Information overload

Since my first presentation on social media and web-based education resources at the 2009 ACEM Winter Symposium — and in many FOAM presentation since — a recurring focus from the audience is:How can emergency physicians and intensivists deal with information overload?

The concern about information overload never goes away. Fear of information overload remains a barrier preventing doctors from using web resources. But, given that humanity has been experiencing information overload since the invention of the Gutenberg press, ignoring web resources to avoid confronting this daunting problem is a maladaptive, self-defeating strategy.

Note: Since this video was made Google Reader no longer exists — I use Feedly as my feed aggregator. Also, emgoogle.com has spread it’s wings and become GoogleFOAM/ FOAM Search

As highlighted in the 400 second long PK SMACC-talk above, here are some LITFL pointers to help ‘Web 2.0 laggards’ pull their heads out of the ground and off-load the stress of information overload in the age of FOAM:

#1. Relax!

You’ve been doing fine so far. The information storm will rain down around you regardless of whether or not you are aware of it — so nothing has changed. So relax, OK! You are still going to get on with the job of being a doctor. A lot of the published medical literature verges on recycled trash anyway and no one will die because you haven’t read everything ever written…

… staff of the journal Evidence-Based Medicine… hand-search about 60,000 articles from 140 journals annually, including the five highest-rating general medical journals and a variety of other specialty journals… the “number needed to read” to find one valid study is about 18 articles.

Glasziou PP. Information overload: what’s behind it, what’s beyond it? MJA 2008; 189 (2): 84-85

Nevertheless, effective use of social media and Web 2.0 tools will make you more efficient at handling the raging torrent of information. This will enable to meet your knowledge needs more easily, and may ultimately improve your effectiveness as a clinician. After all, ‘the times, they are a changing‘.

#2. Know your knowledge needs

Know your knowledge needs. This is a key step in dealing with information overload. There are so many exciting information sources out there — on almost every subject imaginable — it is easy to get distracted from your core needs. Define your needs and only use information sources that contribute to meeting them. How can you determine what your knowledge needs are? If you are a student or trainee then focus on aspects of your exam syllabus, if you are a busy clinician then focus on your day-to-day practice and on clinical questions as they arise.

Don’t be afraid to cull an information source that is low yield — whether that be someone you follow on Twitter, a blog, a podcast, a journal, or some other information source. This might mean that you will miss an occasional useful bit of information. Don’t worry, relax (remember Tip #1?). So long as you remember to ‘be social’ (see Tip #3) and ‘follow the leaders’ (see Tip #4) then although you may miss the primary information source, the important gaps will be filled by secondary sources (see Tip #8).

#3. Build a one-stop shop

Do you fill your email inbox with journal table of contents updates that you resent having to file? Do you find that you hardly ever get to read these anyway because they turn up at an inconvenient time and you forget to go back to them later? Do you waste time repeatedly visiting your 31 favo(u)rite websites to see if anything new has been e-published since the last time you checked?

If you answered yes to any of these questions you need to start using a feed aggregator (aka reader). An aggregator means that you don’t have to constantly “pull” information, it is “pushed” to you instead. Best of all, use a web-based aggregator so that you can access it anywhere — on computers at work or at home, or on your ‘smart’ phone so that you can ‘go mobile’ (see Tip #9). Once you have chosen an aggregator, you need to subscribe to the feeds of your favo(u)rite websites, whether they be blogs, journal webpages, podcasts or Pubmed searches, Twitter accounts or any other continuously updated webpage. The aggregator then collects the incoming stream of information that is automatically pushed to you, storing and categorizing it for you to read at your convenience. Aggregators also let you label or tag your favorites to revisit later, make it easy to discard the dross, and enable you to share your discoveries with your friends and colleagues.

As Google Reader no longer exists, I use Feedly as my Feed aggregator. Feedly provides an eye-friendly magazine-style interface that that integrates these tools, and also makes sharing with other Web 2.0 services a breeze. If subscribing to RSS feeds scares you or sounds too time consuming, just spend 10 minutes a week looking over the LITFL review of the best in EMCC FOAM. For podcasts you can use podcast apps (such as Podcasts, Downcast or Instacast) to have your favourite podcasts ‘pushed’ to you whenever a new episode is released.

#4. Search selectively

By learning to search effectively you can increase your search ‘hit rate’ so that you’re not left wading through a sea of worthless information slime. Time and effort spent learning how to search properly will reap you massive rewards in the long run. Effective searching is essential to “pull” information to meet your foreground knowledge needs. Once you’ve defined your search, you can turn it into a RSS feed and any new publications found by the search criteria can be ‘pushed’ to your feed aggregator (click here to find out how to do this — it’s really easy!). Apart from traditional medicla databases such as Pubmed, you can search for FOAM easily using GoogleFOAM or search the various databases on LITFL (e.g. Podcasts).

