Editorial: Getting the Most from What You Read in Orthopaedic Journals

摘要

Many orthopaedic surgeons tell me they are uneasy about reading scientific journals. This is perhaps not surprising; the Accreditation Council for Graduate Medical Education requires that orthopaedic residents do research, but it has no specific requirements for journal clubs or critical-reading programs for trainees [1]. Training programs allocate resources accordingly, and the result is that some practitioners find reading scientific papers a real challenge. No one is born a good reader of science; this skill improves with practice, and it can be taught and learned. A few principles can help, including a screening approach to help busy clinicians decide which articles to read in depth, a few key questions one can “ask” of a study's methods sections, and available critical-reading tools that can take an interested reader even further. Deciding What to Read Journals publish far more articles than even the most-avid reader could possibly consume. Nearly 7000 orthopaedic articles were published in 2009 and the compound rate of growth was 10.2% [8], suggesting that this year more than 15,000 orthopaedic articles will see daylight. Thomson Reuters indexed 74 orthopaedic journals for its calculation of the 2015 Impact Factor (the latest year for which data are available [3]); Scimago listed 225 [13]. There probably are more. We need to be choosy about what we read, since it's impossible to digest it all. One possible screening approach is to identify a small number of trusted sources—perhaps skim the contents of a high-quality general-interest orthopaedic journal or two, a subspecialty journal, and a leading medical or science publication. Since even three or four journals will deliver more content than most of us can reasonably consume before the next issue comes out, we need to be still-more selective. Start by reading the article titles, and for those that seem worthwhile, skip to the Conclusions section and ask, “If it were true, would it matter to me?” Do not, at this point, try to determine whether it is true, since without a deeper dive it's impossible to know. Just use that question as a screening test. If an article passes that test, skip directly to the Methods section of the paper, and begin the real operation. Key Questions for the Methods Section The thoughtful consumer of orthopaedic research will focus on two main themes while reading an article's Methods section: Validity and bias. Validity comes in two flavors: External validity (generalizability) and internal validity (methodological rigor). Criteria for external validity—whether a reader can generalize the results of a study done by other people in other places to one's own practice—are the same regardless of the type of article, while the criteria for internal validity vary by study type. One needs to consider both external and internal validity to ascertain whether a study's findings are applicable and trustworthy. External validity (generalizability) checklist Does it apply to my practice? Do the patients in this article look like my patients? Do my skills and experience compare with those of the surgeons in the study? Are the technology and facilities used in the study available to me? The key factors in determining whether the findings from a study might generalize well to one's own practice pertain principally to the patients and practice setting, the skills and experience of the provider performing the intervention, and special technology, tools, or facilities that might be needed to do the job well. Patient-specific factors like age, activity level, and workplace demands (or workplace injuries) can differ dramatically from one study to another, and warrant consideration. Findings from tertiary-care practices do not always generalize well to community orthopaedic settings and vice versa. As in sports and musical performance, the background and experience of the performer can matter tremendously. Often, authors write about procedures they have done hundreds