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Got Knowledge? Why Stop There?


Tue Oct 08 2013

Got Knowledge? Why Stop There?

Information management is the process of creating value by transforming data into information into knowledge into wisdom. Within the concept of knowledge, there is also a value progression: book knowledge, applied knowledge, and experience-tempered knowledge.

For example, would you prefer a high-performing medical student or an experienced surgeon to perform an intricate operation. Medical education produces a knowledge worker—a physician, and the process of accumulating medical knowledge provides a clear example of the value progression.


During its first two years, medical school is traditionally similar to all prior classroom learning experiences, with the exception perhaps of volume and intensity. Young medical students absorb enormous amounts of anatomy, biochemistry, physiology, pathology, genetics, histology, pharmacology, microbiology, neuroanatomy, human development, and so forth. The resulting understanding of the structure and function of the human body provides context for managing human health. Having completed the first two years, medical students know a lot, but they are by no means physicians. They are students who are prepared to take the first of a three-part licensing examination.

The second half of traditional medical school is a significant shift from classroom instruction to clinical rotations in which students join residents, fellows, and clinical faculty as they provide patient care, largely in hospital settings. Students learn mostly by watching and, occasionally, doing. Students use the exposure on various rotations to determine the specialty they will pursue in post-graduate training.

Successful completion of four years of medical school and passing the second of the three-part licensing exams earns the student a Doctor of Medicine degree. The student has become a doctor, but a doctor ready to be a PG-1 (Post-Graduate year 1, formerly intern), not yet your personal physician.

Residency programs do a superb job of translating a resident's book knowledge into applied knowledge. This process starts during the clinical years of med school, but accelerates as new doctors do less watching and much more doing—under the close supervision of the more senior residents, fellows, and staff physicians.

Learning is intense because training typically occurs in a busy hospital with critically ill and injured patients showing up 24/7/365. The third part of the physician licensing exam occurs after the PG-1 year; a medical license is awarded if the student passes the test. Physicians at this stage are licensed and eligible to practice, but generally elect to continue at least two more years in the residency program and potentially more in a subspecialty fellowship.


Now, we have a young doctor with book knowledge and applied knowledge, and typically we have a person who is well trained and up-to-date on the latest in medical science. The intensity of residency training crams a great deal of experience into the package as well, although most physicians value the additional seasoning gained over years of practice. Traditionally, this has been the pinnacle for physicians' knowledge, but there's tremendous potential for something more—wisdom.

Wisdom can be distinguished from knowledge as the capability to anticipate what will happen rather than an understanding of what has happened. It takes the latter to achieve the former, but wisdom does not automatically follow knowledge. When I was taking care of diabetic patients, for example, we knew how well we were controlling the disease for any given patient. What I did not know was how well I was managing a population of diabetic patients; how I was doing compared to how I would expect to be doing or compared to how colleagues were doing in my medical group/city/state/country/world.

Big Data holds the promise of extending the value progression from knowledge to wisdom in medicine, business, and everywhere. The ability to combine learning from individual experience with learning from collective experience, to assess observed performance against some yardstick of expected performance, and to analyze variances in outcomes to gain insights into what's working and what's failing all hold the promise of helping us better anticipate how to achieve better outcomes.

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