Abstract
The ultimate improvement for leaders of the disciplines of clinical medicine to help bring about is the transition from universally quasi-scientific medicine to universally scientific medicine. This requires cultivation of clinical research that truly is relevant for the advancement of the knowledge-base of practice in the discipline at issue – by virtue of the form of the objects of study. Contemporary clinical research remains seriously wanting in this critical respect, as was evinced by review of a number of eminent examples chosen by the students in this course.
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Given what clinical medicine is – the aggregate of the arts/disciplines of (the practice of) clinical healthcare and not a (set of) science(s) (propos. II – 1.7, 8) – there is no science in, or of, clinical medicine; but there is, of course, science for clinical medicine, ultimately quintessentially ‘applied’ clinical science for the advancement of the knowledge-base of clinical medicine (propos. I – 2.5) – providing for clinical medicine that is not only rational in its theoretical framework (addressed above) but increasingly scientific as to the genesis of its knowledge-base.
A major theme in this course – in its Theory of Clinical Medicine part, preparatory to the Theory of Clinical Research part – was the necessary form of the knowledge-base of clinical medicine, namely that of GPFs (cf. above), along with the point that the use of GPFs can be made practical by means of their incorporation into gnostic expert systems. This has a critically important bearing on objects design in quintessentially ‘applied’ clinical research and, thereby, on the form of the results – of the numerical evidence – that such research is to produce.
A related major theme was the necessary movement from the evidence produced by research with appropriate objects design to knowledge of the form of the objects of research – generally evidence from derivative rather than original research. While the making of these transitions was presented as being, in principle, a function of the relevant, topic-specific scientific communities, the operational proposition was that the relevant evidence be made – suitably – to enhance the tacit knowledge of the members of the various expert panels that are the source of the GPFs for the expert systems (propos. III – 1.15–17).
The students in this course – residents and fellows in the McGill University Health Centre – reviewed nine example studies of their own, collective choosing, presenting them in class during the last (fourth) week of the full-time course. They judged none of them to provide suitable guidance for their practices, even if the results be taken to represent actual knowledge about the respective objects of study. Throughout, the problem in this was the form of the result, that it was too simplistic, not providing for the necessary distinctions that are to be made. They weren’t suitably-designed GPFs in form.
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Miettinen, O.S. (2010). Research for Further Improvements. In: Up from Clinical Epidemiology & EBM. Springer, Dordrecht. https://doi.org/10.1007/978-90-481-9501-5_17
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DOI: https://doi.org/10.1007/978-90-481-9501-5_17
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