Knowledge Dissemination: Continued Medical Education

Key words: Knowledge, Medical Knowledge , hoarding , dissemination


Introduction:

At the simplest level, dissemination is best described as the delivery and receipt of a message, the engagement of an individual in a process, or the transfer of a process or product. It is also helpful to think about dissemination in three broadly different ways, viz., dissemination for awareness, for understanding , and for action. Indeed, effective dissemination of a knowledge product will most likely require that it satisfy all three in turn: utilization is the goal. Knowledge is a "thing" that simply needs to find a good home… Nowhere is this more apparent than in the worthy effort to define dissemination as consisting of four activities: spread, exchange, choice, and implementation.

Definitions of dissemination also reflect differing assumptions and beliefs about the ways in which knowledge is used, indeed about the very nature of knowledge itself. The focus varies from perceiving dissemination and utilization as linear, mechanical processes of "transfer," in which knowledge is packaged and moved from one "place" to another, much as an appliance might be packaged and shipped, to characterizing the process as highly complex, nonlinear, interactive, and critically dependent on the beliefs, values, circumstances, and needs of intended users.

Scholarly research makes a profound contribution to the social, cultural and economic wealth of a country. The results of research, referred to here as "scholarly knowledge", is created, organized, preserved and disseminated within the scholarly communication system. Many countries are undertaking national research strategies aimed at understanding and navigating these changes. In order to optimize the dissemination of scholarly knowledge, it is critical that we develop a comprehensive research strategy to examine the future of scholarly communication in this country.

Creation, manipulation, management and dissemination of knowledge cannot go on forever without determining what impact it is having on those who create it and those who use it. This paper explores methods of determining the impact of disseminated Knowledge. It does this by first defining what knowledge is. This is followed by a discussion on different mediums through which knowledge may be disseminated. It then discusses two questions – when do we know when to disseminate knowledge and how do we know when it has been disseminated.(1)


MEDIUMS OF KNOWLEDGE DISSEMINATION

Contrary to Plato and Foskett’s definition of knowledge, it is postulated that knowledge is information that is acceptable to a norm about a subject. In treating different mediums that may be used to disseminate knowledge, it is argued that mediums of disseminating knowledge can be grouped into two main categories, namely natural and man made mediums. Natural mediums of knowledge dissemination include audio and gestures, which are performed by all leaving beings whereas; man-made mediums include all mediums of communication that man has developed out of transforming matter.

Knowledge itself cannot be monitored, only presence in its carrier can. Ipso facto, analyzing different carriers of it or usethereof, not knowledge itself, can do evaluation of knowledge because an indisputable truth is that presence of knowledge is only manifest in its application. In monitoring and evaluating knowledge as transformed matter, the criteria of process and progress; relevance, efficiency, effectiveness, impact and sustainability may be used respectively. Techniques of analyzing applied knowledge data abound. For something to count as knowledge, it must actually be true. I see knowledge as information that is acceptable to a norm about a subject. As long as the information that you have conforms to an established and acceptable societal norm, it is knowledge it does not have to be true. If it conforms to an established norm, it will always be believed. As soon as the norm changes, what you know becomes information. When people do not believe you, it is simply because what you say to them is not acceptable to their norm. Good knowledge is useful knowledge. It permits man’s survival by allowing him to use it to solve his problems.

When we attend schools or listen to priests preach to us and accept what they tell us as reasonable and pass it on to other people or use it to solve our problems, what we are doing is simply accepting new norms about new or existing subjects. According to Polanyi, “…tacit knowledge is what is in our heads and explicit knowledge is what we have codified” Given that tacit knowledge is knowledge that is in our heads the easiest and the only way to disseminate this type of knowledge is through organs of the body. We can communicate it through voice. This method of communication is largely applied in schools from primary to tertiary. Besides explicit communication, a lot of information and knowledge is passed on from one person to another through gestures. Laughing is a simple sign of happiness. Shrugging your shoulders indicates that you do not know. Of unique interest to note though is that gestures are not universal, they are unique to societies. Nodding one’s head means that one is in agreement with what is being said after the European fashion. The converse is true in the Asian culture. In the Asian culture when you shake you head from side to side this means concurrence with what is being said. One of the notable efforts to try to address the problem of different norms and standards on gestures is what has come to be known as the sign language which came into being as an effort to address different human beings impairments such as speech and hearing. This confirms the definition made earlier on that knowledge is that which conforms to a norm about any subject.

