Staying Current

Photo credit: Chris Devers

Photo credit: Chris Devers

Hands down the most common question I field is this:

How does one stay current on the research?

The answer is easy. Read everything that has ever been published from cover to cover, analyzing the statistical accuracy of their findings and the true clinical significance of their conclusions. Hell, while you’re at it, you might as well also develop supernatural powers in order to look into the future and read all of the articles that are going to be published. What’s the matter you lazy piece o’ crap? Too BUSY?

Ok. So let’s try that. Let’s look at what was published on the ACL last year (2013). Oh. Only 1252 articles ON ONE FREAKING LIGAMENT OF ONE FREAKING JOINT!!! We are well over 1000 for this year (2014) already so you’ve got some serious catching up to do…

See if this sounds familiar:

“Come on! I REALLY need to stay current on the research.” Sets the most recent journals on desk in a “to-do” pile. Everyday you glance at the pile as you are running from one patient to the next. One month goes by and the next group of journals come in. Add them to the stack. Repeat for a while. When you get around to finally having a moment, the stack is huge and you give up discouraged. Going about it that way is just not going to work, at least not at first.

We are talking about a lifestyle change so let’s compare to another lifestyle change like diet. If you tried to go from unlimited gorging on snacks and junk food to nothing but celery (yuck) in one day, you would fail miserably. You will then see the endeavor as hopeless and give up. What you need to do is go easy on it. Set easy to reach goals and stick with them.

Here I bring you the Erik Meira Guide to Staying Current on the Research™!!! By using my system I guarantee that you will be able to spout off research at will so that you too can sound like a pretentious and pedantic jerk.*

*Guarantee neither real nor binding in any way

First, LET’S FIND SOME RESEARCH!!!!

Find 4 journals that apply to your practice

Your practice is unique to you. I can’t pick your four journals. There are plenty of physical therapy journals out there, decide which ones are most specific to your setting. But don’t just pick four physical therapy journals. I recommend that at least one (preferably two) is a medical or surgical journal. Do not become too insulated to the physical therapy viewpoint. As an example, if you are a sports PT like me, you might pick these four:

Another sports PT might pick four other journals that would be just as good. You may see more chronic pain, or workman’s comp, or just shoulders, or a ton of spine. Fit your journals to your practice.

Visit the website of one of those journals once a week

You already have four journals picked out. Take one and head to its website. I recommend that you do this at a set time each week. Maybe every Thursday during lunch. Or while you are watching Monday Night Football each week. Whatever you do, set a recurring time and stick with it. Don’t just say, “Whenever I have a free moment” – that ain’t gonna happen. Each week visit another journal site. After one month (four weeks), start over with the first journal which should now have a new issue. But what are you going to do on that website?

Read the titles of the articles in the current issue

A couple things to note here: Just read the TITLES of the CURRENT issue. Remember, go easy. Read those titles and they will usually give you the gist. So far I have asked for MAYBE five minutes of your time each week. (SIDE NOTE: Hey jerk! Yeah YOU! The one throwing the fit complaining about how little you can trust an abstract let alone a title. Shut your cake-hole. I’ll get to that. By the way: YOU are part of the problem, punk!)

Think of reading newspaper headlines. If you are reading the headlines each day, you have a sense of what is going on in the world. Similarly, if you read the titles of what is being published in the literature, you have a sense of what is going on in the research. This is important as you head to the next step.

If a title piques your interest, read the abstract

So you see a title that makes you raise an eyebrow. Ideally this title should go against what you would have expected instead of reinforcing a previously held belief (more on this soon). Or, it’s on a topic that you keep seeing over and over again (hot topic in the literature right now). Click on the title and up pops the abstract which is a brief synopsis of the study. Read that. Ponder it. Then move on. Don’t overthink one article. (Ignore the “You can’t just read the abstract!” a-hole. That person is actually an idiot. Again, I’ll get to that.)

If you found a really interesting abstract, get the whole article

Ok. So far I haven’t asked for much. Reading titles and abstracts is free and only takes a few minutes. Getting the full article, that takes having an actual subscription and therefore money, right? Yes and no. Some journals are open source and free to access. APTA membership gets you access to many automatically (SPTS members get access to three journals – all for $60 a year). You may have a friend you can email that has university access and can throw you a copy. When all else fails, go back to that abstract. See that email address at the top? That’s the author. Send them an email and ask them nicely for a copy of their article, expressing your strong interest in learning more. They are usually excited to share.

