Smart is Sexy – Answering Clinical Questions with Justin Morgenstern

Jason Hine: Alright, hello and welcome to the SimKit podcast. Thank you for joining us today for our talk about answering clinical questions. Now, I know you might be thinking Jason, could you possibly come up with a more boring topic for a podcast? Well, I’m going to argue that while the title might seem a little boring, The topic it’s not. It is actually sexy. It’s a sexy topic and let’s talk about why we all know that one clinician physician who just knows everything it seems.

Jason Hine:  He or she has the answers to all questions and can give them with a beautiful high point view of the supporting data as though it were a submission to the cans film festival that pulleys that knowledge that that confidence that they have you have to admit. It’s alluring it’s captivating. It I’d say it’s downright sexy. Well, I’m excited to tell you that. Today, I’m going to buy a man who can bring your sexy back. No, I’m not talking about Justin Timberlake. This is Justin Morgenstern from the first 10, EM blog and Justin. Thank you so much for joining us.

Justin Morgenstern: I don’t think I can live up to that introduction at all, but it’s an absolute pleasure to be here.

Jason Hine: we make no guarantees that he will bring sexy back to you, but I think that this is an important topic to to go over because having that knowledge base and having that ability to Dissect. The data to present it to your colleagues, to your learners to your nurses? It is, it it gives you confidence. I think it’s a learning. It’s captivating to have that person that can talk in that way. And so being able to Give you a means as a listener give you the ability to do this to structuralize how you approach a clinical question. It’s very important. So again, Justin, thank you for joining us for this topic. So I’ve admired.

Justin Morgenstern: Yeah, it’s A demon is an absolute pressure and…

Jason Hine: Oh sorry. Good.

Justin Morgenstern: I think it’s even more than that. I honestly think this will make your clinical life more enjoyable because if you don’t really have a way of answering these questions for yourself, you just have to trust somebody else and you actually sort of have to do that, cookbook medicine. But once you can dig in here, you have way more flexibility to do things with your patients. And it just makes day-to-day work in my mind, way more enjoyable and it’s gonna make my career way longer. So I really, really think that everybody should at least give it a try.

Jason Hine:  But, fantastic. So you’re not saying it’s not only sexier, but it also prevents burnout and improves career longevity. Those are a lot of old claims.

Justin Morgenstern: I mean, I’m not sure everybody thinks that reading literature is gonna act in that way, but I really think so.

Jason Hine:  I’m with you, I’m with you and I appreciate again you’re coming on because I’ve really admired your sort of literature review process for first tent, sorry, because I’ve really admired your literature review process for first 10. Am for some time now and I wanted you to come on and sort of help our listeners figure out the ways they should be approaching a clinical question. as an example, let’s say, I just saw a 67 year old diabetic who came in to our department, unfortunately, in DKA because a well-intended provider prescribed, her a steroid burst for a questionable sciatica Now, I want to look up. Was that really necessary? What’s the data for steroids in sciatica? How should I go about that as a clinician?

Justin Morgenstern: Yeah, so it’s a really great question and we’re not gonna do the clinical side of that today. But how we answer the question? And I’ll say, a couple things how you go about. This really depends on what you’re trying to do. So my search strategy, when I’m writing up a really long article for first 10, am it’s gonna be very different from just truck looking up. Something after a shift also say in terms of the search, I don’t know that I’m great at this. I do have some tricks. I’ve been doing it for a while, but I don’t think it’s my strongest EBM skill.

Jason Hine:  And.

Justin Morgenstern: I have no medical like librarian. So I actually think if I can I will skip this search if at all. Possible, if there’s somebody out there that’s already done, a search strategy to look up data for me. I want to just use that that work. So, if there’s a recent systematic reviewer, or a recent clock room review, I’m just gonna go straight to that. Because even though I want to read the papers myself, these people will have had a medical librarian. They will spend hundreds of hours searching through the data. So I might as well just use that for myself.

Jason Hine: That’s a fantastic strategy, right? If it’s already been built, why build it yourself? Why do the work? Someone else has already done for you. Just if you would go through a little bit of the details on this. So do you go to the Cochran Library, or Do you go to Google and search Cochran review, steroids and sciatica? Once you find the articles, you said that you might go through each paper individually. Why would you do that?

