Monday, June 13, 2011

Indian doctors , learning, and CME

In reality, all learning is self-learning. We talk about teaching doctors to help them keep uptodate, but in reality, no one can teach anyone else - it's only the student who can learn ! A good teacher will provide as many avenues and opportunities as possible, so that students can learn for themselves.

Adult learners are a different breed - and this is especially true for doctors, who are highly qualified and very busy professionals, with major time constraints.

Not only is it hard for them to take time out of their busy schedules to learn, it's even more important for us to ensure that whatever techniques we use to teach doctors, these are proven to be effective in helping doctors to improve their knowledgebase.

Unfortunately, lectures and presentations at medical conferences are very ineffective ways of transmitting information. Most doctors will forget over 80% of what is presented during a conference - and this poor transmission of information has many reasons.

1. The material is poorly prepared
2. The lecturer is boring
3. The listener cannot ask questions or clarify his doubts
4. The material is not relevant to the listener

The only effective way of ensuring that doctors remember and learn effectively is by making sure that what is taught to them is relevant to their needs - they should be able to use the information , because it is directly related to the problems which the patients they treat they have.

The trick is to provide content which is tailored to their patient's needs - and this is something which is very difficult to do in real life in a conference.

A far better way of teaching doctors efficiently is to help CME become an integral part of their patient care. The best way of doing this is by providing them with high quality medical content ( from books and journals ) which is tailored to the kind of patients they are seeing at that time.

Fortunately, most patients present with routine problems and doctors can treat this without having to refer to a book or journal. They have enough experience and expertise to be able to handle common medical problems with ease. However, when they do see a complex or difficult patient, they may be stumped. Sadly, rather than use this as a learning opportunity, most doctors will just muddle their way through, using whatever (outdated) knowledge they have - or asking a consultant for help. Good doctors do feel helpless and inadequate at this point - but few will have the maturity or the time to go to a medical library to do more research about their patient's problem.

While a consultant maybe able to help their patient, and they can learn from what the consultant did, this is actually not the best way of learning. Ideally, they should have a trusted reference source which they can tap - right at the point of care, so they can refer to this, and refresh their knowledge; or find out what the latest clinical guidelines are. This is where evidence-based medicine ( EBM) can help in dramatically improving medical care - but we need to make sure it is easily available to the doctor on his personal computer/ smartphone, so he does not have to waste time and energy in hunting for this information.

It's very encouraging to see many initiatives ( such as BioMedCentral) which are using open source medical publishing models to ensure that doctors do have access to this kind of information. However, these efforts and still patchy and uneven - and difficult to sustain, because of the lack of funding.

Medical textbooks and journals which are published by commercial publishers are still the most reliable source of authentic, reliable and updated information - and everyone understands the importance of being able to provide this kind of content to doctors . However, medical journals are expensive to subscribe to, so that this is still not a very effective solution in real life for Indian doctors.

The good news is that the world's largest online medical library,MDConsult, with over 80 full-text medical text books and medical journals , from the world's largest medical publisher, Elsevier, is now available to Indian doctors at a highly subsidised price ! I will talk more about this in my next post.

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