Thread by @Retlouping

A new episode of “old man shouting at clouds” this episode is called “first in best dressed” why does the information we learnt first stick the longest and strongest and why “unlearning” then learning new information is so tough.

Most clinicians learnt a great deal of what they currently use in clinical practice as their foundational knowledge in their university training,this applies despite length of time you have been qualified, in many. Most of us still have flawed information that needs unlearning

I have recently posted a series of clinical case studies to challenge our clinical reasoning processes, observe our reasoning biases and suggest some new views. Interestingly a lot of the questions revolve around long held beliefs.

When faced with new information that contradicts our understanding and beliefs we often handle this information is several ways , here is a link to an interesting paper on the subject ideals.illinois.edu/bitstream/hand…
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One of the other difficulties we face when our clinical biases are challenged by new evidence is that we must try to unlearn the information that lead to our bias and replace it with the new data and evidence. cft.vanderbilt.edu/wp-content/upl…
This interesting paper discusses this 👇

Unlearning requires recognition and reflection and is best facilitated by discussion and proposals in a participant centred approach. 👇

I have often proposed on twitter that if we are to embrace a patient centred care and educational model, then we should also provide clinical education utilizing the same process.

Before people change what they believe, there has to be a realisation of the bias and a “growing pains” learning and realisation process. I often refer to the unconscious incompetence to unconscious competence model. Realisation, reflection, acceptance and action are required.

Realising that you need to change is the first step to change.
Many of use are aware of the Dunning Kruger model of over confidence based on minimal knowledge. One must be self aware to change this bias.

I am a fan of Blooms taxonomy despite some of it’s flaws, it is a useful model to highlight some of the deficite in our current learning strategies. I often say “to know of, does not mean you necessarily know it.” Many course reach level 3 “applying” information....

But fail to encourage learning at the upper three levels. The case studies I have posted over the last few days and various conversations on twitter highlight that people are stuck at “knowing of” applying and have not progressed to “knowing it” analysis, synthesis and evaluation

I am a proponent of the “Socratic method” and participant centered learning. This type of teaching method allows participant to adopt a group problem solving learning environment which moves through all six Bloom’s levels.
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Past of this process involves challenging our current beliefs and biases, unlearning via consensus and a relearning and replacement / updating with new information.

Let me be clear unlearning is tough, it requires one to reflect and challenge , sometimes long held beliefs. A good example of this is shown in the treatment of stomach ulcers, it took many years for MDs to unlearn the old stress stomach acid models & replace with the infection..

Model due to H-pylori and stat treating with antibiotics, rather than antacids and anti anxiety meds.
Unlearning is not forgetting facts, unlearning is a process of recognizing a long held “fact” is actually flawed and needs updating, a bit like updating your phone or computer.

My own bias was challenged by the recent clinical post on Neurogenic claudication v PVD, challenging long held view that the cycle test and walking were valid tests. This is why evidence matters, it allows us to unlearn and replace.

I hope some of this makes sense. Thanks for reading.
“Ancora Imparo”

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