Tuesday, May 5, 2015

Month 4/12 of "21 Days to Expert Enough": Journals

     Every project I've undertaken this year has resulted in little breakthroughs in efficiency and knowledge, and April was no different. The process of reading 21 journals last month revolutionized the way I think about and read journals, and will forever influence the way I continue my medical education.

    First, an overview: I read 7 issues of the American Family Physician, 6 issues of Family Practice News, 2 issues of Consultant, 2 issues of The New England Journal of Medicine, 2 issues of PracticeLink, 1 issue of Journal of the American Medical Association, and 1 issue of Kansas Family Physician. Below are my thoughts on each one, and my overall takeaways from the month.

American Family Physician
     The AFP is the peer-reviewed bimonthly journal of the American Academy of Family Physicians. I found the their articles, which consist mainly of review articles on the diagnosis and management of fairly common conditions, to be the most helpful to my day-to-day practice. I even photoscanned into Evernote the tables I found most helpful, which was a neat little breakthrough in efficiency. Prior to this functionality of Evernote being available, I would either tear out a page to be filed somewhere I would never see again, or laboriously type out or dictate a summary in an Evernote document, which never looks as good as a table and can be harder to find later. This is something I plan to continue in the future, with not only the AFP but other useful tables I come across.

Family Practice News
    FPN, which is a free bimonthly independent newsletter that all residents here somehow have started getting, turned out to be a surprisingly readable publication with many interesting articles. All articles are fairly short, and most chronicle new developments in various areas of medicine, including Rheumatology, Dermatology, Endocrinology, Nephrology, Pulmonology, and Pediatrics. I found Neil Skolnik, MD's "Clinical Guideline" article each issue the most practical, though there were many other good ones. However, some of the articles are simply irrelevant to family physicians, and the overall quality of articles is lower than most of the other publications I read. In the future, this will be a great publication to quickly skim every couple of weeks when I pull it out of the mailbox.

     Consultant is a monthly independent subscription-only peer-reviewed publication that focuses on case presentations. My former roommate had a subscription to this journal, and I took his back-issues off his hands when he moved out a couple months ago. We still get his new issues in the mail, too. Each article has over 20 articles that highlight interesting cases, as well as a few expanded review articles on the management of certain conditions. When I started reading these articles later in the month, I was struck at how this format stimulated my brain in a different way than did the AFP review articles, as I tried to solve each case and think of what I would do next in similar situations. One of the most important things I learned this month was how important it is to continue to stimulate yourself to think along these lines; the formulation of a broad differential diagnosis and a good working knowledge of the work-up and management of certain conditions is a central but often- neglected aspect of medicine. I'll keep reading this one.

The New England Journal of Medicine
     Widely considered to be the premier journal in American medicine as well as one of the top journals worldwide (along with the U.K.'s The Lancet), NEJM is an editorial- heavy and primary research- heavy bimonthly publication with an unabashed statist / liberal slant. I have a big stack of back-issues on my shelf, also obtained from my former roommate during his exodus. My favorite articles each month are the in-depth case reports and the image challenges with subsequent case descriptions. Though I disagree with some of their editorials, they are all well-written and are generally thought-provoking, so I also usually benefit from reading them. It's easy to quickly skim the abstracts of the original research articles and glean the take-homes of each publication without delving into any of the details, which is what I suspect most readers do-- especially those of us who aren't sub-specialists, actively involved in research, or preparing for a presentation. In the final analysis, the benefits listed above probably aren't worth the hefty annual subscription fee, so I'm just going to keep working through back-issues for now.

Journal of the American Medical Association
     Similar to NEJM, JAMA is a widely-respected peer-reviewed editorial- and research- heavy bimonthly statist / liberal publication. I enjoy their clinical challenges, and it's also nice to skim through the abstracts to see what new developments are coming down the pike. It turns out my free subscription just ran out, however, but I have a lot of back-issues to go through. Although it's nice to stay current with with the state of original research, I probably won't miss it when it's gone.

     A free quarterly publication focused on helping residents and graduates find their dream job, PracticeLink is chock-full of helpful job search tips and perspective. Certainly worth a read at this time in my career, and something I'd recommend to any and all current residents.

Kansas Family Physician
     The quarterly publication of the Kansas Academy of Family Physicians, this publication focuses on local news, and the issue I read only had one clinical article-- on breastfeeding, which I skipped because it looked boring. Though nice to see photos of familiar faces, it's one I probably won't even waste time flipping through in the future.

     To sum up, I enjoyed getting in the habit of reading a few articles before I go to bed every night, and really benefitted from the opportunity to critically evaluate the pros and cons of each journal that hits my mailbox. I now clearly divide articles into ones I benefit from (clinical reviews, case presentations, and certain editorials) and ones I should skip (most original research, specialty articles, and most political / statist editorials). In addition to journal articles, I constantly read Medscape and New York Times articles I get via email, and have done so for years now. I've also made a habit out of listening to Audio Digest lectures via cd or the Audio Digest app whenever I'm in the car, which has been of huge benefit to me. The topics I benefitted the most from were ones which I read or listened to with the intent of teaching, so I hope to eventually make this my default mindset with everything I read.

     As I look toward to future, I'm excited about increasing my efficiency at going through articles, ultimately via Litz, which is a speed-reading app I recently purchased which I hope will soon be compatible with the online versions of many of these journals. I also hope to use it to speed-read some books next month, as I try to plow through 21 books in 30 days-- but more on that next time. Right now, I'm switching gears and starting to think about building a website, which I've never done before. Does anyone out there have any helpful tips or resources on how to do this? I would appreciate anything you could send my way. Hopefully by the end of the month, I'll have a hot, fresh link for you all to feast your eyes upon!

     Until then, keep climbing.