How many times have you attended a conference or even a lecture at grand rounds and been excited about practice-changing information only to forget to put it into practice once you are back in clinic? As a provider who attends and presents at numerous conferences each year this is definitely a problem I have personally encountered.
I have seen residents and fellows get excited by the latest evidence from a guest speaker or new journal article that includes a practice-changing conclusion only to review charts days later seeing the “old” evidence still in use. Why can’t we more readily change our practice?
The company PILS, Inc. (Practice Improvement Learning System) aims to “change your old ways” and enhance your current practice. Founded in 2009 by a group of family physicians and medical educators, PILS encourages physicians to log these practice-changing pearls online. Then using their “Commit to Improve” system, providers are sent periodic email reminders of these practice-changing pearls to ensure this new learning “sticks”.
Med Pearls in many ways is the “companion” app to PILS, but can be used on its own. I have been using it now for several years and frankly ONLY use the app. The content of the app, as stated on the PILS website, comes from multiple sources including the author’s experience teaching in academic medical centers, providing Continuing Medical Education [CME] to various audiences, medical editing and writing for written and electronic formats (one of the founders is the Editor of the journal, Family Practice Recertification), and medical management in academic and group practices. All of this information has been distilled into a very user friendly point of care app.
Let’s say you were just attending a medical conference in primary care. At the conference you learned about how screening for lung cancer in select current and former smokers with CT can decrease mortality from lung cancer. Previously, let’s say you hadn’t been routinely ordering CT’s for lung cancer screening. You are determined to change your practice and improve the care of your patient population. The PILS/Med Pearls system gives you multiple options to permanently “change your old ways”.
When you first open the app, it immediately pops up a list of specialty categories from “Cardiology” to “Surgery/Anesthesia”. Once you tap on “Pulmonary/Allergy”, you will see the list of medical pearls relevant to that specialty. In our example, you would see a pearl called “Lung Cancer Screening: B Grade Evidence from USPSTF”.
Once you tap on this particular pearl, the app opens a screen that looks like an email message on Gmail or your default iPhone mail app. Across the top are options to share the pearl via email, Facebook, or Twitter. The message has the title about “Lung Cancer Screening” and the body of the message is the pearl which summarizes the USPSTF lung cancer screening recommendation. The message also contains a link to the abstract of the citation on PubMed.
The really interesting option is a “button” at the bottom of the pearl called “Commit to Remember Reminder”. Pushing this button instantly sends you an email to whichever email account you registered in the app or on the PILS website. The message states:
Hello Douglas Maurer
Thank you for selecting your personal myPearl. Your personal myPearl is listed below. The myPearls process uses a proven educational technique of gentle reminders, by providing you with your personal myPearls on scheduled intervals. You will receive 4 brief emails from myPearls over the next 3 months listing the pearls you chose to adopt into practice. Thanks for participating with myPearls.
In August 2013, USPSTF proposes a Grade B recommendation in favor of annual LDCT for those aged 55-74 with > 30 pack years smoking and less than 15 yrs of abstinence Recommends stopping (or not starting) screening after 15 years of smoking abstinence (Grade B = moderate to high certainty of moderate to substantial benefit = offer or provide this service)
Citation: U.S. Preventive Services Task Force 2014
This reminder system is the most unique feature of the app, but when would you use the app otherwise? If I am looking for the answer to a clinical question at the point of care rapidly, I use UpToDate, Dynamed or Essential Evidence Plus (see our previous article on this topic on deciding which resource is the best to use).
Certainly, in this case I could search the app and find this particular pearl on lung cancer screening. But with only ten pearls under the “Pulmonary/Allergy” specialty topic, it is very unlikely that the answer to my next clinical question in this subject area would be in the app. But that really isn’t the purpose of the Med Pearls app in the first place. Med Pearls shines by trying to be a resource for primary care providers to “log” practice-changing topics and increase the likelihood of actually implementing them through their Commit to Improve system.