Dear Scott Richardson
Thank you for the ideas and bibliographic references, they fit like a glove for
the EBM book that we are writing for brazilian physicians.
Cheers
Moacyr
__________________________
Moacyr Roberto Cuce Nobre
Unidade de Epidemiologia Clínica
InCor - HCFMUSP
fone/fax: 55 11 3069-5941
celular : 55 11 9133-1009
Citando Scott Richardson <[log in to unmask]>:
Dear patient list members:
Great to see this focus on the potential value of asking answerable
questions, both foreground and background. Some additional points to ponder:
a. When we began using and teaching about questions, we reckoned that honing
them to sharp focus might help us in 7 ways:
1 - use scarce learning time on evidence directly relevant to our patients'
clinical needs
2 - use our scarce learning time on evidence directly relevant to our own
learning needs
3 - suggest high-yield search strategies
4 - suggest the forms that useful answers might take
5 - when sending/receiving a patient in referral, might improve communicate
more clearly with colleagues
6 - when teaching, help our learners understand content of what we teach,
while modeling a useful skill for lifelong learning
7 - answered questions could build both our knowledge and our learning skill,
and would reward (rather than punish) our curiosity
b. Other research so far suggests that clinicians who are taught this
structured approach to questions:
1 - ask more questions: Villanueva et al, BMC Med Inf Decis Making 2001; 1:
4.
2 - undertake more searches: Cabell et al, JGIM 2001; 16: 838 - 44.
3 use more detailed search methods and find more precise answers: Booth et
al, BMLA 2000; 88: 239 - 46; and Rosenberg et al J R Coll Phys London 1998;
32:
557 - 63.
c. Scanning the abstract Ben S. finds, I am unsure of which of the 7
potential benefits above is being examined; perhaps the full text will tell us
more.
Even if this study is robust and powerful enough to 'disprove' one out of 7,
would that mean it has disproved all 7?
d. Just as with trials of clinical interventions, might we not expect trials
of focused questions to show effect sizes that vary? Is it time for a
systematic review yet?
e. There are those who claim ONLY value of questions is point #3, as stepping
stone to better searches, and then highlight limitations of current search
engines and databases in using our questions to find answers. Even for these
folks, and while recognizing the short-term value of pragmatic compromises, in
the long run we might ask - should we be trying to re-design the humans to fit
the machines, or trying to design the machines to help the humans?
f. I look forward to the results of well done, nuanced inquiries into
benefits (and harms) of asking focused questions, so we can move beyond the
recommendations of enthusiasts (including me) into evidence-informed
recommendations
about how best to practise the craft of using questions for lifelong
learning.
g. In the meantime, is it still worth teaching our learners some flexible and
useful ways to turn their knowledge gaps into answerable questions, to give
them the 'key to the library door'? I think so, and I'd welcome more
thoughtful
discussion.
Hope this clarifies more than it confuses.
WSR
W. Scott Richardson, MD
Three Owl Learning Institute
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