Medical Journals

[TheDBird90]

I don't understand how reading medical journals (as required by the attending) helps with learning with patient care. There's not one be-all, end-all of medicine source it seems. If there's so many treatment recommendations (with new journal articles coming up) and different recommendations even in UpToDate (one person said there were five different methods of treatment available for one condition), then which one is the correct treatment to use? Maybe this comes from experience, or clinical judgement. I didn't know medicine was going to be this variable; I guess it's an inperfect science. I think I tend to see the world in black-and-white, due to Asperger's. I thought maybe after I work as an MLS for a while I could seriously consider medical school for clinical pathology, but I don't even know if it's worth it if there aren't even enough residency spots available in this country.

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[Cawolf]

Evidence-based practice is taught as a way to combine clinical judgement, patient factors, and the literature.

 

[TheDBird90]

Evidence-based practice is taught as a way to combine clinical judgement, patient factors, and the literature.

Huh... OK. I have no idea how medicine works. Interesting

 

[mimelim]

I don't understand how reading medical journals (as required by the attending) helps with learning with patient care. There's not one be-all, end-all of medicine source it seems. If there's so many treatment recommendations (with new journal articles coming up) and different recommendations even in UpToDate (one person said there were five different methods of treatment available for one condition), then which one is the correct treatment to use? Maybe this comes from experience, or clinical judgement. I didn't know medicine was going to be this variable; I guess it's an inperfect science. I think I tend to see the world in black-and-white, due to Asperger's. I thought maybe after I work as an MLS for a while I could seriously consider medical school for clinical pathology, but I don't even know if it's worth it if there aren't even enough residency spots available in this country.

Being able to read and critically analyze medical journals is an important and valuable skill. Is it mandatory to function as a clinician? Absolutely not. There are plenty (majority) of physicians that don't keep up with advances/guidelines in even their own field. However, most people in medical education and most of the public expect and/or 'demand' that physicians keep updated, thus we expect students to learn. Journal articles are difficult to understand and appreciate. Most physicians want a single protocol to follow (despite this being a major criticism of mid-level practice), but no study/article is perfect and there are always nuances. The vast majority of physicians have level 2 scientific reading skills. They look for the p<0.05 and then take home a binary, "This is bad" or "This is good" reflection.

A few tid-bits.

#1 If there are multiple treatments available for a single condition, it typically means that none of them are particularly good or that the pathology is poorly defined or there are overlapping pathologies that look similar. There is a lot of trial and error in clinical medicine.
#2 There are plenty of residency spots in the United States for well qualified applicants. There aren't enough spots for everyone to go into whatever specialty that they please, but if you matriculate at a US MD school and function above the 10th percentile and have reasonable expectations, you should have zero worries about matching. Since I know it will come up... Even if you are in the bottom 10th percentile, your chances of not completing residency are pretty freaking small. By far the biggest problem for people completing training are social and professional reasons, not academic ability. (Because we select for academics over all else, which is a very large mistake in my opinion).

 

[libertyyne]

Being able to read and critically analyze medical journals is an important and valuable skill. Is it mandatory to function as a clinician? Absolutely not. There are plenty (majority) of physicians that don't keep up with advances/guidelines in even their own field. However, most people in medical education and most of the public expect and/or 'demand' that physicians keep updated, thus we expect students to learn. Journal articles are difficult to understand and appreciate. Most physicians want a single protocol to follow (despite this being a major criticism of mid-level practice), but no study/article is perfect and there are always nuances. The vast majority of physicians have level 2 scientific reading skills. They look for the p<0.05 and then take home a binary, "This is bad" or "This is good" reflection.

A few tid-bits.

#1 If there are multiple treatments available for a single condition, it typically means that none of them are particularly good or that the pathology is poorly defined or there are overlapping pathologies that look similar. There is a lot of trial and error in clinical medicine.
#2 There are plenty of residency spots in the United States for well qualified applicants. There aren't enough spots for everyone to go into whatever specialty that they please, but if you matriculate at a US MD school and function above the 10th percentile and have reasonable expectations, you should have zero worries about matching. Since I know it will come up... Even if you are in the bottom 10th percentile, your chances of not completing residency are pretty freaking small. By far the biggest problem for people completing training are social and professional reasons, not academic ability. (Because we select for academics over all else, which is a very large mistake in my opinion).

Is this a real scale? Where can I learn more about it?

 

[aldol16]

OP, the issue is with how you view science. Science isn't black and white. There's no one way to solve a problem or answer a question. There are multiple ways and many of them might give you the same end result. They might work in different ways and present their own unique obstacles. It's the scientist's (or physician's) job to synthesize that knowledge and choose the "best" treatment option. There might be multiple "best" choices and that's okay. That's just science!

 

[LizzyM]

Take a look at this:
http://jamaevidence.mhmedical.com/content.aspx?bookid=847&sectionid=69031434

There are a couple of audio file links on the right side of the page that you might find informative.

The point is not to browse the literature but to read it deliberately to answer a clinical question. Should I use this new drug to treat this patient with rheumatoid arthritis? Has it been tested in a clinical trial? Was the clinical trial well designed? Are the results valid? Are the results generalizable to my patient population and my specific patient? The McMaster series is something my school has used for a generation to teach medical decision making and now it has been compiled into a book.

