There is a common discussion almost yearly that is heard around the country in academic hospitals. Older generations of physicians will often make remarks about the ACGME duty hours that are in place for resident physicians, stating that in their day, they routinely worked 36+ hours in a row and rarely had a full day off. In 2011, the Accreditation Council for Graduate Medical Education (ACGME) instituted a 16-hour work limit for intern doctors. This change, added to the 2003 work hour changes which limited residents in all specialties to an 80-hour work week (averaged over a 4 week period), 1 day off in 7, and a maximum shift length of 24 hours (with 6 hours additional for education and handoffs).
There is a common concern (although until now unfounded) that fewer hours worked during residency may lead to substandard patient care. With the sheer volume of medical conditions that are known in 2016, no physician can be expected to have learned everything during their residency. Learning in medicine never stops.
Harrison’s Principles of Internal Medicine was first published in 1950. Now in its 19th edition, the two-volume set spans over 3,000 pages of densely packed medical information. Similarly, the Red Book of Pediatric Infectious Disease was first published in 1938 and was 8 pages long. Now, the 30th edition is over 1,100 pages with more added in each new edition. Besides the new information of previously unknown conditions, there is constant revision of the presentation, diagnosis, work-up, and treatment of known conditions. With the constant changes, physicians must be up to date with evidence-based guidelines. This is where the use of medical algorithms can assist medical students, residents, and older physicians.
There are several thousand internal medicine algorithms available online and via iOS and Android app which are further searchable by specialty or sub-specialty. Additionally, to complement the Red Book of Pediatric Infectious Disease, there are hundreds of pediatric infectious disease evidence-based algorithms available. Recently, the Medical Algorithms Company created a complete set of algorithms that reflect the information provided in the pediatric community-acquired pneumonia guidelines. This guideline of over 30 assessments, questionnaires, and scores goes through pediatric pneumonia diagnosis, complications, therapy, prevention, and follow-up. This is an invaluable tool to assure that children receive the most recent evidence-based care for community-acquired pneumonia.
Using medical algorithms for clinical decision support enables healthcare professionals to have the power of a gold-standard evidence-based guideline at their fingertips to assist them in calculating symptom or treatment scores. Additionally, the description and interpretation section of algorithms available from www.medicalalgorithms.com can fill in educational gaps and serve as a reinforcement for previously learned information that a member of the healthcare team may be less familiar with.
Even though it would be impossible for one person to remember the seemingly exponential amount of medical knowledge available today, there are medical algorithms as support tools available to assist.