMO, Patrick Cawley, MD, SHM’s current president, tends to circulate articles on quality improvement and hospital management.”—AS

“We’ll take a list of top conditions relevant to our practice, to review as a working group and then take that to the rest of the group to decide how we’ll standardize care,” says Julia S. Wright, MD, director of hospital medicine and an associate professor of medicine at the University of Wisconsin School of Medicine and Public Health, Madison.

On top of setting up specific searches, many hospitalists use their institutions’ subscriptions to services such as:

  • UpToDate, the evidence-based, peer-reviewed electronic resource for doctors;
  • InfoPOEMs, Patient-Oriented Evidence that Matters from Essential Evidence Plus;
  • Epocrates and Micromedex, for drug-related information;
  • JournalWATCH;
  • The Medical Letter;
  • The Hospitalist’s “In the Literature” department; and
  • PubMed.

Physicians each have their favorite subscription services. Bill Stinnette, MD, a hospitalist for the Permanente Medical Group, Inc. at Kaiser Permanente San Rafael Medical Center in northern California, recommends MedPage Today daily headlines online as “an excellent source for breaking news and studies, with subspecialty areas, interactive features, FDA alerts, and CME.”

Kenneth Patrick, MD, hospitalist and ICU director of Chestnut Hill Hospital in Philadelphia, uses Medscape as his main online update method. After having completed a personalized profile of his interests, Dr. Patrick now receives e-mail links and general articles based on his criteria. “There’s no paper, it’s done at a convenient time and location, you don’t have to remember where you put that journal you were reading when you were interrupted, and there’s online CME credits,” he says.

Gatherings Become Informative Discussions

Despite enthusiasm about getting information electronically, many hospitalists continue to benefit from—and enjoy—good old-fashioned journal clubs. For example, the quarterly “Lunch and Learn” at the Hospital of St. Raphael in New Haven, Conn., developed by hospitalist Ilona Figura, MD, “has been a real hit,” says Steven Angelo, MD, director of hospitalist services there.

“On a rotating basis, each hospitalist presents an interesting case and leads our group in a discussion of the differential diagnosis, similar to what is done in the NEJM case presentations,” Dr. Angelo says. “At the end of the meeting, the presenter then provides the relevant points from the literature.”

Organization Tips

Now that you’re armed with several ways to retrieve information, how do you store and retain it? Below, a few tips from your peers:

1. Organize it in file folders on your computer. Most hospitalists we asked don’t use different e-mail addresses for electronic mailings, but instead separate e-mails by topic, body systems, or disease conditions. For example, Dr. Wright maintains a file on inpatient diabetes management. She also catalogs notes to keep track of what’s in each folder. “I’m a little bit compulsive,” she admits. “I love the learning, so I spend a lot of time with it.”

2. Discuss—even briefly—what you’ve learned. The hospitalists with whom Dr. Wright works are all sponges for knowledge; e-mail discussions within the group help them retain what they’ve read. Dr. Wright also posts on a board in the staff room any applicable data, such as updates in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial.

3. Retain hard copies of pertinent electronic information. When writing a specific paper, Dr. Horwitz prints out articles research-related articles and stores them in a file cabinet. Those are the only ones she prints. She downloads others electronically when she needs them. “I have a vague memory of which journal the ones I liked were in and then I just search again,” she says.

4. Ask a friend or peer. Some updates come simply by making an informal request. Remember Dr. Izakovic? He’s certainly not afraid to ask. “Let me know when your article is published,” he says with a laugh, “so I won’t leave it in a pile.”

Valerie J. Lang, MD, and her hospitalist colleagues in the division of Hospital Medicine at the University of Rochester (N.Y.) School of Medicine and Dentistry hold their own journal club twice a month. “We include the General Medicine division [their outpatient counterparts], which adds a nice perspective to our inpatient work,” she says.

Like the physicians at the Hospital of St. Raphael, these doctors also rotate topic selection and presentation. “For example, the last time [it was my turn], I presented a meta-analysis of DVT prophylaxis in medical inpatients along with a review of how to interpret meta-analyses,” Dr. Lang says.

The General Internal Medicine division at the University of Medicine and Dentistry of New Jersey in New Brunswick, where the four-person hospital medicine group (HMG) resides, takes a slightly different approach. The group has a weekly journal club, reviewing a month’s worth of four major journals, one per week, says Gabriela S. Ferreira, MD.

The Waterbury Hospital HMG, Waterbury, Conn., has its journal club once a month—at a restaurant. “One hospitalist presents an article, and then we eat and get drunk and have a generally good time,” says Rachel Lovins, MD, director of the hospitalist program.

When pressed about whether cocktail availability interferes with information retention, Dr. Lovins admits that’s the reason the presentations are made early in the evening. But she also backs down a bit: “We don’t actually get drunk but the social stuff is so important. It’s glue.”

Although the group totals 20 hospitalists, only a core group of six to 10 usually attends the dinners. Dr. Lovins makes sure everyone gets the pertinent information. “When I present an article, I always write up a summary page and hand it out at the meeting and also e-mail to the rest of the group,” she says. “But I’m a dork and no one else really does that.”

It’s All Timing

Sometimes it’s not about the method of receiving information, but about when and where you receive it. For example, when David Pressel, MD, PhD, director of Inpatient Service, General Pediatrics at Nemours Alfred I. duPont Hospital for Children in Wilmington, Del., encounters a patient with a new and different condition, he researches it immediately. “When learning is attached to a patient you see,” he says, “you’re more likely to cement that information in your mind.”

Dr. Wright uses a similar methodology. “I try to look up a couple of articles on every patient every day, with periodic reviews,” she says.

Other physicians, like Benny Gavi, MD, a hospitalist at Stanford Hospital & Clinics in California, print out articles of interest. “I take one or two articles in the pocket of my white coat to read when I have time, for example, when waiting for a meeting to start,” he says. “The pile is also near where I have lunch and I take an article when I eat.”

One hospitalist, who wishes to remain nameless, uses another time to get his literature scoop: at his daily poop, so to speak, during that block of time each day when he sits and reads. “Continuing education is a lifelong process and can happen anytime,” he says, whimsically. TH

Andrea Sattinger is a freelance writer based in North Carolina and a longtime contributor to The Hospitalist.

Reference

  1. Bennett, HJ. A piece of my mind. Keeping up with the literature. JAMA. 1992;267(7):920.

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