The second type of knowledge is explicit knowledge. This is knowledge that has been codified. How can knowledge be codified? Codification of knowledge came as a result of man’s application of tacit knowledge to transform matter into various useful objects for his survival. Writing is the oldest form of codifying knowledge. Most of the world’s knowledge is in written form in the form of books. With further transformation of matter through application of tacit knowledge other ways of codifying knowledge have emerged over time. We now find knowledge in medium such as recorders, the INTERNET and others. Of particular interest to me is knowledge that is manifest in transformed matter.

HOARDING KNOWLEDGE

There is no stipulated rule on where and when knowledge should be disseminated. The simple answer to this question is knowledge is ready to be disseminated when the holder of it feels it is ready to be. Besides, it does not make sense to acquire knowledge to hoard it. In fact, it is impossible to hoard knowledge because we need to constantly exchange it for survival. Hoarding of knowledge makes sense only when one does it in order to gain comparative advantage over other human beings. Even this is not eternal. Overtime, the hoarded knowledge gets known and is further exchanged. Dissemination of knowledge is often done with a certain intention in mind. When this is the key reason for knowledge dissemination, it is important to determine whether knowledge dissemination has really taken place. This is important for a number of reasons. One, it allows for learning on whether knowledge was successfully disseminated so that if not other means of disseminating it successfully could be devised. For example, at institutions of learning gauging of knowledge dissemination is done through tests and examinations as we all know and two, for accountability purposes. (4) However, the key gauge of whether knowledge has been disseminated is its application. As indicated earlier, as tacit knowledge, knowledge application is seen in the development of different solutions in the form of products and services. In a codified form, knowledge dissemination is seen in the use of the products and services to solve societal problems. Note before, knowledge use does not only lead to useful solutions to societal problems, at times it creates more problems and leads to societal ills. A clear epitome of this is the atomic bomb that was dropped by the Americans on Hiroshima and the current nuclear age in which nuclear bombs, which are an epitome of man’s application of his knowledge, are a threat to humanity.


