I Have A Patient…

 

This is your first day in the internal medicine clerkship. The first patient you see has been diagnosed with chronic kidney disease.  There is plenty of information and data about this patient from her previous medical records, which she has brought with her, and your own evaluation. There is also quite a bit of information you remember from studying kidneys. The patient has been to several medical centers and doctors. After learning that you are a medical student, she confides: “I am really confused. I don’t really know what is wrong with me, what is going to happen, why this is happening, or what my options are. If I could just understand what this is all about I could begin to make some decisions.”

Outline

  • Review a condition to make decisions about patient care informed by the knowledge available in the literature.
  • Learn how to assess your knowledge of a condition and know when to search the literature.
  • Apply your knowledge and make connections to your current clinical situation.
  • Consider what  patient with this condition needs to know and understand before clinical decisions can be made.
What Do You Need To Do?

Refresh your memory: what do you know about this condition? What would be important to review to connect all these pieces of information? The following are examples of things to review when considering a condition: causes, risk factors, pathophysiology, staging, etc.

Make connections between your knowledge of CKD and the information you reviewed in the literature.

Consider, and effectively search for, clinical guidelines that may help inform patient care.

Apply this collective knowledge to your current patient in order to make informed decisions about their care.

 

Why Is This Important?

Developing the ability to assess your knowledge of a condition and knowing when to search the literature will allow you to make informed decisions about patient care.

 

How Can You Make These Connections?

Take the following quiz to assess how much you know about CKD:

Quiz Yourself

Search an appropriate resource to review trusted, well-established information:

Access Medicine is a collection of online textbooks, assessments, images, illustrations, diagnostic and point-of-care tools. Use Access Medicine if you have no prior knowledge of a condition and need to review a textbook.

Up-To-Date and DynaMed Plus are databases of topic reviews and summary information put together by clinical experts. These databases are useful when you have prior knowledge of a condition, but you need to review information. You will be able to find clinically relevant information in a short amount of time.

To assist in issues that deal with clinical decision making, consider whether a clinical guideline may be available that is scientifically sound and can effectively inform practice: Guidelines.

 

Using the Resources

 

Access Medicine

Enter your term in the main search bar – can be the full term or an acronym (you can search for “chronic kidney disease” or “CKD”).

There are possibilities to narrow your search by textbook or topic (left hand side of results screen). You can also limit by publication category: books, quick reference, multimedia, images, cases, or patient education.

Access Medicine is available via mobile applications.

DynaMed Plus

Enter your term in the main search bar – can be the full name or an acronym (you can search for “chronic kidney disease” or “CKD”).

Select the appropriate entry. Use the menu on the left side of the screen to jump to the appropriate section: General Information, Epidemiology, Treatment, Complications and Prognosis, etc.

DynaMed Plus is available via mobile applications.

Up-To-Date

Enter your term in the main search bar – can be the full name or an acronym (you can search for “chronic kidney disease” or “CKD”).

Select the appropriate entry. Use the menu on the left side of the screen to jump to the appropriate section: Natural History, Definition and Classification, General Management, Summary and Recommendations, etc.

Up-To-Date is available via mobile applications.

 

Note: DynaMed Plus and Up-To-Date are similar clinical point-of-care tools. Try searching in both and see which you prefer using. You may find one more helpful than the other when searching for specific pieces of information, like the epidemiology or natural history of a disease.

For more information please visit the Learning at Your Own Pace tutorials page on the library website – http://library.cumc.columbia.edu/learning-your-pace-tutorials

 

Review The Important Concepts

The following review activity will test your knowledge of CKD and the information you learned about in this section:

Review Activity

Summary

Question yourself!  The best way to calibrate how much you know about a condiditon is to ask yourself questions.

Always double check your knowledge! Never assume that you know everything.

Remember the following steps are crucial when you are reviewing a patient’s medical condition:

  1. Identify that you have a question about a medical condition.
  2. Assess what you know about that condition.  Calibration is key.
  3. Choose an appropriate resource to find background information: Access Medicine, Up-To-Date, or DynaMed Plus. Consider if clinical guidelines would be beneficial.
  4. Use that resource efficiently to get the information you need quickly.