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An article of interest related to this thread that I just came across this morning: Soc Sci Med. 2006 Aug;63(4):1084-96. Epub 2006 Mar 7. 'When I first came here, I thought medicine was black and white': making sense of medical students' ways of knowing. Knight LV, Mattick K. Peninsula Medical School, University of Exeter, Plymouth, Devon, UK. [log in to unmask] Personal beliefs about what knowledge is and how we understand, integrate and apply knowledge (known as personal epistemologies) are entrenched in the process of decision-making. Evidence-based medicine in all its forms brings with it the need for an ever more sophisticated appreciation of individual patients' perspectives and 'scientific' perspectives within the clinical encounter. However, current theoretical perspectives on personal epistemology focus more on scientific ways of knowing where knowledge is abstracted and logical. We conducted semi-structured interviews to investigate medical students' personal epistemological thinking towards the end of their second year of training at a new medical school in the South West of England. Whilst responses were varied, students appeared to express predominantly simplistic levels of epistemological thinking according to current developmental models of personal epistemology. However, the process of professional identity formation together with epistemological thinking brought together both scientific and experiential ways of knowing in a way that has largely been ignored by current theorists in the domain of personal epistemology. PMID: 16519978 --- Ronán Conroy <[log in to unmask]> wrote: > One key element that has received less attention in > this thread are > the professional, social and ethical aspects of EBH. > We tend to > concentrate on the appraisal of individual studies, > and to ignore the > context in which that evidence is gathered > (scientific and social) > and the uses to which it is put. > > As a possible corrective, I would recommend these > starting points: > > Ethics: Emmanuel and his colleagues' masterly JAMA > paper. Every > student should read it. We get students to appraise > a paper ethically > using a template derived from the Emmanuel criteria, > and we are also > redesigning our ethics committee application form > around the paper. > Paper free; start from here > > http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? > cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10819955 > > > Professional: An understanding of the economics of > healthcare > funding, and of how very powerful commercial > interests will attempt > to recruit medical professionals. Students love > nofreelunch, a > splendid website devoted to briefing them on the > bigger picture > behind all those freebies: > > http://www.nofreelunch.org > > Social: the PLoS collection on disease mongering and > the creation of > ill health is a good springboard for discussing the > effects on society. > > http://collections.plos.org/plosmedicine/diseasemongering-2006.php > > I also give them a wonderful paper from > Pharmaceutical Executive to > read, so they can see the world the way Pharma does. > It includes the > chilling line "It's not just that metabolic syndrome > has become > better understood, better publicized, or better > supported by an > infrastructure of journal articles, meetings, and > associations. > Behind those events and dozens more like them > something far more > basic is happening: A new disease is being born." > > http://www.pharmexec.com/pharmexec/article/articleDetail.jsp?id=80917 > > > > ========= > Ronán Conroy > Royal College of Surgeons in Ireland > [log in to unmask] > +353 (0) 1 402 2431 > +353 (0) 87 799 97 95 > http://www.flickr.com/photos/ronanconroy > Bill Cayley, Jr, MD MDiv [log in to unmask] Augusta Family Medicine Home Address 207 W Lincoln 3433 McIvor St Augusta, WI 54722 Eau Claire, WI 54701 Work: 715-286-2270 Home: 715-830-0932 Page: 715-838-7940 Cell: 715-828-4636