Praxis Pointers: reciprocal publication of practical pearls

Context and setting Our residents are required to keep a logbook of procedures performed during training. Electronic logbook users asked for added background information to be linked to each procedure for rapid reference while in the field. Users also asked for the ability to annotate these instructions for their own use. Why the idea was necessary Handheld computer users were frequently observed beaming notes and tips to each other informally. Teacher feedback at faculty development workshops provided a vast array of accumulated experiential knowledge and practical pearls around surgical procedures. There was clearly a need to disseminate these tips amongst our learners and teachers. This also needed a central review and audit mechanism to control the potential spread of inaccurate information. What was done Our electronic procedure log, Praxis, was specifically designed to optimise the collection of peripherally collected data onto a central database server for easy access by curriculum directors and evaluators. As part of the fully automated data synchronisation process, updates to the program are simultaneously sent back to the remote handheld computers. We used this same mechanism to distribute contextual instructions about each procedure. Learners could annotate certain segments of these instructions with practical pointers gleaned during their community rotations. Teachers were encouraged to add their favourite tips and pointers. Sophisticated database replication techniques prevent changes from 2 users clashing at the central server. All pointers submitted are centrally audited before being added to the server's update pool. Evaluation of results and impact Praxis Pointers have been well received by learners and teachers. Ease of use was commended – no additional steps are needed because this bidirectional publishing occurs invisibly as part of their regular recharge, backup and ‘hotsync’ routine. As expected, there was an initial flurry of enthusiasm when the initiative was launched in 2001. Since then, pointers have steadily rolled in – to date, we have collected 416 tips, covering 208 of our list of 219 (95%) procedures. The spread is good, with a maximum of 6 tips for 1 procedure. A total of 59 pointer ‘authors’ have contributed. No pointers have been rejected as incorrect or inappropriate. Only 3 have been rejected because of duplication of content. The electronic synchronisation process has proved remarkably robust and needs little maintenance. Remote users are able to synchronise from across several provinces and are not blocked by Internet firewalls, even from small rural hospitals. Qualitative feedback suggests that we need to educate users about the potential value of their tips – many are reluctant to contribute because they do not feel that their tip is worth adding. Some users have expressed concern about the liability associated with authorship of a pointer. A formal peer review process would help counter this. Many users have requested automatic notification of what new pointers are added. This feedback might encourage further contributions from others. Educational theory suggests that the act of crystallising a pearl into the short format allowed by this mechanism helps to further integrate the information into longterm learning. This needs further study.

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