Young Kidney Professionals’ Perspectives and Attitudes about Consuming Scientific Information

A Focus Group Study

Abstract

The digital era has seen rapid changes in how information is consumed. Traditional dissemination of scholarly work through biomedical journals may not be optimally tailored to the preferences of younger clinicians and researchers. We aimed to describe the perspectives of young clinicians and researchers in kidney disease on consuming scientific information. Three focus groups were conducted during the 2017 American Society of Nephrology Kidney Week with a total of 29 nephrologists and researchers (ages 40 years old and younger) purposively sampled through our networks and the American Society of Nephrology registration database. Data were analyzed thematically. Of the 72 participants invited, 29 participated from 28 centers across 13 countries. Five themes were identified: capturing and retaining attention (with subthemes of triggering interest, optimizing readability, and navigation to sustain motivation); having discernible relevance (resonating with clinical and research interests, supporting professional development, action-oriented and readily applicable, able to disseminate, contextualizing the study, and filtering out informational noise); immediacy and efficiency in processing information (requiring instantaneous and easy access, enabling rapid understanding, and facilitating comprehension of complex concepts); trusting legitimate and credible sources (authoritative indicator of importance and quality, reputable experts broadening perspective, certainty and confidence with collegial input, accurate framing and translation of the message, ascertaining methodologic detail and nuances, and integrating the patient perspective); and social dialoguing and debate. Immediate and digitally optimized access motivated young kidney professionals to consume scientific information. Mechanisms that enable them to distil relevant and new evidence, appraise and apply information to clinical practice and research, disseminate studies to colleagues, and engage in discussion and debate may enhance their comprehension, confidence, interpretation, and use of scientific literature.

Introduction

In the past two decades, the internet and other advances in technology have rapidly changed the way that information is communicated and consumed (^1–3). However, the publication of scientific information from clinical or academic settings remains predominantly through “traditional” biomedical journals (^4–7), which may not be optimally tailored to how clinicians and researchers access, consume, and use evidence in the modern age. This could limit the effectiveness of scientific information for supporting professional development, clinical decision making, patient care, and research (⁸).

Many biomedical journals have broadened their dissemination strategies to include email alerts, online e-prints, visual abstracts, mobile applications, podcasts, and YouTube as well as the use of social media platforms, such as Twitter and Facebook, to amplify communication of scientific work (⁴,⁵,^9–13). Recent studies indicate that articles on Twitter are three times more likely to be downloaded compared with those that were not featured, although these articles were selected for dissemination and may be biased to the interest of the readership (¹⁴). Some trials have shown that articles randomly selected to be shared on social medial did not show a change in 30-day page views (¹⁵,¹⁶). Although the majority of health professionals use technology to access information, the challenges of keeping up to date with the overwhelming dispersion of information and the barriers to information seeking, such as time constraints and inadequate information and communication technology infrastructure, have been well described (⁴,⁸,^17–21). However, there is limited understanding about clinicians’ and researchers’ perspectives on how different forms of communication affect the way that they access, consume, and translate scientific information into clinical practice or research.

Many journals currently disseminate scientific information through print and online journals, email alerts, social media (Twitter), podcasts, applications, press releases, and visual abstracts. To inform the dissemination and discussion of science published in nephrology, we conducted this study to describe the motivations, attitudes, and perspectives of young clinicians and researchers in kidney disease on consuming scientific information published in peer-reviewed biomedical journals.

Materials and Methods

We used the Consolidated Criteria for Reporting Qualitative Health Research (²²).

Context

The impetus for this study was to inform strategies to improve editorial and publication processes of the Clinical Journal of the American Society of Nephrology (CJASN).

Participant Selection

Nephrologists, nephrology trainees, and researchers in kidney disease age 40 years old or younger and English speaking were eligible to participate. We focused on younger professionals, because they can provide relevant perspectives on the new and emerging ways that science is being consumed by the next generation of clinicians and researchers. We identified potential participants from our networks (colleagues and collaborators who could suggest potential participants) and the American Society of Nephrology (ASN) Kidney Week 2017 Registrant database. We used purposive sampling to obtain a diverse range of age, sex, years of clinical or research experience in nephrology, country of practice, and experience in clinical practice and/or research. Invitations were sent by email. Approximately six to eight participants are recommended for a focus group (²³); thus, ten participants were confirmed for each group. The University of Washington Human Subjects Division determined that this study qualified for exempt status (STUDY00002797). Participants consented to be audiotaped.

