Keeping Up With the Literature: New Solutions for an Old Problem

Abstract

Pharmacists utilize medical literature to provide evidence-based care to patients. However, staying up to date with current literature can be challenging, especially with the increasing number of publications produced in a growing number of journals. While evaluating literature is a standard in pharmacy education and training, the specific skill of keeping up with the literature is often not included. We explore the following 5 strategies to help pharmacists stay up to date with the literature: medical journals, social media, podcasts, teaching/precepting, and continuing education/board certification. Pharmacists are encouraged to evaluate which tactics fit best into their practice and incorporate them into their workflow, as well as routinely reflect on the system they create and continue to modify as needed.

Clinical pharmacists improve patient outcomes by providing direct patient care based on their drug knowledge, communicating said knowledge to other practitioners, and using their knowledge to improve systems of care. ¹ All these activities require pharmacists to keep up to date with the medical literature to be able to provide evidence-based care to patients. The difficulty of keeping up with the medical literature has been discussed since the 1950s.^2,3 The specific need for pharmacist to keep with the literature and to have a strategy to keep up with the literature has been written about since the 1970s.^3,4

Keeping up with literature is not easy. It is mentioned as a top challenge for medical residents. ⁵ In the 1950s with 3000-6000 scientific journals, it was considered difficult to keep with the literature.^2,3 Methods of keeping up with the literature have changed from 1950s methods of handwritten notes and use of Index Medicus. ² In 2017, 2.5 million medical articles were published, a number that doubles every 7 years. ⁶ Randomized controlled trials and systematic reviews in a topic area are published in up to 800 different journals per year with a rate of up to 7 new articles per day. ⁷ The number of medical journals is also doubling every 20 years. ⁸ With this avalanche of new information, it can be difficult to determine a strategy to keep up. Although being able to evaluate literature and provide evidence-based care are part of the ASHP PGY-1 Residency Objectives ⁹ and the AACP CAPE outcomes ¹⁰ for PharmD graduates, the skill of keeping up with the literature is not included. However, with innovations in technology and advancements in resources for pharmacists, several opportunities now exist for obtaining and evaluating literature. We will provide guidance for pharmacists to help keep up with the literature by outlining 5 strategies: journals, social media, podcasts, teaching/precepting, and continuing education/board certification.

Medical Journals

Medical journals are the mainstay of medical research; however a thoughtful approach must be taken in retrieving relevant publications. One method is to determine pertinent journals to your practice area and select to have new issues alerts emailed to you that provide the table of contents, also known as electronic table of contents (eTOC) alerts. ¹¹ The most persistent journals are often published by professional societies, or you can search for high impact (average number of citations) journals in a specific area. Pharmacists can quickly scan the titles to determine relevant articles to add to their reading list. Abstracts can also be reviewed before a final reading decision is made. Additionally, multiple databases and search engines, such as PubMed (National Library of Medicine; Bethesda, MD) and Google Scholar (Google, Mountain View, CA), provide customized alerts for users. Users identify specific topics or keywords and then are automatically emailed when articles meeting these criteria are published. Personal or institutional subscriptions are normally required to then access full articles. Pharmacists must be mindful that editing or tailoring the customized alerts may be needed to ensure they are receiving the most relevant information for their needs. In addition, pharmacists must evaluate these emails, whether eTOC alerts or customized alerts, and not simply delete or overlook them, as well as schedule time to read the articles they have selected, to benefit from this approach. A dedicated email address for these alerts may help to organize these alerts.

