It began like any other journal club meeting. Anesthesiology residents were gathered in a Duke Medicine classroom to review the latest medical literature from their specialty: evidence-based research that might move the needle on treatment protocols and patient outcomes.
As the discussion on aspirin use in patients undergoing noncardiac surgery got underway, Ankeet Udani, MD, meeting moderator and assistant professor of anesthesiology, began reading aloud comments from thought leaders across the globe who had remotely weighed in via Twitter, as well as relevant tweets from clinicians participating in real time.
“We were looking for a way to augment the current classroom format using social media and realized that most medical students and residents are already using Twitter,” says Udani, co-creator of the Duke Anesthesiology Twitter Journal Club along with colleague Jeff Taekman, MD. “We wanted to provide a broad perspective for our residents of what people are doing in our field around the world.”
Topics for the quarterly journal club, drawn from recent studies and journal articles, are posted to Twitter 1 week before the in-person meetings, Udani explains, inviting clinicians, academics, and experts to contribute. The input they provide and the online comments sent in during classroom discussions are later organized and posted online, which sets the Duke Anesthesiology Twitter Journal Club apart.
“Ours is not the first online journal club, but we are unique because we moderate the online Twitter feed and curate the entire discussion to create an everlasting resource for all anesthesiologists,” says Udani.
Social media is among the many tools that clinicians are using to keep current in their field, a matter of critical importance to patient safety and the quality of care. In a 2014 survey by online medical network Doximity, 98% of physicians reported that reading medical literature was either “important” or “very important” to their practice, and 16% believed that staying current directly helped save the life of a patient in the last year.
But reading every published article is neither practical nor possible. Moreover, not all are relevant to every specialty, and some lack scientific validity while others are tainted by bias. To keep their knowledge base fresh, physicians must become adept at separating the wheat from the chaff or rely on resources that vet scientific literature on their behalf.
A good starting point is the medical guidelines from reputable professional organizations, which provide clinical recommendations regarding the diagnosis, management, and treatment of diseases, says family physician Bernard Sklar, MD. “Most doctors are guided by their professional organizations, each of which have their own set of competencies that they think doctors need to be updated on,” he says.
Most professional organizations also offer a subscription-based RSS feed, enabling physicians to automatically download relevant articles, and many peer-reviewed medical journals offer a similar service. RSS feeds appear as a series of headlines and summaries, enabling doctors to quickly locate content that matters to them.
To answer specific clinical questions related to patient care, the American College of Physicians suggests that doctors begin their literature search with a resource such as PubMed, a free online search engine from the US National Library of Medicine. The PubMed search tool allows users to create filters that help weed out irrelevant content. For example, the systematic reviews filter displays citations for systematic reviews, meta-analyses, reviews of clinical trials, and guidelines.
Mobile apps also help bring the current body of medical knowledge into the examination room.
Two commonly used apps are DynaMed (EBSCO, Ipswich, MA) and UpToDate (Wolters Kluwer, Boston, MA), both of which are evidence-based, clinical-decision–support resources that integrate findings from research studies. Docphin (New York, NY) and Read (QxMD, Vancouver, BC, Canada) also provide access to medical literature from a wide range of journals.
In addition, groups like Cochrane Library offer a collection of high-quality, independent evidence to inform health care decision making. Many medical organizations enable specialists to download clinical guidelines, white papers, and best-practice statements to their personal devices.
Facebook, Twitter, and Google+ offer yet another platform for keeping current as sites like Cochrane Library become active on social media. Blogs, including those from PLoS One, can also shed new light on evidence-based therapies. In addition, audio podcasts from influential medical journals and medical schools, including the New England Journal of Medicine and Johns Hopkins Medicine, can help keep practicing physicians informed about current medical news while delivering the added benefit of expert opinion.
Whatever tools physicians use to help keep pace with innovation, they must always evaluate the literature with a critical eye, says Brian Alper, MD, MSPH, a family physician and founder of DynaMed.
Threats to validity abound—some due to bias and some due to error. “It’s complicated how many different factors can bias our science,” says Alper. “You have to look at the details of how the research came together.”
The best resources are timely, trusted, and capable of condensing the complete body of medical literature into summaries useful to physicians at the point of care. “Health care professionals need the best information available to help guide their practice, and the information keeps changing,” says Alper.