Once you get that pdf, use a free research organizer like Mendeley or Zotero to automatically organize all of your research articles into a searchable database. Much better than having those pdfs randomly scattered all over your desktop and document folders.

Think about the article

There are a couple basic things we need to remember here. First, what exactly IS research? Well, it is the science of medicine and I’ll let Kimball Atwood of ScienceBasedMedicine.org describe what that is:

When you think of science, please think of it first as a way—the only accurate way that we have—to understand nature. If, instead, you think first of P-values or confidence intervals or randomization or blinding or allocation concealment, you’re misled.

The other thing to remember is that you can find an article to support ANYTHING you want to believe. You need to leave your confirmation bias at the door. As a matter of fact, science is not for you to confirm what you believe, but to challenge what you believe. When you find yourself getting excited with agreement, pause and reflect. Ask this question:

How else can I explain these findings? What else might be at play?

Don’t get too bogged down in statistics. Yes that matters, but before you even consider study design and statistical analysis, consider whether or not they are asking a scientific question or whether or not the initial premises are sound. These are very simple questions that many many studies fail to stand up to (sadly).

Also, some studies will just be over your head. Don’t sweat it. That article isn’t for you. There are plenty others for you to read.

Science is a dialogue

So the jerk that tells you that you cannot trust an abstract is misguided. First, they are basically telling you that if you don’t have time to read an article front to back and critically analyze the design, statistics, etc then don’t even bother. Of course those things matter but that mindset is just not helpful. They are actually pushing people AWAY from the research which is the last thing we want to do.

Yes, you cannot trust an abstract, but you also cannot trust an entire well conducted study in isolation either! A great study only answers one very focused scientific question. It must be corroborated by other similar studies and then later studies will build upon that idea over time.

First and foremost be aware of the dialogue. This doesn’t mean you need to “catch up” on previous literature. Just start today. As time goes on you’ll start saying, “I’ve seen this kind of thing before,” or “Woah, this explains some old concepts in a whole new light.” Time will give you that – you can’t learn that overnight.

Don’t…

  • …trust social media. Social media is the WORST place to get your research. What you will get is the cherry-picked greatest hits from people you already agree with. Huge mistake. Remember, in order to find the truth you need to challenge your beliefs, not confirm your biases. You need a more complete exposure.
  • …dismiss the skeptics. They are friends of the profession, not enemies. Hear them out. Listening to them doesn’t mean they are necessarily right, but they will help you keep you biases in check. As Aristotle said, “It is the mark of an educated mind to be able to entertain a thought without accepting it.”
  • …be easily swayed by one study. Read it. Ponder it. Then move on. Don’t have a knee-jerk reaction. Remember it is a dialogue, consider all of the evidence. Beware the person who cites the same study over and over again. One thing I have said many times before:

If one study changes everything for you, it is because you only read one study.

Do…

  • …start today. As I said, the longer you pay attention to the dialogue (just read those titles) the more comfortable you will be with the discussion. Sure, I have more than 15 years of practice experience, but more importantly, I have more than 15 years of following the research discussion. Every article I read today is put into the context of all that history.
  • …attend professional conferences. Go to Combined Sections Meeting (CSM). Sure there are some great educational sessions and preconference courses at CSM that summarize current concepts but you always need to take that with a grain of salt. There are also platform sessions. Watch the researchers present their abstracts (JUST AN ABSTRACT?!?!) and then discuss their findings with other researchers. You get to see the dialogue in action.
  • …want to know the truth more than be proven right. Put your ego aside. Have a humble desire to know what is REALLY going on, not just prove that you “knew it all along”. No one cares if you were right.
  • …keep it simple. Take it easy. You have a long career ahead of you. Just read those headlines and keep an open mind. As you get more comfortable expand to eight or so journals a month (two a week). No, you can’t follow every journal. If an idea is important enough, it will drift into your reading list eventually. Don’t worry.
  • …stay skeptical. Remember:

The most obvious answer is almost NEVER the right answer.

Be consistent, have a desire to learn, pay attention, and keep evolving.

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