February 2, 2012

Publisher’s Post: Clinician Learning 3.0

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John S. Shelton, PhD

Physicians Postgraduate Press, Inc., Memphis, Tennessee


As publisher of The Journal of Clinical Psychiatry, I have the opportunity to frequently meet with educators and clinicians to discuss issues of concern in their communities. The explosion of online learning opportunities has raised concerns among some that the advent of this new medium is leading to a decrease in the quality of learning, which could result in a diminution in the quality of care. Simply put, the worry is that some physicians are turning to “quick” online references rather than digesting more thorough evidence-based works.

A little background: New medical knowledge becomes available so rapidly that a clinician’s knowledge base will increase 4-fold over the course of his or her professional career.1 In the past, books and lectures were the preferred learning formats. Now, more clinicians turn to the Internet and use e-learning devices—tablets and smartphones—to gain information. The sources for this information vary and may include traditional CME presentations, online review services designed to deliver information rapidly, or even social media.

In theory, mobile devices are an ideal method for physicians to keep abreast of new information because many of the sources can be updated quickly, they are convenient to use, and information is available at the point of care. While physicians have expressed satisfaction with e-learning, the burning question remains: Do these formats lead to sustained gains in knowledge that translate into practice changes and improved patient care?

It is extremely important that both educators and learners weigh in on this issue, for while e-learning may seem to have led to a sea change in the way clinicians’ learn, will it turn out to be a sailfish moving at 70 mph or a beached whale? Please share your thoughts.

Financial disclosure:Dr Shelton is the owner and president of Physicians Postgraduate Press, Inc.


1. Smith R. What clinical information do doctors need? BMJ. 1996;313(7064):1062–1068. Full Text

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13 thoughts on “Publisher’s Post: Clinician Learning 3.0

  1. Point of delivery availability of latest information enhances quality of care, I believe, and I have come to rely on pharmacological information particularly. However, more broad based experiential issues probably suffer from neglect if the only source of learning is from the internet.
  2. I find this approach very helpfull and I am able to use the new informaton frequenty in my practice. In my opinion the key is to understand the source of the information .One needs to understand if there is an agenda by the provider of the iformaton beyond informing. Thus I avoid all drug company sponsored informaton and wait for independant sources to discuss drug related issues. This is also true for all out come studies. Know your provder of info.
  3. Technology has created improved efficiency leading to today’s global transmission of information. This is as true in medicine and psychiatry as it is in business, politics and social media. E-learning in psychiatry is efficient and therefore should only expand.
  4. just as augmentation strategy is used in psychopharmacology, i believe e-learning may “augment” one’s knowledge and it is still worth reading books and articles for more in-depth learning.
  5. E-LEARNING is a great complement for education but it shouldn´t be the only sourse. On top of that, having a day out, just to attend a conferense, seminar , etc makes you focus on the subject you whant to learn, more than the little time in between patients and other related work issues.
  6. I believe the issue Dr. Shelton is rightly raising is not whether electronic media have a place, but whether we actually learn best–change practice, retain the knowledge, apply the information–from something we glance at in passing vs. something we write out, for example. Any insights from the neurobiology of learning and memory?
  7. The danger associated with “quick” forays onto the internet is that one is likely to find information that is unverifiable. Access to journal articles catalogued by the NIH PubMed is very useful but, in order to understand the conclusions researchers have arrived at a clinician needs a rather greater fundamental understanding of science than most exhibit. The gap between science and medicine is nowhere greater than when considering the mind/brain. This gap is growing rapidly and, in my opinion, if psychiatry is to retain its “authority” mere access to treatment advice on line will not be adequate. Clinicians are at risk of becoming technicians.
  8. I have been working with E-Health and naturally with E-Learning in Medicine for quite sometime. I strongly feel that learning platform in medicine will change due to Internet based information availability. Having said so, I believe and experienced that physician’s learning requirements can be classified in to three categories, (a) learning for information on latest developments – edited contents, (b) learning for clinical practice like bedside decision support, and (c) learning for developing documented clinical excellence. The “a” category can be well utilized from web information provided the content is from genuine sources, which can be put through internationally accepted search engine, professionally tailored and marked with authenticity tags. Then “b” is kind of enterprise system coming out of health systems or institutions for their own use and can be shared. And “c” category consists of E-Learning tools like CME applications. Agreeing with Dr. Shelton I would like to recommend that it is now optimum time to develop an international web based medical knowledge management tool for physicians, as we find in ICD10 coding or like uniform clinical knowledge distribution system that will ensure similar and uniform care delivery process for desired quality of care through uniform clinical knowledge availability, keeping in-view geographical and cultural context based information requirements for clinicians in different parts of the world. There may be some sources like PubMed and WebMD, but still it requires lot more work for clinicians get their targeted information and access to information.
  9. Great discussion. The internet is a great way to learn, as are books. Like some books and lectures, internet commentaries can be bias, not always delivering the true facts. I like Sikder’s idea in that e-learning can be very useful, but like other reliable resources, needs to be discussed and reviewed by peers before we rush into delivery of new types of services.

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