Academic practitioner: to be or not to be?

How would you define learning? Webster's dictionary defines "learning" as acquiring knowledge or skill by study or experience, while "study" is the act or process of applying our mind in order to acquire knowledge by reading or investigating. Unfortunately, Webster's definition of the term study emphasizes acquisition of knowledge without properly emphasizing the importance of acquiring wisdom. What's the difference?

Knowledge: The Greek term "gno'sis" (as in the word diagnosis) translated as knowledge indicates familiarity with relevant information (or facts) acquired by personal experience, observation or study. Unfortunately, many of us have been taught to over-emphasize the accumulation of new knowledge to a point where we neglect the development of two other essential components of learning—wisdom and understanding. How would you compare the attribute of knowledge to the attributes of wisdom and understanding? Is knowledge of this difference of practical value?

Apply it

Wisdom consists of acquiring a combination of knowledge and understanding that enables us to successfully apply knowledge. Those who acquire wisdom recognize the importance of acquiring sufficient breadth of knowledge and depth of understanding to provide sound clinical judgment. Although essential, facts per se are of little value to our patients. Medical facts only become useful to the extent they can be used to define and solve clinical problems. If we acquire knowledge, but do not learn how to properly apply it, we will not acquire wisdom. With these concepts in mind, how would you define understanding?

Learning more about knowledge

Understanding is a blend of many attributes in addition to knowledge. They include understanding, discernment, thinking ability, intelligence, experience, diligence, shrewdness (the opposite of being gullible or naive) and good judgment. Let us consider the attribute of understanding in greater detail.

Acquiring understanding calls for contemplating how new information fits in with the knowledge we already have. It is related to the ability to see how various aspects of a subject relate to each other, and also the ability to grasp how individual parts work together to form the whole. Those who seek to understand knowledge are not satisfied with a mere superficial view of a subject. As with a puzzle, they continue to study until they understand how to put separate pieces together in order to see the whole picture. In other words, the person who understands a subject can see the entire forest in addition to the trees.

This aspect of learning is important because we are unlikely to be able to retain and properly apply new knowledge unless we understand it. In addition, isn't it true that when we attend continuing education meetings, we are likely to become frustrated unless we understand where each new piece of information fits into the scheme of things?

For example, the priority of information learned about therapy of a specific disease should initially encompass why treatment is needed, followed by learning about when and how to give specific, supportive, symptomatic or palliative forms of treatment.

The why and when of the learning process provides us with a firm foundation for determining how to treat and prevent various diseases. If a veterinarian knows how to treat or prevent a disease, but does not understand why or when such action is warranted, misapplication of acquired knowledge is inevitable.

The result can be catastrophic to our patients. However, if we continue to keep our minds open in context of learning more about a subject, time, continued study and experience will also help us gain greater understanding. In contrast, selfish pride, stubbornness, self-will and independence can stunt the growth of our power of understanding.

Learning and study redefined

Now that we have defined knowledge, wisdom and understanding, how would you redefine learning? I propose that Webster's dictionary definition of learning and study be expanded such that they become acts or processes of applying the mind in order to acquire knowledge, wisdom and understanding. As we personally experience the deep satisfaction of saving a patient's life, or restoring its health as a result of application of our knowledge, wisdom and understanding, learning often becomes an energy-deriving and exhilarating process. What at first seems to be a disciplined exercise becomes, with time, a form of great satisfaction.

It's academic

So, are you an academic practitioner? How do these principles relate to our theme of whether or not it is practical? Perhaps you are thinking about the meaning of the word academic. Although the exact definition of academic may vary depending on the context in which this term is used, in context of medical vernacular, an academic diagnosis often is associated with the stereotype of being theoretical or something that has no direct practical application. Likewise, an academic clinician is often perceived as one who is associated with the ivory tower, and one who lacks practical experience in dealing with the real world. However, in context of providing quality patient care, is this perception valid?

Please consider this point. Differences in missions of university veterinary teaching hospitals from missions of veterinary hospitals staffed by colleagues in private practice have often been misinterpreted to reflect the mistaken notion that academic problem solving by university faculty is fundamentally different from practical problem solving by general practitioners. Again, I ask the question, is this distinction valid?

When viewed in context of appropriate application of knowledge, wisdom and understanding in caring for patients, it is apparent that this difference is conceptually inaccurate. True, there are unavoidable differences in the quantity of readily available knowledge, wisdom and understanding in veterinary teaching hospitals that are staffed by many specialists compared to private practices that are staffed by one to four primary-care veterinarians. However there is no barrier, except a self-imposed one, to acquisition and use of knowledge wisdom and understanding that aids in management of patients in either environment.

Please let me illustrate my point by asking you to consider this question. If you or a member of your family were faced with a life-threatening illness, would you have more confidence in the recommendations of a physician trained to think in an academic way that incorporated the fundamentals of evidence-based medicine, or in the advice of a physician who adopted the philosophy of empirical thinking in a practical way?

What is the point?

In context of appropriate patient care, the point is that the true nature of academism relates primarily to the orientation of our thoughts, rather than our relationship to a private practice, specialty practice or veterinary teaching hospital. The key issue is realization of the need to think in an academic or scientific way. It involves the way we look at things. In providing care for our patients, shouldn't we seek and rely on verifiable diagnostic and therapeutic observations that could, if necessary, be reproduced by other members of our hospital?

To illustrate, would you continue to rely on a thermometer that measured a normal temperature of 101ºF on one day, and a normal temperature of 105ºF the next day?

In context of quality patient care, scientific thinking is a major responsibility for all of us. We should all be striving to practice academic ways of thinking. The concept of academic practitioner should be encouraged. Why? Because the application of such thinking to our patients allows us to demonstrate our compassion in the way most expected of us, namely by being professionally competent. One of the most important goals of our profession is to foster, encourage, promote and demand academism from ourselves and from our colleagues. Of course, in the process, we should not minimize the need for practicality.

However, our allegiance to practicality should not be misdirected. Practicality may be a virtue, provided one does not hide behind it as an expedient excuse for ignorance.

Carl A. Osborne DVM, PhD, Dipl. ACVIM

Dr. Osborne, a diplomate of the American College of Veterinary Internal Medicine, is professor of medicine in the Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Minnesota.