From: iain jamieson <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, March 08, 2001 7:12 PM
Subject: Re: hx, exam and diagnositcs - was CO poisoning
> Simon, I take on board what you say - but by now you.
> I and a lot of the Docs on this list are fairly enior
> with a huge wealth of experience behind us.
> We are going to work this way anyway.
Thanks for the support, but I'm still firmly on the steep part of the
learning curve! Plus, for the foreseeable future most ED care is delivered
by those without a wealth of experience.
> The benefits of the "full clark in" is good for med
> students to systematise what they do and guide them
> into asking questions that experience dictates they
> wouldn't neccesarily ask.
maybe - they certainly need some way of aquiring the full breadth of
questions and skills. Whether we do that in the traditional sequence, all
the hx, followed by all the exam, followed by the differential is debatable.
> Your average A/E junior however will learn on the job
> just how to hone in on the diagnosis and treat/triage
> appropriately.
They may learn these things on the job, but we do teach them as well, and we
should teach them in the same way we expect them to develop.
> There is value in learning the basics first. It's also
> a fairly safe approach.
True - you need to have the full range of skills from which you pick and
choose.
> Glasgow are currently doing a thing with med students
> that encourages integrated thinking,they dont do anat,
> physiol etc.. but instead study these with relation to
> clinical cases, but only time will tell wether this
> makes them better Docs.
> You'll remember a consultant at Hope (now retired) who
> told us all as fairly young med students that , given
> a month he could teach us to pass our clinical finals.
> The initial system based approach is just a map. It's
> only when we've got experience that we can take the
> appropriate "shortcuts".
My premise is that they are not really shortcuts. If it the way better and
more experienced clinicians think and practice can these techniques and way
of thinking be taught? (question rather than statement).
Simon Carley
SpR in Emergency Medicine
Manchester Royal Infirmary
England
[log in to unmask]
Evidence based Emergency Medicine
http://www.bestbets.org
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