"Bringing in Journals" -- another third year myth?

[AmoryBlaine]

So I always hear about how important it is to "read around your patients" especially current literature and stuff. Many sources (SDN and otherwise) suggest that you "bring in articles to share with your team."

Now I'm not that far into my 3rd year, but does anyone do this? On every team I've had so far, everyone but the attending would have wanted to kill a person that did this. I have never seen it done. I certainly cannot imagine showing up to rounds and giving reading material to the residents...

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[raidermedic]

I've never seen this. As to whether to do it or not I would say follow the lead of the residents. If they are constantly bringing in journals then you could probably get away with it. If they never bring in journals, don't even bother to read the articles for journal club, and are complaining about never having any free time then no, do not bring in journals. And expeically don't do it in front of an attending.

 

[erin682]

I absolutely saw this done on my internal medicine rotation and did it myself some. All the students did, folowing the lead of our sub-I. I would say following the lead of the residents is not a great idea as they are evaluated entirely differently than you. Students are expected to demostrate that they are actively seeking out information on their patients. Surgery on the other hand was entirely different. I think you would be laughed out of the building if you tried to present an article on surgery rounds.

 

[dentate_gyrus]

I absolutely saw this done on my internal medicine rotation and did it myself some. All the students did, folowing the lead of our sub-I. I would say following the lead of the residents is not a great idea as they are evaluated entirely differently than you. Students are expected to demostrate that they are actively seeking out information on their patients. Surgery on the other hand was entirely different. I think you would be laughed out of the building if you tried to present an article on surgery rounds.

Right on about surgery. Only exceptions are the zebras and the requests for presentations. If a true zebra comes in and you can't find an adequate text citation you may show the article you read about the disease to your intern and let them grab some glory by letting them pass it up the food chain. Never present it on rounds. This is what the walk from the SICU to the OR is for. IMHO.
Making your resident look good never hurts.

 

[THP]

I'm on my 4th rotation of 3rd year and have yet to see a med student or a resident bring in an article. We occasionally have to make a handout and give a 5 min presentation on a topic as part of the course requirement. Generally an overview from UpToDate is sufficient. I don't think I have read a single journal article 3rd year that wasn't specifically assigned.

 

[Hernandez]

Absolutely. When I've done this, however, it was encouraged by the attending and i'd not give copies to the residents unless they asked.

while UTD is handy, it should only be the beginning of understanding since UTD is hardly all encompacing.

 

[Paws]

I have only seen this once and I almost laughed out loud. A student and resident brought an article in for rounds and offered it up to the attending like it was a scented offering to the Gods. It seemed sort of pathetic since the article was about some really obscure thing it could be - well, like I could become Italian if I closed my eyes and wished hard enough.

What I mean is that it was just too way off and obscure. But, sadly the attending did actually get excited, too. In the end, the diagnosis was just a regular condition. I think it's different if the attending or senior resident brings it in for the team, but when a student does it it smacks of pretention. I think too, it's more important to try and foster good group dynamics as much as possible, rather than be gunning for one's own reputation. Saying something in private or walking down the hall, instead of on rounds may be more appropriate. That particular group was not very well functioning ...

 

[fuzzyerin]

I'm a PGY2 and I have occasionally had sub-I's who found good and interesting articles, but rarely students who have brought articles to my attention. I love articles though ~ I read them, file them, and my senior and I for the last year and a half have always looked for articles when we were on nights together about one of the interesting cases overnight. Be it just a good general review article on the subject or something new that came out, I read lots of articles. I think I did it once as a student. But since certain people are cited about certain things in the field, it's worth reading their articles.

 

[erin682]

I guess its school/attending dependent then. One of my criticisms at the end of my medicine rotation was not doing enough in the way of bringing in articles. My attending said we should be trying to teach them something they didn't already know. Which is BS of course.

 

[pillowhead]

I guess its school/attending dependent then. One of my criticisms at the end of my medicine rotation was not doing enough in the way of bringing in articles. My attending said we should be trying to teach them something they didn't already know. Which is BS of course.

Definitely brought in articles on my internal medicine and pediatrics rotations--it was clearly expected for a good grade. If you're trying to teacch the team something they don't already know, that's generally a waste of time because to do that requires you to find something really obscure (i.e. not testable). However, I've had attendings who've asked for a reviews of basic topics that are good to be familiar with--inpatient management of COPD exacerbation, pleural effusion fluid analysis, outpatient vs inpatient management of pneumonia, etc. Reading articles for that stuff helps for the shelf and is good info to know.

 

[(nicedream)]

I think bringing in articles is good. I don't actively search for them, but often when JAMA or NEJM comes in the mail it will have something in it that I know would be of interest to my attending, and since it's brand spanking new, I know that he hasn't seen it and will probably appreciate me summarizing it to him since his busy schedule doesn't allow the amount of reading he'd like (evidenced by the stacks of unread journals in his office).