Social Media

Of the many social media platforms, Twitter has emerged as the most commonly used platform for keeping up with the literature.^12,13 Twitter is a text based social media platform that allows users to share messages of up 280 characters and interact. An examination of 1700 randomized controlled trials in orthopedics showed that 82% of the online mentions of these articles occurred on Twitter. ¹³ With randomized controlled trials in a subject area published in hundreds of different journals, ⁷ Twitter may expose pharmacists to some of these trials in journals that they are not actively following. Updates from medical ¹⁴ and pharmacy ¹⁵ conferences are also posted to twitter with the number of tweets per conference growing. In addition, Twitter is a method to keep up with preprints. ¹¹ Twitter has online journal clubs ¹⁶ where professionals interact with each other at a specified time by posting messages or responding to prompts about a specific journal article. Twitter journal clubs have been shown to provide more knowledge than traditional journal clubs and provided a journal club venue for practitioners without access to a traditional journal club or subject matter expert. ¹⁶

Podasting

Podcasts are audio recordings or interviews that can be listened on a variety of devices. There are pharmacy specific podcasts, ¹⁷ podcasts for different medical specialties ¹⁶ and most major journals include podcasts with each issue. ¹¹ Most high-quality podcasts also include a list of their references discussed for further study. ¹⁷ Pharmacists can seek out podcasts most relevant to their practice area. The majority of podcasts are not targeted at a specific level of learners, and are designed to be consumed by anyone from students to seasoned practitioners. ¹⁷ They provide an avenue for auditory learners to keep up with the literature. Podcasts can be listened do during other daily activities such as chores or commuting.

Precepting and Teaching

Many pharmacists precept pharmacy students and residents and can utilize learning activities with them to stay up to date with the literature. Most clinical pharmacy rotations require learners to review recent literature, whether through journal clubs, topic discussions, or other patient-care related activities. Preceptors can use these as opportunities to review current literature from their reading list. For example, preceptors may assign an article in their practice area to a learner for a journal club that was recently published or new guidelines are discussed in a topic discussion regarding how to manage a specific disease state. Preceptors can even consider other tactics, such as clinical debates, to meet the needs of the learners and introduce the opportunity to review new literature. ¹⁸ In addition, pharmacists who have formal teaching responsibilities, such as lecturing at a college of pharmacy, need to design and routinely update their materials. This includes evaluating new literature, such as guideline updates or clinical trial findings, to address in their presentations.

Continuing Education and Board Certification

Pharmacists are required to complete continuing education requirements for pharmacy licensure. Continuing education is designed to be a structured educational activity to support the development of pharmacists to maintain and enhance their competence. ¹⁹ To achieve this, there is a wide range of continuing education programming, whether at meetings of professional organizations or online seminars. Many of these integrate new literature by providing updates and new information regarding pharmacy practice and evidence-based care. There are often specific sessions on top papers in a certain area or that review new guidelines. Pharmacists should seek out opportunities to attend programming that is beneficial to their practice area. Additionally, pharmacists have the opportunity to become board certified by the Board of Pharmacy Specialties (BPS) in pharmacotherapy, as well as in specialized pharmacy areas, such as pediatrics or ambulatory care, if they meet certification criteria. ²⁰ Initially pharmacists must prepare for their board certification examination; after they have passed their exam, pharmacists have the option for BPS-approved programming for recertification credit. Pharmacists completing these activities have the opportunity to review new literature in their designated specialty.

The 5 strategies provide a variety of opportunities pharmacists can utilize for keeping up with the literature. Likely many pharmacists will find that a single tactic is not sufficient, but a combination of these strategies will best set them up for success. They should closely evaluate which strategies work best for their practice and how to implement them into their workflow. For example, some of the strategies, such as setting journal alerts and listening to podcasts, should fit into a repetitive routine. Whereas, attending continuing education programming requires planning ahead to fit these intermittent events into one’s schedule. Pharmacists should not get discouraged or overwhelmed when attempting to keep up with the literature. Importantly, pharmacists should reflect on the system they create and continue to modify it as needed.

Keeping up with the literature is not an easy task, especially with the significant increases in the number of publications in a growing number of journals. Pharmacists must be vigilant at staying up to date on medical literature to practice evidence-based care. The 5 strategies listed above can help pharmacists to efficiently accomplish this.