I practice clinical electrophysiology in a private practice setting in Louisville, Kentucky. I follow patients, render opinions, do catheter ablations, and implant devices. When I left Indiana University residency and fellowship training in 1996, ablation of atrial fibrillation and cardiac resynchronization therapy did not exist. These two procedures now constitute the majority of my practice. Lifelong learning after residency, therefore, has been a necessity.
In private practice, you sometimes get bogged down in day-to-day work — that is how medicine works. But when lulls occur, or when cases present unexpected challenges, the tools we have available in 2015 make it easier than ever to keep up. The key is to make learning a priority, not an extra.
Tip 1: Use Digital Tools for Lifelong Learning in Medicine
One of the niftiest tools I use to keep up-to-date is Twitter. The truth about our digital world is that we all are overwhelmed with information. It is up to us to create our own filters. I have “hired” about 400 people on Twitter to bring me the information that is important to me. I use Twitter to follow medical journals, from the famous ones like the NEJM and JAMA on down to the specialty journals in electrophysiology and even those outside my field. I also follow people: physician leaders like Richard Lehman, scientists like Harlan Krumholz, bloggers (too numerous to count), statisticians (I especially like stats people), journalists, politicians, curators, sports people, and skeptics. The skeptics may be the most important people I follow. I like skeptics because I have learned, especially in clinical science, never be too sure of something.
Another tool I find invaluable is Evernote. The Evernote app allows me to save and collate documents, online posts, journal articles, and even rambling thoughts. I see something on the internet, and I clip it to Evernote. I see a patient who reminds me of an important concept, and I tap it into Evernote. At medical meetings, I make notes in Evernote. If it is important, I put it into Evernote.
Tip 2: Learn Through Writing
Writing is also an essential component of how I learn. Indeed, I have discovered no other tool for learning that comes close to the power of writing. The day I wrote my first blog post on a medical topic was a tipping point. I found out quickly that to explain something in words, you must have a deep knowledge of the topic. In this way, writing is like teaching, only writing is harder because you can’t use facial expressions, spoken language, and whiteboard drawings.
A specific example: You write a sentence. You make a claim. In 2015, the internet allows someone who has more knowledge than you to read that claim. They write back to say you are wrong. The next time you write a sentence that makes a claim, you think, wait, where did that knowledge come from? I had better back that up. You do research. This process takes you places. You discover things, like epidemiology, epistemology, behavior psychology, and the like. You are now a professional learner.
Tip 3: Find Your Own Lifelong Learning Strategy
So when do I get my learning done? My learning brain works best in the early morning. That is when I read and write. People are different. That strategy may not work for everyone. It is interesting that my muscles work best in the early morning too, so sometimes I have an internal debate: Should I train my mind or my body at 0500?
Learning makes me feel almost as good as a spirited bike ride. The way I celebrate learning something new is to write about it. The act of writing a blog not only helps commit a nugget of knowledge to long-term memory — it also serves as digital notebook. I refer back to my blog often.
I think my colleagues see me as a learner — a goofy one at times. When I show colleagues a new study, sometimes they look at me as if I am exceptionally well-read. “Gosh, John, you sure do read a lot.” What they don’t know (yet) is that the people I have chosen to follow on social media brought this study to me.
Day-to-day duties get in the way of “book” or online learning, of course, but it would be a mistake to think routine patient care is not an important way to learn. The thing I try to pay attention to as I see patients is what they teach me. It sounds like a cliché to say that our patients teach us the most, but it is true. That is, if we make the effort to notice.
I have always been curious, but now as a mid-career doctor, I am acutely aware of the need to stay up-to-date. I don’t want the youngsters to show me up — at least not too easily.
The biggest challenges for young clinicians will be to remain skeptical and to embrace uncertainty. Future clinicians will have great pressure to follow protocols and checklists. Employed caregivers will be expected to accept the status quo. But medical knowledge is not like that. It changes. What was rarely remains what is. The thing I have learned most about being a lifelong learner is how little we actually know.
Share your thoughts on lifelong learning in medicine in the comments below. How do your needs and strategies as a general internist differ from those of Dr. Mandrola? How are they the same?
Dr. John Mandrola practices clinical electrophysiology in Louisville, Kentucky. He also blogs about his experiences in clinical care at drjohnm.org, and he writes regularly for theheart.org.
This post is part of the “Lifelong Learning” series. In our next segment, find out how a busy doctor and mother of three keeps up with core medical knowledge.
Good points John. I am a later career life physician – who also works in a area non-existent when I graduated (in the COUNTRY) – Adolescent Psychiatry. I have been cleaning out my old notes and dusty file folders of “knowledge” that one accumulates over the years (I’ll get around to that sometime – but it just goes in the box) and was wondering if you have been reviewing any of your OLD knowledge? Looking back most of the content was useless – anatomy seems to have held up the best – but someone just discovered nerve cells in foreskins a year ago and someone else discovered a new light sensitive retinal cell not known until about 10 years or less ago. They never even taught us that knowledge is part of the scientific process – it’s the best we have until new stuff comes along?
MV, Thanks for the note. I do not look back on my notes. They are all gone. I once made a notebook of Gen Surgery. It was all in my handwriting. That’s the thing about blogs, though. I often refer back to my old notes there. Unlike paper notebooks. my digital links are permanent.
Thank you for sharing this.
Great ideas come from many different people and places.
Again, thank you.
Nice job, John! I have always been an advocate of life long learning. In fact, I frequently work it in when giving talks to medical students and residents. Unlike John, I am past being a “mid career doctor,” and as an “academic” feel the need to impart some wisdom to my younger colleagues. I have found that my best learning is from teaching. This may be in the form of writing an article or chapter, showing a resident how to do a particular procedure or technique, quizzing a medical student about anatomy (which is being neglected in modern medical school unfortunately), or editing a text book. As professionals, we should all consider ourselves are both teachers and students–it never ends. The bottom line (which I am known for) is that regardless of your learning style–social media, attending conferences, reading articles or books, or writing them–embrace the concept of life long learning–it will make you a better doctor!
No doubt. I feel a huge debt of gratitude for my mentors. They helped me immensely. I have few regrets of the choices I made, but one mild one was not staying on as a teacher. Maybe that’s why I love social media so much: it’s a way to teach to an immense classroom, a global classroom.
Thanks for this post John, it was most interesting. I agree also in your point about lifelong learning; it’s never too late to learn a new skill and the value achieved from upskilling is difficult to quantify but it’s certainly a positive. Even a total change in career is possible if one so wishes. Studying medicine in countries in South America or in Europe (eg Bulgaria and Romania) also opens this avenue up to those who previously may not have been able to afford it.
Great post John, really enjoyed your view on the matter. Very insightful. Really found your view on the challenges faced by young clinicians very thought-provoking. Many more students are choosing to study in Bulgaria to train as Doctors and Dentists and I find this post a great aid for lifelong learning
What an incredible post, Dr John. Not many patients are aware of the necessity of doctors to take on the lifelong challenge of constant self-learning and self-improving. As a medical student myself, I love learning and gaining knowledge – especially when it’s focused on a field that I particularly like. I cannot stress enough to people of the older generation how they should be exploiting the internet and online applications – like you are. We have access to such a huge wealth of knowledge that it would be a shame not to use it. I have lots of respect to your dedication, thank you for sharing.