 

[Paws]

I've had attendings who've asked for a reviews of basic topics that are good to be familiar with--inpatient management of COPD exacerbation, pleural effusion fluid analysis, outpatient vs inpatient management of pneumonia, etc. Reading articles for that stuff helps for the shelf and is good info to know.

I agree with this policy, that would be a terrific way to learn. Especially if the attending asks you to do it.

 

[DebDynamite]

One of our attendings made it a point to have us bring in journal articles about pertinent issues and teach each other weekly. It was a valuable learning tool because the topics were relevant for our level (MS3's). This attending moved to NC and will be starting at Duke soon. I think this is kinda humorous because some of Panda Bear's posts have alluded to the research/article citing that abounded when he was at Duke. This attending was journal article CRAZY.

That said, it was helpful.

 

[tr]

Definitely brought in articles on my internal medicine and pediatrics rotations--it was clearly expected for a good grade. If you're trying to teacch the team something they don't already know, that's generally a waste of time because to do that requires you to find something really obscure (i.e. not testable). However, I've had attendings who've asked for a reviews of basic topics that are good to be familiar with--inpatient management of COPD exacerbation, pleural effusion fluid analysis, outpatient vs inpatient management of pneumonia, etc. Reading articles for that stuff helps for the shelf and is good info to know.

Yeah, we have a lot of people bring in articles. It seems to be pretty common. Usually the article-bringers are either attendings or students; the residents have too much other work to do.

You can totally teach the team stuff. Everyone usually knows basic workup and management issues; but people won't normally know epidemiology, prognosis, or late-breaking guidelines on diagnosis/treatment unless the illness is extremely common.

I actually prefer to present something obscure that people won't know than something common that everyone on the team already knew except me. If they don't already know it they're more likely to pay attention. A couple of times I've been specifically assigned to talk about something basic and important; and while it's good for me to look it up, it's painful for the residents to have to sit through it. I hate when people's eyes glaze over while I'm talking.

Anyway, if you've never ever seen another student or an attending bring in an article, maybe you would look like a wanker if you did. But maybe not. You could try it once and see how it goes over.

 

[Quixotic]

I brought in articles during the first month of my first rotation. For some of the attendings I brought in an article each day on one of the problems my patient had. For others, I would give a 1 minute blurb about each patient every day pertaining to the disease etiology, diagnosis, treatment or presentation. I found both of these to be great teaching tools not only for myself, but for the residents as well. I think you should do it because it will help your own learning at minimum.

 

[tiredmom]

I was told by a resident on pedi to be sure to bring in an article to talk about. I didn't do anything formal, just brought something from the latest JAMA and summarized it with 1 of the residents, the other student, and the attending while we were waiting for everyone else to show up for rounds. It felt pretty awkward, but ended up getting written about on my eval in a very positive way. It still felt really awkward though.

 

[8744]

I have only seen this once and I almost laughed out loud. A student and resident brought an article in for rounds and offered it up to the attending like it was a scented offering to the Gods. It seemed sort of pathetic since the article was about some really obscure thing it could be - well, like I could become Italian if I closed my eyes and wished hard enough.

What I mean is that it was just too way off and obscure. But, sadly the attending did actually get excited, too. In the end, the diagnosis was just a regular condition. I think it's different if the attending or senior resident brings it in for the team, but when a student does it it smacks of pretention. I think too, it's more important to try and foster good group dynamics as much as possible, rather than be gunning for one's own reputation. Saying something in private or walking down the hall, instead of on rounds may be more appropriate. That particular group was not very well functioning ...

Paws, this is a great post. You capture the spirit of rounds exactly and with a beautiful economy of style.

Hey. I always kept my mouth tightly shut on rounds because invariably, anybody who asked a question was assigned to research it and present something about it the next day.

This happened to me exactly once. Momma Bear did not raise her children to be idiots and after my lesson it took the jaws of life to pry my mouth open.

I despise asking and being asked questions on rounds.

Yes. I hate being assigned extra work. I do my own reading at my own pace and dislike, intensly, the randomness of instruction on rounds.

 

[8744]

All this reminds me of my brief experiences with PBL where my mission every morning was to quickly google something about whatever we were studying, print it out, and skim it long enough to know a little about it.

And then, naturally, remaining grimly quiet, silently egging on my more studious classmates as they hogged the discussion.

Once, I printed out "1984" on regular paper, put it between the pages an article I had downloaded from the internet, and spent several enjoyable PBL sessions requainting myself with it.

I just don't like interactive learning.

