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Most doctors take pride in their medical knowledge, and the
hallmark of a medical professional is his medical expertise.
Unfortunately it is a sad fact of life that most practicing
doctors are too busy to keep up to date with the newest medical
knowledge . Few read medical journals ; some do attend medical
conferences, but primarily to meet friends and socialize ,
rather than to learn; and most depend upon their “friendly
“ medical representative to educate them. Many senior
doctors feel that their years of accumulated experience mean
that they do not need to learn anything new anymore. However,
as Michael O’Donnell points out in A Sceptic's Medical
Dictionary , clinical experience can be defined as making
the same mistakes with increasing confidence over an impressive
number of years.
This sorry state of affairs a poor reflection on
the medical profession today and can actually be
dangerous for you. Thus, if a patient has a poor
medical outcome because you are not up to date you
can be sued for medical negligence. Keeping up to
date is important not only to protect yourself ,
but is also essential if you wish to build a successful
medical practice. Your colleagues are much more
likely to refer patients with complex problems to
you if you have a reputation for being well informed
and well read.
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Unfortunately, most doctors have never been taught how to
learn. While we have all learnt how to cram, burn the midnight
oil and bluff our way in the viva, so that we managed to pass
all our exams during our days as medical students and residents,
most of us have never learnt how to manage knowledge. We need
to remember that we are now adult learners , and have different
learning needs , as compared to the days when we were medical
students, and our only requirement was to pass an examination.
One of the reasons many doctors find it difficult to continue
learning is that they are often not motivated enough, and
most carry on a successful practice based on outdated information
which they were taught decades ago. Another problem is the
sheer size of the information which needs to be mastered.
Not only does the task appear overwhelming, the rate of acquisition
of new information is so rapid, that keeping up seems to be
a full-time job ! As a famous medical professor once told
his students, “ Half of what I am going to teach you
is wrong – and I don’t know which half !”
Not only does medical knowledge have a short half life, we
are also literally drowning in an information overload.
So how can you cope ? Essential to information mastery is
understanding the relationship between data, information,
and knowledge: data are raw facts and figures; information
is data organized into a meaningful context; and knowledge
is organized data (i.e., information) that has been understood
and applied. We need to focus on knowledge, and hopefully
transmute that into clinical wisdom with the help of experience
and judgment.
While it is important to retain the information
you need on a day to day basis in your head, it’s
even more important to know where to find reliable
information when you need it – for example
, when you are presented with a patient who has
a difficult clinical problem. Unfortunately, even
in this day of “information overload”
where doctors are surrounded by tons of information
, studies show that approximately two–thirds
of questions that arise in a clinical practice remain
unanswered ! It seems to be a case of : “
Water, water everywhere, but not a drop to drink
!” This is because doctors need user friendly
information, at the “point of use” –
at the patient’s bedside , when it can be
applied clinically.
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Most doctors are reluctant to “look up “
information in front of the patient , because they
feel that this will cause the patient to lose confidence
in them, as it suggests that the doctor does not
know everything. However, good doctors have learnt
that looking up information in front of the patient
can actually impress the patient that you have taken
the time and the trouble to confirm key facts –
and this can be very reassuring to the patient !
Every doctor needs a personal medical library, so
that he has the information he needs at his fingertips.
However, medical books become outdated and journal
subscriptions are very expensive. Fortunately, the
advent of the internet has made accessing knowledge
much easier – and much less expensive as well
! MDConsult , a commercial service at http://www.mdconsultindia.com,
provides Indian doctors access to the world’s
largest online medical library, with over 40 full
text respected medical text books and 50 full text
medical journals, for less than Rs 6000 per year
!
US companies have gone one step further, and now offer ingenious
software solutions tailor made for doctors, which provide
medical knowledge at the bedside through PDAs ( hand held
personal digital assistants, which act as intelligent electronic
aides or “peripheral brains”). Even more exciting
is the recent use of computer technology to assist doctors
in applying their knowledge to solving clinical problems.
Computer support can be used to make the best possible medical
decisions , and expert systems and artificial intelligence
hold a lot of promise. Excellent examples are Medweaver at
www.diseaseref.com and PDXMD at www.pdxmd.com.
Doctors are lifelong adult learners , and the key to knowledge
management is self-management: knowing what you need to know.
You need to be your own filter, so you can turn off unneeded
data , and focus only on what you need to know, so that your
learning is self-directed. You should also be aware of your
preferred learning style. Many doctors learn by reading, while
others prefer alternative options:
- visual ( by watching, for example, as an observer);
- Establishment, when you have created a name for yourself;
- verbal ( by listening, for example, by attending lectures)
; or
- kinesthetic ( by doing , for example , by assisting an
expert)
The most efficient technique is that of modeling (imitating).