#5. Be smart, be social

Having a robust social network of highly intelligent people with similar interests means that high yield information is ‘pushed’ to you effortlessly. The key is to build a network of people that will help you meet your knowledge needs. This is why the team at ‘Life in the Fast Lane’ are so enthusiastic about encouraging our medical colleagues to embrace Web 2.0 tools — the symbiosis of synergistic sharing is incredibly powerful. The more people interested in emergency medicine, toxicology, retrieval, critical care, and acute medicine there are that start tweeting, social bookmarking, blogging, and podcasting the greater the flow of information, but there will also be more filters (see Tip #7) resulting in a higher signal-to-noise ratio for important information as becomes retweeted, virally blogged and bookmarked.Learn more by reading Medical Social and Professional Networks, Is Social Media the Rock’n’Roll of HealthCare?

#6. Follow the leaders

Try to identify people who are innovators and have an enthusiasm for sorting, sifting, and filtering information. During their virtual travels searching the outer reaches of the info-verse, these explorers will collect and pass on only what they find useful or interesting, having panned out scarce golden nuggets from the information rapids. Pay close attention to these people — if they don’t Twitter, blog, or use social bookmarking tools then encourage them to do so so that we can all reap the benefits!

#7. Find fabulous filters

Instead of trying to sort the wheat from the chaff yourself, use ‘filters’ to keep your background knowledge up-to-date. There is simply too much information around for a practising clinician to sort themselves — indeed Clay Shirky has stated that information overload is not the problem, the real problem is ‘filter failure‘.

Filters can be people in your social network (see Tips #5 and #6), blogs (see below), journal summaries, review journals (e.g. Current Opinion in Critical Care for intensive care, the Clinics of North America series as well as Emergency Medicine Practice and EM Critical Care), or the editorials, reviews, and “from other journals” sections of the major medical journals. There are also great free evidence-based medicine resources such as The NNT, BestBETs.org and of course the Cochrane Collaboration. Podcasts are also useful for accessing summarised and filtered information particularly if you ‘go mobile’ (see Tip #9).

Our own LITFL Review is a great ‘one stop shop’ for accessing recent social media educational offerings relevant to emergency medicine and critical care. It includes blogs, podcasts and other online media. Some of the best blogs I use as filters for recent additions to the medical literature include:

Emergency medicine — Emergency Medicine Literature of Note, Skeptic’s Guide to Emergency Medicine
Critical Care — PulmCrit and Critical Care Reviews
Resuscitation — Resus.ME
Toxicology — The Poison Review

#8. Bathe in the flow

Let the ebb and flow of the information tide wash over you. You don’t need to read everything that is twitted or is fed to your feed reader. Just read what catches your eye — whatever looks like meeting one of your knowledge needs. Remember, that really important information tends to get repeated — whether syndicated by multiple blogs, retweeted by multiple tweeters, or featured in the “from other journals” section of the major medical journals. If your miss the first wave, you’ll catch the second or third if you have a functioning social network and have well chosen filters.

#9. Go mobile

Although lots of doctors have smart phones, in Australia at least, they often don’t use the ‘smart’ part! I know doctors who freely admit that they have iphones but only use them for phone calls and text messaging. If you are one of these people, I strongly encourage you to start integrating your ‘smart’ phone with social media/ web 2.0 tools.

Transfer pdfs of articles to your ‘smart’ phone so you can read them sitting on the train, get the ‘Google’ app so you can skim through your feed reader while you languish in the queue for your coffee, and listen to podcasts so that going to the supermarket becomes an enlightening experience… ‘Going mobile’ lets you fill in the wasted moments of the day so that you can dance effortlessly through the information minefield.

#10. Find focus, time tasks, and “firewall” your attention

Multi-tasking is a myth. Constant interruptions hinder your ability to assess whether information is useful, as well as your ability to absorb it. “Firewall” your attention. Prioritize your tasks and work from the top, one by one. If you are dealing with a high-priority information task then turn off the phone, your Twitter application updates and any other technology they may distract you. Set yourself deadlines for tasks and give yourself a time limit for the minimum time for constant absorption in the task at hand before you are allowed to check email, Twitter or your feed aggregator. Use an alarm clock if necessary.

…and remember, relax!

From the medical journals:

Beasley JW, Wetterneck TB, Temte J, Lapin JA, Smith P, Rivera-Rodriguez AJ, Karsh BT. Information chaos in primary care: implications for physician performance and patient safety. J Am Board Fam Med. 2011 Nov-Dec;24(6):745-51. PubMed PMID: 22086819; PubMed Central PMCID: PMC3286113.
Berger E. Web 2.0 in Emergency Medicine: Specialty Embracing the Future of Medical Communication. Ann Emerg Med. 2012 Apr;59(4)A21-23 [fulltext]
Cadogan MD. Web 2.0 rollercoaster. A ride we should all take. Emerg Med Australas. 2009 Feb;21(1):1-3. PubMed PMID: 19254306.
Fraser AG, Dunstan DS. On the impossibility of being expert. BMJ 2010; 341:c6815
Smith R. What clinical information do doctors need? BMJ 1996;313:1062-1068 (26 October)
Smith R. Strategies for coping with information overload. BMJ 2010; 341:c7126