Data Collection

The focus group question guide (Supplemental Material, Supplemental Table 1) was developed on the basis of a literature review (⁴,⁵,⁹,¹⁰,¹⁸,²⁰,^24–26) and team discussion. Before the focus groups, participants received a link to selected CJASN articles, podcasts, and visual abstracts, and they were also asked to reflect on consuming information published in other biomedical journals. We conducted focus groups during the ASN Kidney Week (New Orleans, LA in 2017) to maximize geographic diversity of participants. Three focus groups were convened on the basis of venue availability and scheduling restrictions. Investigators A.T., D.C.C., and J.O.S. each facilitated one 1-hour focus group, while the other two investigators recorded field notes. All focus groups were audio taped and transcribed.

Data Analyses

Using thematic analysis, A.T. read the transcripts and manually coded the transcripts line by line to identify concepts that were inductively derived from the data. Similar codes were grouped into themes and subthemes. These were reviewed, discussed, and revised by all members of the investigator team who had read the transcripts (A.T., D.C.C., and J.O.S.) until agreement was reached. The revised themes and transcripts were entered into HyperRESEARCH software (version 3.7.5; ResearchWare Inc.). A.T. recoded the transcripts electronically to the revised themes, which were rereviewed by the investigators. This form of investigator triangulation ensures that the range and depth of data are reflected in the findings. We emailed participants a copy of the preliminary findings and invited comments. Any additional perspectives received were integrated into the final analysis. These two processes ensured the credibility and confirmability of the findings (²³,²⁷).

Results

We sent the invitation to 72 participants, who all responded. Those who declined were not attending ASN Kidney Week or had conflicting commitments. Of the 30 confirmed to attend, 29 participants from 28 centers across 13 countries participated. Most (27; 93%) were nephrologists or nephrologists in training. (Table 1) Thirteen (45%) were men. All participants accessed journal articles online (not limited to the CJASN), 23 (29%) accessed print journals, 17 (59%) listened to podcasts, 14 (48%) used Twitter, 11 (38%) used Facebook, and 21 (72%) used journal mobile applications (Table 2).

Table 1. - Characteristics of 29 early career kidney professionals participating in focus groups

Characteristic	N (%)
Sex
Men	13 (45)
Women	16 (55)
Age group, yr
<35	9 (31)
35–40	20 (69)
Role
Nephrologist	22 (76)
Nephrologist in training	5 (17)
Researcher (nonclinician)	2 (7)
Country of practice
United States	11 (38)
United Kingdom	4 (14)
Australia	3 (10)
Hong Kong	2 (7)
Other a	9 (31)
Ethnicity/race
White	14 (48)
Asian	10 (34)
Black	2 (7)
Hispanic/Latino	2 (7)
Arab	1 (3)
No. of publications as author/coauthor
0	2 (7)
1–20	19 (66)
21–40	2 (7)
41–60	2 (7)
>60	4 (14)

^aThe other nine countries included Brazil, Canada, Guatemala, Italy, New Zealand, Nigeria, Singapore, South Korea, and The Netherlands (one participant from each country).

Table 2. - Frequency of access to journal articles reported by 29 early career kidney professionals participating in focus groups

Mode a	Daily	Weekly	Fortnightly	Monthly	Yearly	Never
Journal article (print)	0	8	2	8	5	6
Journal article (online)	15	9	1	4	0	0
Podcasts	0	2	3	2	10	12
Videos	0	1	2	9	4	13
Twitter	10	3	0	1	0	15
Facebook	4	2	2	2	1	18
Mobile applications	6	0	4	11	0	8
Journal club	1	6	5	12	1	4

Cell contents are numbers of participants.

^aOther modes indicated included YouTube Channel, blogs, webpage, UpToDate, news, emails (e.g., alerts, journal watch email alerts, and email LISTSERV), and meetings.

We identified five themes: capturing and retaining attention, having discernible relevance, immediacy and efficiency in processing information, trusting legitimate and credible sources, and social dialoguing and debate. The respective subthemes are described below, and the conceptual links across themes are shown in Figure 1. Selected quotations to support each theme are provided in Table 3.

Figure 1.: The themes and subthemes are depicted in this figure, and the arrows indicate the conceptual links between themes. From the left, on being alerted to journal articles, participants needed to be able to easily discern the relevance of the article to their clinical practice, research, or general professional development and wanted to be able to access and understand the information readily. However, prioritizing and contextualizing the information were challenging, and they considered the legitimacy and credibility of the information. Participants believed that they had a responsibility to critically appraise the study when deemed necessary. They also drew on opinions from trusted experts and colleagues to gauge the novelty, relevance, and validity of the information, and they valued opportunities to engage in discussion, dialogue, and debate to gain a broader view on the topic. The social dialoguing and debate provided an opportunity to hear from experts in the field, and at the same time, they drew their attention to the article being discussed, particularly in social media platforms.

