One of the challenges
in medicine includes staying up-to-date on new changes to practice. Yesterday in Rapid clinic, my preceptor and I
reviewed the new 2017 COPD guidelines which illustrated a shift from the
FEV1-based classification criteria to one based on severity of symptoms and
exacerbations/hospitalizations. The
pharmacologic treatment algorithms have also been altered with new escalation
(de-escalation) strategies given that many COPD patients are already on
treatment and still have symptoms or exacerbations. We also reviewed an updated puffer chart
which is a resource that is always very helpful to have in clinic. Medicine is constantly evolving and keeping up
with this is essential in order to provide effective patient care. This can be especially difficult in the ambulatory
setting if you are presented with a rarer condition and you have to balance
this with seeing your patients in a timely fashion.
Learning in
internal medicine encompasses a wide variety of shapes and forms. It is important to not only find the learning
style that works for you (auditory, visual, tactile) but also to explore different
learning settings. In our medical school
training, we are exposed to: problem-based learning, virtual problem-based
learning (online patient cases), lectures, clinical experiences, bedside
teaching, informal teaching with staff/residents, and self-directed learning
(SDL).
SDL is a part
of adult education in which “an individual is to assume the primary
responsibility for planning, initiating, and conducting the learning project.” (Manning et al., 2007) A study by Sawatsky et
al. in 2017 analyzed the Internal Medicine Residency Program at Mayo Clinic and
using a focus group, developed a theoretical model for how residents engage in
SDL. Their model suggested that this is
the process by which SDL happens: building a knowledge framework, having
triggers (external events such as patient cases that stimulate questions), uncovering
knowledge (identifying weaknesses), formulating learning objectives, using
resources, applying knowledge, and finally evaluating learning. The paper discussed personal factors that inspire
the practice of SDL, such as: motivations, individual characteristics, and changes
over time. An example of the latter is
the way in which our questions change as we move through clinical training,
something that all trainees can identify with.
They also commented on contextual factors that influence the pursuit of SDL:
the need for external guidance, the residency program culture/structure, and
the presence of contextual barriers.
Finding the
right information sources for your independent learning depends on several features of the source such as: efficiency, integration with the workflow, familiarity, optimization
for the clinical question, and others.
(Cook et al., 2013) This morning before my afternoon hypertension clinic
I reviewed the 2017 CHEP guidelines on diagnosis and treatment of
hypertension. I used the CMA website to
access the guidelines (https://www.cma.ca/En/Pages/clinical-practice-guidelines.aspx). In clinic, when I need to review doses or
drug-interactions, I will use UpToDate and for a quick reference, I always have
my Pocket Medicine (The Massachussets General Hospital Handbook of Internal
Medicine) on me. To read in more detail
outside of the clinical setting, Approach to Internal Medicine and Toronto
Notes are my go-to!
I’m curious to see what resources my colleagues
like!
SH
Resources:
Sawatsky
et al. (2017). A model of self-directed learning in internal
medicine residency: a qualitative study using grounded theory. BMC
Medical Education, 17(31): https://doi.org/10.1186/s12909-017-0869-4.
Manning.
(2007). Self-Directed Learning: A Key Component
of Adult Learning Theory. Journal of the
Washington Institute of China Studies, 2(2): 104 – 115.
Cook
et al. (2013). Features of Effective Medical Knowledge Resources to Support
Point of Care Learning: A Focus Group Study.
PLOS ONE, 8(11): e80318. https://doi.org/10.1371/journal.pone.0080318
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