A Q&A with behavioral economist Dan Ariely
Continuing Medical Education (CME) and Maintenance of Certification (MOC) activities can be perceived as a burden — perhaps one with an unclear benefit. Sure, physicians value medical learning and keeping up with changes in guidelines and new research, but do you fit it in happily, or do you view extra efforts toward continuous learning beyond your daily practice as a chore?
To explore this concept further, I talked to Dan Ariely, a behavioral economist whose research has explained, among other perplexities, why we act in ways that are not in our own self-interest, and why we overvalue things that we have created.
Josette: Do you think physicians would be rational in feeling that continuous learning is too hard — and doesn’t present enough of a benefit — to be worth the time and effort?
Dan: I think that being a doctor is a really hard job. People are incredibly busy and incredibly stressed, and under those conditions, it’s really easy to be myopic and just worry about what is happening today — finishing up with whatever the momentary hassle happens to be.
My world is similar in that I have a lot to do and I often find myself wondering how I could possibly fit anything else in. I feel like I need to spend my time catching up on the things I’m already behind on. I am in a business of trying to learn about human behavior — and there are lots of sources from which to learn. But there’s a lot of other things to do like respond to emails and go to meetings and try to raise money. And sometimes there are cases where it would be incredibly useful if I could just have some time to sit and read, and I often don’t have the time. I wish I could take detailed notes about everything I’m learning and thinking, but in the stress of the moment, I don’t. Of course it hurts my skills and ability. The reality is that the moment we are stressed and starved for time, we give up things, and the things we give up are not always the right things to squeeze out. They are the things that can be squeezed out, even if they have tremendous value.
But it’s myopic to make decisions on those grounds.
Josette: Can continuing medical education have a monetary value that aligns with doctors’ expectations?
Dan: I don’t think it’s a question of money. I really think it’s a question of stress and priorities.
Josette: ABIM asserts that their MOC program and requirements are aimed at improving medical practice and that people are often not able to evaluate their own weaknesses and knowledge gaps. Are overseeing organizations, like ABIM, falling into the trap (which you describe in your research) of overvaluing what they have to offer?
Dan: Not all learning is useful, and not everything in all classes is worthwhile. Think about it this way: We force kids to think about the long term and go to school — doing that is important. You probably can’t imagine saying to your kids, “Hey, if you want to go to school, that’s up to you — we’re sure you’ll make the right choice.” That’s certainly not the right approach. Now, I’m not comparing physicians to kids. But given the stress that physicians experience, I think that the odds that they will value continuous learning correctly and invest sufficient time in it is unlikely.
Josette: Can the odds be changed to benefit physicians and patients alike?
Dan: Somehow we need to change things so that physicians don’t have as much stress and can make continuous learning a high priority. In Judaism, we have the Sabbath, which is a day when we’re basically forced to have rest (with no electronics) and are supposed to be investing in ourselves in different ways. Now if you don’t have to keep the Sabbath, you would spend your Saturdays working the same as every other day and getting stressed. But if you’re forced to do it, you have no other choice. I think that’s where the solution for continuous learning might be found: Hospitals need to mandate some time that people are not allowed to work and are only allowed to invest in themselves. That way, we’re not leaving it to physicians to make their own trade-offs, but instead are forcing them to make the right decisions.
Readers, do you agree? Would this be paid time? And to make it work, would hospitals have to staff up a bit, so that people have coverage and really feel like they can take the time off to invest in themselves? Contribute your opinion in the comments below.
More from NEJM Knowledge+ on continuous learning:
ABIM Review — Using Reflection to Improve your Performance
Maintaining Multiple Subspecialty Certifications — One Physician’s Experience
Internal Medicine Certification Exam: Your Residency as a Study Tool
Dan Ariely is the James B. Duke Professor of Psychology & Behavioral Economics at Duke University; he has appointments at the Fuqua School of Business, the Center for Cognitive Neuroscience, the Department of Economics, and the School of Medicine at Duke University, and is also a founding member of the Center for Advanced Hindsight and the author of the New York Times bestsellers Predictably Irrational, The Upside of Irrationality, and The Honest Truth About Dishonesty.