Justin Morgenstern: Yeah, so I do a little bit of both. I do actually just go to the Cochrane website itself in search on there or I’ll search on PubMed or Google or the trip database, but I’ll use a little checkbox on the side that says, You know, only give me systematic reviews because in my first search, I just want to see if somebody else can give me a list of important papers. Once I do find a systematic review, I do try to read all the articles myself and I really strongly suggest that people do that. And the reason is, is that met analysis is are really good at giving us the stats, they can combine all these papers together, statistically and give us a really precisely looking number. But men, analyzes can be really bad at bias. They often overlook bias and papers. So, they have this habit of smashing together, a bunch of really bad studies and what giving us what seems to be a really accurate number? But if you actually read the studies, you wouldn’t trust that that number.

Jason Hine: If fantastic is it does sound like it might be a large task to undertake.

Justin Morgenstern: So I use these men analysis to do the search for me, but I still think you want to read the papers yourself and we’ll get there but actually people To daunting. But I think you should be able to read these papers in like five minutes and get a good sense. We’ll get there as we talk. I think.

Jason Hine: Especially if you’re you know, you have several clinical questions from a shift, you come to a meta-analysis that has nine papers. It seems like a lot to die through but you’re saying that if you’re getting practice at it and you do an in a structuralized way which we’ll talk about it, really shouldn’t take too long.

Justin Morgenstern:  No, I think you can read a paper really quickly and you know, if you look at men analysis and there’s 15 papers covered, you can probably just look at the three or four, biggest or the most important and you’re still gonna get a good sense of whether you can trust the men analysis, the conclusion of that review that you found.

Jason Hine: Okay, perfect. And so let’s talk a little bit. Now, say you do that. Search, you find that. There isn’t a systematic review. Then how do you go about it?

Justin Morgenstern: Yes, unfortunately it’s going to be a little bit harder if I can’t cheat and use somebody else’s search, I will do it myself. And unfortunately the reason this sucks is because mostly the scientific search engines suck. You know, PubMed is a standard that everybody talks about, but you sort of have to be an expert to use PubMed. You have to be like a medical library, and you have to know those mesh headings. So personally, I skip over PubMed and go to Google Scholar because I think most people, when you’re just using normal language, Google Scholar will spit out a better result for you. It’ll be more usable and if the those search engines don’t work, I will also search. There’s something called The Trip database, which is another search engine I use. But also look through all those full MED websites that have come out over the last decade to check something like Rebel EM, or the SGEM, and see if they’ve covered this specific topic, because if they’ve already found the papers for me, I can skip this search step again because the search is probably the most painful part of this entire process.

Jason Hine: Interesting. Okay. And so you’re, I know exactly what you’re talking about. When you’re on, PubMed. You almost need like a degree in logics, right? You have And/or and parentheses, and you’re trying to figure out how to create that mesh network of headings. Pretty complicated, is Google Scholar similar or is it like, just typing into Google or does it have that kind of PubMed headings system?

Justin Morgenstern: I mean even with Google it you could get really good at Google and you can use all the quotes and pluses and things like that. But now I find Google Scholar is much more. Common sense you can just type in what you’re actually looking for. So, for this thing, I would just go to Google Scholar and type in something like steroids for sciatica. Maybe tack on RCT at the end, if I’m trying to find specifically the best quality papers. And I think, you know, your top results, there are going to be very usable with. If you type that exact same thing into PubMed, you might have to go through hundreds of pages to find the five, RCTs on the topic. So yeah, Google scholars. Just use plain language which is really nice.

Jason Hine: Okay, excellent. That’s good to know. And then we kind of talked over a little bit but you know I’m familiar with the trip database and summer guard, but tell our listeners a little bit about it and how it functions what’s different between it and Google Scholar versus PubMed.

Justin Morgenstern: Yeah. So I turned to it a lot. Yeah it’s an independent site that was created probably about 20 years ago now by two doctors who I think we’re really interested in evidence-based medicine and basically it’s sort of like an in between much like PubMed they curate specific information. So you’re only gonna find medical science on here.

Jason Hine: It.

