Staying Current: Advice for New Practitioners

Arpita S. Gandhi, PharmD BCOP
Hematology/Oncology Clinical Pharmacy Specialist
Emory Healthcare
Atlanta, GA

I still remember starting my very first job after the completion of my hematology/oncology pharmacy residency and feeling like I was on top of the world. I had subscribed to a gazillion journals and website updates, and I was all set to be the living encyclopedia of oncology therapeutics for my team—or so I thought. As the years passed by, the burden of staying up-to-date with oncology practice began to weigh heavily on my shoulders, particularly as I started delving into various roles and activities for professional development all while maintaining high standards for patient care activities. Becoming a mother was a game changer. I had to set boundaries for maintaining a healthy work-life balance, which involved coming up with an effective and efficient system that allowed me to stay current with updates in oncology therapeutics.

New information is coming out at an explosive rate.^1,2 In the 1950s, the amount of medical knowledge was expected to double every 50 years. In 2020, medical knowledge is expected to double every 73 days.³ At some point in our professional career, each of us has been told that medicine is a lifelong learning journey; however, we must face the reality that comes with this daunting task. It is incredibly challenging to stay up-to-date with one oncology subspecialty, let alone all subspecialties, internal medicine, infectious diseases, and so on. Staying up-to-date involves two tasks: remembering previously acquired information and learning new information. This article offers some tips that can be used to help you stay current with updates in oncology therapeutics.

Tip 1: Remain curious and always challenge yourself.

During pharmacy school or postdoctorate training, remaining curious and challenging yourself is easy just by virtue of being in a training environment. However, this situation can change after training is completed because of the pressure of daily tasks. It is easier to stick to what we know or are familiar with, and given the pace at which oncology therapeutics is transforming, learned information can become outdated fairly quickly. It is important to work in a challenging environment. Curiosity, even about the tasks that have become second nature, is also important. It is an indispensable attribute and is pivotal for sound clinical reasoning.^4,5 Self-reflection, critical thinking, and teamwork become hollow in the absence of curiosity. Challenge yourself to work as a team with colleagues who may practice differently, and establish a nonthreatening environment that will encourage you and everyone around you to be curious and ask questions (e.g., Why is one regimen picked over another?).

Tip 2: Let others curate resources for you.

Researching primary literature to answer questions encountered on a daily basis will keep you up-to-date, but this will not help you proactively identify issues. The amount of information available at our fingertips is overwhelming. It is up to us to create filters. Subscribe to resources that narrow down the many articles published daily to a dozen or so that may be relevant. Subscribing to a Really Simple Syndication (RSS) feed is an easy and efficient way to stay informed about newly published content. Websites create RSS feeds of their content as a strategy to provide continuous updates to subscribers. Subscribing to RSS feeds is a simple process; it requires an RSS feed address and a program that can translate and show content taken from that feed address. There are many different RSS programs that can display and update information from RSS feeds.⁶

• Table of contents (TOC) alerts: Set up an alert for your favorite journal(s) so that you will receive an email or an updated RSS feed when a new issue is published. This can be set up for an individual journal from the journal’s website or via search engine websites such as PubMed’s MyNCBI feature.^6,7
• Feedly is a tool that pulls information from all over the Web (e.g., blogs, journals, YouTube videos, Twitter feeds) via RSS feeds. Instead of having to visit webpages every few days to find updates, it delivers the same information to one place. The number of unread articles shows up in the easy-to-read feeds on the main page, allowing you to review everything on one dashboard. Notes can be made in these articles, though this feature requires a fee. You can also save articles to personalized boards. Feedly allows you to integrate with numerous applications and easily share content to social media outlets.
• EvidenceAlerts is an integrated e-mail alerting system for healthcare providers (covering key trials from more than 120 journals) at no charge. All citations are prereviewed by research staff to ensure quality and are subsequently rated by physicians for clinical relevance and interest.
• Read by QxMD, a mobile app, is a digital one-stop shop for medical literature. It allows you to get feeds of the medical journals of your choosing and organize and review your personal collection of articles. A unique feature of this app is that it links with your institution’s library account, so you can access full-text articles that your library subscribes to with a single click. You can also make a comment on a paper, save it, share it on social media, or send it to someone.
• Podcasts are an easy way of staying informed if you lack the time to read journals. Several medical journals, including the Journal of Clinical Oncology and Lancet Oncology, and professional organizations publish podcasts (including the recently launched HOPA Now) to summarize or supplement what is published in journals or is being discussed among healthcare providers.

In addition to journals, numerous other websites (e.g., Medscape, Cancer Network, Clinical Care Options, U.S. Food and Drug Administration, and Journal of National Comprehensive Cancer Network 360) provide e-mail subscription services through which the latest medical news, clinical trial coverage, drug updates, journal articles, continuing education activities, and more are delivered.

Tip 3: Use social media.

Social media (Facebook, Twitter, etc.) are not for everyone, and let’s face it—they are not PubMed. However, I personally find it helpful to read what experts and nonexperts alike are talking about, particularly for primary literature. It is important to appreciate opposing perspectives: they may further challenge your viewpoints and cause you to dig deeper. Follow journals or medical/pharmacy organizations on social media to read about the latest updates.

Tip 4: Attend conferences.

Megaconferences such as the American Society of Clinical Oncology or Hematology/Oncology Pharmacy Association annual meetings have attendance numbering in the thousands and are great for accessing a breadth of information and learning about the latest breakthroughs. However, smaller-scale conferences hosted on a local or state level can provide just as much value. Choose conferences that are most relevant to your practice, and try to commit to attending at least one annually.

Tip 5: Use a clinical decision support system.

Clinical decision support systems (e.g., UpToDate) are quickly becoming essential tools for healthcare providers because they provide the most up-to-date evidence-based information (e.g., overview of disease, treatment guidelines) at the point of care. These systems can perform many functions, including, but not limited to, streamlining treatment algorithms based on cancer type.

Tip 6: Teach.

Teaching comes in all shapes and sizes. As pharmacists, we are constantly teaching, whether formally or informally, consciously or subconsciously. We can teach only what we know, so encouraging yourself and all those around you to ask questions is a great way to stay up-to-date. I have found that my best learning comes from teaching. This may be in the form of writing an article, lecturing at a college of pharmacy or at a conference, reviewing mechanisms of action of drugs with a learner, and so much more. We should all consider ourselves both teachers and learners.

Tip 7: Attain board certification.

The Board Certified Oncology Pharmacist program validates that the pharmacist has the advanced knowledge and experience necessary to optimize outcomes for patients with malignant diseases. Attaining board certification and subsequently maintaining it require completion of continuing education and offer you a great way to stay up-to-date.⁸

Tip 8: Interact with peers.

One of the most common and effective ways healthcare providers receive medical updates is from their colleagues. Routine peer-to-peer interaction can be a useful way to stay abreast of changing guidelines and cutting-edge research. Ask fellow pharmacists or providers for their thoughts on a new study or recently updated guidelines, for example.

Tip 9: Engage with pharmacy organizations.

Getting involved in pharmacy organizations, whether at a local, state, or national level, is a great way to stay up-to-date. These organizations offer numerous ways to get involved, ranging from participating on a committee to connecting or collaborating with fellow colleagues. Many organizations also have listservs, which generally involve discussions about issues in clinical practice; pharmacists can submit questions and request feedback from members from various institutions. These are great channels for discussing prominent issues, sharing ideas, and networking with colleagues from across the country.

Although I hope you find some of the tips mentioned in this article useful to you in your efforts to stay current, the most important strategy is to make learning a routine activity rather than limiting it to once or twice a year. I subscribe to numerous TOC alerts, but I graze through most of them to find the most important publications. I carefully choose and pay attention to landmark studies that have led to new drug approvals or have changed treatment strategies. I encourage you to carve out a specific time each day (a few minutes) or week (1–2 hours). The hard part is to not lose motivation and to stay disciplined about finding time. There are many ways to learn, and no single way is ideal for everyone. Regardless of your learning style, embrace the concept of lifelong learning—I assure you that it will make you a better pharmacist!⁹

Being an oncology pharmacist is a great privilege. Staying current may seem like a daunting task, but if you make curiosity the foundation of patient care, the task is doable. We make a commitment to serve our patients when we take the pharmacist’s oath. We owe it to ourselves and our profession to maintain this commitment.

References

1. Warner JL. Grappling with the data explosion in oncology. Oncol Hematol Rev. 2015;11: 1023.
2. Beatty PA. Coping with abundance: the burden of progress in medical oncology. Oncologist. 2012;17:294-295.
3. Poorman E. Staying current in medicine: advice for new doctors. NEJM Knowledge+ website. https://knowledgeplus.nejm.org/blog/staying-current-in-medicine-advice-for-new-doctors/. Published November 10, 2016.
4. Adashi EY, Ahmed AKH, Gruppuso PA. The importance of being curious. Am J Med. 2019;132:673-674.
5. Dyche L, Epstein RM. Curiosity and medical education. Med Educ. 2011;45:663-668.
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8. Oncology pharmacy. Board of Pharmacy Specialties website. 2019. https://www.bpsweb.org/bps-specialties/oncology-pharmacy/#1517761118361-6c02bae3-f5a0151778001577715178540776891517858333825.
9. Mandrola J. A mid-career perspective on lifelong learning in medicine. NEJM Knowledge+ website. https://knowledgeplus.nejm.org/blog/a-mid-career-perspective-on-lifelong-learning-in-medicine/. Published March 12, 2015.