CME Crosstraining with Dr. Gurpreet Dhaliwal

Howdy - This Scott Selinger and welcome to the podcast on behalf of the Northern California's chapter of the American College of Physicians Council of Early Career Physicians. I should note that I'm thinking about calling the podcast ABCs for ECPs, ECP's being early career physicians. It seemed a little more legit than the original working title, modeled after my favorite phrase to hear from a patient, "Can I be real with you?" One of my biggest concerns starting off my medical career, is staying up to date. Through medical school and residency, it seemed like so much time was devoted to learning about new practice altering information because I was always trying to catch up with and impress my attendings with things they hadn't heard of. At the end of residency, I think I was subscribed to at least 10 different journals and newsletters, on top of the e-newsletters and listservs, and trying to peruse through all of them is just something I felt I had to do every week. I was always searching for that one little nugget of information that would make life better and easier for my patients and for myself. But now I'm out, and I'm practicing in a busy setting and having trouble to find the time to do as much reading and research. But I still feel that need, that pressure, to stay up to date on all the breaking evidence. Now of course we're required to have our continuing medical education and doing things to fulfill our ABIM maintenance of certification requirements, but that's not my real driving force. I'm sure we've all seen patients either coming into the hospital or transferring to a new clinic on a bizarre outdated medication regimen. And my fear is ultimately becoming one of those physicians. While there's not a fantastic amount of high quality data out there, a systematic review published in the Annals of Internal Medicine about 10 years ago, looked at 62 studies regarding various outcomes relative to physicians years of practice. Almost 75 percent of these studies showed decreasing guideline adherence in a variety of performance and outcome measures with increasing years of experience, and that scares me a little bit. Now I'm sure like all studies there's geographic and practice setting variance, but overall it makes sense that the more entrenched you get into the everyday world of patient care, the harder it is to be able to step back and access your own practice and the advancing practices of those around you. To put it more simply I feel like I'm Rocky in Rocky III. I've come from being a little nothing to an attending physician. I've knocked out Apollo Creed twice, med school and then again in residency and know I'm riding high and taking pictures and even doing pod casts. But I know somewhere out there it's Clubber Lang, some new kid on the block or some new piece of data that's hungry, and slowly working its way up the chain, and if I don't do enough to stay on top of my game I'm gonna get knocked out. So what is an early career physician to do? Well to help get some guidance I spoke with Dr. Gurpreet Dhaliwal, a clinician educator and associate professor in clinical medicine at UCSF who has particular interest in medical education and clinical and diagnostic performance and improvement. Me: Doctor Dhaliwal thanks so much for joining me today. So I guess to dive right in, what mistakes do you feel physicians make starting out; as far as what they try to do with staying up to date with all the recent advances, and new papers and things like that. GD: I'm thinking it's hard to make a mistake in terms of trying to stay up to date. But just doing that itself is a good effort. It's a commitment to lifelong learning. I think one of the mistakes that might be made is that thinking the best way you're gonna do service to yourself and your patient is keeping up with all the new studies that are coming out. A lot of the new studies are alluring and interesting, but a lot of the research doesn't change our day to day practice. They're more news than they are information you can use. So I wouldn't, heavily prioritize reading research articles. Me: I know now there's now tons of different ways that everything is being published. What do you feel are becoming the most common ways that people are using to stay up to date with the changing practices? GD: I think one of the best ways to stay up to date is to recognize that you sort of choose three different streams of learning from the literature that come to you. On one level are things where you just literally get them as a headline. These may be scanning the table of contents that come by email or maybe seeing even I'll get a news alerts about, big research. Then there is another layer of things where you get a more in-depth but still relatively brief report on something, like a podcast or a summary of the article that, that comes from Journal Watch or ACP journal club or something along those lines, and then finally is those moments where you sit down and actually read something in-depth, and by that I mean you're starting to commit more than ... Fifteen to twenty minutes of reading. And when you do that I think that those episodes are few and far between. But, that's when you have to choose whether you're going to read a research article in depth, a review article in depth or maybe read a case in depth. But there's different ways the information is streaming to us and part of that is how much time we have to commit to each one of them. I think a good strategy is that on a daily basis you're getting that headline steam, through your inbox, and on your phone and then within some period you just need to give yourself a little more help with facts in the literature, like reading general watch, and at least once a week you commit to more structured reading, either based on stuff that you have for your patients, or your own general reading. Me: What do you feel are the most efficient things that you do in those areas as far as which services you use? GD: I would describe what I do as sort of cross training. I give myself the same messages multiple different ways so I know that the information exists, even though I haven't necessarily read it in depth, so, for instance, I will get the key table of contents for a lot of the medical journals that I

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CME Crosstraining with Dr. Gurpreet Dhaliwal is an episode from ABC's for ECP's by Scott Selinger.

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This episode was published on Mar 29, 2014.

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