As an internal medicine resident, your days are filled with morning rounds, daily progress notes, admission order sets, and procedures. So, when do you have time to continue to learn and keep up with medical research? Will you need to know about updates to the Surviving Sepsis guidelines as an oncology fellow or learn about PCSK-9 inhibitors as a future hospitalist? In medical school, your professors gave you a syllabus that defined what you needed to know. But, as a practicing physician, staying well-informed and current with the medical literature is different. The number of journals and types of formats for receiving information keeps growing. It can be daunting to figure out where to start.
Recently, NEJM Resident 360 hosted a discussion about keeping up with the medical literature. Panelists included clinicians, research fellows, medical librarians, and a researcher/entrepreneur. In this blog post, we summarize the advice shared in this discussion, provide an overview of the most important factors to consider when developing a strategy for keeping up with the medical literature while in residency, and highlight a variety of resources to help keep you informed.
Sign Up for Electronic Table of Contents (eTOCs) Emails
With thousands of journals, you can’t possibly read every one. Sign up to receive electronic table of contents (eTOCs) for a few journals. Top journals in internal medicine include the New England Journal of Medicine (NEJM), Journal of the American Medical Association (JAMA), The Lancet, the British Medical Journal (BMJ), and Annals of Internal Medicine. If you are interested in a specific specialty, pick one or two of the top journals in that field where practice-changing trials are likely to be published. If you do not know the top journals in the field, ask a fellow or attending or look for a journal affiliated with the main specialty society. Every week, read through the article titles in the eTOCs, pick two to three abstracts from each journal to read, and then read in full the one article that you think could impact your practice.
Subscribe to Journal Digest Emails and Alerts
An email inbox with dozens of flagged eTOC emails is today’s equivalent of the stack of paper journals piling up on your mentor’s desk. Instead of signing up for more eTOCs than you have time to read, consider subscribing to a literature surveillance service such as NEJM Journal Watch that provides synopses and commentary on recently published articles. Some of these services require a paid subscription but your residency program or hospital might help defray the cost. The discussion participants also suggested Medscape and EvidenceAlerts. If you want some levity, The Scope is a weekly e-mail service that summarizes research in internal medicine in an accessible and humorous way. Shop around, find the format that works for you, and then prune your subscriptions until you reach a manageable volume.
Social Media, Podcasts, Videos, and Visual Abstracts
Increasingly, medical journals are creating content in other formats than the traditional print or online text. Many of these formats are available on social media. Some examples include:
Twitter: You might get your news from Twitter, but can you use it to keep up with the medical literature? Yes! Checking the trending research studies on Twitter is one way to identify the most important published research each week. Follow @NEJM and other journals on social media to keep up with what’s new. Often experts and other clinicians engage in discussions about the merits and impact of a research study on Twitter, making it a live, impromptu journal club!
Podcasts: Many journals, including NEJM and JAMA, provide audio summaries of their journal content with weekly podcasts. Other podcasts suggested by the discussion panelists include PodMed from Johns Hopkins and The Rounds Table from Canada. Subscribe and listen to these while commuting, exercising, or cleaning your apartment. If something catches your interest, follow up by reading the article later.
Videos and Visual Abstracts: NEJM Quick Take videos are two-minute videos that summarize a new original research article each week. The use of visual abstracts and infographics that display key findings from a research article is a growing trend on social media. Both videos and visual abstracts that are highlighted on social media can help you decide which papers you want to read completely. Although these visual tools do not capture the nuances of a research article, they can help you stay current.
Apps: If you have a smartphone, some apps could help you keep track of research studies. The discussion panelists suggested BrowZine, Read by QxMD, and an app called Journal Club that provides hundreds of searchable journal articles with summaries. Tools such as Pocket and Instapaper allow you to save articles for later reading.
Start a Journal Club
Another way to make sure you (and your colleagues) stay engaged with the medical literature is by starting a journal club. NEJM Resident 360 hosted a discussion and Expert Consult blog post about how to start your own journal club. A successful journal club begins by choosing an important research article that is relevant to the audience and could change practice in your field. Recruit interested residents, and make sure they read the paper in advance. Invite a faculty mentor who can support you and provide their expert opinion. If possible, provide food (breakfast, lunch, or dinner) to encourage attendance. Journal clubs are fantastic opportunities to learn how to evaluate medical literature and review related guidelines at the same time.
Review the Fundamentals
In this post, we focused primarily on how to keep up with new medical research articles as they are published. But, if you need a refresher or feel unfamiliar with the landmark papers that provide the foundation for clinical practice in your field, spend some time in the Rotation Prep section of NEJM Resident 360 where we provide links to landmark studies, high-yield review articles, and clinical guidelines for many topics in each rotation. Rereading the randomized trials from the 1990s or early 2000s can help you understand how the field has evolved and arrived at the current clinical questions. You can unlock Rotation Prep content on NEJM Resident 360 by using an individual or institutional subscription to NEJM, NEJM Journal Watch, or NEJM Knowledge+. If unlocking with an institutional subscription, you may access Rotation Prep from any location and on any device after the initial sign-in from your school, library, or hospital.
As a busy resident, finding time to sit down and review the material you have selected is undoubtedly the hardest part of keeping up with the literature. Think about how you can maximize your time; perhaps read NEJM Journal Watch while sitting on the train or bus to the hospital, listen to podcasts in your car, watch a NEJM Quick Take video while waiting in line at the grocery store. Reserve one hour per week on your calendar to read the trending articles on Twitter. This time is precious but well spent.
Rebecca is a 2016-2017 NEJM Editorial Fellow and a hospitalist at Massachusetts General Hospital. She graduated from Columbia University College of Physicians and Surgeons in 2013 and completed internal medicine residency at Massachusetts General Hospital in 2016. Her interests include medical education, quality improvement, patient safety, health care delivery innovation, and teaching value in health care.
Ramya Ramaswami is a 2016-2017 NEJM editorial fellow. She is a medical oncologist within the National Health Services of the United Kingdom. Ramya received her medical degree, postgraduate medical and oncology training from Imperial College London, and a masters in public health from Columbia University, Mailman School of Public Health. Her clinical and research interests include cancer prevention, viral driven cancers, as well as disparities and access issues in global oncology.