Justin Morgenstern: So Google, Scholar everything. So you can find not non-medical science in there as well, which can bog down the results, so it’s curated information. But what I find really nice about it is very easy on the sideboard, with a single. Click it sorts information very well for you. So if you just want to see systematic reviews, you click on that if you just want to see guidelines, you click on that if you just want to see RCTs, you click on that. So it’s a really nice way to sort information really quickly and I find again, it’s more likely to spit out, good usable results to me. Then I an initial pub and search will be, It’s changing a little bit. It used to be entirely feet. There is now subscription model. I find that it still works well free but I’m not sure how that will. Over time. But it’s a good one to have in your in your armamentarium here.

Jason Hine: Interesting, that’s good to know and something that I haven’t turned to a ton. So keeping it in mind. So adding up our sort of search engines are tools for de Nova research. He talked a fair bit about Google Scholar. We talked about the trip database and Cochran review and then a little bit of a mention of PubMed, but it’s I’m surprised to find that it’s relatively low frequency or low utility tool for you. Tell me why is it is outdated in terms of searching a clinical question.

Justin Morgenstern: Yeah, so I think I use PubMed a lot, but I generally use it. When I know there’s one specific paper that I’m looking for or I can name the author, like it has all the information you need in the databases fantastic. The problem is the search sucks. There’s search algorithm sucks and people may disagree with me. There, if you’re a medical librarian, the search is fantastic. If you really know how to use these mesh databases, if you really know how to use it, I just don’t think the average condition is gonna take the time to learn PubMed search and in this day and age, we just expect like, you know in Google you type in what you want. And it spits, back the results you want. PubMed is nothing. Nothing like that. So I think it’s the last one that you want to be looking through. If you ever read these systematic reviews, right? They say that we searched on PubMed and we found 10,000 results. And then we went through each of them by hand. And in the end, there was only three that were actually relevant to our study. Like that’s a big, big investment of time. And for the average clinician, you should not be doing that.

Jason Hine: Okay, good. Good information. Get back in. Definitely I’ve seen that you search a general topic and you like cricothyrotomy. Oh my God, there’s, you know, 25,000 articles on the topic, How am I ever gonna sort through that in any reasonable way? So their algorithm just seems a little outdated compared to the others. I was gonna jump down now to the reading of the article, then if that’s okay. Network for you.

Justin Morgenstern: Yeah. Yeah.

Jason Hine: All right, so let’s say that we’ve used those search engines, whichever you so choose. It’s a people are I would imagine are gonna start with the Google Scholar, being familiar with Google as a search engine, The scholar function is, You know, akin to that. So, say we’ve gone through the Google Scholar RCT steroids for sciatica and we found some papers Justin tell me a little bit about your approach for reading these papers and in particular as we mentioned a little bit earlier doing so in a time, efficient way.

Justin Morgenstern: Yes. There’s sort of two parts to this. There’s a first initial screen before you actually download the PDF. So let’s start there. So you can just look on Google Scholar or the link will bring you over to PubMed. And this is the probably the only time you should ever look at the abstract you just really quickly. Look through the abstract and most of the time, I actually skip straight to the conclusion of the abstract, it depends on what I’m doing the search for. But if you look at that conclusion and it’s completely boring or doesn’t tell you anything about what you’re actually searching for, then there’s no time in. There’s no point in spending the time to download the entire PDF. If the conclusion in the abstract is interesting, then I’ll just jump back up again and I’ll look at the app the method section of the abstract and again just a really quick read. If the matte methods in the abstract seem awful, if this is just like an uncontrolled or retrospective chart review, or if it’s like an animal study of rats I can. Why am I gonna spend the time? Finding a PDF logging into a library doing whatever I do it just waste of time so very very quickly. Look at the abstract to see if the conclusion is interesting. And if the method

Justin Morgenstern:  Are even worth download it loading as a first step so you don’t waste any time.

Jason Hine: But fantastic. So we’ve that’s a great sort of superficial dissection of it to, you know, get the cream from the rest of the pile of papers that we may consider investigating once we go through that. We look at the conclusion, we jump back to the methods. Okay, this is enticing to us. Where do we go from there?

Justin Morgenstern:  Yeah, so the big thing is understanding how to read a scientific paper and understanding it is not a book people who are inexperienced with this I think make the big mistake of reading from front to back and when you download a PDF, right? These are things are sometimes 16 pages, sometimes 25 pages and that could take forever and I think this is one of the things that scares people off from reading. So these papers have sections for a reason and I think just understanding them we can go through really quickly tells you what you need, obviously, keep download the paper we no longer need that the title, we no longer need the abstract. Those are just for fine paper.

