UpToDate, Joe’s Goals, and Fortunes.

UpToDate is essentially a concise online textbook for medical conditions. Medical students learn quickly to consult UpToDate for information on topics as varied as causes of hyponatremia (low sodium), manifestations of sickle cell crisis, or criteria for the MELD (model end-stage liver disease) score so that they (1) learn, (2) minimize the chances of looking like complete dolts during rounds, and (3) can expound at length in the “impression” and “plan” portions of their verbose notes. Interns and residents (and presumably attendings, too), continue to consult this useful resource on the fly for information as they evaluate and manage patients.
UpToDate is not a free resource. Word on the street is that within the past year, the company that manages UpToDate has increased their prices by 500%! Thus, any institution that would like to make UpToDate available to staff now must pay a fee that is over half a million dollars.
The folks at UpToDate know how much housestaff rely upon this program. Darn it.
A potential competitor is Dynamed, which prides itself on “superior evidence-based results”. I must confess that I’m impressed with the abundance of (very recent) citations Dynamed provides for different subjects [for things that are relatively uncommon, such as the efficacy of selective serotonin reuptake inhibitors (also known as SSRIs) in contrast to tricyclic antidepressants (TCAs)…]. Information is presented in a concise format, but allows the reader to consult the original articles with ease.
This is particularly striking because the other word on the street is that only 10% of UpToDate is evidence-based. I have no data to support that assertion; that’s just what the (reliable) rumor mill mutters. UpToDate could theoretically brainwash us all with heretical information that would absolutely impact patient care. (Not to say that some of us don’t already do that….)
A disadvantage of Dynamed is that one must already know something about the topic to make sense of the information. UpToDate is a textbook; thus, you can read general background information about progressive multifocal leukoencephalopathy (PML) before learning about appropriate management and treatment of this condition. On Dynamed, you better know what PML is or otherwise, the information doesn’t really make much sense.
>> Joe’s Goals. This is a great application to use for motivation. Joe’s Goals is a Web 2.0 tool that allows you to track your habits; in psychological literature, this behavior is known as “self-monitoring”. The very act of monitoring what you do (or do not do) can change behavior. For example, people who track how many cigarettes they smoke a day often suddenly realize just how often they are smoking, how many cigarettes they are smoking, and how much they are spending on that habit. This information, when blatantly recorded, forces people to become more aware of what they are doing and thus, may foster more rapid behavior change. Maybe. Benjamin Franklin was a proponent of self-monitoring. You could be just like him.
Amongst other things, I am currently tracking my academic reading. I like putting those green checks into the boxes to mark my progress. (And, for what it’s worth, learning theory posits that positive reinforcement—using the green check marks—is more effective in eliciting change than punishment—using the red stop signs. Empirical evidence suggests that the theory is accurate.)