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Newsletter October 2022: What do you read, doctor?

Gabriel M.Gurman, MD
Chief Editor

nl-sept-1Since the first days of my studies, I read medicine. First, there were textbooks for each of the disciplines taught at the university. As students, we used to hear during lectures about experimental and clinical studies, well known all over the world since they have been published in very esteemed and known medical journals, but our teachers never asked us to enlarge our knowledge by reading them. It was enough to get the main points, especially when the results of those studies contributed to the creation of what is called „evidence-based medicine” today.

The next step represented the stage of studying and practising anaesthesia. The choice of this speciality came with an urgent need to combine daily clinical activity with learning the main theoretical aspects of my future profession and return to basic sciences: anatomy, physiology, chemistry and physics. Interestingly, during those first years as a resident, I found in the library special manuals dedicated to our speciality, like physics for anaesthetists or anatomy for anaesthetists.

I must confess that reading anaesthesia was a very chaotic activity for me. From the very first moment, I understood that it would take me one or two years to complete the reading of one or two large textbooks, not only reading but also understanding and retaining the main points, which would help me practice anaesthesia every single day and night.

This situation became more evident when the exams for the specialist diploma demanded deep knowledge, combined with a strong built up clinical judgment and experience accumulated during residency.

I am sure that the above description fits the career of almost all those among us who passed all the stages till becoming fully licensed anaesthesiologists.

Needless to say, courses, workshops, and case discussions all helped us reach the point when we could be sure that, in our hands, anaesthesia was safe.

Nowadays, things seem to have become both simple and also complicated.

The approach to literature became very easy. Almost everything is online, any question can get a quick answer by searching up-to-date textbooks and recent papers.

But at the same time, one has to select what to read. Too many published studies and too many contradictory data of them make our efforts difficult to differentiate important and veridic studies from those without a proven base.

So, here are the three main points that, in my opinion, could represent a topic for a larger discussion.

The first one deals with the young resident’s approach to literature. When one is supposed to take part, from the very first day, to the clinical activity, either in the operating room (OR), or in the intensive care unit (ICU), or in the pain clinic, how this young resident is supposed to obtain, as quickly as possible, the main theoretical data about what his older colleagues do every single day?

Many years ago, as a young professor of anaesthesiology at my own university, I concluded that my young, new colleagues needed a much simpler manual, a cookbook, to be read and understood in just a couple of weeks.

Nothing in those manuals (one for anaesthesia and the other for critical care), which I wrote and published, went into too deep knowledge.

Each subject was treated in very few pages, and only the most pertinent notions necessary for understanding each situation in OR or ICU have been included in those manuals.

Later on, each of those young physicians’ theoretical knowledge went deeper. They accumulated more data from textbooks and published studies but have been spared from witnessing procedures and technics which they could not understand.

But what about the young specialist, who is supposed to go on and improve and enlarge his/her theoretical knowledge? Does he/she know how to approach the new data, interpret confusing articles, and separate papers with significant input on the profession from those which represent more a personal opinion than well-documented data?

I must confess that I have no ideal solution for this last point.

I am as confused as many others because I have no data about things done in this direction in various departments of anaesthesia and critical care in our continent.

Is there any course for young specialists which would guide them on how to differentiate a good paper from not a so-good one? Is there any department which dedicates a part of its meetings by presenting new papers and offering the participants an opportunity to discuss them and draw the right conclusions?

One of the solutions to the above questions could be scientific meetings.

During the COVID pandemic, all our congresses and symposiums have been held online, a situation which included only a few occasions for open discussions.

But these days, with the return to the “normal” situation, we must emphasise the crucial importance of scientific gatherings which give the chance to every participant, but especially to those younger ones among us, not only to listen to a presentation but also to initiate a discussion, by asking pertinent questions and also expressing their own opinions.

Once back to his/her place of origin, the young colleague would become more able to distinguish between what is important and what is negligible between a well-documented paper and one which presents disputable conclusions.

This is why the process of continuing medical education is so important for all of us. It is not only about improving our theoretical knowledge but also offering us the necessary tools to separate the wheat from the chaff.

Finally, one cannot forget the danger of what was called by Beall (1) „predatory journals”, a source of misleading information, since all of them have only a commercial interest. The papers published in these journals do not pass peer review or revision by an editorial board, but they will be published because the authors, eager to enrich and embellish their CVs, paid for it.

Since our readers have access to a very good editorial published in the European Journal of Anaesthesia and Intensive Care (2), I will not go on with further details on this topic. I strongly recommend that editorial, which includes some advice for avoiding predatory journals.

So, the answer to the question of this editorial is not simple. Professional reading is a full-time job for the practitioner. Each of us is supposed to understand the theoretical base of any manoeuvre and technique fully.

Besides, I believe in our common sense and ability (gained during years of practice) to select those journals and those papers which are worthwhile and not give pseudoscience a chance to confuse our knowledge and negatively influence the daily activity in the OR or ICU.

References 

  1.  Beall J. Ann Med Surg 2013;2:47 
  2. Rosencwajg S et al. Eur J Anaesthesiol 2022;39:299 
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