Hunt and forage. Most of us seek information in 2 ways. Sometimes we hunt, searching for information to answer specific questions. To hunt for information, we need to assemble sources that will allow us to find what we need in the least amount of time. Some computerized sources of information are designed to lead us to well-validated, predigested information within 1 minute of starting. InfoRetriever, The Cochrane Database of Systematic Reviews, and Best Evidence, are CD-based databases that provide validated information in an easily searchable format.* In addition, various Internet sites are available that give access to valid, predigested information, including this journal’s POEMs online (www.infopoems.com), Bandolier (www.jr2.ox.ac.uk/Bandolier), Dr’s Desk (drsdesk.sghms.ac.uk), the TRIP database (www.ceres.uwcm.ac.uk), and DynaMed (www.dynamicmedical.com).
At other times we forage; rummaging for new information. To stay up to date, it is necessary to develop an information-gathering plan. This is not as onerous as it sounds. We can use POEM bulletin boards to keep on top of new information. These sources, such as Evidence-Based Practice, Evidence-Based Medicine, and ACP Journal Club, use specific criteria to identify and present the results of studies that investigate patient-oriented outcomes.
We need to forage and hunt to keep up to date and to find information as necessary. Without both, you do not know what you are looking for and cannot find it when you do.
Use YODAs. In the Star Wars mythology, Yoda is a mentor who provides guidance and interpretation. In a previous paper we defined a YODA—Your Own Data Analyzer—as a person or source of information that can take the best information available, analyze it to determine whether it is valid, and interpret it within the context of clinical practice. In medical practice, we need to identify our own YODAs and also be one for others.
A YODA can be a colleague or someone in the community who has demonstrated an understanding of evidence-based medicine. We need to identify our YODAs, and ask them regularly for their thoughts on issues we confront in practice. Do not rely solely on their pronouncements, however; ask them to identify the evidence supporting their assertions.
An alternative to local YODAs are published YODAs, such as The Cochrane Library a database of meta-analyses, or the POEMs column and the evidence-based reviews in The Journal of Family Practice. Both the Journal’s evidence-based reviews section and the Cochrane database start with a clinical question and employ all of the valid research literature on the topic to formulate an answer based on the best available evidence. The Cochrane database is available on compact disk or at the Cochrane Collaboration’s Web site (www.updateusa.com/clibip/clib.htm).
In addition to identifying YODAs, we should strive to become one. No one can be an expert on everything in medicine, but we can all become one on a few topics that we find especially interesting. For those topics, know the literature. Become a resource. Once we have developed the confidence in our own YODA-hood, we can be one for others. Our positive influence on our colleagues will help them and their patients.
Be discriminating in CME participation. Choose your continuing medical education (CME) time carefully. The research is quite clear: Most people retain very little information presented at CME conferences. Two options present themselves: (1) pick useful CME; or (2) use the opportunity as an excuse to go to a fun locale. If you decide on the first option, work to identify CME opportunities that use interactive formats, such as workshops during which YODAs present evidence that can be evaluated for validity. Not all evidence-based medicine CME conferences meet this criterion.
Whether listening to a speaker or talking with a colleague or consultant, keep in mind the golden question: “That’s interesting … what evidence supports that idea?” There are hundreds of ways to ask that question diplomatically. It is not a judgment or an accusation, but simply a way to further understand the strength of a recommendation or clinical practice. If it is not a valid POEM, it is not necessarily useful information.
You may also need to spend some time tracking down the information supporting the speaker’s conclusions. Speakers may not have that information at their fingertips but they may be able to point you in the right direction. Always write down your questions for follow-up later.
Learn by doing. We learn best by doing. Consider setting up a practice-based small-group CME.33 Set aside time each month to work with colleagues to answer clinical questions. Decide on a clinical question, find information to answer it, and use the monthly meeting time to present and discuss the information with others in the group.