June 01, 2006
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Staying up-to-date with the clinical literature: an attending’s perspective

Despite the widespread use of electronic resources, attending endocrine physicians feel that they are not able to stay up-to-date.

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Physicians providing clinical care struggle to remain up-to-date with the best in clinical practice. The fund of medical information is expanding at an astounding rate and the number of sources of information increase daily.

At the same time, physicians comment on the decreasing amount of time available to keep up with the clinical literature. Physicians in practice struggle with the increasing load of insurance and regulatory work. Physician researchers struggle with the need to balance staying up-to-date in their research area, as well as clinical medicine, while also balancing the increasing regulatory pressures from human and animal review boards and the number of grants submissions required to obtain funding with the decreasing National Institutes of Health budget.

In 1980, Stinson and Mueller interviewed 402 randomly selected health professionals to obtain information about how they stayed up-to-date with medical information. Only 7.7% of those interviewed were physicians. Use of medical literature was the leading source to stay up-to-date. Additional sources for updated medical information included discussion with colleagues, followed by attendance at local and national meetings and courses.

In 1996, Smith summarized the findings of 13 published studies on how to manage clinical information. The majority of the studies were focused on general practitioners. Several common themes were demonstrated by these studies. The need for medical information updates most commonly occurred while physicians were seeing patients, and Smith estimated a minimum of one clinical question generated by each patient visit. He recommended the development of new electronic information tools.

In 1999, Laine and Weinberg published recommendations on staying up-to-date. They commented on the dual need to remember already acquired medical information coupled with the need to learn new medical information. They recommended first making a personal definition of what it means to stay up-to-date. They also discussed the importance of allotting specified time for this activity. They then discussed various tools physicians can use to stay up-to-date.

A publication by Wyatt and Sullivan from 2005 discussed the difficulty of physicians staying up-to-date with the clinical literature. This paper advocates updating medical information in the “workplace” at the time when questions arise, preferably through information technology.

The majority of papers published on staying up-to-date have been based on surveys or, primarily, general practitioners. Some studies have included specialists but they have not been analyzed separately.

Given the complexity of staying up-to-date, we performed a pilot study on how endocrine attending physicians at three academic institutions stay up-to-date with clinical information and what recommendations they have for endocrine fellows to stay up-to-date.

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Endocrine attending physicians

Electronic questionnaires were sent by e-mail to 48 endocrine attending physicians who were serving on the endocrine consult service from July 2005 through June 2006. The response rate was 75%. All respondents felt that it was important to stay up-to-date with the clinical literature in endocrinology. However, 64% felt that they were not able to stay up-to-date.

The primary reason that endocrine attending physicians gave for why they were not able to remain current was that they did not have enough time. The three most common sources of information used were electronic evidence-based topic reviews, endocrine journals and advice from other attendings. All but one endocrine attending subscribed to at least one medical journal. The most common journals subscribed to were the Journal of Endocrinology and Metabolism followed by the Journal of Bone and Mineral Research.

The distribution of what attending physicians felt fellows should use to stay up-to-date was similar to what they indicated they were doing to stay up-to-date themselves.

The most common time and location for reading clinical update material was at home in the evenings, followed by at home on the weekends, whereas at work was the least common location.

Similar to the findings of Stinson and Mueller more than 25 years ago, the two leading sources of medical information remain the medical literature and information elicited from colleagues. Despite the information from Smith that the need for clinical updates occurs most commonly during the patient encounter, attending physicians most commonly update their clinical knowledge outside of the work setting while at home.

Unfortunately, despite the development of many well-developed electronic medical information systems since 1996, endocrine attendings still commonly feel overwhelmed with keeping up-to-date. Laine and Weinberg emphasized the importance of allotting designed time to keep up-to-date. However, endocrine attendings felt in 2006 that they did not have this time available to them.

Furthermore, the suggestion of Wyatt and Sullivan that getting updated on the medical literature should occur in the workplace setting, the majority of this activity is occurring outside of the workplace setting. The pressure to see an increasing number of patients in a limited amount of time is at odds with the perceived need to be able to find clinical updates while seeing patients.

Possible solutions

Despite the widespread use of electronic resources, attending endocrine physicians feel that they are not able to stay up-to-date. Since clinical questions most commonly occur when seeing patients, one solution would be to have time built into patient schedules to allow for literature review.

It would be important to determine whether such a strategy would improve patient care and potentially reduce costs by decreasing the ordering of unnecessary laboratory and other diagnostic testing. If such a strategy were effective, it would be important for medical insurers to reimburse for literature review time.

For more information:
  • Ellen W. Seely, MD, is Director of Clinical Research, Endocrinology, Diabetes and Hypertension Division, Brigham and Women’s Hospital. She is also a member of Endocrine Today’s Editorial Advisory Board.
  • Stinson ER, Mueller DA. Survey of health professionals’ information habits and needs. JAMA. 1980;243:140-143.
  • Smith, R. What clinical information do doctors need? BMJ. 1996;26:1062-1068.
  • Laine C, Weinberg DS. How can physicians keep up-to-date? Ann Rev Med. 1999;50:99-110.
  • Wyatt JC, Sullivan F. Keeping up: learning in the workplace. BMJ. 2005;331:1129-1132.