Table 3. - Selected participant quotations for each theme identified in focus groups of 29 early career kidney professionals

Theme	Quotations	Group ID
Capturing and retaining   attention
Triggering interest	I really liked the visual abstracts. I’ve noticed a few other journals are doing that, and I’m on Twitter and that’s a really great way to quickly disseminate some of the research, so it will catch my attention and I’ll know I need to go read that article. W, FG1	1, 2, 3
	I do like the visual abstract. It is a very innovative way to grab your attention. Especially in topics you are not interested in. I tried because these are experiments, I tried to understand the topic of the article on the basis of the visual abstract. M, FG2
	The legendary papers have got some kind of postcard figure on them that come up on every slide. That’s what attracts me to papers often. M, FG3
Optimizing   readability and   navigation to   sustain motivation	Somehow [the online article] still seems more designed for someone to print it versus Circulation just redesigned all their online and it’s very friendly for online, you can click, somehow the font and the setup, you can click and get right to the figures easily from the side. W, FG1	1, 2, 3
	Having a way to click and skip to the figures and the methods, there’s a sidebar, you can just very quickly, instead of having to scroll down. Then you can open just the figures. The New England journal it’s tabs across the top, versus Circulation and JAMA, it’s down the side. It’s a lot easier to navigate those. W, FG1
	The [CJASN] website could have a division for different subjects. I would read New England, look at different subjects, and go read all the papers in that field, and I don’t think CJASN has that. W, FG1
Having discernible  relevance
Resonating with   clinical and   research interests	Either the title will be interesting for my research or for my practice, and it’s something that either I feel like I need to know this new thing about, or I haven’t read in a while about, that would be something I would click on. W, FG1	1, 2, 3
	If something is of interest to me, or I’m doing a journal club on it, or I’m interested in the topic, I will pull it from whatever source. I will always look at a pdf and do the whole thing. M, FG2
	I access the literature with two purposes. The first one is to get updated in my specific area of interest. I’m not searching, personally, a lot of new articles or original investigation, I’m searching for something that is grabbing me to the clinical, to the patient’s bedside. M, FG2
Continuing   professional   development	It’s just I feel like it’s relevant, like it would be a good thing to read for my general practice. W, FG1	1, 2, 3
	If you were aiming it at people in training, the series that we’ve mentioned, about renal physiology or immunology for the clinicians, I found those really useful. Thinking about other things perhaps like methodology series that you could do, would be really useful for people in training. M, FG1
	If it’s just to keep up to date on the latest things in nephrology, I subscribe to the table of contents to the top three for nephrology journals, and I can click on it and see the abstract on my phone. If it’s something I actually like, then I’ll have to go to my office and download the pdf and print it out. I never wait for the print, because most stuff comes out online first. If I’m just trying to keep my pulse on what’s going on, then it’s just doing the abstracts from my phone, from the emails. W, FG3
Action oriented and   readily applicable	The only single-piece documents that may change practice would be guideline papers, which are results of discussions from presumed experts in the field, especially if it’s a field that I’m not super familiar with, then we could go straight to AHA or KDIGO. M, FG1	1, 2, 3
	Some of the articles in CJASN that really changed my practice are the ones that focus on new methods or here’s how we should do this. They had one on competing risks analysis. That might be an example where I read the article, I also share it with a lot of people that I know might be interested, in a way it changes my practice. I’m not a clinician, but that focus on methods is really important, and I love that as one feature. W, FG1
	I’m searching for something that is grabbing me to the clinical, to the patient’s bedside. This is what I’m searching in CJASN. M, FG2
	All the fellows try to be members of the ASN, through their fellow training, and we have to look for specific topics for the rounds. I look at every issue for select topics, like sections, like glomerular disease, or in 2015 renal physiology, for the residents, inclusive internal, it’s a very good option to obtain condensed information and important information. Their clinical journal for me is the best way for me to obtain clinical information when you have to translate to the patient. M, FG2
Able to disseminate	I’ll forward on some things that I read that I find interesting, mostly to students and my research group, and it helps when it’s easy to access. The visual abstracts are great to forward on if there’s a way to easily do that, but right now it’s forwarding the table of contents or an alert, email alert that I got of a new paper. Then, I go and try to search and find the paper and maybe attach it, or provide the link to the PubMed and then have them pull it themselves. W, FG1	1, 2, 3
	Some journals do prepare PowerPoint slides for you, which I do use in talks, so if I’m going and looking specifically for a figure, rather than going and opening it in Adobe and cutting it myself and then finding the citation and adding it, it saves a lot of time to just be able to have that PowerPoint slide to drop into my presentation. W, FG1
	I would probably include in the article, especially in the review articles, a sort of slide deck, for instance five or ten slides about the review, or also an original investigation, that can help to disseminate the article to other members of the group. For instance, New England Journal of Medicine, you can download five slides off the article, and we actually utilize it in our presentations in the hospital, maybe during lunch. If you imagine for instance for a review that is organized by a master in the field, probably if I’m preparing a meeting with other colleagues and I have ten slides with a CJASN logo describing the field, probably I would encourage other colleagues to utilize more of the website and also the contents. M, FG2