MEDICAL KNOWKEDGE

Medical doctors claim that their discipline is founded on scientific knowledge. Yet, although the ideas of evidence-based medicine are widely accepted, clinical decisions and methods of patient care are based on much more than just the results of controlled experiments. Clinical knowledge consists of interpretive action and interaction—factors that involve communication, opinions, and experiences. The traditional quantitative research methods represent a confined access to clinical knowing, since they incorporate only questions and phenomena that can be controlled, measured, and counted. (2)
Biomedical knowledge is expanding at an unprecedented rate-one that is unlikely to slow anytime in the future. While the volume and scope of this new knowledge poses significant organizational challenges, it creates tremendous opportunities to release and direct its power to the service of significant goals. One can achieve those by integrating numerous resource-intensive, technology-based initiatives-including personnel, services and infrastructure, digital repositories, data sets, mobile computing devices, high-tech patient simulators, computerized testing, and interactive multimedia-in a way that enables the center to provide information tailored to the needs of students, faculty and staff on the medical center campus and its surrounding health sciences colleges.
Emphasis must be made on discovering, applying, and sharing new knowledge, information assets, and technologies in this way is a collaborative process. This process creates open-ended opportunities for innovation and a roadmap for working toward seamless integration, synergy, and substantial enhancement of the academic medical center's research; educational, and clinical mission areas (5)
Continuing Medical Education
Continuing medical education (CME) plays a key role in test ordering, while pharmaceutical manufacturers’ representatives are important sources of information concerning new therapeutic agents. The dissemination of information is a complex process. Physicians frequently use multiple sources of information in the decision making process. Physicians and planners of CME must be aware of what types of educational activities are best suited for their needs (6)
The tacit knowing of an experienced practitioner should also be investigated, shared, and contested. Qualitative research methods are strategies for the systematic collection, organization, and interpretation of textual material obtained from talk or observation, which allow the exploration of social events as experienced by individuals in their natural context. Qualitative inquiry could contribute to a broader understanding of medical science. The Internet is a convenient but complex source for health information used by an increasing number of health consumers. Especially for people suffering from a chronic illness (e.g., diabetes), information seeking forms a part of the daily management of the disease, a “project of life.” The study of Web texts examines the citation patterns for a specific and controversial health issue: the beneficial or hazardous use of dietary chromium supplementation in diabetes self-management. Texts from different categories of Web sources (scientific, professional, educational, and commercial sources, as well as diabetes discussion groups) were analyzed in order to study how knowledge is transferred between sources, and how diabetics participating in discussion groups refer to and make sense of the information from different sources on the Internet. The citation patterns suggest that deviations from the traditional models of scientific knowledge dissemination can occur in the Internet environment (1).
It is beyond argument that Continued Medical education (CME) should play a very significant role in the changing health care environment. There are various types of literature (e.g., concerning learning and adult development principles, problem-based/practice-based learning, and other topics) that contribute to ways of thinking about and understanding CME. It is gratifying that the Association of American Medical Colleges (AAMC) has made a commitment to helping CME be more effective in the professional development of physicians.
The professional development of physicians is a lifelong commitment that builds on formal and informal opportunities to learn emerging science, apply innovations in clinical settings, and expand understandings of caring for patients. One essential element in that commitment has been continuing medical education (CME), the final part of the education continuum. Although CME has a long history in supporting physicians as lifelong learners, it has become increasingly important and focused during the past ten to 15 years as a result of the impact of changing educational, social, and political forces on medical practice. People in academic medicine can support continuing medical education to respond to the changed and changing health care environment, and suggest new directions for individuals and institutions involved with continued learning.
CONCLUSION
As far as medical knowledge dissemination it is imperative that collaboration among the appropriate academic groups, professional associations, and health care institutions, with leadership from the state bodies, is essential to create the best learning systems for the professional development of physicians.
Building new knowledge-based systems today usually entails constructing new knowledge bases from scratch. It could instead be done by assembling reusable components. System developers would then only need to worry about creating the specialized knowledge. New systems should interoperate with existing systems, using them to perform some of its reasoning. In this way, declarative knowledge, problem- solving techniques, and reasoning services could all be shared among systems. This approach would facilitate building bigger and better systems cheaply. The infrastructure to support such sharing and reuse would lead to greater ubiquity of these systems, potentially transforming the knowledge industry. One sees a vision of the future in which knowledge-based system development and operation is facilitated by infrastructure and technology for knowledge sharing. It is believed that newer initiatives currently under way to develop these ideas would pave a long way in the complex yet simpler process of knowledge sharing and dissemination. The future is looking expectantly to realize this vision.





References:

1. Enabling Technology for Knowledge Sharing
Robert Neches, Richard E. Fikes, Tim Finin, Thomas Gruber, Ramesh Patil, Ted Senator, William R. Swartout AI Magazine, Vol 12, No 3


2. Health discussions on the Internet: A study of knowledge communication through citations: Marianne Wikgrenv Department of Information Studies, Åbo Akademi University, Tavastgatan 13, FIN-20500 Åbo, Finland




3.Continuing Medical Education: A New Vision of the Professional Development of Physicians
Bennett, Nancy L. PhD; Davis, Dave A. MD; Easterling, William E. Jr. MD; Friedmann, Paul MD; Green, Joseph S. PhD; Koeppen, Bruce M. MD, PhD; Mazmanian, Paul E. PhD; Waxman, Herbert S. MD Academic Medicine: December 2000 - Volume 75 - Issue 12 - p 1167-1172

4. Www.researchutilization.org/matrix/resources/review/ -

5. Managing Knowledge and Technology to Foster Innovation at The Ohio State University Medical Center
Cain, Timothy J. PhD; Rodman, Ruey L. MLS; Sanfilippo, Fred MD, PhD; Kroll, Susan M. MLSAcademic Medicine:
November 2005 - Volume 80 - Issue 11 - pp 1026-1031

6. Information sources and clinical decisions: journal of General Internal Medicine Jeoffrey K. Stross Vol 2., No.3 May, 1987, 155-159


NB: This was a lecture delivered at the KNOWLEDGE GLOBALIZATION conference at Dhaka May 2010.Dr Patnaik was invited to chair the session on session of Education. The key note was delivered by Noble Laurate Dr Mohd Yunus. The conference was aimed at sharing knowledge with scholars and researchers across geographic and academic boundaries. It was a
global multidisciplinary conference with delegates from across the world.