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