Contextualizing   the study	Sometimes the papers don’t have a clear message, they seem like someone’s just trying to get them out. I’d much rather see something a bit like the things introduced by journals where research in context is a box that needs to be introduced. M, FG3	1, 3
	I do appreciate the other journals where they actually will say what are the clinical implications or why is this different from the last ten papers that were just published on the same topic. W, FG3
	I like the box with the key points or clinical implication that summarizes where the new article fits into the existing literature and where this would appeal to. W, FG3
Filtering out   informational noise	You need something that is efficient at deciding what you’re going to spend your time on. All those tools that help us decide if we’re going to read the whole paper or not are great. Try to digest it in the most quick and easily accessible way that we can easily say yes no, then read the whole paper when we have a bit of time. W, FG1	1, 2, 3
	There’s a lot of key words in every single article, getting personalized information would be helpful. If you had a setup where you’re going to be sent a visual abstract with maybe a little bit more background information in them that were relevant to you, tagged by the things that we’re interested in, that actually might be helpful. Because in the noise, you tend to look at stuff that might interest you. It’s interesting hearing people who are more close to being fellows or residents, you’ve got a more general knowledge kind of situation. Someone like me is in the position where I’m trying to consume enough knowledge to keep going, but also extremely time poor, so focus on stuff of interest. M, FG2
	Each article has a couple sentences and that give a summary of what’s in the journal and you can read that and skip the ones that you’re not interested in. M, FG2
Immediacy and efficiency in processing information
Requiring   instantaneous and   easy access	Sometimes the trainees will go to the lower-quality journals, because it’s easy access. W, FG1	1, 2, 3
	We don’t have access to CJASN through our institution. I stopped reading it, because I have to log in to ASN, and I can never remember my password. So then I have to go to ASN and log into that, reset my password, and then get into CJASN. W, FG2
	For somebody who is still in general practice, you don’t really subscribe to CJASN. The only time I get to read it is when I go to my PI’s office and be like, can I borrow that because that one had interesting content, because I subscribe to it via email so I’ll look through the contents page … if the academic library doesn’t have it or if you don’t have access to an academic library, you have to rely on friends who do. W, FG3
	If you don’t read it straight away, online it’s very unlikely that you’re actually going to go back and read it. W, FG3
Facilitating comprehension of complex concepts	I hadn’t really listened to podcasts before so I did that specifically for this, and I have to say I quite struggled. I listened to a few of them, and some of them lent themselves quite well to auditory abstract, quality of research, but then some of the more technical ones I found I really struggled without something physical, like a figure or a paper, to stop or think as I was going along. I listened to one on supplementation of vitamin D metabolism, hearing about the different kind of metabolites of vitamin D without something visual to hang on to, I found really difficult. M, FG1	1
Enabling rapid   understanding	Sometimes it’s difficult to understand the area of focus of the article. In the sense that probably the idea is very strong, but sometimes maybe a little bit of introduction more that can better explain the topic of the article would be helpful for me. M, FG2	1, 2, 3
	Something that is very nice are there are some videos that they put on the New England journal, 3-min videos, those are great. As a resident, you just want to have information fast, so just click, get information while you’re just eating breakfast. It’s very helpful, and also, if you want to show something to medical students, you just show them the video, and then they get the full information. M, FG2
	In 5 min [listening to the podcast], I could actually know what kind of study I was listening to, and I could figure out what the study was about and what the conclusions were from the study. I would have spent longer going through an article actually, so it was quite brief and concise and to the point. W, FG3
Trusting legitimate and credible sources
Authoritative   indicator of   importance   and quality	If somebody very credible on Twitter says this is a good article, you’re probably not going to disagree with them. But if you want to make your own judgment, then you have to read the whole thing. M, FG1	1, 2, 3
	One of my favorite things to read in CJASN are the editorials, because they’re a great update on an important, timely topic, usually written by a leader in the field, and it’s really valuable for me as a young trainee to see what experts in the field are saying. W, FG2
	I’m a bit embarrassed to say it, but I think the author actually does draw my attention to it as well. I know you should keep an open mind, but I guess a lot of the top authors have almost got their own brand as far as they probably wouldn’t put their name to something that’s substandard and poor. M, FG3
	Especially if one of my senior collaborators or people in the field who I respect, they put something on their Facebook, then I go and read that article. W, FG3
Reputable experts   broadening   perspective	Someone who really knows about the subjects tweets about it, and you’re like oh, I’m seeing this from a different angle now. A bit in the same way as when you go to a conference and an expert presents something, it’s not the same as when you read it, and you might not have the same subject knowledge as the person who is talking about it. W, FG1	1, 2, 3
	I also never used Twitter prior to this year, and now, I’m learning more about it and its utility in education. What’s nice is the quality of people that join in on these live discussions is very high, because often, it is the author of the journal. Sometimes in training, we get into our little bubbles, whether our own institutions or own groups, and it really brings an international audience to the discussion, which I think is so very valuable. It’s a really broad range of professionals, from students, residents, people who are PhD researchers across the field. W, FG2
