How much effort is needed to keep up with the literature relevant for primary care?

Objectives: Medicine must keep current with the research literature, and keeping current requires continuously updating the clinical knowledgebase (i.e., references that provide answers to clinical questions). The authors estimated the volume of medical literature potentially relevant to primary care published in a month and the time required for physicians trained in medical epidemiology to evaluate it for updating a clinical knowledgebase. Methods: We included journals listed in five primary care journal review services (ACP Journal Club, DynaMed, Evidence-Based Practice, Journal Watch, and QuickScan Reviews). Finding little overlap, we added the 2001 ʹʹBrandon/Hill Selected List of Print Books and Journals for the Small Medical Library.ʹʹ We counted articles (including letters, editorials, and other commentaries) published in March 2002, using bibliographic software where possible and hand counting when necessary. For journals not published in March 2002, we reviewed the nearest issue. Five primary care physicians independently evaluated fifty randomly selected articles and timed the process. Results: The combined list contained 341 currently active journals with 8,265 articles. Adjusting for publication frequency, we estimate 7,287 articles are published monthly in this set of journals. Physicians trained in epidemiology would take an estimated 627.5 hours per month to evaluate these articles. Conclusions: To provide practicing clinicians with the best current evidence, more comprehensive and systematic literature surveillance efforts are needed.