Since clinicians, scientific journals have been touted as the link between research results and the improvement of clinical practice, but are times changing?
An interesting editorial was published this week in the BJSM, in which a survey (n = 2000) examined which resources clinicians use to change their clinical practice. The result may come as a surprise to some and a confirmation of a long-held opinion to others, but clinicians do not use magazines to change their clinical practice. Instead, courses and peer-to-peer learning lead to direct clinical change.
At the center is an interesting question: Were magazines ever a driver for changes in clinical practice? Systematic reviews perhaps, but small RCTs are unlikely to change a person's practice. Clearly, this is not an argument to get rid of small-scale research as, after all, many RCTs and other types of research pools collectively shift the dynamics over time through systematic reviews, frameworks and policy changes. Rather, the argument is a combined approach; Journals and course providers work together to create a new way of translating research into practice.
It is not clear what this might look like, and there are advantages and disadvantages to ideas. Above all, the risk of magazines accrediting courses that align with their beliefs and audience comes with the risk of bias and profit. With the advent of predatory magazines, it will almost certainly become a race to the bottom, and any independent or private course provider will be accredited anyway, making the entire accreditation process meaningless.
The better option would be for journal providers to work with course providers to improve clinicians' ability to effectively evaluate evidence and know what good evidence looks like, and then use that to change practice. This will also help clinicians understand what good courses are and not also to change the practice for the better. This is just a thought and the mechanics of how this could work is currently unclear.
Why don't articles change practice?
Now it is likely that there is a minority of readers who reflect, I read articles and I use them to gradually change my practice over time. The editorial in the BJSM and this article are not intended to discourage you. You should definitely keep doing what you're doing, but the reason you're in the minority is likely because you have a certain type of skill – relentless energy levels and the ability to quickly assess research, as well as access to them Articles in the first place.
Fatigue and Work-Life Balance – Let's face it, the last thing most of us want to do when we get home from work is to sit down and read a bunch of research articles figuring out what we could have done better with this stubborn knee pain in the clinic today.
Paywalls & Accessibility – There are still too many magazines hiding behind Paywalls. So when there is a high impact article that is relevant to clinical practice, it is difficult to access. Yes, many hospitals have OpenAthens access, but there is just one more password and username to forget. The difficulty of renewing access is timely and cumbersome.
Difficulty Evaluating the Evidence – The rise in predatory journals and misinformation and ambiguity, as well as the sheer volume of content, make it difficult for busy clinicians to view and evaluate journal information.
Some surprises
Survey data for the 2000+ clinicians who responded is fully available. One of the surprises is the role of social media. Publishing a magazine article is still a more popular way to change practice in the province than a podcast, SoMe post, or YouTube video. Perhaps this is due to the trustworthiness of the sources, the quality of the content or simply the fact that as a profession we are still adjusting to online / virtual CPD. It would be interesting to see what the results would be if this survey were repeated a few years from now.
Clinical implications
There are no immediate clinically important findings from this leading article, but rather long-term considerations. The way we learn to improve our practice is changing. Peer-to-peer discussions and attending courses are the most popular ways to improve clinical practice, but some questions still remain. If this specialty is specific, it is unique to physiotherapists and, in the longer term, the Covid-19 pandemic will change the way we learn and change our practice than we currently believe. Perhaps attending a course virtually will be seen as more valuable than it is now as quality and accessibility improve during the pandemic.
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