Staying current

[JustPlainBill]

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So I had a brief pause at the end of first year and early second year when I didn't get beat on about my medical competence. I actually received the highest marks possible on my reviews from 3 services - all off service rotations and in one instance from multiple people in the same off service rotation.

Well, it's starting up again, now that I'm back with my own people...with one exception -- got abused severely in a review by an attending who diagrammed, from memory, the ACC guidelines for pre-op clearance as amended by the recs from ACCP, complete with named/numbered criteria for each box in the diagram...you get the idea....

So, my question is this - I just found out about the national guidelines clearing house (or something like that) and have used it to help with various situations in my 2nd year inpatient and it's been good....but where do most people go to remain current in treatment standards, etc? Do you just read the AFP journal/NEJM? How do YOU stay current?

 

[lowbudget]

you get the idea....

Not really. There's a difference between getting abused and being taught. I don't know anybody who is born knowing the ACC flowchart for preoperative clearance. So either your attending needs a vacation or you need to quit being so sensitive about people beating down on you when in fact they're just trying to show/teach you something. I just can't imagine someone asking you to do pushups or get waterboarded for not knowing it.

Then again, I'm not you and I don't go to your program so I'm not really one to judge. Most residents I know use Sabatine's Pocket Medicine and the ACC flowchart as well as Goldman is in there (Cardiac section, Preoperative Eval). I don't bother memorizing the flow chart personally, because it's not worth my time. Instead, I bust it out everytime I have a patient just to make sure I'm doing the reasonable thing.

To answer your question though, the national guidelines clearinghouse is useful but difficult to read. You've got all these specialty societies like ACC that pubish guidelines, so just go to their website and fart around. You're bound to find something. You know in family medicine, we'll use the USPTF guidelines because that's on your in training exam, so go to their website and they're right there in front of you.

But generally, I use AFP, emedicine, and UpToDate. For current events, I listen to NPR on my way to work, watch the local/national nightly news, and read MedPageToday.

Worse comes to worse, just Google it. "Atrial fibrillation guidelines" "testosterone guidelines" "preoperative guidelines" and look for the most current article.

Nobody memorizes these things. Don't bother, because they're so many of them and they change every 2-5 years anyways.

 

[JustPlainBill]

Not really. There's a difference between getting abused and being taught. I don't know anybody who is born knowing the ACC flowchart for preoperative clearance. So either your attending needs a vacation or you need to quit being so sensitive about people beating down on you when in fact they're just trying to show/teach you something. I just can't imagine someone asking you to do pushups or get waterboarded for not knowing it.

Good point that I've tried to be sure I'm not doing....no, here it seems that if you don't quote a patient's framingham risk or CHA2DS2VASC score when presenting, your medical competence is called into question....and that seems to be the theme. For a while there it was causing me to doubt myself but then I had some good reviews from people who didn't know me and there were multiple reviews saying the same thing, so it changed my perspective. No, I'm not being waterboarded or dropped for 20 here, but being berated in a public area is common....trying not to be too sensitive about it and just take it in stride, figuring the guy didn't get any last night and move on.....

Thanks for the tip, 20 more months and we're done...

 

[cabinbuilder]

Impossible to know/keep up on everything.

I know what I am comfortable with, know what I'm not.

I try to go to 2 conferences a year, read what I can, use Uptodate almost everyday to may sure I am ordering what I am supposed to on obsure things.

 

[Bernie3144]

For family medicine, DynaMed, hands down. It's the only program/app I will ever pay money for.

This program makes you look like an evidence-based/guidelines star. Everything from HPI through diagnosis and treatment have levels of evidence listed for each one of them and the most up-to-date article supporting its evidence. They even break down the studies used so you don't even have to go to the actual article. Each topic on DynaMed is updated daily, UpToDate maybe 3 x per year.

Here is a good chart comparing the two: http://harrell.library.psu.edu/content.php?pid=203158&sid=1713938

Here is a BMJ study showing that DynaMed is superior to Clinical Evidence, EBMGuidelines, eMedicine, and UpToDate:

"Evidence held to be relevant to clinical practice is inserted at different rates in point of care information summaries, and these products vary widely in their speed at updating content. Our citation analysis showed that Dynamed clearly dominates the other products (Clinical Evidence, EBMGuidelines, eMedicine, and UpToDate). Slowness in updating could mean that new relevant information is ignored and could thus affect the validity of point of care information services. Ultimately, whenever the transfer of relevant information is inappropriately slow, this can affect the care of patients, potentially denying treatments of proved benefit. This happens despite the fact that many of these products promote themselves to the clinical community as being regularly updated with the latest evidence."