Quality assuring our learning from others
http://www.100md.com
《英国医生杂志》
1 Division of Medical Education, Warwick Medical School, University of Warwick, Coventry CV4 7AL
Correspondence to: Ed Peile ed.peile@warwick.ac.uk
This fascinating case has generated a rich diversity of responses on bmj.com,1 and as many have said, all thanks to Miss Webb, her family, and medical team for allowing us to participate in such productive case based learning. The diversity of responses is multidimensional: across disciplines; across countries, health systems, and medicolegal and ethical contexts; across levels of experience; and across the spectrum of orthodoxy. Therein lies much of the value—we are prompted to consider aspects that we would not otherwise have thought about. But how do we separate the cranky from the erudite?
We need to adapt the tools of evidence based learning for appraising expert opinion and grey literature, which includes web resources.2 Are there any reliable filters that we can use? The clues we have on the rapid responses website are the name, specialty, location, and perhaps seniority of the contributor. Looking at the 60 or so responses to this case, none of that information seems to help the quality appraisal process.
Some contributors cite references. This is helpful, especially if we take the time to check them out. Are they in peer reviewed journals? Do they support the writer's contention? What was the reaction of the scientific community to the publication? The presence or several references may add only pseudo-weight to a contention. In the end, there is no short cut to the process of validating an interesting contribution to case discussion; we have to ponder it and triangulate it before we can safely incorporate it into the scripts3 that influence our practice.
This case is memorable. Like many of the cases that I have encountered or been taught about, it will enter my memory bank and perhaps contribute to future "pattern recognition" components3 of my clinical reasoning. When is the right time to appraise the quality of the suggestions made by respondents? If, in years to come I encounter a clinical situation which triggers recall of something someone said in a case discussion, I am obviously wise to check the most recent evidence before acting in a situation of uncertainty. So do I need to bother about separating the wheat from the chaff when I read these contributions? I am not aware of any evidence from educational psychologists on this point, but common sense would suggest that I should critically appraise suggestions from colleagues here and now. If I don't, I might later be detrimentally influenced by the easily recalled wacky suggestions rather than supported by the wise advice from fellow learners.
Competing interests: None declared.
References
Siotia AK, Chaudhuri A, Muzulu SI, Harling D, Muthusamy R. Postoperative hypoxia in a woman with Down's syndrome: case outcome. BMJ 2005;330: 1068.
Sackett D, Richardson WS, Rosenberg W, Haynes RB. Evidence based medicine: how to practice and teach EBM. 2nd ed. London: Churchill Livingstone, 2000.
Schmidt H, Norman G, Boshuizen H. A cognitive perspective on medical expertise: theory and implications. Acad Med 1990;65: 611-21.(Ed Peile, professor of medical education)
Correspondence to: Ed Peile ed.peile@warwick.ac.uk
This fascinating case has generated a rich diversity of responses on bmj.com,1 and as many have said, all thanks to Miss Webb, her family, and medical team for allowing us to participate in such productive case based learning. The diversity of responses is multidimensional: across disciplines; across countries, health systems, and medicolegal and ethical contexts; across levels of experience; and across the spectrum of orthodoxy. Therein lies much of the value—we are prompted to consider aspects that we would not otherwise have thought about. But how do we separate the cranky from the erudite?
We need to adapt the tools of evidence based learning for appraising expert opinion and grey literature, which includes web resources.2 Are there any reliable filters that we can use? The clues we have on the rapid responses website are the name, specialty, location, and perhaps seniority of the contributor. Looking at the 60 or so responses to this case, none of that information seems to help the quality appraisal process.
Some contributors cite references. This is helpful, especially if we take the time to check them out. Are they in peer reviewed journals? Do they support the writer's contention? What was the reaction of the scientific community to the publication? The presence or several references may add only pseudo-weight to a contention. In the end, there is no short cut to the process of validating an interesting contribution to case discussion; we have to ponder it and triangulate it before we can safely incorporate it into the scripts3 that influence our practice.
This case is memorable. Like many of the cases that I have encountered or been taught about, it will enter my memory bank and perhaps contribute to future "pattern recognition" components3 of my clinical reasoning. When is the right time to appraise the quality of the suggestions made by respondents? If, in years to come I encounter a clinical situation which triggers recall of something someone said in a case discussion, I am obviously wise to check the most recent evidence before acting in a situation of uncertainty. So do I need to bother about separating the wheat from the chaff when I read these contributions? I am not aware of any evidence from educational psychologists on this point, but common sense would suggest that I should critically appraise suggestions from colleagues here and now. If I don't, I might later be detrimentally influenced by the easily recalled wacky suggestions rather than supported by the wise advice from fellow learners.
Competing interests: None declared.
References
Siotia AK, Chaudhuri A, Muzulu SI, Harling D, Muthusamy R. Postoperative hypoxia in a woman with Down's syndrome: case outcome. BMJ 2005;330: 1068.
Sackett D, Richardson WS, Rosenberg W, Haynes RB. Evidence based medicine: how to practice and teach EBM. 2nd ed. London: Churchill Livingstone, 2000.
Schmidt H, Norman G, Boshuizen H. A cognitive perspective on medical expertise: theory and implications. Acad Med 1990;65: 611-21.(Ed Peile, professor of medical education)