Lifelong medical education in a world of digital information overload

To maintain professional competence and provide the best patient care, physicians need to keep up with the latest scientific knowledge. In the past, most physicians had a “bookshelf” that granted them quick access to a limited range of personally selected knowledge sources. Now, in the digital age, the potential knowledge sources are unlimited. Consequently, building and maintaining a personal digital knowledge repository is increasingly challenging despite a range of advanced new tools, none of which seems to meet all the users’ needs.

The problem with scientific journal publications

There are thousands of journals and their numbers are constantly increasing. Not only has research itself sped up in recent decades due to technological innovations, but the number of new articles published seem to be increasing disproportionately. Open-access publishing, a movement launched two decades ago to make research findings more visible and accessible to society in general, seems to have turned into a global industry driven by processing fees. Being a publisher seems to promise a perfect world. Almost all the work is done by their clients. The authors write the articles, their peers review them for free, the authors give up all their rights and even pay to have their article published. Thus, with the current systems, publishers have no incentive to limit the number of articles. Authors, on the other hand, lack any good reason to submit only scientifically meaningful manuscripts rather than low-quality studies, which clutter the reviewers’ mailbox and, at best, boost the author’s personal career. The result is an exorbitant number of newly published articles. Of the meaningful articles, only a few sentences carry new and insightful information. The rest of the manuscript is written to prove that “new” is “true” and to discuss it in its context.

Information overload

We are facing unmanageable information overload. The European Society of Neurosurgery’s Peers for Peers project (peersforpeers-neurosurgery.org) screened more than 6000 articles in 2022, in the field of vascular neurosurgery alone, and found fewer than 50 that were “highly relevant” and none at all that qualified as a “game changer”. The project team screens only articles retrieved from PubMed, but there are a plethora of other sources of knowledge, including databases, congress recordings, magazines, blogs, forums, video platforms and many websites, which inform us about the latest innovations, findings, key opinions and every other form of news. On top of this comes everything considered as established knowledge, such as guidelines or textbooks.

Drawbacks of scientific articlesfor learning

At the beginning of their medical career, young residents start collecting the puzzle pieces of knowledge needed to master the topics of their specialty. The ultimate goal is to make sure all the puzzle pieces are collected in one place and are always up to date. In the analog era these puzzle pieces were collected in a textbook where the available evidence was summarized. New insights from journal publications were incorporated in a new edition to keep the textbook up to date. Textbooks are often nicely illustrated, well-structured, condensed, and interconnect related topics. Scientific articles aim to provide the latest evidence and are written in a rather unemotional and rigidly structured manner. In contrast, textbooks may also describe and summarize the experience of the authors, as well as their tips and tricks, thus arousing emotions in the reader that facilitate consolidation of the material in the reader’s memory.

Keeping up to date as a clinician does not end with reading the most recent publications. It not only demands consolidation, but a good clinician needs to be able to transfer newly acquired knowledge into daily practice. To achieve this aim, key information needs to be accessible easily and quickly whenever it is needed. Moreover, information that is well-presented, nicely illustrated and well-structured without unnecessary, distracting trappings, helps us to focus on the essential. Our experience shows that organizing everything in a digital knowledge hub considering the points below helps to master lifelong learning.

Tips for a digital knowledge hub

1. Use a software package that allows you to manage all file types. It should be able to handle not only PDFs, Office files, videos, images, websites, etc. but should also allow handwritten notes to be created or added.

2. Dedicate time to organizing your knowledge in a contextual relevant manner. Saving piles of PDFs only clutters up your device and keeps related information separated. Pin key information from PDFs to a notebook or write a summary while you are reading them. Make sure that you always keep the link to the source. Take your time to think about the structure of your collected “facts” and how to best illustrate them. Well-organized and nicely illustrated content is much easier to remember than fragments of plain text.

3. Your knowledge hub should be accessible anytime and from anywhere quickly and easily. This is key to retrieving, repeating, discussing, applying and updating your content. And it ensures that you have the information you need at hand whenever you need it.
   

The lack of an appropriate app

The major challenge is to find a software package that provides you with all the tools needed to build and maintain this kind of knowledge hub. There are plenty of reference managing tools, but either they focus on organizing PDFs and serve as reference managers, or they aim to improve your scientific writing and make publishing more straightforward, or they offer some kind of fact cards that help you to easily learn to repeat facts but lack the ability to store the source behind them. A recent survey found that most respondents are not happy with the tools they use and often lose track of important information. A change is needed, and new solutions are required. A small team of scientists and software engineers from the University Bern are currently looking in detail at the components of the optimal software solution that will collect, retrieve and consolidate knowledge in this digital, fast-paced era. The “Elumity” project addresses the need for a comprehensive knowledge hub, where sources of different formats can be stored, and key information collected on a new medium similar to the old-fashioned concept of flashcards. Facts collected on cards can be accompanied by a question you can use to test yourself. In the spirit of our times, “Elumity” offers a facility for sharing and collaborating on creating cards with peers and publishing and collecting cards beyond your own network.

Summary

The digital age is challenging the traditional way of building and maintaining a structured, lifelong personal library for one’s own professional “textbook” knowledge. The digital formats, the sheer number of information sources, and the fragmentation of tools and knowledge within different files and formats calls for new ways of collecting, advancing, sharing and updating the knowledge repository relevant to a specialty. The Elumity project addresses the challenges of staying up to date in the digital era and will offer a new software solution to build your personal knowledge hub.