Our experience in teaching residents is that using the focused clinical
question serves multiple purposes. It truly requires the learner to
recognize what is significant about his/her particular patient and to
clarify what the intervention is designed to accomplish. This turns out to
be a remarkably important general teaching exercise (identifying high risk
patients does not come as naturally to trainees as one would suppose for
example). We then , having taught them how to search MEDLINE and secondary
data bases efficiently and, when necessary, in some detail, recommend
starting "wide" and then if not enough "hits" narrowing down using
increasing components of the question (we are able to teach some of the
time in a room with multiple computers and team a physician and a librarian
so trainees have the opportunity to do it wrong and get advice about a real
patient question right then and there).
Someone recently quoted Yogi Berra as saying something like "If you don't
know where you are going, you are likely to end up somewhere else." Sounds
like a rationale for structuring a good focused question that indicates
you know your patient and have some sense of the ramifications of the
intervention you are planning.
I want to take this opportunity to say what a wonderful learning experience
this discussion group is for me and to wish all on it a very happy new
year.
Eleanor Wallace, MD, MACP
Professor of Medicine
SUNY Health Sciences Center, Brooklyn
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