Medical Knowledge

Personal knowledge is a physician's most valuable tool. This knowledge is constantly being challenged by new situations that arise in daily practice. As well as reacting to these external challenges, you can keep your knowledge up-to-date by regularly challenging yourself.

Total Knowledge
Your personal knowledge is the sum total of all the facts you have ever learned. Educational experts say that we learn by organizing these facts into patterns which are easier to remember than the individual facts themselves. As new facts are acquired, they are added to the existing patterns.

Experience
Experience represents how we use factual knowledge. Each time we deal with a new problem, it adds to our knowledge, regardless of the outcome. In other words, we learn what works and what doesn't. We use this information whenever we deal with a similar problem in the future.

Core Knowledge
This is the information that you need to keep up-to-date in order to deal effectively with the common problems that arise in your particular practice.

Insufficient Knowledge
It is common to encounter a problem that requires knowledge or experience that you do not possess – some of these can be approached by applying general principles from your existing knowledge. Others can be solved by acquiring information from reference sources, such as medical textbooks, medical journals or professional colleagues. Some require referral to an expert who has the experience to deal with the problem.

Knowledge Gaps
Everyone has gaps in their professional core knowledge. It might be because we never learned the facts appropriate to a particular problem, or else we learned the facts, but now they are forgotten through disuse. New facts may have been discovered, but we are not aware of them. Or perhaps our information represents only one side of a controversial subject. When a knowledge gap is identified, the best approach is to identify that the gap exists, and then make an effort to acquire the knowledge to fill it.

Medical Uncertainty
There is an interesting body of literature which deals with uncertainty in medical decision-making. It deals with how physicians behave when they really don't know the answer to a problem. They may deny that there is any lack of knowledge. They may procrastinate about making a decision, in hopes that the problem will solve itself with the passage of time. Unfortunately, this literature deals more with the problems that arise, rather than suggesting solutions.

Knowledge Challenges (External)
Studies conducted in physician's offices show that almost every patient contact results in some questions to which there is no immediate answer. The studies further show that answers are only obtained to about thirty percent of these questions. Patients now have access to many different sources of medical information besides their personal physician. This section presents basic approaches to certain common knowledge challenges, such as:

1. The patient who has found medical information on the Internet.

2. The pharmaceutical representative who suggests that you should use his new product.

Knowledge Challenges (Internal)
It also helps to regularly test your own knowledge.  In their blah-blah document, the Royal College of Physicians and Surgeons suggests that specialists have an organized plan for regularly reviewing their knowledge. This section suggests methods for defining your own list of core knowledge topics and planning a review of each of these topics over time.

The “Five Minute” Approach to Evidence Based Medicine
We all would like to have free time to do literature searches and critically appraise the results, but these opportunities are often rare. You can still apply the principles of evidence-based medicine to your own knowledge whenever you use it to solve a current problem, or whenever you acquire new knowledge.

• When did you learn that fact?
• From whom did you learn it?
• What was their evidence to support it?
• When did you last use the information?
• Is it time to review this information?

Fact Testing

• Test facts as they are used
• Particularly important to regularly test commonly used facts
• A way to keep up to date
• When did I learn it?
• What was the evidence
• Is it still current