	It forces you to think about things outside your subject matter, and maybe something that’s online, refreshable, live discussion is more palatable than reading a paper article that could be long or listening to a long podcast of something that’s definitely not in your interest. The key is you know that there’s going to be experts in that field in the discussion, so you consider that it will be valuable time spent. You would be getting that information from people who are experts in the field and have gone through the literature, so it’s like okay, those are things I should focus on when I read about this in the future, if I choose to read about it. W, FG2
Certainty and   confidence with   collegial input	Articles that are a real game changer in practice just get talked over every platform and even in the traditional journal, and you hear about it in meetings and outside, so you somehow get to know about it. I don’t think an article itself ever changed what I do, unless I’ve talked to someone about it and discussed it as a group, a few people at least. It’s always once everyone has discussed it together and decided we want to change something. W, FG1	1, 3
	In the end, we still traditionally discuss with colleagues or coworkers or people we trust. People on Twitter said it’s very important, maybe I’ll get on Twitter, but still, I like to discuss with colleagues and go to conferences or journal clubs or see the reception from others, that’s important to decide what myself I’m going to do. W, FG1
Accurate framing and   translation of the   message	There’s a lot of variability in terms of the quality of the abstracts themselves. I believe they’re not actually made by the author—most of them aren’t actually made by the actual authors, but it’s a third party, I think there’s visual abstract editors who turn somebody else’s article into a visual abstract. So, I feel like occasionally they actually miss the point, or it’s just a little bit off, it seems like. M, FG1	1, 3
	I see a study with a clinical trial with 40 patients published in CJASN drawing conclusions which has a lot of methodological flaws. But then that study, it’s something that’s interesting, and it’ll be in the ASN newsfeed that morning with a catchy title that’ll make such a big impression on so many people, maybe they’re not in this field and they just look at the title. It sometimes distorts some of the poor-quality studies that get accepted in CJASN, and then are highlighted in these newsfeeds. W, FG3
	I think for CJASN, controlling the message. I’m not sure how closely the journal works right now with the authors in terms of the press releases to make sure that you don’t have these silly titles. For example, at my research institute, we have a media consultant group that will actually work with us on the press release to make sure you’re sending the right message. W, FG3
Ascertaining   methodologic   detail and nuances   for critique	You cannot judge the quality without reading the method, to critically appraise anything, you’ve got to read the paper. W, FG1	1, 2, 3
	The research question is missing from the visual abstracts. M, FG2
	With Twitter and research papers, you run the risk of oversimplifying and even sometimes sensationalizing things that are nuanced and do need some detail. W, FG3
Integrating patient perspectives	I would add a patient’s perspective editorial. What does the patient think about the study? I don’t know if that’s possible, because you really need to have educated patients, but I think there are educated patients who could write a section in an article. M, FG2	2
Social dialoguing   and debate	I also like things like the Nephrology Journal Club on Twitter. Though I never actually wrote anything on it. I’m a bit remote from my training area, and when I read something I don’t have any other nephrologist around me to discuss it with. I’ll actually want to discuss the paper, I can go on Twitter and see what other nephrologists have written. So it’s kind of my little journal club, even though I’m not going to journal clubs right now because I’m doing research. W, FG1	1, 2, 3
	It’s more when people argue about something that you get more knowledge or when people just discuss. That makes it very interesting. W, FG1
	Whether it’s the Twitter journal club or blogs or ASN community, I think they did chats of some papers, something that helps encourage a dialogue might be of interest to other professionals. I think it goes to your comment for those who aren’t privy to a regular journal club with other nephrologists or may actually still want to tune in and want to communicate, I think would be helpful. And they could also, at least for researchers, whether it’s networking or collaborating based on, at least this being a jumping point from a paper that they discussed online. I think if we had the ideal resources, doing something that brought people together. Another thought along those lines is well, if it was us designing it, is there a way to poll what else do people want, the people who aren’t in this room. What would they want to see in CJASN, and whether it’s a way to get access to the broader group of subscribers to know what people want, and actually cater to them. W, FG1
	Every week or two, I’m at a journal club, and we’re going in detail over articles, and you start to realize, some journals you’re more likely to get articles that have big problems, and some the articles just don’t have those problems. I’ve noticed, started to get a sense of the quality of the articles based off of that. M, FG2
	Researchers will always want to learn how to improve things, so whenever you see something that is not your topic, specifically what they did, methods that you can use in something you would like to do, you know the author is going to be there and you can ask specific questions—why you did this, why you didn’t think about this, and they will respond for sure without getting upset, so you know that they are there to participate. I think it is a learning experience about the specific topic, but also from a research perspective, you learn about methods from the person who wrote the paper or the person who was there. A lot of people, experts in their field, they can tell you what they think and there’s always a good discussion. M, FG2

