Are we providing doctors with the training and tools for lifelong learning?

BMJ 1999;319;1280 [abridged] ( 13 November )

Changing the doctor-patient relationship

POEMS and how they help us become lifelong learners

ALLEN F SHAUGHNESSY AND DAVID C SLAWSON FROM THE UNIVERSITY OF VIRGINIA DISCUSS WITH ABI BERGER HOW DOCTORS COULD KEEP THEIRMEDICAL KNOWLEDGE UP TO DATE

Learning how to become a competent doctor is a bit like running a bakery. At the beginning of our medical education, teachers help to stock our empty "shelves" with new "loaves" of information. The "heavy lifting" is the actual learning process of getting the information on to the shelves. Teachers help by telling us what bread to stock and what to do with it.

Good bakers make good medical students. They take information in and store it, while also being good at taking the right loaves down from the shelves at exam time. But what happens in practice, after formal training is over, as information continues to flood in? We may well not still have teachers around to indicate what we should be learning, nor do we have any advice about which loaves are past their expiry date. We can quickly get stuck with old stock.

One possible solution for this problem is the concept of "Patient Oriented Evidence that Matters" (POEMs). POEM "bulletin boards" offer relevant new information, as it becomes available, in a carefully filtered way, so as to provide clinically useful information.

Competing interests: AFS and DCS receive royalties from the sale of InfoRetriever software and the newsletter Evidence Based Practice: POEMs for Primary Care.

1. THE JOURNAL OF FAMILY PRACTICE HAS A SECTION THAT REVIEWS EIGHT POEMS EACH MONTH

--such as "Riboflavin can prevent migraine headaches" (taken from Neurology)

2. CLINICAL PREDICTION RULES

--such as "What's the probability that this patient has heart disease?" (based on his or her serum cholesterol concentration, blood pressure, and smoking status)

3. HISTORY AND PHYSICAL CALCULATOR

--such as calculating the probability that a patient with a cough has pneumonia

4. EVIDENCE BASED TREATMENT GUIDELINES

--such as the AHCPR guidelines on acute back pain show that physiotherapy is actually harmful for a patient with low back pain

5. EVIDENCE BASED PRACTICE SYNOPSES

--such as short and 'concise POEMs

6. COCHRANE REVIEWS

--such as "Should a woman with a breech baby undergo caesarean section?"

7. DRUG INFORMATION

--such as recommended dose, formulation, cost, and risk of use in pregnancy

8. DIAGNOSTIC DECISION AIDS

--such as "Is this patient at risk of a pulmonary embolus, and is treatment indicated?"

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Rapid Responses:

Read all Rapid Responses

Burden of producing accurate POEMs: Nicky Mackenzie
bmj.com, 14 Nov 1999 [Full text]
What a let down: Tim Webb
bmj.com, 25 Nov 1999 [Full text]
EBM strategy: Roberto Lede
bmj.com, 30 Nov 1999 [Full text]
Please check InfoRetriever: David C Slawson
bmj.com, 2 Dec 1999 [Full text]
POEMS and physiotherapy for back pain: Jennifer Moffett
bmj.com, 13 Dec 1999 [Full text]