Intended for healthcare professionals

Changing The Doctor-patient Relationship

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

BMJ 1999; 319 doi: (Published 13 November 1999) Cite this as: BMJ 1999;319:1280
  1. Allen F Shaughnessy, director of researcha,
  2. David C Slawson, associate professor (
  1. a Harrisburg Family Practice Residency Program, PO Box 8700, Harrisburg, PA 17055, USA
  2. b Box 414, University of Virginia Health Services Center, Charlottesville, VA 22908, USA
  1. Correspondence to: D C Slawson

    Medical practice is evolving rapidly as new information supplants old Gone are the days when newly graduated doctors were armed with most of the information they wouldneed for a lifetime of practice Today's clinicians are required to be lifelong learnersso that they continue to adapt to the changing ecology of the medical environment Are oureducational systems preparing doctors for this role?

    Summary points

    “Lecture and test” teaching methods arm learners with plenty of information but not the skills to update and replace it

    Although computers put information at everyone's fingertips, insufficient attention has been paid to how this information is delivered

    Traditional evidence based medicine focuses primarily on identifying and validating written information; this is unrealistic and too time consuming for most doctors

    Efforts to increase the use of the best available evidence at the point of care must focus on the relevance of the information to patients and clinicians

    Doctors need a first alert method—a bulletin board—for relevant new information as it becomes available and a way of retrieving the information about which they have been alerted

    Learning to learn

    Learning and developing competency in medicine is a little like running a bakery. We begin our medical education by having professors and teachers stock our empty shelves with new “loaves” of information We, of course, do all the heavy lifting—the actual learning—to get this information onto the shelves, but our teachers are always there to tell us what bread to stock and what to do with it.

    People who are good at “stocking their shelves” with information given to them by their teachers make good medical students. They excel in school and perform well on tests. They become expert at storing the right answer on their shelves, ready to pull it down when the question comes up in the examination.

    Information overload

    Many doctors become frustrated, …

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