Bigger on the inside

Today I am shamelessly likening our Insider’s Insights to Dr Who’s TARDIS, our latest edition, on responding to journal reviewers, was released earlier this week. Simply put, our Insider’s Insights ARE bigger on the inside. The deception is deliberate. Our Insider’s Insights are designed to act as a ready resource on special subjects, they can be used to quickly check on specific points, brush up on a subject (if you have 5 minutes to spare) or serve as a starting point if you are looking for a deeper understanding. We have taken the time to identify the key points so you don’t have to. The Insider’s Insights format provides the information you need in an easy to access fashion while also providing references to the source materials. The information they contain has been curated by your peers and is designed to help you do your job.

Why is this important? We live in a ‘just-in-time’ society, we face pressures on our time from every angle. And yet, we work in a highly regulated industry where we are expected to absorb, understand and apply ever more information. All aspects of our industry require us to gain competence, and this necessitates more learning than ever before. As Alexander observed in his poem, ‘Essays on Criticism,’ published in 1711, we cannot master everything. He put it more eloquently: “one science will one genius fit, so wide is art so narrow human wit.” Technology may have made the pharmaceutical industry safer and those working in it more informed, but it has not made our jobs any easier. Although we are exposed to fewer printed materials (in the face of online training), we are still being expected to about more in ever greater detail (particularly in the field of clinical study oversight).

Information overload is happening everywhere [1][2]. For example, over 1.9 million new book titles were published in the last year alone [3], and a recent estimate put the ‘indexed’ internet pages at 4.59 billion and growing, the great majority of which include significant amounts of written text [4]. It can be argued that those of us working in the pharmaceutical industry are expected to ‘soak up’ and curate considerable amounts of ‘necessary’ rules and regulations.

It’s not just the practitioners of medical research facing information overload, don’t forget clinical trial subjects. Volunteers recruited to clinical studies are expected to read, digest and agree to the conditions described within consent forms and patient information leaflets: documents that were once 2–4 pages long in the 1990s are now 25–35 pages of complex text (circa. 10,000 words) [5][6].

Since the average college-level reader reads about 200–400 words per minute [7], it is no wonder many of us feel pressured by the amount we need to read, who ever reads the terms and conditions you just signed.

I remember seeing adverts for speed-reading programs in magazines in the 70’s and 80’s, selling the idea that there are ways of reading much faster with full information retention and comprehension. The concept is back, this time driven by ‘new’ software applications (e.g., Spreeder, Spritz, Outreader) that claim to increase your reading speed through technology that manages the pace of your reading and eliminating ‘bad reading habits’ like subvocalizing (moving your lips) or eye movement regressions. Can we really markedly increase our reading speed with technology (to 2000 or more words per minute)? Evidence from cognitive psychology suggests such claims are unrealistic because comprehension declines sharply at extremely high reading speeds [8].

I learnt about the saccadic (French for jerk) movements of the eye as a physiology undergraduate in the 1980s. As we read our eyes very briefly fixate on a portion of text, and before jumping to another [9]. Mostly, we are happily unaware of this mechanism. It all happens extremely quickly. For example, the average fixation period in an experienced reader is about 250 msecs and the average saccade (jump) takes 25–30 msecs [9][10]. That is mind-numbingly fast.

The physiology of the eye dictates that only a small portion of our visual field has the acuity necessary to process normal print size letters. We all have different focal ranges for this ‘high acuity’ zone located at the fovea (the centre of the retina), and its efficacy varies slightly with type size and distance. Even when you include the para-foveal area, where vision is still somewhat clear, it rarely encompasses more than 20 letters [9][11]. Objects beyond this narrow window show up with ever decreasing acuity, our processing ability decreases. This contrasts with the idea promoted by most speed-reading programs, that you can train yourself to use your peripheral vision to absorb whole lines or even pages at a single fixation.

As your eye moves saccadically through a document you will sometimes make regressions. These are eye movements that go back to previously read text. We can expect around 10–15% of our eye movements to involve regression, even skilled readers, and these serve an important purpose [9]. Although some regressions happen because a saccade overshoots (racing ahead in the text), most serve to address failures in comprehension [9]. Put simply, something we have just read (or think we read) didn't make sense as we processed the incoming information. In milliseconds, the muscles positioning our eyes are recruited to correct the problem by returning the fovea’s focus to the text we just scanned – perhaps we missed or misread a word.

