DynaMed and the Elephant in the Room
Coffee vs. tea, dogs vs. cats, Windows vs. Mac, and DynaMed vs. UpToDate. In each case, you really can’t talk about one without comparing it to the other. We are fortunate to work, study, and teach at a well-funded private institution where we can try out a wide variety of resources. Lane Medical Library offers access to the two biggest players in the comprehensive point-of-care information tools for clinicians arena. Comprehensive Point of Care tools are designed to be used rapidly in the clinical setting and include current information about clinical topics, but also include multimedia to enhance learning, a drug database, and access to patient information materials. Both UpToDate and DynaMed were launched in the early to mid-90s by MD information pioneers. UpToDate has become the darling of students, residents, attendings, and clinicians in private practice over time. Hidden in the big shadow cast by UpToDate, DynaMed has continued to evolve and improve, and with the current version a truly worthy contender to the 800-pound gorilla.
DynaMed & UpToDate Comparison Table
| Facet | UpToDate (UTD) | DynaMed (DM) | Verdict |
| Style | Paragraph | Outline | User preference |
| Evidence-based | More expert opinion,Less well referenced | More overtly evidence-based with easy access to key reference information | DM |
| Breadth/Scope | A bit wider | A bit narrower | UTD |
| Depth | A bit deeper | A bit shallower | UTD |
| Built-in drug info | From Lexicomp | From Micromedex | Tie |
| Patient information | Yes, UTD written materials | Yes, link to vetted resources | UTD in a photo finish |
| Navigation | Multiple overlapping articles about a single topic, can be hard to figure out what to read | Single unified article about a topic | DM |
| Mobile app/CME credit for time spent | Yes/Yes | Yes/Yes | Tie |
| Cost/yr (both are free while you are at Stanford) | $560 (UTD is very cagey about sharing this information without you sharing a lot of your personal information) | $400 | Edge to DM |
| Best audience? | Academic and hospital-based healthcare providers | Community-based primary care providers | No clear winner |
DynaMed and UpToDate are found on the Lane Library home page under Top Resources. You can also install both mobile apps and activate your subscription through Lane Library by following the instructions on our mobile apps page.
There is very little literature found in PubMed that compares DM and UTD (1-3). Each article reports a similar ability to find an answer to a clinical question. Two studies found it took less time to find information in UTD, and that users preferred UTD and felt more comfortable with answers found there. One article stated that the source and quality of evidence supporting a point was more easily determined in DynaMed. Discussions in each article mentioned that in all settings the students and residents tested had used UTD extensively before but were not familiar with DM. They questioned whether familiarity explained the time needed to find answers. Conflict of interest issues have been raised about UTD (4).
Let’s look at appendicitis in adults:
Initial navigation: On typing Appendicitis in the DynaMed search box, two articles are offered, one for adolescents and adults and the other for children. More choices need to be made for where to start in UpToDate. You choose between Adult/Child and then Management/Diagnosis/Clinical manifestations and Differential Diagnosis, and more.
In DynaMed the information about appendicitis in adults is all in one “article”. A succinct outline format with clear references, links to tables, or graphics are in easy reach. UTD feels much more like a textbook: paragraph style, increased depth of information, need to change to a different article to read through all the material about one topic. Tables and references are easily accessed in both.
Lemierre’s Syndrome: This rare complication of pharyngitis just appeared in an information request. I was sure UTD would have information, but DM surprised me with a nice article about the topic. I think this shows something about DM’s recent evolution to a more comprehensive resource.
Final Message
Take advantage of the wealth of information resources you have at Stanford. Try not to rely solely on the familiar. Test DynaMed thoroughly and compare it to UpToDate. While you are at it, try out Embase, GIDEON, CABI Global Health, and other databases that Stanford provides. Depending on what you do and where you go after Stanford, the access to information you are used to here may be diminished. You may have to decide how best to spend your “information budget” for the resources you need for your practice.
References
- Bradley-Ridout G, Nekolaichuk E, Jamieson T, et al. UpToDate versus DynaMed: a cross-sectional study comparing the speed and accuracy of two point-of-care information tools. J Med Libr Assoc. 2021;109(3):382-387. doi:10.5195/jmla.2021.117
- Elovic A, Pourmand A. DynaMed Plus App Review. J Digit Imaging. 2020;33(1):21-24. doi:10.1007/s10278-019-00263-7
- Baxter SL, Lander L, Clay B, et al. Comparing the Use of DynaMed and UpToDate by Physician Trainees in Clinical Decision-Making: A Randomized Crossover
- Trial. VanDeMark SH, Woloszyn MR, Christman LA, et al. Examination of Potential Industry Conflicts of Interest and Disclosures by Contributors to Online Medical Resource Databases. JAMA Netw Open. 2022;5(7):e2220155. doi:10.1001/jamanetworkopen.2022.20155
Great article. One advantage of UTD is that ABIM allows its use as a open-book resource on its Maintenance of Certification Exam. You have to be a very adept UTD user for it to be helpful because with less than 2 minutes/exam question you can easily waste a great deal of time. This means learning all the shortcuts available, using the search function with articles, and getting lots of practice. So the irony is that DynaMed, with its more succinct summaries, might be a better exam resource vs. UTD, but was not selected by ABIM.