Justin Morgenstern: People started the beginning but the introduction. You know, if you had new absolutely nothing about a topic, it’s sometimes interesting. But the introduction is an a non-systematic review on the topic. It’s really just the author’s opinions on a topic and when you’re trying to read a scientific paper, you’re not reading it to get the author’s opinions. You’re reading it for the science. So almost always I just skip the introduction. It’s a waste of time because you’re reading for science. Not for somebody else’s that, you know, medical and education. So that saves you some time right off the Bat, the method section is gonna be by far. The most important section. We’re gonna come back to this in a second because understanding how to read the method section is really, really important. This is working. We’re going to spend the bulk of our time, it scares people, but I’ll give you a technique that I think makes this pretty easy for thinking about the methods.

Justin Morgenstern: The results. This is why you pick up the paper. Honestly you can get really bogged down in the results section as well. I think it’s really important to just simplify this. You are clinician when you’re reading a paper. You know what results are important. The author’s often present like a million things, you know, serum rhubarb level, whatever you want to know, you know Does this treatment save my patient’s life? Does it make their life better? You know the result you care about. So just skip and find those in the results section. Don’t you don’t have to read every single part of the results section. The discussion section is very much like the introduction section. Again, This is not necessarily science, It’s the authors opinion about their results but you want to draw your own opinions. You don’t want to listen to the authors opinion. So again, I think just like the interactions guys, and you can completely this Skip, the discussion section and then same thing with the conclusions. This is the authors opinion about what their results show, but the whole point of downloading, this paper is to make draw your own conclusions. Not to just accept the authors conclusions. If you just wanted to accept

Justin Morgenstern: Authors Conclusions, You could have just read the abstract. So again I think you just skip the conclusion section so in this entirely long PDF, I skipped the instruction, I skipped the discussion, I skipped the conclusions. I spend my time on the methods and now you can see why I can probably read a paper in five to ten minutes rather than the 30 minutes, it takes the average person.

Jason Hine: Fantastic. I love that. So if we’re going to dissect the chunks, we’re gonna, unless it’s something new, right? Maybe you’re getting high sensitivity troponin for the first time. No real information on it. You’re gonna go through that introduction. Reboa, Sure, this is an unfamiliar topic. Let’s read that introduction steroids sciatica. We don’t really need to go through a history lesson on that or, you know, dive into the, the sort of nuances of what’s happened prior to this paper. So we cut that out. We’re going to jump to the methods and results. By the time we’re kind of done with those, we should have our own conclusion so we can glance at with the opinions of the authors were as well and go over the discussion if we so choose. But it’s also, as you mentioned, just a sort of non-systematic review of what’s been discussed. So the meat of the matter lies in the methods and results,

Justin Morgenstern: Yeah, if you’re just reading for pleasure, reading the introduction, and the discussion is in a lot of ways, like listening to an episode of EMRrap or whatever. You’re getting background information, but that’s not why you downloaded as scientific paper. Now, that being said, if you want to do a much deeper dive, if you’re in a write, something like I write on, on my website, an in-depth topic review often hidden in the introduction or discussion, there are links to other papers other studies done on the topic. So it really depends on why you’re reading this paper. So I it’s not like I never read them, but if you’re just trying to figure out what this paper says, they aren’t telling you the science.

Jason Hine: Sure, that makes sense. Okay. And so now where do you go? You’ve sort of gotten your first paper. Do you allow that paper to sort of dictate the direction you go in terms of the next paper read? Sometimes I find that I find my first interesting paper on topic. The one that I think is probably gonna most accurately answer my question and when I go through their references I find 10 more and it just becomes this like expanding, You know, pile of papers. That almost dilutes my ability to get definitive information from it. Do you go back to your initial search with Google Scholar? Do you kind of do a combination? What’s your process from that? First paper on a topic.

Justin Morgenstern: Yeah, so I’m I may not be the best person to ask this specific question for the average clinician because what I’m sort of known for is these deep dives? And I do tend to be a down the rabbit hole kind of person. I’m one of those people who could lose an hour into Wikipedia clicking links and learning more, and more and more. So I I don’t know that I’m fantastic at the the shortcut and…

Jason Hine: Sure.

Justin Morgenstern: part of this, unfortunately, the worst part of evidence-based medicine is that no single trial is ever gonna stand on its own. Science is all about replication and,…

Jason Hine: Right.

Justin Morgenstern: And seeing whether the results are true. So you do sort of have to have a sense of the, what they entirety of the science says that being said. So if I’m trying to do a quick review on a topic, the Orcutt that I use, if you have that systematic review, you know that forest plot that sort of shows, you get a bunch of little dots that show how much of an effect it has I tend to circle the few that are furthest away

Justin Morgenstern: From the midline. Those are the papers that show the biggest effect and so those are the ones that are going to be driving the, you know, the positive effect that, that you’re you’re finding. And so, if you, if you read the, the trials that are the most positive and they seem like real trials to you, then you probably don’t need to read the ones that are more negative. And so, I, I tend to read more and more if I’m surprised by the results, if they’re really positive. Trials, seem really bad to me. Then I’m gonna have to read a few more to make up my my mind. If the really positive trial seem great, then I can probably stop.

Jason Hine: That makes sense. And unfortunately sometimes in these Cochran reviews you do find those really strongly swaying ones. Tend to be the ones with a smaller n little less robust, research method. They you know, are oftentimes almost the outliers and so coming back to that idea of making sure, you know that the methods is of high quality before you really take on a paper, find its PDF and go through. That’s obviously going to be important. But I see the point of sort of finding the papers that are the hardest hitting. In terms of affecting the outcome that matters to our patients and chasing those

Justin Morgenstern: Yeah, and I may not have said what? I think hardest thing is that is the best. Yeah, it’s the ones that have either the biggest effect size, or the largest and end. So I tend to look at a one of those graphs and pick out the one or two biggest trials and then the one or two most positive trials and then often the one or two most negative trials. So there’s 20 trials. Like I can limit that down to five or six and only go really deep. If I still have questions after reading, sort of those outliers, I would say.

Jason Hine: Perfect, that makes tons of sense. All right, so let’s say we did that, we found our data, we went through, sort of steroid, use and sciatica we use Google Scholar. Unfortunately, there wasn’t a Cochrane review on the topic, so we found five RCTs that we thought were valuable and came to our to our endpoint. We are ready to impress our nurses, our colleagues, and of course, our patients with our evidence-based medicine prowess. And it feels good. You know, that sense of security knowing that you’re doing right by people by our patients. And at least that you’re doing it with the current best evidence and you’d like to chase that feeling a little bit. You’re pretty quickly though. Intimidated just by the sheer breath of material that an emergency medicine. Clinician is expected to know. So Justin, how can someone stay up today on the key literature that’s relevant to emergency medicine today?

Justin Morgenstern: Yeah. So the nice thing is that that’s probably pretty easy in this day and age. It really depends on what you’re trying to keep up up to date in. Like if there’s a specific topic that you’re really interested in if you’re a PE guy you probably need to have a different approach. But for the average dog who just wants to sort of know all the things coming out, I would say that this is mostly you want to let somebody else do this for you. So it used to be Jerry Hoffman and Rick Bukata but I still subscribe to the Emergency Medicine Abstracts but there’s lots of options. There’s journal, watch or info poems or you use a full med site like the Skeptics Guide to Emergency Medicine or Rebel Yam and I guess I can name my own site first 10 am. But I would say there are a lot of nerdy people out there reading a lot of papers and doing the filtering and presenting, what are the best papers anytime. So I would pick a couple of those sources and let them tell you what the best literature is.

Justin Morgenstern: I also tend to suggest like, you pick the one, one, two or three biggest journals in your areas and at least just get the email so that every time annals of emergency medicine comes out in in our field, get the email. So you can at least like scan through the titles that are coming out. But for the most part, you don’t want to be doing this as a busy doctor. Let somebody else do it but then listen to their summaries.

