Jen, that was really great. I really saw a healthy exchange of information and, boy, you got to a decision really quickly with the student. That was really great. I was wondering if you could help me understand the decisions you are making about, again, balancing the efficiency, the limited time that you had, with how do you engage the student in that setting. Maybe, talk about whether, is it typical for you to be pointing out things in the article more for the student? Or, do you typically have them go and read it and come back? And, how might you alter what you did if you had more time at the table. >> No, retrospectively, when I was looking at this, it looks like we rushed things way too much. We had a lot of time in the afternoon and we really could have spent a lot of time having her go read the article and then come back and bring me the information that she found. And I really wish I would have done that in this particular circumstance. So- >> Yeah, go ahead. >> I was going to say that if I would have had her read it, and then she could have told me what was important, then I could have seen where she is in her development. Whether or not she just skipped right to the results because that's the answer that she wants to find or whether or not she was able to articulate the reason that she thought that this patient met the guidelines that we were looking at. >> So what kind of questions might you ask them to get that information from them? >> So first I would have asked her, what was the first thing that she looked at? And I find that learners kind of skip right to the results, especially in clinical guidelines. And then afterwards, challenge her to actually look at where the guidelines come from, what search terms they used, and then try to see whether or not our patient actually fits in the guidelines that we have, that we’re looking at. >> Interesting. In your experience, are learners keyed into that? Do they typically remember where search terms were used in a guideline or is that something that they typically ignore when they go through these? >> I think it depends on how busy things are. If they're looking at it and really reading the article, I think that that's something that they actually do notice. But when I give them such a limited time to find the answer to the question, sometimes I think they skip to the answer >> How interesting. Well I think, one of the things that I've detected in learners is how much they loved the results. And I think you really kind of kept her motivation because you were focused on the decision at hand. And I loved how at the end, you really got her to commit to what she would do based on the information, are you going to get a chest X-ray or not? And that felt like a really good opportunity to bring it all together. I noticed that during that discussion you talked a lot about, Level A, B, C, and D. Was that important in the discussion, and why did you spend so much time on that? >> Yeah, I think it's extremely important because I think that the learners, when they look at the results, they see what they think is the answer. But they don't necessarily understand how strong that evidence actually is. >> Mm. >> So if they take the time to actually read the beginning of the paper, look at what each letter corresponds to, then they can see the strength of the evidence that they're looking at. I think it's really important, because it's increasingly important in these different guidelines, because not every guideline is the exact same and different letters correspond to different things. And since they're putting it in there, I think it's really important that we actually take a look to see what it corresponds with. >> So that's a consistent thing you emphasize with learners as it relates to these practice guidelines? >> Absolutely. >> Wow, that's great. I think that's something that we often forget is that, like you said, the answers aren't always clear. They're the best recommendations. And understanding the depth of the strength of evidence and information underlying those recommendations is important to process as part of our decisions. I thought you did that enormously well Jen. >> Well thank you, I think they just really need to understand that not all recommendations and not all guidelines are created equally, and that's why that's very important to look into. >> Great Jen, well thank you for spending the time, and thanks for working with this student on such an important topic. >> Great, thank you.