 

[Barry Otter]

Attendings like articles, especially about more obscure sh*it, because they're too busy/lazy to read on their own. At my institution, med students bring in articles all the time, especially in medicine and peds.

I dislike bringing articles because no one's going to read it and it'll be a waste of paper and time. I have my own agenda, which isn't necessarily the attending's, and I'd rather do my studying in my own time.

 

[8744]

Journals are low-yield, especially for medical students and residents. I'm an Emergency Medicine resident and it makes a lot more sense for me to read Tintanalli (the monster EM textbook) as opposed to a journal article. The really classic journal articles (like the one on goal directed therapy for shock) have already been incorporated into the medical world. Most of what you get in Journals is speculative, heavy with statistics, and not even that interesting.

Panda reads his EM journals because they have big words and lots of pictures but JAMA goes right into the trash. (Well, I read the creative writing piece in the front but that's it.)

 

[Paws]

Panda, I agree with this. I am a new third year and I am just trying to figure out the basics of basic stuff, I need bread and butter information not something obscure and zebra-ish.

I think that's why I was so aggravated by the student on my team and his obscure diagnosis. I know I sound like such a big pain, all complaints and such, but I would like to focus on building a good foundation and then one day yes, something obscure. There's so much to learn and there's nothing wrong with boring, basic stuff to start out with.

 

[AmoryBlaine]

Journals are low-yield, especially for medical students and residents. I'm an Emergency Medicine resident and it makes a lot more sense for me to read Tintanalli (the monster EM textbook) as opposed to a journal article. The really classic journal articles (like the one on goal directed therapy for shock) have already been incorporated into the medical world. Most of what you get in Journals is speculative, heavy with statistics, and not even that interesting.

Panda reads his EM journals because they have big words and lots of pictures but JAMA goes right into the trash. (Well, I read the creative writing piece in the front but that's it.)

Funny you mention this. I was looking at the eval sheet for one of my rotations and the "honors" section for medical knowledge included something like "uses multiple sources, including primary literature, to add to his/her knowledge base."

That seems like so much BS to me for an MS-III level. You can have a patient with a relatively common problem and read TONS of useful info in a text or on UTD,
but if you do an OVID search all you come up is papers about T24xpq67.4 knockout mice who lived for 1.4 +/- 0.9 weeks longer when they were given some unapproved drug by a bunch of PhDs in Korea.*

* no offense meant to PhDs or Koreans, I'm actually quite fond of both groups of people.

 

[NDESTRUKT]

I've always just gotten relevant articles that pertains to the differential diagnosis or the treatment. Oftentimes there are new or experimental treatment plans that attending and residents will find interesting. It doesn't mean you're going to use it, but that it's just out there.

I never hand out journal articles unless asked for...and I only bring it up when I present that patient and very briefly - "I read in this article that blah blah has been treated with blah blah and found it interesting." It's not that they care about whether or not it's applicable but that you're taking interest in your patient's condition.

 

[velo]

So I always hear about how important it is to "read around your patients" especially current literature and stuff. Many sources (SDN and otherwise) suggest that you "bring in articles to share with your team."

Now I'm not that far into my 3rd year, but does anyone do this? On every team I've had so far, everyone but the attending would have wanted to kill a person that did this. I have never seen it done. I certainly cannot imagine showing up to rounds and giving reading material to the residents...

I did this all the time on Medicine, although I never brought in a copy of an article--I'd write up a quick one-page, bullet-pointed summery and make a copy for the people on the team.

If you do it wrong I'm sure you'd end up looking like a tool, but if you pick a good, focused clinical question that's relevent to a patient on your team then everyone really appreciates it. My attending especially seemed to like it in his eval and said it affected patient care several times.

However, my attending the first month was much more receptive to taking time for med student literature review than the attending on month two. So I'd say test the waters, and if your team is receptive go nuts.

good luck

 

[8744]

I've always just gotten relevant articles that pertains to the differential diagnosis or the treatment. Oftentimes there are new or experimental treatment plans that attending and residents will find interesting. It doesn't mean you're going to use it, but that it's just out there.

I never hand out journal articles unless asked for...and I only bring it up when I present that patient and very briefly - "I read in this article that blah blah has been treated with blah blah and found it interesting." It's not that they care about whether or not it's applicable but that you're taking interest in your patient's condition.

That's the point. It's all fake.

 

[blinknoodle]

I'm just beginning clerkship and have yet to see anyone bring in articles during my surgery rotation. I have gotten articles myself, though, especially for the wild and wacky emerg patients. I rarely had the same consultant twice on emerg, so it would not have had the same impact, but I still really wanted to share my articles on coital headache.

 

[DrBodacious]

I think it is ridiculous that in medical school, students complain about things like other students presenting articles.