Many physicians don't read critically but do a quick peek at the results, look to see if the outcome of interest reached statistical significance and call it a day. That's not a good way to practice but some people get away with it.

 

[libertyyne]

Take a look at this:
http://jamaevidence.mhmedical.com/content.aspx?bookid=847&sectionid=69031434

There are a couple of audio file links on the right side of the page that you might find informative.

The point is not to browse the literature but to read it deliberately to answer a clinical question. Should I use this new drug to treat this patient with rheumatoid arthritis? Has it been tested in a clinical trial? Was the clinical trial well designed? Are the results valid? Are the results generalizable to my patient population and my specific patient? The McMaster series is something my school has used for a generation to teach medical decision making and now it has been compiled into a book.

Many physicians don't read critically but do a quick peek at the results, look to see if the outcome of interest reached statistical significance and call it a day. That's not a good way to practice but some people get away with it.

That's if they bother reading it at all. In my experience a large number of doc's seem to be on autopilot after residency( especially in small community hospitals), if they learned it in residency thats the way they do it. If the literature contradicts them, the literature is bad. But, there are some amazing doc's as well, who can slice and dice endpoints and patient populations from the most recent studies and change their practice accordingly.

 

[LizzyM]

That's if they bother reading it at all. In my experience a large number of doc's seem to be on autopilot after residency( especially in small community hospitals), if they learned it in residency thats the way they do it. If the literature contradicts them, the literature is bad. But, there are some amazing doc's as well, who can slice and dice endpoints and patient populations from the most recent studies and change their practice accordingly.

They are at the mercy of drug reps.... so sad that patients in small community hospitals are the recipients of the medical care provided by those practitioners.

 

[TheDBird90]

Being able to read and critically analyze medical journals is an important and valuable skill. Is it mandatory to function as a clinician? Absolutely not. There are plenty (majority) of physicians that don't keep up with advances/guidelines in even their own field. However, most people in medical education and most of the public expect and/or 'demand' that physicians keep updated, thus we expect students to learn. Journal articles are difficult to understand and appreciate. Most physicians want a single protocol to follow (despite this being a major criticism of mid-level practice), but no study/article is perfect and there are always nuances. The vast majority of physicians have level 2 scientific reading skills. They look for the p<0.05 and then take home a binary, "This is bad" or "This is good" reflection.

A few tid-bits.

#1 If there are multiple treatments available for a single condition, it typically means that none of them are particularly good or that the pathology is poorly defined or there are overlapping pathologies that look similar. There is a lot of trial and error in clinical medicine.
#2 There are plenty of residency spots in the United States for well qualified applicants. There aren't enough spots for everyone to go into whatever specialty that they please, but if you matriculate at a US MD school and function above the 10th percentile and have reasonable expectations, you should have zero worries about matching. Since I know it will come up... Even if you are in the bottom 10th percentile, your chances of not completing residency are pretty freaking small. By far the biggest problem for people completing training are social and professional reasons, not academic ability. (Because we select for academics over all else, which is a very large mistake in my opinion).

Wow, you've boosted my confidence.

Yeah, I need to understand that there's nuances in medicine that you only learn through experience (I assume).

 

[AnatomyGrey12]

but I don't even know if it's worth it if there aren't even enough residency spots available in this country.

First of all, wut?

Second, I agree with the above, there is no end all be all with how to practice medicine or even science in general for that matter. A lot of medicine is experiential, anecdotal. We try different things until it works and then we do those things until we find something better. Medicine is constantly changing to improve outcomes and has been practiced this way for a long, long time.
Often to find something new someone had to try something that has never been done before.

 

[libertyyne]

I don't understand how reading medical journals (as required by the attending) helps with learning with patient care. There's not one be-all, end-all of medicine source it seems. If there's so many treatment recommendations (with new journal articles coming up) and different recommendations even in UpToDate (one person said there were five different methods of treatment available for one condition), then which one is the correct treatment to use? Maybe this comes from experience, or clinical judgement. I didn't know medicine was going to be this variable; I guess it's an inperfect science. I think I tend to see the world in black-and-white, due to Asperger's. I thought maybe after I work as an MLS for a while I could seriously consider medical school for clinical pathology, but I don't even know if it's worth it if there aren't even enough residency spots available in this country.

This might help

That being said, there is a lot of gray and usually boils down to what is considered standard of care. That standard of care would be taught or seen during your residency. Like all things in life there is a lot of uncertainty but knowing the quality of evidence you are reading and critically reading the evidence makes the most difference in understanding the certainty being expressed in a study. I would take a class that teaches you how to look at evidence. It is by far the most meaningful class I have taken in my life.

Furthermore,I would personally only worry about the problem of uncertainty in medicine after being accepted to medical school, and even then residency will teach you how to act in these situations. Plus , if there is no clear evidence supporting a specific treatment, it is pretty much patient and MD choice of treatment options.

 

[Goro]

There are more residency slots in the US than there are MDs and DOs to fill them.

, but I don't even know if it's worth it if there aren't even enough residency spots available in this country.

 

[TheDBird90]

There are more residency slots in the US than there are MDs and DOs to fill them.

Thanks. I just felt confused after watching this: