N7020: Cranial Nerve 3

Module 6

What is one new thing you learned in this module, or something that you knew but had forgotten?

This module was a good opportunity to review some of the finer points of plagiarism. We reviewed these definitions during our first week in the DNP program at the U of U during our orientation to the Student Code. However, as Malcom Gladwell and Richard Posner discuss in the NPR podcast, plagiarism is not always black and white. With millennia of ideas and exabytes of content now available at our fingertips via the internet, we must ask ourselves: Is it possible to have a completely original thought? 


A friend sent me the following anonymous quote: "To steal from one is plagiarism; to steal from many is research." Indeed, there are clear cases of directly stealing and exploiting the intellectual property of others and these must not be tolerated. However we must also recognize that we all inevitably draw from numerous others in our work, both consciously and subconsciously. We must take care to give credit where credit is due, and to develop the skills to make new connections and produce new ideas and progress.

The future of health care?

Some interesting links...

Watson: Supercomputer and Medical Wizard-  http://www.medscape.com/viewarticle/740079

Medicine's Future: There's an App for That- http://www.ted.com/talk /daniel_kraft_medicine_s_future.html

Module 5

How did the readings influence your perception of your own clinical decision-making?

To summarize my graduate school experience thus far: The more I learn, the more I realize I don't know. This Module has driven that realization home yet again. When I think about the sheer volume of medical information that I will need to process for each and every patient encounter in my future clinical practice, I am overwhelmed. Production of new information and evidence- largely facilitated by technological advances- has accelerated to the point that much of what I learn in my classes at the U of U may very well be already outdated by the time I begin practicing two years from now. When I think of the challenge of synthesizing this avalanche of data into evidence-based, unbiased, patient-centered care... well, it's daunting to say the least!

Then I take a breath and remind myself that these very same technological advances are also providing us with more and more tools for managing this information. A fascinating recent article in Science (http://www.sciencemag.org/content/early/2011/07/13/science.1207745) describes how the Internet is serving as external "transactive memory," literally changing the way we remember facts. Instead of memorizing the data itself, we remember how to access the data via a search engine or electronic file. Advances in clinical decision support systems, mobile health applications for diagnostics and patient monitoring, and the new frontier of personalized genomic medicine are breathtaking.  Instead of being mistrustful and resistant to technology as an aid for clinical decisions, I believe we must recognize with humility that developing these tools is the only way to truly provide evidence-based care.
 

Mobile Devices Wiki

http://editthis.info/nurs_6004_mobile_devices/Main_Page

Module 4

Whether we realize it or not, all health care providers are teachers in some form or another. Whether it be in mentoring students, conducting research, or educating a patient and family about a new diagnosis, this is a skill used constantly throughout a range of roles and settings. Health information is meaningless unless it is communicated clearly and effectively, and we must therefore hone this skill carefully and constantly adapt our teaching to the learning style of our audience.

I am excited by the ever-growing teaching tools becoming available through technological advances. One effective tool I have seen many providers use is drawing a diagram or picture for the patient or student to explain a complicated or technical disease process, procedure, etc. Unfortunately, the majority of health care providers are not great artists, and so these drawings end up being fairly crude representations. Imagine an interactive application where you could literally show a patient the effects that diabetes or hypertension has on different organ systems. How might that affect their understanding of the importance of following a treatment regimen? These tools are evolving at a rapid pace, and will undoubtedly become more commonplace at the bedside in the future.

Module 3

If you want to find an answer, you must first know how to ask the question! The PICO format is a helpful tool for formulating clinical questions. The next step is translating the major elements of the question into searchable terms, and knowing how to combine these terms (e.g. Boolean operators). Without understanding the "language" of the database you are using (e.g. MeSH terms in PubMed), your search may not yield accurate or complete results. Finally, you must be able to narrow down your results (e.g. apply limits, review abstracts) and manage your resources in order to extract meaningful information with appropriate citations. These steps form the basis for literature search and review in clinical research for evidence based practice.

In this module we practiced utilizing clinical databases and reference management software, two essential tools for our education and future careers. I received crash course in both of these programs (PubMed and EndNote) in my first semester of the DNP program last fall, when we jumped in with both feet in N6000 Evidence Based Practice I. It was worthwhile to review the tutorials again and familiarize myself with some additional functionalities of both programs. I continue to use both programs almost daily in most of my courses, as they make literature review simultaneously more thorough and less time-consuming.