At the close of my first year in fellowship, a co-fellow opened a packed cabinet behind her desk, and untold volumes of methodically annotated medical articles burst forth. Impressed not only by her diligence but also by the sheer volume of paper, I made a mental note to read more and to read more efficiently. I wanted an organizational strategy that would allow me to track my professional learning in a manner that was automatic, accessible and portable. Hopefully, when my turn came to finish fellowship, pack up my belongings and move across the country, I wouldn’t lose all my hard-won knowledge to the recycling bin.
After continued work on this problem, I teamed up with Mike Putman, MD, a rheumatology podcaster who also takes reading the literature and organization seriously, to share some of our top tips.
Physicians consume an extraordinary volume of information, but both of us initially did so haphazardly. An attending would hand Mike a paper to read; Mike would desperately scribble notes in the margin and cram it into his packed, white coat pockets, later dropping it into the shred bin with mountains of protected health information. A co-fellow would quote a recent NEJM article, and I would wish that I too had read it. Both of us have dug through PubMed for hours, trying to find that perfect citation that we knew we had read but simply could not find again. Fellowship is busy and neither of us had time for that kind of stress.
There is no perfect system, but a few general principles can help you realize your goals to read more and read more efficiently. A good system automatically scours the literature for new and relevant papers. A good system captures the necessary information, whether it be from your favorite attending, your journal of preference or an article a friend emailed you. A good system lets you annotate efficiently and stores your hard work in a readily accessible location. And a good system is made of up good components. Here are a few we recommend.
These [programs] build an easily accessible library that never crinkles, picks up coffee stains or accidentally finds itself inside a shredder.
Whatever system you devise, we recommend having one that automatically searches the medical literature and delivers papers directly to you. One option is through the National Center for Biotechnology Information (NCBI), which maintains PubMed and allows you to create an account with custom searches that generate daily, weekly or monthly summaries, according to your preference. As a fellow, I have set up alerts for articles that have been published by faculty at my institution. It’s a great way to effectively learn from your mentors, and impress them by showing you’ve read their most recent paper.
For those who prefer a mobile option, Mike runs all of his searches through the QxMD app. This free application allows you to follow medical specialties, specific journals, keywords and even curated lists of publications. It will link to your institution, so you can get hard-copy PDFs delivered straight to your phone. You can save relevant articles to your own collections and share these with co-workers or journal clubs. It can also send regular email alerts with suggested articles and links to your social media accounts for easy sharing.
For those who prefer to multitask, podcasts offer a great option for your morning commute or afternoon run. Rheumatology-specific podcasts have proliferated over the past several years and offer a great place for a trainee to start. They present short, easily accessible dialogues, and the creators spare you the work of finding or critiquing important articles. Podcast aggregators, such as Overcast and Podcast Addict, make it easy to subscribe to new podcasts and organize your listening. Some of our favorite rheumatology podcasts include The RheumNow Week in Review, Rheuminations and The Evidence Based Rheumatology Podcast run by our very own Mike Putman. NEJM This Week, JAMA Clinical Reviews, and Annals on Call can also help keep your general internal medicine knowledge sharp.
Finally, such platforms as Twitter can be powerful tools for staying abreast of new research and relevant topics in healthcare (see our article “Tweet to Target”). Some of our favorite follows include Healio Rheumatology (@HealioRheum), and Rheum Journal Club (@rheumjc), which hosts a monthly discussion of recent studies from the rheumatology literature. NEJM, JAMA, The Lancet and other major medical journals also have Twitter accounts for general medicine content. Even more than podcasts, Twitter allows for a highly curated feed, where you receive information from your favorite sources as soon as it arrives.
Organizing Your Library
With the powerful tools above, collecting information occurs naturally. The real challenge becomes deciding which articles to read and how to organize all those papers.
Unfortunately, none of the aforementioned services allow you to take notes that can be accessed later at your convenience. Google Docs and Evernote both function beautifully in this capacity, allowing you to save papers and take notes for later. Both services offer web-based applications that can be accessed from home and work. Neither, however, offers the ability to transform your newfound library into publications.
For an all-in-one solution, both of us recommend a citation manager, and we prefer EndNote or Zotero. Both services allow for annotations on the papers themselves, have powerful search features and let you cite directly into MS Word when writing your own papers. Zotero also supports Google Docs for those who prefer to use its online suite of tools. The programs can build a bibliography to the specifications of your target journal and allow you to make collections so you can keep research projects or reading lists separate. Most importantly, these build an easily accessible library that never crinkles, picks up coffee stains or accidentally finds itself inside a shredder.
We hope you’ve found these tips and tools helpful. A combination of these resources has helped us build evidence-based practices. Experiment with different options and share what you find with us. We’re always looking for better ways to streamline our workflow and get the most out of our valuable years in fellowship.
Tyler Williams, MD (@TylerWilliamsMD), is a second-year fellow at Cleveland Clinic and current chair of the Fellows-in-Training Subcommittee. He is interested in value-based care and will start his career with Intermountain Healthcare in Utah at the completion of fellowship.
Mike Putman, MD (@EBRheum), is a second-year fellow at Northwestern University and a member of the Fellows-in-Training Subcommittee. He is pursuing large vessel vasculitis research on a T32 training grant and hosts the Evidence Based Rheumatology Podcast. He is originally from the Chicago area and enjoys spending time outdoors with his family.