Sure, bringing in articles may annoy the other students on your team, if the other students on your team are the type that are insecure about being one-upped.

Although, you should attempt some tact when bringing in an article.

For one, you should actually have looked it up out of interest in a particular unaswered question, not just looking up an article on X disease that your patient has. That is just blatent ass-kissing, so blatent that attendings will see right through it.

I prefer to just talk about what I read about in my assesment and plan. I give a very brief version of an article, such as "a randomized double-blinded study from NEJM of X number of patients showed that in fact it is common for patients with X disease to present in this atypical manner." If someone asks, I usally have a couple copies of the article on hand.

Of course, I'm talking about medicine rotation. If you are on surgery, you will annoy everyone by sucking up time with a prolonged presentation.

The bottom line is, in our evaluations for our clinical rotations, there are boxes that attendings have to circle that asses how much you read around your patients. i.e "student never/rarely/sometimes/often/always reads around his or her patients" or "student contributes to the learning of the team" So even if you read up on every one of your patients, if you don't show what it is that you've read-up on, you'll get a worse eval than you deserve. Presenting articles is a good way to make sure your work is being recognized, besides the obvious facts that you can teach your team something and better assess your patient's problems.

And if you have a low-quality team, and you end up annoying your residents or other students, I wouldn't worry about it, because they don't grade you and reading around your patients is a good way to learn.

 

[8744]

I think it is ridiculous that in medical school, students complain about things like other students presenting articles.

Sure, bringing in articles may annoy the other students on your team, if the other students on your team are the type that are insecure about being one-upped.

Although, you should attempt some tact when bringing in an article.

For one, you should actually have looked it up out of interest in a particular unaswered question, not just looking up an article on X disease that your patient has. That is just blatent ass-kissing, so blatent that attendings will see right through it.

I prefer to just talk about what I read about in my assesment and plan. I give a very brief version of an article, such as "a randomized double-blinded study from NEJM of X number of patients showed that in fact it is common for patients with X disease to present in this atypical manner." If someone asks, I usally have a couple copies of the article on hand.

Of course, I'm talking about medicine rotation. If you are on surgery, you will annoy everyone by sucking up time with a prolonged presentation.

The bottom line is, in our evaluations for our clinical rotations, there are boxes that attendings have to circle that asses how much you read around your patients. i.e "student never/rarely/sometimes/often/always reads around his or her patients" or "student contributes to the learning of the team" So even if you read up on every one of your patients, if you don't show what it is that you've read-up on, you'll get a worse eval than you deserve. Presenting articles is a good way to make sure your work is being recognized, besides the obvious facts that you can teach your team something and better assess your patient's problems.

And if you have a low-quality team, and you end up annoying your residents or other students, I wouldn't worry about it, because they don't grade you and reading around your patients is a good way to learn.

You don't get it. We don't mind other students bringing in articles. We don't mind the mindless question either. For my part, I wouldn't care if the honors students were following the attending home to wash his car and paint his house, the key concept being that they're doing it on their own time, not mine.

Presenting articles, asking questions...it all prolongs the agony of rounding, particularly with an attending with no life and therefore no incentive to shut up and get on with it.

 

[Paws]

I am begining to think that rounds are less about the patient and more about some other agenda like, I dunno, checking off the box on your job requirements saying: "participated in an educational experience." That would apply to the residents and attendings. It seems like a real sad way to 1) actually teach and 2) provide decent medical care to patients.

I am with Panda, I do my best to keep my mouth shut and try not to look bored, but I find them excruciating and sort of meaningless.

 

[8744]

I am begining to think that rounds are less about the patient and more about some other agenda like, I dunno, checking off the box on your job requirements saying: "participated in an educational experience." That would apply to the residents and attendings. It seems like a real sad way to 1) actually teach and 2) provide decent medical care to patients.

I am with Panda, I do my best to keep my mouth shut and try not to look bored, but I find them excruciating and sort of meaningless.

Too right. I'll admit that when you first start rounding as a medical student, even though it sucks you still do pick up a lot of information. But after a while you realize that they keep talking about the same stuff. By your third medicine rotation you are totally jaded about sodium, potassium, and the other electrolytes which seem to be the only thing a lot of medicine people are interested in.

 

[Adcadet]

I've frequently brought in articles. A few simple rules: it must a good article. Relevant to the patient, common enough that everyone will see it again. Not UpToDate, as anyone can pull an UTD. Must be a good article - the best in the field, and/or the most current well done study. Sometimes its nice if it contradicts a widely practice that isn't based on data. And don't force it upon people. I like rotations where you have a team room or table with a collection of articles in the corner. While presenting you patient you can refer to the article, show your copy, and mention that there's a few extras in the team pile.