Well Raj, that was a fantastic way to talk that medical student through finding search terms, and knowing where to actually find the information that she's looking for. >> Thanks. >> I can tell you, that was the gold standard, absolutely. But the one question I have for you is, in a clinical setting, do you actually have the time to take 12 minutes to be able to do that? >> That's a really good observation, Jen. I would say, absolutely not. I think in the nature of our clinical practice, it really is difficult to spend that amount of time, at one time, with a learner to walk them through all of the steps in such a deliberate way. But I do think that there are some nuggets out of there that there's some areas that were higher priority, that if I had much less time, that I would have focused on. I also think that sometimes learners, when they're at a fundamentally more basic level, you have to walk them through the mechanics. But then once they get more and more sophisticated, you can just make assumptions that they know things and jump to an area that you find to be the most troubling spot. So something I didn't do at the beginning that I could have done is say, where would you struggle the most, as you're thinking about where to go to answer this question? And then the learner could just identify for me, this is the area I struggle the most. I can make assumptions that the rest of the stuff is okay, and I would just focus on that area. So that's one technique. Now, that comes with a little bit of trust of the learner. >> Absolutely. >> But the other technique is trying to figure out which are the areas in the formulating questions and identifying the resources that we should spend most of our time on. >> And does the level of the learner change how much time you spend with them? >> The level of the learner changes what I talk with them about, it changes the content of what I talk about. It doesn't necessarily change the amount of time that I spend. And what I try to do is just a rapid biopsy at the beginning. If I've never met the learner before, and they walk in. I would say, all right, the patient has asked this question. You have this question. What are you thinking about doing in order to answer that question? And then I listen. If they say, boy, I'm not really sure, but I probably go to Wikipedia. I might say, all right, this is someone who needs a little bit more coaching >> Of course. >> In how do you structure a good clinical question. How do you think about secondary versus primary literature. If they say, you know, this is therapeutic question and I think I'm going to go to a systematic review. Then I'm thinking, okay, this person's at a different level and I might be able to focus on, well, which types of systematic reviews? What specific outcomes are you focused on? In this case, I didn't do that. And I probably should have and that would have made the session become more efficient, because I think this learner was actually more sophisticated than she let on. >> Seems like that to me too. >> Some of the areas that I struggle with with students are the structured clinical question. So if you're looking for an area to focus on, I really do think that the outcome of interest is probably the most important zone to have a conversation with the learner on. Because the outcome is driven by what the patients are interested in. For example, with this patient, is she more interested in reducing the intensity of her headaches or the frequency of her headaches? And that would vary based on the type of therapy that we might be thinking of. It also will give me a sense of whether the learner's interested in surrogate intermediate outcomes, for example, just reducing blood pressure, or would they be more interested in a different scenario? Or would they be more interested in mortality? >> Mm-hm. >> Saying that, well, reducing blood pressure is supposed to reduce your rate of stroke or heart disease or heart attacks. And they'd be defining that as an outcome. >> Mm-hm. >> So actually prompting the student to say, what are the outcomes of interest you'd be interested in, in trying to find in the information, is another good way to biopsy. And then focus the discussion. >> Okay great, I think that's great advice. Thank you so much for your time. >> Great, thanks, Jen.
