Throw away your backlog of unread journal articles! It is surprising advice to be given at a seminar on evidence-based medicine, but this is what Jonathan Underhill, head of evidence-based therapeutics at the National Prescribing Centre, thinks pharmacists should do.
At the European Association of Hospital Pharmacists 2011 congress held in Vienna, Austria, from 30 March to 1 April, he asked members of the audience to raise their hands if they had a “guilt stack” — a pile of unread papers that they hoped to get around to reading. Nearly all of the hundred or so people in the audience raised their hands. But how come he did not suggest that they get their heads down and start reading?
An impossible task
The first reason is that, with so much evidence being published, it is impossible to keep on top of it all, said Mr Underhill. He explained that there are about 40,000 articles published every week. Even when the articles that are not relevant (ie, those without patient-oriented outcomes) are filtered out, there are still thousands left.
In fact, according to Mr Underhill, there are so many that, if a person took 15 minutes to read each article and read for 10 hours a day and six days a week, he or she would be four weeks behind in his or her reading at the end of the first week, four months behind after the first month and five years behind after the first year. It is no wonder that many clinicians feel overwhelmed by the scale of the task!
This sentiment was echoed by Ana-Christina Ribeiro Rama, who is medicines information manager at Coimbra University Hospitals, Portugal. “It is a paradox because now we have so much information that we cannot get the information we need when we need it,” she said in the same session.
In addition to the volume of published research, there is also the problem of understanding the context of all the evidence. Mr Underhill believes that it is not particularly useful to read just one article: “If you have just read that paper, then you have just read that paper. What you need is . . . an evaluation of that paper in the context of the rest of the evidence — what has come before and after.”
Another challenge is having the skills to analyse critically the articles in peer-reviewed journals. “In our experience, people who see patients are not very good at critical appraisal because they don’t do it often enough,” he pointed out.
It is important to accept that you cannot know everything. Dr Ribeiro Rama suggested that pharmacists should spend time identifying their areas of specialism so they can better focus their efforts in keeping up to date.
For those topics that do not fall within the areas identified, she believes pharmacists need to get used to the idea of thinking: “I don’t know and I don’t care.”
Use your time wisely
“You haven’t got days and days to be able to dedicate to staying up to date,” said Mr Underhill. In fact, he proposed, most clinicians have about one hour — at most — each week to spend updating their knowledge. So how do you make the best use of this so-called “golden hour”?
He recommended that clinicians should each adopt their own method of staying up to date effectively and efficiently, and suggested using an internationally recognised concept called “information mastery” to help them do so.
Information mastery traditionally incorporates two techniques: foraging and hunting. He described foraging as “a method of being alerted when new relevant information is published. . . . It [is] being pushed out to you filtered for your own development, for your own field.” Subscribing to email alerts, such as those from the NPC or the National electronic Library for Medicines, is one way of doing this.
Foraging for information is complemented by hunting, which is used when a clinician needs to find information. All healthcare professionals should have a method they use to get the best answer quickly using a variety of sources, starting at the top of the hierarchy of evidence (eg, Cochrane reviews) and moving all the way down to individual studies or case reports when the more robust sources of evidence are not available.
Hot-synch your brain
To these two techniques, Mr Underhill suggested adding a third called “hot-synching”. He likened it to plugging an iPod into a computer to be updated. “Hot-synching is making sure your brain is synchronised . . . with the latest evidence.”
It is about identifying the key conditions that you see commonly and checking that your approaches for managing those conditions still match the best evidence. Hot synching seems to be more focused than foraging (where information about a variety of conditions is pushed to a recipient) and more general than hunting (where you are finding an answer to a specific question).
So, how does one start hot-synching? There is no set way, according to Mr Underhill, but he suggested reading “pre-digested” sources of evidence — like review articles or clinical guidelines — rather than focusing on original papers in journals. These predigested sources, he said, should have no product-specific or commercial interest, they should have a published methodology, should translate evidence to practice and should provide advice in the context of the evidence that is available.
For each topic that a pharmacist identifies as a core area of practice, he or she could hot-synch about once every six months, Mr Underhill recommended. So go now and throw away your “guilt stack”. Replace it with planned and focused hot-synching to ensure you make the best use of your precious golden hour.