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How to keep up with the literature



[This essay was written in response to psychiatric residents at Tufts Medical Center who requested advice on how to keep up with the research literature.]


The best advice comes from William Osler: Let the old men read the new books; you students should read the journals, and the old books.


So that’s the advice, and there are two pieces to it:


Read the journals.

And read the old books.


The journals


Which journals should you read?


My advice is to pick one general journal and one specialty journal, and read every article in it every month. You should read the title and/or abstract of each article. Then pick 2-3 articles per issue that interest you and read the actual article itself. By doing so, you’ll be up to date about the most recent studies.


Which general journal?


The most obvious for psychiatry residents is the American Journal of Psychiatry, published by the American Psychiatric Association. Another option is JAMA Psychiatry, published by the American Medical Association. You will find many of the articles uninteresting and highly specialized unfortunately. These articles are mostly written by researchers for researchers, rather than for clinicians. But since these are the most highly cited journals, the most important studies tend to get published there. It’s good to stay on top of those studies. About 80% of the studies are in genetics and neuroimaging, because those topics are best funded now; they are not the important ones. Focus on the other 20%. Other options for general journals if you want to expand your reading would be to get outside of the US. The British Journal of Psychiatry takes you across the ocean, as does Lancet Psychiatry. Both are excellent journals. Acta Psychiatrica Scandinavica takes you onto mainland Europe, still in English. And the Canadian Journal of Psychiatry is broad and accessible and perhaps the best of Europe and North America.


Which specialty journal?


Here I would recommend that you emphasize whatever interests you the most. And you can change your interest over time. Are you interested in depression? Then Journal of Affective Disorders. In bipolar illness? Then Bipolar Disorders. In schizophrenia, then Schizophrenia Research. In psychotherapy, then American Journal of Psychotherapy. In neurobiology, then Molecular Psychiatry. Just pick one and read it every month, again selectin 2-3 articles of interest each month.


The old books


Although the request is about how to keep up with the literature, I will advise you without solicitation that keeping with the literature is meaningless if you have no context for it. You have to know how we got here, because most of the literature today is going to be out of date tomorrow, or is just plain false. That’s where the old books come in. They give you a broad picture of psychiatry that has stood the test of time; that’s also why they are better than the new books, because the new books share the same faults of the current journals: they are blind to the falsehoods of today that we will only see clearly tomorrow. The old books have gone through the winnowing process of decades so that those that remain standing are true, and their falsehoods have been already disproven or are obvious to see or in fact aren’t there.


Which old books?


You have to test out what appeals upon reading, but I’d recommend Emil Kraepelin: Clinical Psychiatry, Frank Fish: Clinical Psychopathology, Paul McHugh and Philip Slavney: The Perspectives of Psychiatry, Leston Havens: Approaches to the Mind, Goodwin and Guze’s Psychiatric Diagnosis (available in current updated editions), Frederick Goodwin and Kay Jamison: Manic-Depressive Illness, Edward Shorter: A Brief History of Psychiatry.


Getting caught up with the literature


It’s one thing to keep up with the literature. But you also need to get caught up with the literature that preceded you, the studies of the past decade or two or three that are either classic studies or that already provide a baseline fund of knowledge on which the current literature builds.


To access this recent literature, which is neither current nor old, you will need to turn to digital sources, like Google Scholar and PubMed.


An excellent way to get caught up with recent studies is to do so as the topics come up in your clinical work. This a core aspect of the idea of evidence-based medicine. The idea is that you should use your cases to go to the research literature. In this approach, you are not reading based on just a topic of interest, or in an abstract sense, but you are supplementing that approach with a case-based approach. If you see a patient with a certain drug-related possible effect, search it online; if you see a case of treatment-resistant depression, search the topic online. This is a way to get up to date on studies in recent years relevant to your case.


How do you do it?


A common mistake is to go directly to PubMed. The latter is difficult to use for a topic, since it provides everything that links to keywords and it does not winnow the studies easily based on any features. The most recent always come first, while the classic papers might be lost among hundreds of others.


The solution is Google Scholar.


This search engine provides the most cited papers right up front, which makes it easy to find classic papers. It also has an easy to use interface so that keywords are more relevant. Once you identify the studies of interest in google scholar, you can then cut and paste them into pubmed to find the full reference or the original citation. You can then either get the pdf directly, or paste the citation into the university library link to obtain the pdf through your university or hospital license.


Make it a habit to go from your cases to google scholar, and from google scholar to pubmed or pdfs. That way you’ll be adding to your fund of knowledge as you see cases, and you’ll be more likely to remember what you learn since it has practical relevance to patients that you see.


Summary


My advice is the same as Osler: Read the journals, and the old books. Leave the new books to the old men. Young people need to learn the old ideas well, and see what’s new, and then they can tell what’s true from what’s false. Remember the old adage: Half of what you will learn is false; you just don’t know which half.

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