Jason Hine: Perfect. I love that answer, mostly, because I think that’s what I do. So that’s gonna confirming my, my general practice that we need a a net, right? We need a an initial filter. And when I talk with the residents about this, I actually think there’s a detriment in medical education and that we, we do teach how to break down journal articles, right? We have journal club, we learn about how to critically appraise in article, but we’re not teaching people as well. The power of, you know, foam or of the educational infrastructures out there to allow for a filtering effect and even to critique a foam piece itself, right? We don’t have great skills in, you know, explaining why America academic life and emergency medicine is so great. And some, you know, how you can really take an article or a blog or a podcast and dissect it in that way, but I strongly believe and it sounds like you do as well that these entities like Rebel. Like

Jason Hine: Journal feed like some of those that are out. There are a means of allowing us to get access points with all of the plethora of materials that are relevant to our trade.

Justin Morgenstern: Yeah.

Jason Hine: And as emergency physicians, we have so many specialties that we need to keep our finger on the pulse of that. These entities are vital for us to really us be keeping ourselves a breath. So when you find an article,…

Justin Morgenstern: Yeah, just like we’re Just like,…

Jason Hine: That is good.

Justin Morgenstern: You’re gonna critically appraise any article you come down, you know. I I don’t I don’t think you should just trust what these FOAMed sites say. But they’re really good at getting information to you and then you can put on your critical thinking hat and think about what they’re actually saying, but they’re doing a lot of work for you that it would be silly not to use that work.

Jason Hine: Right. Exactly. And so, when you get an article through email, emergency medicine, abstract sets groundbreaking, That’s, you know, vital for us to know. Obviously, as you mentioned, you probably are going to see it in your RSS feed. If you’re keeping anal anals on your watch list or on your email, things, like the classic trial, like some of these large large sort of groundbreaking, or I want to say that again, sorry. I’m trying to figure out how to wait a way of saying what I’m trying to say but but right exactly. So if you’re using, you know, emergency medicine abstracts and you’re getting, you know, your information that way when you come to a landmark article, it’s important to not just take it as face value. As you said, we need to read that literature and hopefully you’re seeing it in different formats. You know? If it’s coming across in journal, feed, emergency medicine abstracts or if you have ANNALs being pushed to your phone or to your email, you’ll see these huge landmark trials that we as ed physicians need to know. And yes, we need to break those down on our own, but use some of these agencies for filtering. What is important? And what is not?

Justin Morgenstern: Yeah, and actually, it’s not really what we were supposed to be talking about, but you already said it how to use these tools. We don’t talk about very much. So like, when I listen to MRAP, I listen on 2x speed and I go through the entire thing because 10 years in my practice, I’d say 90% of the segments. I sort of know where it’s a refresher. But then when I hit that one where I’m like, oh, I haven’t heard this in a while. I slow it all the way down and really concentrate and really think same thing with the emergency medical abstracts like, again, most of the time, these are whatever papers. I’m not gonna change your practice but the one or two a month. I pause, I email myself. I download the paper and I think about it myself. So you got to realize when you’re doing screening and when you actually have to pause and really focus and learn

Jason Hine: That’s well, said I like that sort of processes of, right? Like we said we’re it’s a filter. We want to have touch points with all of these different fields of medicine and you know, knowing the conclusion of a simple orthopedic tip in terms of splinting that’s important, but probably not in a journal that you need to relisten to and download and read on your own. But when you hit those huge trials, or those groundbreaking ones, knowing that it’s time to come out at 2x speed, listen to it, listen to it. Again, find the primary literature and review it yourself. That’s gonna keep you sharp. Awesome. All…

Justin Morgenstern: Yep.

Jason Hine: So, I’m gonna try to do a summary of what you’ve mentioned and said and then I want you to see how I did. Correct. Me and add If there’s anything that we haven’t talked about. How’s that sound?

Justin Morgenstern: Sounds great.

Jason Hine: All right. Excellent. So we’ve had Justin here today, from first 10, am We’ve been talking basically about how to answer a clinical question? And then we had a little tidbit there at the end about how to use some of these powerful emergency medicine. See. Then we added a little tidbit in there about how to use some of these other agencies, you know, podcasts or blogs to allow ourselves to stay sharp. So, into the clinical question realm, When Justin comes across a question that he wants to answer, he is going to the Cochrane Review to Google Scholar and to the To the Trip, database to type in for the question itself. Ideally, we have someone who’s already done this work. We already have a good Cochran review on the topic. We can dissect those and it’s important as you mentioned to read the articles yourself, But if somebody’s done this curating for you why not take advantage of that use your Cochrane view or other curation methods?

