Underutilization of evidence-based strategies in the diagnosis and treatment of venous thromboembolism among trainees.

BACKGROUND

The knowledge and attitude of trainees toward the use of prediction rules in the diagnosis of venous thromboembolism (VTE) is understudied. The extent of knowledge as far as imaging strategies in the setting of VTE and use of low molecular weight heparin (LMWH) among trainees is also understudied.

METHODS

This was a cross-sectional study; between October, 2006 and March, 2008, surveys were distributed at grand rounds and national medicine board review courses. Respondents returning completed surveys included 43 medicine attendings, 139 residents, and 134 medical students Emergency physicians were called at work and 46 completed an abbreviated version of the survey. Attending and trainee responses were compared.

RESULTS

Over 60% of students and 40% of residents did not use any prediction rules. Most attendings (>60%) did not use a prediction rule. Among attendings, 48% of emergency physicians and 30% of medicine attendings felt that prediction rules were too complex to use. Knowledge about imaging techniques and diagnostic protocols for VTE were worse for students than for residents. A substantial minority of all respondents (17% of students, 12% of residents and 13% of medicine attendings) would not use LMWH in the therapy of non-massive pulmonary embolism. In general, level of training did not translate into a greater proportion of correct responses to clinical scenarios or greater knowledge about imaging systems and strategies.

CONCLUSION

Trainees do not use a structured approach to VTE diagnosis. LMWH therapy is underutilized by a large minority of trainees and attendings. A top-down approach is needed to revitalize evidence-based management of VTE.