CME Crosstraining with Dr. Gurpreet Dhaliwal - a podcast by Scott Selinger

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  I'm sure we've all seen patients either coming into the hospital or transferring to a new clinic on a bizarre outdated medication regimen.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 serv

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