We learn most rapidly and effectively by observing an expert
correctly performing the desired behavior, and then trying to
model( copy) the desired behavior . Whether it’s surgery
or tennis, seeing and working with someone who performs the
skill proficiently is worth a thousand words. This is why taking
a “sabbatical” and spending time with an expert
is so useful.
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All the learning in the world is of no use until you integrate
it into your clinical practice. An efficient way of doing this
is to develop clinical protocols or flow charts for tackling
the common problems you face on a daily basis. You can then
update and modify these protocols, as you acquire new information.
Not only will these protocols allow you to learn more effectively,
they will also help you to practice medicine on a more systematic
basis.
To become effective learners, we need to make use of insights
from the field of adult learning, which teaches that as we mature,
our approach to learning changes. In order to learn new information,
we require that this information be interactive; relevant; practical;
and connected to past experience. This is why most doctors promptly
forget over 90% of what they hear in a lecture in a medical
conference – because the information is of little practical
use to them, or has been poorly presented. This is why newer
teaching formats have been developed, which use multimedia and
computer simulation, and since these actively involve the learner,
they are more effective in ensuring that the information transmitted
is retained.
Knowing how to learn is essential, and you need to find out
which of the following learning styles works best for you.
Activists
Activists believe in doing things, and their philosophy
is: "I'll try anything once". They are
happy to try out the newest drugs, and thrive on
the challenge of new experiences but are bored with
implementation and longer term consolidation. They
are happy to play with new medical equipment and
love devising new instruments and operative techniques.
Reflectors
Reflectors like to stand back to ponder experiences and observe
them from many different perspectives. They collect data, and
prefer to think about it thoroughly before
coming to any conclusion. Their philosophy is to
be cautious, and they prefer sticking to what has
worked for them in the past and stood the test of
time.
Theorists
Theorists adapt and integrate observations into
complex and logical theories. They think problems
through in a vertical, step by step, logical way.
They like to analyse and synthesise. They are often
the medical college professors, who prefer looking
at the “big picture”.
Pragmatists
Pragmatists are keen on trying out new ideas and techniques
to see if they work in practice. They are down to earth people
and their forte is solving problems, which they see ‘as
a challenge'. Their philosophy is: "If it works it's good";
and they are interested in getting results, rather than worrying
about why things work the way they do.
Each learning style has its own advantages and disadvantages.
It’s helpful to experiment with different styles; and
you may also need to adapt your style, depending upon the material
you need to learn !
The most effective way to learn is to learn around
your patients. This is the secret behind most successful
doctors– they use their patients as their
textbooks. Patients present with clinical problems,
and while most patients have “garden-variety”
routine problems which are easy to tackle, some
have complex problems for which you need to hunt
for information in order to provide a solution.
Finding out information about your patient’s
problem is the best way to keep on learning. Most
of us remember our patients, and if we read about
their illness, this knowledge will “stick”.
You can find this information formally by referring
to text books and journals – or informally,
by talking to colleagues, or referring your patient
to a consultant. This is why you should treasure
your rare patients – because you learn the
most from complicated cases !
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The best doctors are those who learn the most from their patients
– after all, patients are the true experts on their own
illness . While they may not teach you about the pathology of
their disease, your patients can teach you a lot about courage,
coping skills , how to die and even how to live – if only
you will listen . As a doctor you are privileged to be granted
access to a human being’s innermost secrets - make the
most of this privilege !
Your mistakes can be very valuable teaching tools. We all make
mistakes in medicine – after all, this is an imperfect
science and we are all human beings. However, rather than try
to “bury “our mistakes , we should actively try
to learn from them. A post-mortem used to be the classic teaching
tool in medicine for exactly this reason. Of course, rather
than make mistakes, it’s best to learn from others’
mistakes. This is why CPCs ( clinicopathologic conferences)
are such a useful learning tool. Unfortunately, most of us hide
our mistakes, rather than try to correct them , which means
that valuable learning opportunities are lost.
We all have areas of ignorance . Rather than be ashamed of these
, we need to actively identify these , and try to fill in the
gaps in our knowledge. Remember that nothing is so difficult
that it cannot be learnt !
Learn other stuff as well – not just medicine ! The more
you use your brain, the better it performs ! Learning is fun
if you are motivated – and you can have a ball learning
new skills, such as tennis or golf.
Finally, remember that the best way of learning
is to teach ! If you do not have medical students,
you can always teach your patients . This is not
always easy to do – after all, you have to
understand a topic very clearly before you can successfully
explain it to someone else !
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