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Tag: internal medicine

Three articles about Pubmed

Three research papers about PubMed were published in open access journals in a short period of time. Two of them are written by the same authors and are dealing with the use of Pubmed among clinicians. The third one talks about two different approaches to teaching PubMed to medical students.

Answers to questions posed during daily patient care are more likely to be answered by UpToDate than PubMed

Hoogendam A, Stalenhoef AF, Robbé PF, Overbeke AJ.

Department of Medicine, Division of General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.

Authors observed 40 residents and 30 internists in internal medicine department in an academic medical center while they searched PubMed and UpToDate. They noted the information source used for searching and the time needed to find an answer to the question. What they eventually found was that specialists and residents in internal medicine generally use less than 5 minutes to answer patient-related questions in daily care. Also, more questions are answered using UpToDate than PubMed on all major medical topics.

Analysis of queries sent to PubMed at the point of care: observation of search behaviour in a medical teaching hospital

Hoogendam A, Stalenhoef AF, Robbé PF, Overbeke AJ.

Department of Medicine, Division of General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.

The objectives of this study was to identify queries that are likely to retrieve relevant articles by relating PubMed search techniques and tools to the number of articles retrieved and the selection of articles for further reading. Authors again observed specialists and residents in internal medicine department. They conclude that queries sent to PubMed by physicians during daily medical care contain fewer than three terms. Queries using four to five terms, retrieving less than 161 article titles, are most likely to result in abstract viewing. PubMed search tools are used infrequently by our population and are less effective than the use of four or five terms.

Measuring medical student preference: a comparison of classroom versus online instruction for teaching PubMed

Schimming LM.

Gustave L. and Janet W. Levy Library, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029-6574, USA.

The purpose of this study was to compare satisfaction of medical students learning PubMed entirely online with those attending traditional librarian-led sessions. Skills assessment scores and student feedback forms from 455 first year medical students were analyzed. Student satisfaction improved and PubMed but assessment scores did not change when instruction was offered online. Comments from the students who received online training suggest that the increased control and individual engagement with the web-based content led to their satisfaction with the online tutorial.

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Brush up your clinical skills with video podcasts

Podcasts can be a great educational tool. They are a free video or audio series, like a TV or radio show that you download and play, whenever you chose, on your computer, TV, iPod, iPhone or other portable media player. There are numerous podcast directories which can help you find interesting podcasts. One of the most popular and certainly the one which started it all is iTunes Store. Apart from offering music, TV shows, movies and iPhone/iPod applications for sale, it features thousands of different podcasts. Among them many are related to medicine, and some can even help you improve your clinical examination skills. To be able to watch these podcasts, you will need to have iTunes installed on your computer and preferably a broadband Internet connection. Some of the episodes can be quite big and take a long time to download on a slow connection.

Here is my selection of video podcasts from the iTunes store which can help you brush up your clinical skills.

Clinical Examinations
by Professor Karim Mearan
Imperial College London, Faculty of Medicine

Exam
This podcast currently has 5 episodes featuring a physician performing following examination:

  • Cardiology
  • Respiratory
  • Cranial nerves
  • Neurological – lower limbs
  • Neurological – upper limbs

Integrated Clinical Method
by ICM Team
Swansea University Medical School

exam
So far, there are in total 10 episodes with two physician demonstrating different exams:

  • Cardiovascular system
  • Respiratory system
  • Abdominal
  • Lumbar spine
  • Cervical spine
  • Ankle and foot
  • Knee
  • Hip
  • Elbow
  • Shoulder

Uva Clinical Skills Videos
by Office of Medical Education
University of Virginia

exam
In this series you will find clinical examination videos, but also videos depicting medical procedures and tips for taking patient’s history.

Clinical exams

  • Knee
  • Low back
  • Shoulder
  • Upper extremities
  • Lower extremities
  • Skin
  • Vital signs
  • Chest
  • HEENT
  • Cardiac
  • Abdominal
  • Neurologic
  • Ophtalmoscopic

Medical procedures

  • Central line placement
  • Intubation
  • Standard venipuncture
  • Butterfly venipuncture

History taking

  • Sexual history
  • Interview with sexual health issues

Neonatology
by Rijeka University School of Medicine
neonatology exam
While all of the above mentioned podcasts demonstrate clinical examination of adult patients, this one show you how to examine newborn babies. Until today, 11 videos are made available demonstrating clinical examination of primitive reflexes.

