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From the Editor

Above All, It Must Be Consulted

Kanter, Steven L., MD

doi: 10.1097/ACM.0b013e31821a4795
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All of us complain about information overload. Sometimes, we fret as though we are shouldering a new burden that was somehow thrust upon us by the Internet. There is no question that information overload exists, nor is there any doubt that it presents a formidable challenge to those who must stay abreast of the latest developments in a particular field of inquiry. But information overload is not a new problem.

In fact, writing in The Atlantic Monthly in July 1945, Vannevar Bush, then director of the U.S. Office of Scientific Research and Development, was concerned about this very issue. In a now classic article, “As We May Think,”1 Bush wrote, “A record if it is to be useful to science, must be continuously extended, it must be stored, and above all it must be consulted.” (By record, he meant a printed article, a photographic image, or other document containing information.)

Above all, it must be consulted. Bush recognized that a given record could help advance thinking and practice only if it was found and used when it was needed. But Bush also notes,

Mendel's concept of the laws of genetics was lost to the world for a generation because his publication did not reach the few who were capable of grasping and extending it; and this sort of catastrophe is undoubtedly being repeated all about us, as truly significant attainments become lost in the mass of the inconsequential.1

Bush, who had been responsible for coordinating the scientific efforts of academia, business, and all branches of the military to support the war effort, worried about what scientists would do once the war was over. He urged scientists to address the challenge of information overload. Given the very large amount of information available on almost any given topic, how does one access what one needs? In Bush's words:

The difficulty seems to be, not so much that we publish unduly in view of the extent and variety of present day interests, but rather that publication has been extended far beyond our present ability to make real use of the record.1

This observation, of course, also reflects present-day concerns about the vast and growing amount of information accessible via the Web. Bush continued:

The summation of human experience is being expanded at a prodigious rate, and the means we use for threading through the consequent maze to the momentarily important item is the same as was used in the days of square-rigged ships.1

Bush noted a disconnect between the mechanisms used in 1945 to store information in archives—e.g., alphabetically or numerically—and how the human mind works to retrieve a piece of that information. He explained that the human mind does not index data alphabetically or numerically, but rather follows an “associative trail,” relating one piece of information meaningfully to the next.

He noted that associative trails in the mind can fade over time, but suggested that connecting bits of information stored on physical media had the advantage of permanence. Thus, in a few sentences, he predicted what we now call hypertext, a term that would be coined some 15 years later.

Although hypertext is useful in many ways and enables one to follow an associative trail of interest through a set of documents, it is not a sufficient solution, by itself, to the problem of information overload. Other information search strategies are needed.

So, how can a journal like Academic Medicine make its content more easily accessible to those who want to follow an associative trail, connecting articles and ideas in meaningful ways?

Obviously, one can use any of several online search engines to locate content of interest in this or any journal. But the editorial staff and I believe that there is added value in being able to browse through a collection of articles that share a common theme. For this reason, we have made the “Collections” feature available on Academic Medicine's Web site,

Perhaps you recall reading an article in the journal about global health education but cannot remember when it was published. In two clicks (one on “Article Collections” and one on “Global Health Education”), you can see the titles of about 20 articles—with hyperlinks directly to the articles—that have been published on this topic.

In some cases, a group of articles are connected by an overarching theme, visible from a “10,000-foot view,” which might not be easily retrieved as a group using specific search terms. For example, see the Collection on “The Changing Face of Academic Health Centers.”

Also, the Collections feature enables us to highlight emerging themes in the journal. For example, we are seeing more submissions about the clinical outcomes of educational interventions. Thus, we created a Collection that, at the time of this writing, has six published articles but likely will grow quickly.

In addition to those mentioned above, current Collections include AM Classics, Clinical and Translational Research, Conflict-of-Interest, Health Care Reform, International Medical Education and Collaborations, International Medical Graduates, Medical Education Around the World, Osteopathic Medicine and Medical Education, Population Health Education, Quality and Safety, and Responsible Conduct of Research.

We will continue to develop Collections that align with the journal's five focus areas—education and training issues, health and science policy, institutional issues, research practice, and clinical practice in academic settings—that highlight emerging areas and link articles that share broad, overarching themes. And we would be delighted to receive suggestions from you for future Collections (send an e-mail message with your suggestion to [email protected]).

Over 60 years ago, Bush lamented, “Thus far we seem to be worse off than before—for we can enormously extend the record; yet even in its present bulk we can hardly consult it.” However, he conveyed a hopeful note for the future, predicting that “wholly new forms of encyclopedias will appear, ready made with a mesh of associative trails running through them.”1 We hope that the Collections feature facilitates your associative trails as you find the information you need in Academic Medicine.

Steven L. Kanter, MD


1 Bush V. As we may think. The Atlantic Monthly, July 1945. Accessed March 4, 2011.
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