How mindlines develop - A qualitative study of medical knowledge creation
The evidence-based medicine (EBM) movement has fundamentally changed the way medical knowledge is created and generated thousands of guidelines – which are rarely fully followed, for complex reasons. Evidence based guidelines are typically based on randomized controlled trials (RCTs), but they are less good at capturing other sources of evidence, including laboratory studies, qualitative studies, routinely collected data and clinical intuition.
This was clearly not intended by the pioneers of EBM. They argued that clinical expertise and patient preferences should be integrated with the best evidence. Moreover, the best evidence should not be limited by a simple and restrictive hierarchy of evidence, as some clinical issues cannot be solved with RCTs such as in case of patients with multi-morbidity. The problem is that clear and agreed methods to weigh and include different types of knowledge in guidelines are lacking. The Guidelines International Network (with input from NICE and comparable bodies in other countries) seeks to identify “methods and promising initiatives for appraising and including a wider range of knowledge sources in guidelines”.
The concept of “mindlines” could be helpful to improve the generation of guidelines. Mindlines are collectively shared, mostly tacit knowledge, shaped by many sources including accumulated personal experiences, education (formal and informal) and the narratives about patients that are shared among colleagues. Since mindlines play such an important role and provide an alternative view on clinical knowledge creation, they could potentially inform the development of guidelines that clinicians will follow as they are meaningful and useful for everyday practice.
The goal of this research project is to gain a broader understanding of the processes of medical knowledge creation.
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