Methods used for information capacity and knowledge building

question 2:

• In what ways do paediatric physicians in Nigeria engage in information practices towards patient care?

Figure 32: Methods used by the paediatricians for information capacity (literacy) and knowledge building

Taught programmes and courses

Interviewee’s were almost unanimous in their views that courses which were designed specifically for teaching information competence were rare during their respective periods of

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learning at the medical schools. They also faced similar limitations collectively in their post- qualification practice.

However, it appeared that some of the courses taught pre-qualification and post qualification to the paediatricians, even though less detailed on specific information skills, provided avenues for learning the importance of information application to patient care. The taught programmes and courses that took place while the physicians’ were already qualified were either part of the activities within the hospital or externally organised events, such as workshops and conferences.

Except for a few cases, most of the courses offered were not focused on providing skills that directly honed people’s individual information capabilities, as it was revealed, “most of the things we did were basically clinical things right from the start” (Interview 1, Male, and Resident). The courses taught at the medical schools were generally tailored toward providing only the medical knowledge required for discharging patient care, but not the skills required for information search to support such care.

Two of the interviewees seemed to have had a rare difference from the general experience of other physicians during medical school training on information skills development. They said:

“[…] during my medical school training there were terms when our courses included some computer training and how to use the internet. I think that was geared towards making us understand that there’s a wider information base over the Net that we can access and use to

better our knowledge and practice” (Interview 16, male, Resident).

“[…] in the medical school where I trained in Enugu at the UNTH, there was this mandatory IT training done in conjunction with Afrihub where they give you various strategies on how to access information, use the internet and the do the basic information search things” (Interview 2, male, Resident).

Some rare opportunities during post-qualification provided direct teaching of information skills to the physicians. As one interviewee revealed:

“During residency I attended conferences and seminars where we were taught how to do research and how to conduct information searches. We were taught research methodology and how to use the internet for information search. We were introduced to the use of PubMed

for obtaining medical information […]” (Interview 11, female, Senior Registrar). Similarly another clinician said:

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“[…] I remember the last conference I attended […] one of the slots was about how to search for information […]” (Interview 15, female, Consultant).

Besides these few cases of conscious information skills teaching, the majority of physicians complained of having experienced a general inadequacy of information skills training at their respective medical schools during professional education.

Use of documentary sources

Reliance on documentary sources such as books and the internet for solving information needs and improvement on knowledge was a general practice among the physicians. Some interviewee comments revealed the most recurrent information activities:

“I go to my textbooks first, and then I go to the internet. I go to the most important textbook – Nelson, then I support it with other textbooks and then I go to the internet. But if I am not close to my textbooks because I don’t carry them all the time, I go to the internet first”. (Interview 3, Resident, male).

I check for information in my book and if I can’t see it in my book I go online to check it in the internet (Interview 12, Registrar, female).

“I make use of textbooks. There are standard textbooks that we use; a lot of them. You see when you walked in here I was reading. I read my books… I make use of the internet every day and my textbooks”. (Interview 2, Resident, male).

Ready availability was ascribed as the reason why these sources were used; ‘I first start with what is readily available which may include my textbooks’ (Interview 6, Resident Female).

Learning in the process of practice

Several learning experiences were suggested in interview comments as accompanying the physician’s continued engagement with the process of patient care. One of such experiences associated with practice was an awareness of the appropriate sources of medical information to meet an information need. In one physician’s view: “You must be aware of the source where

the particular information you need for something is, and I think it’s something you develop as you keep practicing”.

Perhaps the opportunity afforded by this means of learning and self-improvement explains why one resident physician affirmed confidently that:

“As I am now, I believe that before I leave here today I would have become a better person than I was through the information I will receive […]”. (Interview 2, Resident,

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From the enthusiasm of this resident physician, it was obvious that the opportunity to learn in this way infuses people with the satisfactory feeling of belonging to a community of practice that works as a group to develop each other’s capabilities. The resident further explained “[…] so we work together as a group, everybody is just striving learn. Even the consultants get extra

motivation, extra challenges. Some of them might ask you to look something up and report to them next day. So from that you know your deficiencies and they correct you.”

It appeared that learning through practice presented the paediatric physicians with a slightly different type of experience from the conventional classroom type of learning. The type of experience associated with this iterative process of learning through practice was described by one interviewee:

“This profession is about skill acquisition. You do it the first time and you might not get it rightly, you do it again and your knowledge of the process improves. Now when you do it repeatedly it becomes part of you. That initial stage is when you will need to consult information sources more for guidance and as you repeat the procedures your knowledge and ability to handle it broadens” (Interview 10, Resident, female).

The significant point made by this description is the occurrence of a progressive increase in the physician’s confidence, competence and proficiency ascribed to knowledge building in practice.

Independent Learning

It was evident in the comments from many physicians that a very significant contributor to people’s information experiences and practices was their willingness to engage in independent learning. People learnt independently through conducting research, personal reading, and engaging with their patients.

When many interviewed physicians echoed in different ways a comment such as; it was just what I learnt from people and from personal effort’33, what was generally the underlying disapproval was the scarce opportunities available to them for formal information literacy training. The recourse to various forms of self-learning which perhaps bolstered their individual information experiences was firstly, a result of this vacuum in their learning experiences, and secondly, it was forced in most cases.

