An educational tool to assist in the management of hepatic metastases in patients with colorectal cancer

Welcome Methods Authorship Strengths/Weaknesses
Using MetResect Principles Anatomy Tutorial
Selection Options By Category By Faculty By Case Matching
Overview of Resources References by Author References by Topic Expert Comments by Topic
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Strengths and Limitations of MetResect

There are some powerful positive features and some important weaknesses in the basic design and content of MetResect.

An important plus is that a basic strength and central part of medical education is the experience of clinical problems and the flow of the work. Examining cases and how they were treated is an important way to fix in the mind how expert clinicians evaluate and treat patients. Such an approach reflects what is actually happening clinically. This strategy of interviewing an expert conversationally and transcribing and delivering to the practicing clinician commentary and opinion from these interviews is a popular technique used by Neil Love and Research To Practice. A 150-minute audio program of a think tank meeting of the investigators of this project reviews many similar cases to those presented here.

There are important limitations however to this approach. The alternative is to take a reductionist approach: organizing thinking into a set of principles and simple logical flow diagrams. This allows one to get immediately to the heart of the matter. This is the basic approach taken by many guideline panels, such as the NCCN. A reductionist strategy is arguably faster and surer. Nonetheless these two strategies complement each other.

There are some very specific concerns about MetResect having to do with how the materials were prepared. Although the tables showing treatment preferences of multiple doctors are fascinating to review, it is not clear how and why the doctors actually disagreed. Specifically there may have been some ambiguity in some of the cases. The panelist doctors individually responded to a 2-3 sentence scenario without consultation of the presenter of the case or access to x-rays. Were the differences in the opinion about treatment based on truly different views on fundamental principles or due to simply a different interpretation of the clinical details of the case? It is not surprising that some of the panelists would not recommend the same treatment as the discussant (who also was the treating doctor) if they interpreted the basic clinical details differently.

Thus MetResect is a very extensive, powerful piece of work, but as it evolves it can be added to and perhaps improved upon. After you use this tool your feedback using the "Contract/Evaluate MetResect" link (shown below and at the bottom of most of the pages) will be very helpful in shaping further refinements.


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