ID, identification; W, women; FG, focus group identification; M, men; JAMA, Journal of the American Medical Association; CJASN, Clinical Journal of the American Society of Nephrology; AHA, American Heart Association; KDIGO, Kidney Disease Improving Global Outcomes; ASN, American Society of Nephrology; PI, principal investigator.

Capturing and Retaining Attention

Triggering Interest.

Participants were prompted to read articles because of visual abstracts, video casts, Twitter posts, titles and figures of the articles, email alerts, editorials, and podcasts, because these would “catch their attention.” Visual abstracts were particularly appealing, because they were “colorful,” were “illustrative,” and provided “a very quick overview of the study.” They were considered useful to obtain “the brief results” of a study and “to get an update on something that is new,” and some believed that visual abstracts would help to “reach a wider audience.” Twitter posts were a “great signpost” to articles that could be of potential interest or relevance.

Optimizing Readability and Navigation to Sustain Motivation.

Participants emphasized the importance of online readability and ease of navigation when accessing articles on the website or a mobile application—“even just the [CJASN] website could be spruced up, more friendly for phones, tablets … a better interface.” Online journals articles appeared to be “more designed for someone to print it” rather than to read online, and participants wanted to be able to access different sections of the paper (e.g., figures or methods) more easily.

Having Discernible Relevance

Resonating with Clinical and Research Interests.

Articles piqued the participants’ interest if the topic was aligned with their specific research or clinical focus, particularly if it provided a comprehensive update and in-depth information to enable a deeper understanding on the subject. To improve relevance, they suggested having themed series and a “division for different subjects,” such as hemodialysis or cardiovascular complications, on the journal website; on downloading a pdf, they suggested having links to other papers on the same subject. They suggested that email alerts could be personalized on the basis of keywords that could be selected on the basis of their interests.

Supporting Professional Development.

To keep up to date and have their “pulse on what is clinically relevant,” participants reviewed the table of contents in top general biomedical journals, such as the New England Journal of Medicine (NEJM), as well as nephrology journals. The “surface skimming” helped participants to gauge what the broader medical community was “worried about—especially if people were using a new drug, or if there’s a new trial.” They valued articles that offered in-depth discussion and presented the evidence in a question and answer form, such as those provided in the NEJM resident edition.

Action Oriented and Readily Applicable.

Participants valued publications that could be immediately implemented into practice or research, such as the CJASN “clinical series, which were reviews and what to do in practice.” Guidelines documents published by Kidney Disease Improving Global Outcomes or the American Heart Association, for example, were thought to have the potential to change practice. Specific articles were sought to discuss a specific problem that they encountered. Research methods–focused papers were also useful—“some of the articles that really changed my practice are the ones that focus on new methods … they had one on competing risk analysis.” One participant mentioned that seeing the “statistical or epidemiological concept applied directly to nephrology resonated a lot more than learning it abstractly.”

Able to Disseminate.

Participants used scientific information to prepare lectures or forwarded papers to their trainees or colleagues. They remarked that some journals prepared PowerPoint slides for specific articles, which enabled them to quickly “disseminate the article” and could be “utilized in presentations at the hospital.”

Contextualizing the Study.

It was important for participants to clearly understand “what are the clinical implications [of the study] and why it is different from the last ten papers that were just published on the same topic.” They suggested including a box with the key points or clinical implications as well as “a summary of how the new article fits into the existing literature.” One participant highlighted “Richard Lehman’s [commentary as] the most useful distillation of the medical evidence there is, every week, which he just writes about six lines about all the major papers from New England, JAMA, BMJ, JAMA Internal Medicine.”

Filtering Out Informational Noise.

Participants felt “swamped with information from millions of different sources.” They remarked that “a lot of it is not information that I need or care about; so many new things were happening in medicine, nephrology doesn’t change that rapidly. I don’t need all of this information, most of its just noise, how do you weed out the noise and figure out if something did change?” Participants suggested tools and strategies to help them focus and decide on what to read, such as curated content on the journal website, article or journal summaries, themed series, mobile applications that filter content, and customized email alerts.

Immediacy and Efficiency in Processing Information

Requiring Instantaneous and Easy Access.

