Andrew Booth refers to
- The few articles there are about the most common problems
- The need to access full texts (this problem of hard copy was highlighted not long ago)
- Pessimism [due to poor hit rates]
- Neverthelss giving it a go
- But that [succcessful] teaching in real time needs "some degree of success".
I am associated with a Masters programme in Family Medicine. Frankly EBM in South Africa is, I judge, embryonic. I find the techniques of effective electronic searching alone - as this List bears witness - are pretty demanding. To prepare myself to be semi-competently resourceful about it to the guys out there in our bushface is quite a learning curve. The amount of suggestive advice and experiences on this List on all aspects of the process from Question to Application has been remarkable and enlightening. Thanks indeed.
BUT, as Andrew hints, there is this worrying doubt about the exercise. For me, the opportunity to introduce and put it across - hands on if possible of course - [we have a part-time, self-directed, distance learning programme] will be limited. The aim will be to provide enough insight for the guys to lift off on their own. The doubt comes in about the sincerity of "setting up" a successful demo and practice search to show what CAN result when, considering the sort of real life circumstances Andrew mentions, the chances are so low of them having encouraging degrees of successful searches in their real time problems (not to mention their African context] which we will have encouraged them to go for. It seems to me its going to take time a) for primary care based research to gather momentum, b) for it to become databased, let alone c) being systematically reviewed. Skilled medical librarianship to help (the offers of which, waiting to be tapped into, in the "first world" have also appeared on the List) is at an utter premium. There is also the well ventilated problem of downloadable full text vs hard copy.
I recognise the value of the DLS-style optimism for getting the whole show well onto the road. And that that evangelical fervour is needed anywhere in the world for progress. But I have these big doubts about trying to show (GENERALISE) that this is for every GP and Rural Doctors' to get into now. I am beginning to try to conceive a kind of Phase One strategy like for improving clinical reasoning and decision making, acknowledging clinical uncertainties, making better use of existing resources. Only pointing the way to and supporting those who can handle the generally rather barren fruits, with bursts of serendipity, that "the Net" will offer them at present (self-directed learning at its most challenging of course).
Or maybe this angst (bear with me for thinking out loud) and the sincerity thing is best dealt with by being totally honest about hit rates at present. Come to think of it, maybe that may be good too, for showing guys the reality of what many think is a buzz to be into. Will it so to speak sort the men from the boys? Maybe, like a lot of things in life, it is the training and role modelling at undergrad level which will work (as also appears on the List). For the rest of us it just has to be catch up stuff anyhow?
I had better send all this tonight, before rubbing it out in the cold light of the morning. Sorry if I should have anyhow.
Ronald
Dr Ronald Ingle
Senior Lecturer, Family Medicine
Medical University of Southern Africa
Pretoria
0204 South Africa
Email [log in to unmask]
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