Knowledge, lost in translation
Authors: Kamran Abbasi
Journal: Journal of the Royal Society of Medicine (2011)

The pursuit of knowledge is no longer enough for clinicians. We have to absorb it, communicate it and, most importantly, translate it. Typically, like other core skills that clinicians have never been taught properly, knowledge translation is something of a mystery. For a start, the definition of knowledge translation is problematic – is it even a worthwhile concept? A second dilemma is working out how long a knowledge translation process takes?

Such inscrutable questions are predicated on an understanding of how to acquire the knowledge that requires to be translated. Clinical textbooks were once the knowledge resource of choice, synthesising the essentials and the minutiae of every specialty. But a textbook doesn't move at the speed of the Internet, where knowledge is formed and reframed in moments. Clinicians list online resources as important sources for updating knowledge in their specialties. Google is the first and most loyal friend of a clinician searching for a clinical answer.

The Internet offers helpful solutions but poses challenges, foremost of which is how much we trust the information we are reading? A failing of medical journals is that an answer to any particular clinical question rarely resides within our rainforests of peer-reviewed pages and clouds of web archives. Clinicians therefore look elsewhere, at Wikipedia for example; we might distrust the web but in a moment of need we will give it the benefit of doubt.

Is Wikipedia the most important knowledge resource in the world? Seventeen million articles in 262 languages, sixty-five million visitors each month to the English version, make a compelling case. A survey of junior physicians estimated use of Wikipedia at 70%. Yet anybody can edit Wikipedia, why would we trust it? The evidence is less damning than perception. Wikipedia is no less reliable than other encyclopaedias. A researcher deliberately introduced small errors into biographical articles on Wikipedia and 50% of these errors had been corrected by other people within 48 hours. As a result, David Metcalfe and John Powell encourage medical professionals to be actively involved with Wikipedia and help develop it (JRSM 2011;104:488–489).

Wikipedia might help us with facts but facts are only one dimension of knowledge argue Trisha Greenhalgh and Sietse Wieringa (JRSM 2011;104:501–509). Aristotle described knowledge as being composed of facts (episteme), skill (techne), and practical wisdom (phronesis). Facts need to be placed in context – which requires tacit awareness – interpreted, and linked to further questions. With this broader definition of knowledge, medicine is neither a science nor an art. It is an uncertain, paradox-laden, judgement-dependent, science-using, technology-supported practice.

Consequently, our current concept of knowledge translation is over-simplified, based on a false premise of a know–do gap that defines knowledge and practice as distinct entities. This is unsustainable conclude Greenhalgh and Wieringa. Knowledge translation as a precise term has outlived its usefulness – and presumably the clumsy concept of a know–do gap can go with it?

But before JRSM considers a total ban on knowledge translation, a second review in this issue examines time lags in translation research. How long before original research is implemented? How long from drug discovery to commercialisation? Curiously, a frequent answer to such questions is 17 years (JRSM 2011;104:510–520). We will reap what we sow but we might wait two decades which helps explain why it takes over 30 years for doctors to be recognized by the British honours system. Bear this in mind as you impatiently wait for the publication of this year's honours list. If you fail you might wish to consider a New Year's resolution to transfer your expertise to one of the top 10 specialties for honours (JRSM 2011;104:521–524)?