Some participants were stymied by publisher pay walls and restricted and password-protected access to journal articles—“I often forget my password to go on the website, and sometimes the institution says the most recent year is not available. It’s very frustrating; it’s the primary barrier for why I won’t disseminate something.” This was problematic for participants in countries where their institutions could not afford subscriptions to journals. Some stopped reading such journals (including the CJASN) and resorted to “lower quality journals,” which were easier to access. Participants emphasized that “accessibility and efficiency” were key for their “generation.” Some used the mobile application so that they could “access it anywhere … and look at the full paper on the mobile app.”

Enabling Rapid Understanding.

Being able to gain a “quick overview” of the study was important: for example, if participants were using the information as a reference for writing a “book chapter” or wanted to get an “update on something that’s new.” Abstracts, in both text and visual forms, had to be sufficiently comprehensive and provide an “introduction that can better explain the topic of the article.” Some found that the NEJM short videos provided comprehensive information in a condensed way.

Facilitating Comprehension of Complex Concepts.

Some participants who listened to journal podcasts felt that more technical or complex articles were not amenable to “auditory abstracts” and suggested that an accompanying “figure or a paper” was needed to help understand the concepts.

Trusting Legitimate and Credible Sources

Authoritative Indicator of Importance and Quality.

Scientific information was perceived to be of high relevance and quality if it was published in a well regarded journal (“if a paper went through the process of being vetted by CJASN reviewers and editors and got accepted, it bears some quality there”); supported by a trusted colleague (“if somebody very credible on Twitter says this is a good article, you’re probably not going to disagree with them”); or written by respected authors. Some believed that, if a high-impact journal, such as the NEJM, went to the effort of publishing a video or podcast on the article, then “it must be important.” Some gauged the importance of studies by reading the editorials written by an expert in the field—“it’s really valuable for me, as a young trainee, to see what experts in the field are saying.”

Reputable Experts Broadening Perspective.

Participants gained a more comprehensive and balanced perspective on research articles if respected experts in the field discussed studies in editorials or presentations or on social media. Editorials provided an introduction, outlined the “pros and cons” and the “clinical relevance” to provide a “broader perspective,” and enabled participants to “learn something”—“The editorials help turn what would be an abstract, that I wouldn’t think anything of, into something that I could get something from.” Viewing comments from experts on social media allowed participants to understand “a limitation of a study, or the good side of a study” that they would not have considered.

Certainty and Confidence with Collegial Input.

Obtaining input from colleagues was important in absorbing and applying scientific information—“I don’t think an article itself has ever changed what I do, unless I’ve talk to someone about it and discussed it as a group.” They attended conferences or participated in journal clubs to “see the reception from others” before deciding on the implications of a study to their own contexts.

Accurate Framing and Translation of the Message.

Some were concerned about the variability in the quality of visual abstracts and urged the need to accurately communicate the study. They were wary of newsfeeds that could be potentially misleading—“it’ll be in the ASN newsfeed that morning with a catchy title, it’ll make such a big impression on so many people, and maybe they’re not in this field. It sometimes distorts some of the poor quality studies that get accepted.” They advocated for journals to take responsibility to “control the message” in terms of accuracy and content delivered through official dissemination channels (e.g., journal visual abstract and the ASN newsfeed).

Ascertaining Methodologic Detail and Nuances.

If participants wanted to critically appraise the study and make their own judgment about the paper, they believed that it was necessary to scrutinize the full article. They could not just rely on the abstract or external commentary. Some were concerned that Twitter feeds could be an “echo chamber with the same five to ten people who are most vocal on it,” and thus, they could be “a little bit skewed,” or they were conscious of “risk of oversimplifying and sensationalizing things that are nuanced.”

Integrating the Patient Perspective.

Some participants suggested to include the patients’ perspective so that they could interpret the study in light of the patients’ voice—“I would add a patient’s perspective editorial … what does the patient think about the study?”

Social Dialoguing and Debate

Engaging in discussion and debate with colleagues, including on social media and online platforms, enhanced the participants’ understanding and interpretation of information. They were able to perceive studies from a “different angle,” gained interesting and informative insights (“people argue about something, then you get more knowledge”), and at times, had direct communication with the authors. Some who were in training recognized that “we get into our little bubbles, whether our own institutions or groups” and that platforms, such as Twitter, brought “an international audience and a broad range of professionals to the discussion.” These forums allowed those who could not attend regular journal clubs to participate in discussions about papers, and participants felt better connected in the nephrology community. Participants supported mechanisms that encouraged such dialogue—“something that’s online, refreshable, live discussion is more palatable than reading a paper article that could be long, or listening to a long podcast of something that’s not in your interest.”

Discussion

Young nephrologists and researchers were drawn to specific scientific publications mainly by email alerts, visual abstracts, social media, and editorials. Their interest would be sustained if the article was optimized for online reading and navigation and if it had discernible relevance for their clinical practice, research, or professional development. They wanted to be able to identify the most relevant and critical studies amid the considerable amount of other information received and contextualize the study to ascertain importance and novelty. Inefficiency and inability to access full-text articles were major barriers to consuming scientific information, particularly if they sought to read the whole article to ascertain the methodologic details to critique and interpret the study in more depth.