  • Introduction: Primitive Reflexes
  • Walking reflex
  • Tonic neck reflex
  • Sucking reflex
  • Rooting reflex
  • Pull to Sit
  • Moro Response
  • Magnet reflex
  • Grasp response
  • Galant’s reflex
  • Crawling reflex

You’re still here? Go on, hurry and download some of these excellent podcasts and become a better clinical examiner.

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Peculiar medical research – round 2

Article titled “Lying to Each Other: When Internal Medicine Residents Use Deception With Their Colleagues” was published by Dr Micheal Green and others in the Archives of Internal Medicine. I decided to present it, despite the fact it was published exactly eight years ago, because the subject it explores is still very real, and the article itself is thought provoking and well written.

Objective

Authors wanted to answer 3 questions:

  1. What is the likelihood that resident physicians say they would deceive other physicians in various circumstances?
  2. What factors increase the likelihood of using deception?
  3. Who do residents believe are more likely to deceive a colleague – themselves or their peers?

Subjects and Methods

Survey to assess physicians’ attitudes toward using deception with colleagues was designed in the form of 5 vignettes. These vignettes, each with two versions, addressed 5 reasons a resident may be motivated to use deception:

  1. To avoid extra work
  2. To protect a colleague
  3. To avoid embarrassment
  4. To protect a patients’ confidentiality
  5. To cover up a mistake

In the first vignette, residents were asked to exchange call with a colleague who either wanted to (1) attend a bridal shower or (2) be with her sick father. In the second, residents were asked to substitute their own urine for a colleague’s urine drug screen, when the chance of being caught was either (1) 0% or (2) 20% to 25%. In the third, residents were asked by an attending physician to report a laboratory result, when the likelihood of being ridiculed or reprimanded for not recalling the result was either (1) high or (2) low. In the fourth, residents were asked by a patient to protect the patient’s privacy by falsifying a diagnosis in the medical record, when the diagnosis was either (1) rheumatoid arthritis or (2) genital herpes. And in the fifth, residents who failed to perform a rectal examination were asked about the presence of blood in a patient’s stool, when the patient either (1) had an uneventful night or (2) had an acute myocardial infarction due to anemia from an upper gastrointestinal tract hemorrhage.

Access the article (free full text) to read the actual content of each vignette (Figure 1) and test yourself.

Survey was distributed among all internal medicine residents at the 4 teaching hospitals.

Results

Figure 2 from the article summarizes a large part of the results.

Results / Figure 2

Additionally, women were found to be 8 times more likely to indicate they would fabricate a laboratory value when they were likely to be ridiculed than when they were not.

When it comes to witnessing deception, 22 % reported having seen a resident intentionally lie to (or deceive) a medical student in the last year, 43% had witnessed a resident lying to another resident physician, and 41% had witnessed a resident lying to an attending physician.

Conclusions

Many residents say they would lie to a colleague to avoid doing that person a favor. Deceiving colleagues
about clinical issues is less likely, but far more serious. A small percentage say they would falsify a medical
record to protect patient confidentiality, fabricate a laboratory value to avoid ridicule, and lie about performing a neglected aspect of the physical examination to cover up a mistake.

Authors offer some advice to medical educators:

  1. Address the issues of professionalism and collegiality as part of the ethics curriculum that is required for all medical residents.
  2. Be aware that residents, like any group of people, exhibit a wide range of moral behaviors, and, sadly, the possibility that the resident is not telling the truth should be included in the differential diagnosis.
  3. Educate yourself about the potential impact of teaching styles on residents’ behavior, so you can reduce the risk of being lied to.
  4. Become aware of the particular circumstances under which residents may be more likely to deceive, so you can take appropriate measures to reduce incentives for this behavior.
  5. Residents need to be exposed to excellent role models who demonstrate not only the technical skills expected of physicians but the moral ones as well.

Hope you enjoyed, and better yet found usefull the article presented in this round of peculiar research series. Be sure to read the round 1 too.

Images copyright © 2000 American Medical Association.

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