This phenomenon has been identified as a potential inefficiency that we might use technology to correct by exposing us to one word at a time, beamed, as it were directly to the fovea and doing away with need for scanning text. In fact, comprehension suffers when a process called rapid serial visual presentation techniques (used to show readers one word at a time) are used to eliminate regression (as occurs in some popular speed-reading programs, like Spritz) [8][12]. This effect is particularly noticeable with texts are complex and longer than your average sentence, typically the sort of texts we are expected to absorb in the pharma industry.

Speed-reading programs also aim to cut down fixations of longer than the usual 250 msecs. Once again, these perceived deficiencies have a reason and are not caused by lack of visual perception but rather because of difficulties we may experience with word identification or understanding [9]. Both regressions and extended fixations increase in all readers with the unfamiliarity or conceptual difficulty of the text [9], it is evident that such speed-reading solutions may not be the solution if comprehension is the goal. This raises the question, could there be ways we might read smarter if there is no obvious shortcut to reading faster? This is a question we asked ourselves when designing our Insider’s Insights. We considered the purpose of the Insider’s Insights and concluded that we needed to find an efficient way of imparting information to the busy people in our industry, enabling different users to use our documents in different ways. The goal was to split key ‘understandings’ into defined areas on the page, minimising long strings of text. We have attempted to find a happy medium between summarising the data in an infographic-style format, providing valued content that can quickly assimilated, as well as identifying sources for additional information. Please let us know how they can be improved if you disagree.

We would love to hear your opinion. Niche is committed to regularly delivering new issues of the Insider’s Insight, you can sign up here to get notification of when new issues are released. This year, we have delivered three new editions and we have a further 10 in the pipeline for the next 12 months. Topics are selected when our team identify subjects that would be well served by information being provided to foster understanding. The authors of our Insider’s Insights are practitioners in the field and they bring their experience and insight to the documents they create.

References

1. Bawden D, Robinson L. The dark side of information: overload, anxiety and other paradoxes and pathologies. J Inf Sci. 2009;35(2):180-191.
   https://doi.org/10.1177/0165551508095781
2. Eppler MJ, Mengis J. The concept of information overload: A review of literature from organization science, accounting, marketing, MIS, and related disciplines. Inf Soc. 2004;20(5):325-344.
   https://doi.org/10.1080/01972240490507974
3. International ISBN Agency. Global ISBN output report. London: International ISBN Agency; 2017.
   https://www.isbn-international.org
4. de Kunder M. The size of the World Wide Web (indexed web). WorldWideWebSize.com; 2016.
   https://www.worldwidewebsize.com
5. Paasche-Orlow MK, Taylor HA, Brancati FL. Readability standards for informed-consent forms as compared with actual readability. N Engl J Med. 2003;348:721-726.
   https://www.nejm.org/doi/full/10.1056/NEJMsa021212
6. Beardsley E, Jefford M, Mileshkin L. Longer consent forms for clinical trials compromise patient understanding. J Clin Oncol. 2007;25(9):e13-e14.
   https://ascopubs.org/doi/10.1200/JCO.2006.09.5227
7. Carver RP. Reading rate: A review of research and theory. Academic Press; 1990.
   https://www.sciencedirect.com/book/9780121657359/reading-rate
8. Rayner K, Schotter ER, Masson MEJ, Potter MC, Treiman R. So much to read, so little time: How do we read, and can speed reading help? Psychol Sci Public Interest. 2016;17(1):4-34.
   https://doi.org/10.1177/1529100615623267
9. Rayner K. Eye movements in reading and information processing: 20 years of research. Psychol Bull.1998;124(3):372-422.
   https://doi.org/10.1037/0033-2909.124.3.372
10. Leigh RJ, Zee DS. The Neurology of Eye Movements. 5th ed. Oxford University Press; 2015.
    https://global.oup.com/academic/product/the-neurology-of-eye-movements-9780199969286
11. McConkie GW, Rayner K. The span of the effective stimulus during a fixation in reading. Percept Psychophys.1975;17:578-586.
    https://doi.org/10.3758/BF03203972
12. Potter MC. Rapid serial visual presentation (RSVP): A method for studying language processing. In: Kieras DE, Just MA, editors. New Methods in Reading Comprehension Research. Hillsdale (NJ): Erlbaum; 1984.