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Collaborative learning and continued professional development

Learning by mutual co-operation among the physicians appeared a popular practice that provided people opportunity for building their knowledge. The physicians within the paediatric department were normally grouped to work in teams and different units on the clinic days assigned to each team or unit. However, in order to foster learning

opportunities, the physicians collaborated to share knowledge across their different groups. These opportunities were by way of mutual arrangements or through the weekly clinical conferences that compulsorily brought all the teams and units together for information sharing.

The collaboration that takes place mutually when challenges with patient care arose was described by this interviewee: “[…] people went home and checked up textbooks and the Web, came back and discussed and arrived on something”. (Interview 5, Resident, Male). Using a particular incident to explain the merit of this collaborative way of learning, this interviewee said:

“What helped the process was the availability of the sources to consult and the fact that different ideas were collated. The group effort helped the process because it offered us the opportunity to make comparisons and take the best possible route”. (Interview 17,

Resident, male).

Another form of collaborative learning was when people belonged to learning societies or associations to improve their knowledge. Some of these learning groups were formed at the medical schools, while others existed within the community of practice of the already qualified physicians at the hospital. One interviewee described his own involvement:

“I was in an Association in school called Medical, Research and Maternal Society where we had lectures and seminars on information skills […]”. (Interview 8, Resident Male). Already qualified and practicing physicians participate in the activities of different learning associations to build on their knowledge as described by a Consultant:

“The medical association here organises what we call continuing medical education and doctors are expected to participate so they could get information on current issues in managing patients” (Interview 19, Consultant, male).

Discussing about the various information activities paediatricians in that hospital engaged in, another clinician said; ‘we also attend external paediatric seminars around the country’34.

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These associations provided the physicians with the opportunity for collaborative learning, networking and a continuous platform for knowledge building. The forums also provided the clinicians with the opportunity to closely interact with colleagues from other hospitals to exchange ideas and share information. Many clinicians perceived the information received at these meetings as useful to their work-roles.

Shared knowledge among colleagues

Similar to collaborative learning, where purposeful cooperative arrangements for information sharing and knowledge building existed among the physicians, was the practice of sharing knowledge at the interpersonal level. By putting calls across to colleagues or face-to-face discussions, people mutually shared knowledge that facilitated personal decisions during patient care.

Choices made about initial contacts are usually determined by individual preferences or levels of experience as shown by these comments:

“[…] the first thing I do is to call my colleagues. The information they give usually helps me […]”. (Interview 10, Resident, female).

“I am a Resident doctor, the consultant owns the patient and even if he’s not there, I can put a call across to him and he will come and review with me. If he’s not on duty at that point, we’ll discuss on phone”. (Interview 2, Resident, male).

“[…] when you feel there is need for clarification, the first person to contact is your senior on call. For example, I am a registrar and if such need arises for me I call my senior registrar and when we cannot solve the problem, we call our consultant”.

(Interview 12, Registrar, female).

“[…] I can call another colleague elsewhere or some other doctors outside the paediatric field if I feel they could have the knowledge of what will help. Sometimes I call on a pathologist and sometimes I call on an urologist, so it depends on the case. I had this difficult case sometime in the past in the new born unit and I had to ask the matron if she had an idea of what to do in that case and her suggestion helped[…]”(Interview 14,

Consultant, male).

Some physicians attributed various merits to discussing with colleagues. A clinician revealed through this comment that; ‘last year someone taught [him] how to use Google scholar’35, in which case that aspect of knowledge was unclear to him until he discussed with a colleague. Comments such as; ‘you might have a different dimension and you get a different view of that

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case’ and ‘when I discussed with my colleague…there were other things we found out’36 exemplify the physicians’ belief that this practice had advantages for the improvement of knowledge.

In the same vein, similar comments suggested that during the discussion process people ‘pick up useful information’37 and ‘understand better…confusing presentations in a disease

condition’38. In the aftermath of attendance to conferences, people were inclined to sharing their experiences to the benefit of enhancing other people’s knowledge. A clinician reported that: “…when colleagues attend these conferences, they share their experiences with others and that keeps everyone abreast of current happenings particularly new ways of managing particular sicknesses”39. An example of this practice was described by this comment:

[…] some might not have gone for neo-natal resuscitation for years, but when a few attended the recent conference at Abakaliki on neo-natal resuscitation, they came back and updated others […]”. (Interview 3, Resident, male).

A Consultant described the contribution made by the community of practice toward facilitating this method of learning during clinical seminar presentations:

“[…] a lot goes on in a typical day when we do ward rounds. So what happens is that the resident that took the call documents everything and will do a formal presentation where we take a critical look at what was done. We look at everything; the way you presented your history, your confidence and choice of words […]”. (Interview 19, Consultant, male). This type of learning under the close supervision of superiors was also replicated at a wider scope in groups where paediatricians were assessed in units. This Consultant further said:

“[…] on Wednesday afternoon we do a clinical conference. What it entails is that the units pick up a case in their unit, read around it, summarise issues and present it to the whole house. The team is taken up on how they managed the case for them to defend what they did for that child. If there’s anything the team did not do right, we point it out, because it happens. It is a learning process […]”.

At some points, some of these discussions bring up startling self-reflection for the physician; ‘…sometimes you will discover that the things you thought you know that someone can explain it better and that helps you gain more insight’40. In this way, discussions with colleagues serve as a gateway for the physicians to learn from potentially useful information

36 _{Interview 2} 37 _{Interview 1} 38 _{Interview 10} 39 Interview 9 40 _{Interview 16}

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held tacitly by their colleagues and explicit knowledge obtained through team research and presentations.