Some gained a broader and more balanced perspective on studies when they could reflect on the opinions of reputable experts in editorials, presentations, or posts on social media platforms. They had more confidence in interpreting the studies after seeking input from trusted or respected colleagues. Opportunities to engage in discussion and debate, whether it be in person or via online journal clubs, enabled young professionals to gain international and multidisciplinary perspectives on the topic or paper, and this interactivity also generated enthusiasm for consuming scientific information.

The usefulness of medical information may be determined by relevance × validity/work (ease of access) (²⁸). Our findings show that clear relevance to clinical practice or research motivates efforts to access scientific information. There seems to be a gradient in the perceived necessity of ascertaining validity depending on the purpose for obtaining information. For a general update, summaries (e.g., textual or visual abstracts) that are informative and accurately communicate the message are regarded as adequate. This can pose a challenge for journals in capturing attention and distilling complex concepts without oversimplifying or overstating the importance of study findings. To gain in-depth understanding and certainty in interpreting and translating the information to inform practice, critically appraising the full article is necessary to ascertain the validity of the study. Determining relevance and validity is also facilitated by hearing the opinions of other colleagues and experts. Discussion and debate among colleagues, mentors, and experts in the field were thought provoking and educational. Social media provided an opportunity to interpret and understand the information in light of international and multidisciplinary input.

The utility of information may also be tempered by the effort required to access the study (²⁴). Many journal websites and articles are not optimized for viewing online or on mobile devices, and publisher pay walls and passwords are deterrents to retrieving articles (²⁰) as participants in our study noted. Currently, the content of most major journals is free to people in low- and middle-income countries, most journals have select “open access” content, and research articles funded by public health agencies become freely available after a prespecified period, usually 1 year.

There are some potential limitations to our study. Only three focus groups were convened with English-speaking participants, we could not feasibly include all countries, and early career kidney professionals who did not attend the ASN Kidney Week could not participate. Participants were selected through networks of the authors. The majority had experience in research with at least one publication, and the views of nephrologists who work outside of academic settings may not have been captured extensively. Thus, the transferability of the findings to the wider population of kidney professionals, including multidisciplinary clinicians, is uncertain. Also, the prompt materials were on the basis of the CJASN content. However, participants were asked to discuss perspectives on dissemination strategies used by other journals. Finally, we recognize the need to capture the perspectives of other age groups, because the transition of consumption of knowledge is challenging.

We suggest using contemporary technologies to capture and retain attention by increasing access to publications and streamlining presentations to facilitate online viewing and sharing, distilling messaging to emphasize relevance and reduce excess information, ensuring rigor in scientific review and reinforcing this with expert perspectives that provide context, voicing the patient perspective, and facilitating discussion. The CJASN has introduced visual abstracts and podcasts into the nephrology literature, published press releases, developed an application, and facilitated online discussions with ASN Communities to draw attention to new work. The CJASN publishes editorials and expert perspectives each month and recently launched the Patient Voice editorial series. The NEJM has multimedia resources, including short videos and interactive cases with short quizzes, and it facilitates an online journal club for residents. The Journal of the American Medical Association (JAMA) produces podcasts that include clinical review, medical news, performance improvement, an Editors’ Summary, and author interviews as well as journal-based continuing medical education (CME) online quizzes. The Annals of Internal Medicine has “channels” with information targeted at different specialties, CME courses with articles and quizzes, and short videos of presentations and clinical cases (with slide sets for teaching and content review). The NEJM, the JAMA, and in nephrology, the American Journal of Kidney Disease (AJKD) have online forums or blogs, which provide expert commentary and insight into scientific articles, updates on content, and additional context to complement content published in journal articles. The British Medical Journal requires authors to describe how patients were involved in the research process. They publish a patient-led series called “what is your patient thinking,” and they invite patients to write editorials. Online journal clubs allow the exchange of opinion and participation by experts to gain new insights about the article discussed (²⁹). NephJC is a nephrology online journal club on Twitter. To date, >2500 twitter handles have used the #NephJC hastag in over 40,000 tweets (²⁹). “NephMadness” is an online interactive medical education activity to drive global discussion and debate about published articles in nephrology that is delivered through the AJKD blog and Twitter platforms (³⁰).

Immediate access and digitally optimized navigation support motivation to attain scientific information. Mechanisms that enable early career kidney professionals to distil relevant and new evidence, appraise and apply information to clinical practice and research, disseminate studies to colleagues, and engage in discussion and debate may enhance their understanding, confidence, interpretation, and use of scientific literature.

Disclosures

None.