End of Rotation Evaluation- Cardiology
I had heard the phrase “evidence based medicine” repeatedly during the first two years of medical school. This phrase became a reality in my third year. Text books were a good starting point when reading about a diseases but often lacked details and nuances seen in real-life cases. Hence I began my third-year rotations using Uptodate.com to gain a more comprehensive clinical knowledge of diseases. I used the website to devise a diagnostic and management plan for patients presenting with acute anemia on the pediatrics hematology- oncology service.
However, uptodate was not a sufficient learning resource for my surgical rotations since I was required to know human anatomy and familiarize myself with surgical steps before scrubbing into any case. Therefore, I used the database accesssurgery.com to gain a more in depth knowledge about the indications, risks and benefits of different surgical procedures and to review human anatomy as the readings laid out surgical procedures step by step. Had I not sought for a learning source beyond uptodate.com, I would not have been successful during my surgery rotation and received the following evaluation “ [Yusra] showed high level of knowledge and interest in and out of the OR. Very sound understanding of anatomy and physiology.”
OSUWMC Guideline for Diagnosis and Manegement of Hepatorenal Syndrome
When internal medicine rotations started at the end of my third year, I felt very comfortable using uptodate and accesssurgery. I now wanted to challenge myself with searching for management guidelines and robust clinical research that guides management. On my hepatology rotation, I used my university hospital’s central website to find a clinical guideline for treating suspected hepatorenal syndrome in liver failure. On my cardiology rotation, I took care of a patient who had undergone stent placement after an NSTEMI. When developing his management plan, I wanted to know how long the patient will need to be in the hospital before he can be discharged. Uptodate did not provide a concrete answer but alluded to a risk stratification system. Hence, I used my university’s database of online journals to find a journal article further exploring risk factors. In light of my research findings, I proposed on rounds that we discharge my patient that day as he had completed 24 hours of monitoring. When asked to explain my recommendation further, I handed my attending physician a printout copy of the research article I had found and summarized the research findings. My attending physician agreed that discharging my patient that day was plausible but wanted to monitor him for another since he was in the grey zone of cardiac risk factors. My attending physician commended me on integrating research evidence in developing my plan. I also learned from this experience that, before applying the results of any study to clinical practice, I must ask myself: does this study apply to my patient? In response to this incidence, my cardiology evaluation read “ [Yusra] actively sought out literature to support plans and ideas on patients” and that I am “able to use resources for patient care.”
As I reflect on my journey from using uptodate to finding research articles in medical journals, I realize that identifying learning resources required practice and learning itself. My experience with doing background research to write manuscripts for a case report and retrospective study on breast cancer has further enriched my experience with evidence based medicine. This experience is important because, as I learn about ocular diseases in residency, I will need to identify authentic learning resources and reliable research studies to enrich my medical knowledge and inform my decision making. I realize that medicine is a career of lifelong learning and I’m encouraged that I have developed the skills of identifying and integrating external learning resources in my practice. This skill will be beneficial throughout my career.