Putora and Oldenburg publishing in JMIR.org present a fascinating and insightful review of how medical decisions are made in the “absence of evidence-bsed guidelines”. Using crowd sourcing or “swarm-based medicine physicians add a further source of information to evidence based medicine or eminence-based medicine.
There are many concerns about the limitations of evidence-based medicine, but there are two obvious ones. First, evidence-based medicine is based on available data. However, relevant data is not available for all relevant issues. Also, trials with a negative outcome are underrepresented in medical literature, rendering the evidence base biased and the view of reality skewed
What struck me as I was reading this paper was how much of what the authors present fits with the work of Malcolm Knowles and the subsequent work of Dr. Hank Slotnick. Knowles is considered the father of adult learning theory and practice. His primary idea was that adults will learn only when faced with a problem.
Knowles characterized adult learning as follows:
- Self-concept: As a person matures his self concept moves from one of being a dependent personality toward one of being a self-directed human being
- Experience: As a person matures he accumulates a growing reservoir of experience that becomes an increasing resource for learning.
- Readiness to learn. As a person matures his readiness to learn becomes oriented increasingly to the developmental tasks of his social roles.
- Orientation to learning. As a person matures his time perspective changes from one of postponed application of knowledge to immediacy of application, and accordingly his orientation toward learning shifts from one of subject-centeredness to one of problem centredness.
- Motivation to learn: As a person matures the motivation to learn is internal
In the early 1999 Dr. Slotnick took wrote the following paper “How Doctors Learn: Physicians’ Self-directed Learning Episodes” which identified four stages of physician learning. They are:
Stage 0: scanning for potential problems
Stage 1: deciding whether to take on the problem
Stage 2: learning the required skill and knowledge
Stage 3: gaining experience
Two other considerations to this paper are small group learning theory where small groups tend to be more productive and effective at sharing and learning. And the idea of communities of practice where groups coalesced around the need to solve a problem. Once the problem was resolved the community went away.
I believe the authors have identified that the Internet is driving the more productive and efficient application of the above theories and principles. It will be interesting to see if educators will begin to put new Internet based learning principles in place as more work such as yours is provided.
I wrote to the authors and received the following response which is important:
Maybe if physicians become more aware of their swarm behavior it will influence how they approach learning. Possibly by integrating distribution/cooperation into these learning stages, currently they are focused around a single point of view.
It is also fascinating to reflect on how small learning groups behave, when their boundaries by which they are defined disappear through constant interaction with the outside..
Take a look at the article it is important and points to a tend.