The attainment of knowledge

Abstract

Writing two and a half millennia ago, Confucius stated that “By three methods we may learn wisdom: First, by reflection, which is noblest; Second, by imitation, which is easiest; and Third by experience, which is the bitterest.” The edict fully applies to modern medical education and training. The attainment of knowledge through experience may be the fruit of the personal and/or collective compilation of knowledge gathered by personal observation of individual cases or case series. It may also incorporate formal randomized clinical experimentation to compare outcomes attained from two or more different management options. Originally transmitted down the generations by oral tutor-student communication, it eventually was more widely made available by the publication of case presentations, case series, or randomized controlled trials. This compilation of knowledge by experience is the most bitter since for every success story documented, there would be several failures that would have fallen by the wayside or eventual successes that were only accepted after a pendular shift in attitudes towards their use. The importance of experiential knowledge in current practice can be best illustrated by Isaac Newton’s comment that "If I have seen further it is by standing on the shoulders of giants." We are where we are today because of the giants that have preceded us. With their experiential, experimental and rational acquisition of knowledge throughout the ages, they have laid down the foundations of knowledge that we have developed and rely upon in modern practice.