Continuing to learn while I stay on top of my responsibilities, both as a doctor and as a working parent with three boys, is a challenge. But I’m not a special case. Every busy, conscientious clinician has a thousand things to do each day. Keeping up with the medical literature, — and maintaining and refreshing your core medical knowledge — doesn’t happen automatically. You have to integrate it into your lifestyle. What I do may not work for everyone, but I’d like to share my practices and let you decide for yourself.
It’s a Lifestyle
I think of lifelong learning like the lifestyle changes we ask patients to make when they’re diagnosed with a chronic condition. In short, make it a habit that you incorporate into your daily life. Then it won’t seem so daunting.
I’m not the kind of person who has time to learn by sitting down with a pile of journals in a room at the end of the day or with a newspaper sprawled out during breakfast. I like to learn while I’m on the go, whether it’s on the elliptical machine at the gym in the morning or on my daily New York City bus commute. I’m a multitasker at heart.
While I exercise, I listen to podcasts. Some of my favorites are the New England Journal of Medicine podcast with Steve Morrissey and the NEJM Journal Watch podcast with Joe Elia, and general news podcasts I enjoy from the PBS NewsHour, NPR, and The Economist. I don’t listen to all of these every day, of course, but I always listen to something. While I am sweating it out on the machine, I absorb important information that I can use in my practice .
On my bus commute, my phone is my learning lifeline. I may be unusual in this regard, but I use content from the NEJM Group almost exclusively. I shopped around a bit in the beginning and found that the NEJM tools worked best for me. I like the daily Physician’s First Watch, which is also from the NEJM Group, and the First Watch roundup at the end of the week. I also use my phone to read Journal Watch content in general medicine, hospital medicine, diabetes, and lipid management. I’m not the kind of person who can hear something once and know it cold. Each of these sources of information reinforces the other. Some of the daily headlines from First Watch get explored further in Journal Watch stories, and I value that repetition.
I’m also a visual learner. I enjoy the NEJM Image Challenge, the Images in Clinical Medicine, and especially the Quick Takes. I scan for these “clickable” features that usually appear in the periphery of other emails I get from NEJM, like in the margins of the weekly journal headlines or at the bottom of the NEJM Resident e-bulletin.
When someone walks into my practice or in conversations with colleagues, I want to be familiar with the latest. I like to be familiar with what my colleagues and my patients are talking about. I owe it to them to know what’s happening and not just work in a silo.
How I Reinforce My Core Medical Knowledge
Keeping up with the latest information is just part of the puzzle. I also use NEJM Knowledge+. It helps me with practical stuff like accumulating CME credits and maintenance of certification, of course. But more important than that, it makes me review essential topics, the core medical knowledge that I must constantly review if I want to continue to be a good clinician throughout my career.
The NEJM Knowledge+ Question of the Week is tremendously useful and relevant, and it provides me with a link to the larger NEJM Knowledge+ product. When I see the NEJM Knowledge+ question via email on my phone, I am the beneficiary of a quick, teachable moment while on the go. If I have time to be on my laptop, I can use the weekly email to link to the full product, where I spend a longer stretch of time answering several NEJM Knowledge+ questions and brushing up on highly relevant content that I use in practice every day. And I trust the information and tools because they’re super-relevant, free of commercial bias, and surprisingly easy to use.
The last piece of my learning puzzle is a huge one: point-of-care learning. For this I use Up-To-Date. As I set up at the start of a patient care or precepting session, or as I settle in at a computer to write notes after seeing all of my inpatients on the wards, I always have a window open for Up-To-Date. I am incredibly grateful for our institutional membership to this tremendous database. It answers clinical questions, both big and small, that come up for me in real time. It is easily searchable and rich in content. If our institution didn’t have a membership, I would have to buy one for myself.
Starting Is the Hardest Part
It may sound like I’m spending countless hours on learning. I’m not. I figure it amounts to maybe 15 minutes a day. I couldn’t do it if I had to hunt all of this information down. I simply put in a little time up front by signing up for alerts from various products, and now it all comes to me.
My advice to someone who thinks this is too much work: Start small, and build a habit. Don’t bite off more than you can chew. Maybe start with just the alerts from Physician’s First Watch or try NEJM’s Quick Takes. Then once it becomes second nature, you can add more — or not. But I think you probably will once you see how easy it is.
I haven’t figured it all out yet, but I’ve put in a lot of effort to get myself on the right track. I want to keep up with new developments and strengthen my core medical knowledge because doing so makes me a better doctor. But keeping up is also satisfying for me — I like to learn, and NEJM Group’s products have made it easier. I love that they “journal watch it” for me — a phrase I started using in the past year or two to mean that NEJM Group does the homework and uses its tremendously knowledgeable, skilled team to distill information for me and make it as simple as possible.
Do I ever falter in my habits? Of course. The most obvious times are the 2 weeks I spend on service, about 6 or 7 times a year. That’s when I exercise less, take cabs instead of riding the bus, and just generally get in a hunker-down mode.
But I always get back to my routine. You just have to find the sources that are right for you and discover your unique routine. Once you’ve set it up, sticking with it turns out to be not so tough.
What’s your routine for keeping up? Share what works for you with everyone who’s reading here on the NEJM Knowledge+ blog. I’m always open to suggestions and new ideas.
Dr. Levy is a general internist with a hybrid inpatient/outpatient clinical role at a large public hospital in New York City. She also serves on the faculty of the New York University School of Medicine.
This post is part of the “Lifelong Learning” series. Read about a mid-career perspective on lifelong learning in medicine by Dr. John Mandrola, a clinical electrophysiologist and blogger at drjohnm.org and theheart.org.