If there’s not one out there, then you’re going to use these same agencies. With preferences for again, Cochran or the Trip database, and Google Scholar above PubMed because of their sort of filtering ability. When you find an article, you’re going to read the conclusion. And then come back to the methods to sort of do a very quick litmus test of quality. If you think that it’s quality, you find the article and then you are essentially skipping the, you know, abstract the introduction and getting into the methods and results. To sort of see what kind of conclusions you as a clinician can draw on the material. If you have time, you’re welcome to do the discussion and see what the author’s conclusion of their own research was, but really by the time you’ve read the Methods and Results. You have digested that article in its entirety and this when you’re getting practice at adjusting, says takes, maybe, five, 10, or so minutes.

Once you’ve gone through your literature review on your handful of quality papers on the topic, You’re done. You can kind of wrap it up. You can dive further into the references if you so choose to get really in down the rabbit hole and to get a full breath of what’s out there. But sticking with the largest trials and the ones with the most effect on outcomes for our patients is where you’re most time efficient and doing this research. We then kind of concluded talking a little bit about how we get these articles or this information across our desk. We enjoy the idea of being knowledgeable on a topic matter but it’s nearly impossible. Given the number of specialties that we need to be up to date on for us to do this independently going through primary literature. So by using blogs and podcasts and other filtering methods, we find the articles that are of great value and listen to the authors conclusion on a, you know, using emergency medicine abstracts as an example, we listen and re-listen to that. But then we also need to dive into literature on our own accord doing the same method that we just discussed. Justin had I do anything to add subtract. What do you think?

Justin Morgenstern: Yeah, it sounds like a great summary of how I find data. The bigger one that we maybe didn’t completely address is how we actually read that that method section and how we read the papers and maybe that’s a topic for and a couple entirely another podcast, right? I think the one thing to say very quickly about it is people get really daunted by statistics and I think it’s really important to realize that as clinicians, we shouldn’t be reading the statistics, there are statisticians for that. We’re just trying to think Is this paper fair? Like, was this a fair race? And I think most of the time you can just do that with calm and sense. You just think, you know, you want to make sure that like people were using these same finish line that there wasn’t like cheating, there aren’t running one person uphill one person down, you’re just trying to figure out what whether it was fair?, which just means in medicine. You know, we’re the groups, they’re similar, where we treating them the same? So if you just think about clinical questions, forget about the stats and I think you’ll do a really well, reading a paper.

Jason Hine: I like that. And yes I think a specific podcast on how to go through the methods section of an article would push it into the very boring topic matter, probably. So maybe we’ll save it for another time and people really want that we can have Justin back to go over, how to read the method section, but I think that, that sort of 10,000 foot view, that sort of gestalt, that we as educated clinicians can do is fair, right? When we are comparing two groups in these articles, it’s pretty easy. We should be able to tell without much dissection of the statistics whether there is a fair comparator between the two.

Justin Morgenstern: Yes, I think that’s entirely right. It just remember why you’re reading the paper, you don’t have to be the scientist, you have to be a practicing doctor. So, I just finished reading. I have a trial about N95, for example, but it says right in the paper that it was N95 versus surgical masks. But both groups were N95 some of the time, but not all of the time. So if you say that out loud, you’re like, Oh yeah. Okay, so it’s, you’re basically comparing the exact same thing in both groups. So, of course, the outcomes are the same. I think, most doctors are smart enough to read, read the paper, but where people get turned off as they get so distracted by these statistical terms and things like that, we can get more into depth on it. People want there’s a post called Evidence-based Medicine is easy on my website first10EM and if you just want an approach to reading a paper from that, same that clinician viewpoint, I would suggest starting there.

Jason Hine: Yes, they will definitely throw that into the show notes and Justin, thank you for doing what you do in this regard because again, I’ve always looked up to your evidence-based approach, and your ability, your ability to, and willingness to dive into a literature to such a degree. I hope that our listeners are able to take a small piece of who you are and what you do, for our specialty to their own practice. And guys, I know I learned a lot. I hope you did too. Justin, thank you so much for joining us today.

Justin Morgenstern: It was an absolute pleasure.