What do you find most challenging in your role as an internal medicine trainee?
“Being a doctor is a physically demanding job, and it’s not easy to juggle work around exams and building a portfolio. Each year, we need to log a set amount of patients and procedures and do quality improvement projects . These need to be signed off by different consultants and senior colleagues, and this can be difficult to achieve around our other responsibilities.
As a doctor, your job also has lots of responsibilities. You’re caring for patients, and also worried if you are doing things right when you can’t get confirmation from a senior colleague. BMJ Best Practice helps with this as it can play a good role in helping me as a doctor and building confidence from the evidence-based research.”
Why do you use BMJ Best Practice?
“BMJ Best Practice is a reliable evidence-based tool, which is very useful while working in the NHS. It covers the NICE guidelines very well. It covers almost all medical conditions, and every condition comes with a summary, case history, epidemiology, etiology, and there’s a systematic and algorithmic approach of the diagnosis and management of that specific condition. The introduction of the Comorbidities Manager makes your job much easier, as most of the time patients are not like the exam questions. They are patients with different comorbidities, and you have to think about many different things at the same time, which might be difficult in a stressful situation.
I also find the patient leaflets really interesting, and recently I offered the Endocarditis leaflet to a patient and their family in a renal ward.
Another very important aspect is the CPD calculator, as you can scroll through BMJ Best Practice and read about the topics and get CPDs points. I used this for my appraisal last year, and I will use them for my Annual Review of Competency Progression (ARCP) this year.”
In what scenarios do you find BMJ Best Practice most useful?
“When I clerk patients I always have BMJ Best Practice with me, and I go through the diagnosis and make sure I’m not missing any bit in the history, an important diagnostic investigation, or even therapeutic measures.
I also use it for practising and revising, especially for my membership exams. Sometimes you just need to revise a topic, and you need a reliable source with the latest information. For example, for my Internal Medicine Trainee (IMT) interview, it was extremely helpful because I needed to go through the various scenarios. I also use it for teaching medical students, as you want to make sure you don’t miss out on anything.”
“When I clerk patients I always have BMJ Best Practice with me.”Maryam Barfei, Internal Medicine Trainee, UK
Do you use the BMJ Best Practice app?
“Yes I do. It’s good to have it with me all the time, and once downloaded you can use it offline. It’s very good to use during ward works. I always use the app because it’s much easier than going back to the computer to check the website, as I can use it from my pocket.”
Do you have an example of when you have used the BMJ Best Practice Comorbidities Manager?
“One of the most common examples of when I use it is with patient admissions with an acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD), which we have a lot of during autumn and winter time. COPD patients usually have different comorbidities, and I was dealing with a patient that had heart failure, chronic kidney disease and diabetes. Using the Comorbidities Manager is useful as I could check how frequently we needed to check their blood sugars, for example. They might have needed to go towards ventilation, and the Comorbidities Manager is useful in knowing whether this is the right decision for that specific patient or not. Using the comorbidities tool and BMJ Best Practice, you can tick through the things you may forget to make sure you’re being safe.”
Can you describe the impact BMJ Best Practice has had on your practice?
“It made me more confident in making decisions and providing the correct treatments. Especially during night shifts, when we don’t have senior support like the daytime. When I walk down in the morning with the consultant to review patients, I feel more confident. I think it has also helped me to learn, because in medicine, we learn as we work, and revising a topic as you see the patient is the best way to learn. Over time, I reflected on how experienced I became after just a few shifts using BMJ Best Practice.”
Who would you recommend BMJ Best Practice to?
“Everyone! To be specific, to all medical students and junior doctors because it makes them a safer doctor, and a safer doctor is a better doctor. BMJ Best Practice can accelerate and consolidate your knowledge. Even senior doctors can benefit from this tool as we don’t know everything all the time. For example, I might be in dermatology in four years time and I might forget about celiac disease, so I can simply just go and check, did I ask all the right questions to the patient? Did I actually refer the patient to the right team? I think everyone can use it.
Besides the doctors, we also have physician associates working with us. We’ve also got Advanced clinical practitioners in the Emergency Department for example. To be honest, everyone working in the healthcare sector can benefit from BMJ Best Practice.”
“I might be in dermatology in four years time and I might forget about celiac disease, so I can simply just go and check, did I ask all the right questions to the patient? Did I actually refer the patient to the right team? I think everyone can use it.”
Maryam Barfei, Internal Medicine Trainee, UK
What made you decide to become a BMJ Clinical Champion, and why?
“I think BMJ Best Practice is a fantastic tool and I would really like to be the advocate to help others use it. I was able to learn how BMJ Best Practice works, and how I can use it as a tool in my day-to-day practice. I also received the latest updates and changes, such as having early access to the Comorbidities Manager, which I could then show to my colleagues. I can also build a network with my peers and the BMJ Best Practice team, and ultimately contribute to the improvement of patient care. As a champion you have to have initiative, be proactive and display great leadership skills.
What we’re looking for and what we’re always talking about in healthcare is quality improvement, and isn’t BMJ Best Practice one of the best and most available tools that we have to quality improve the care of our patients instantly?”
Maryam also has a Youtube channel about her journey as a doctor in the UK, which you can find here.