How physicians can continue to learn efficiently? 7
Professor Sanjiv Chopra led Continuing Medical Education at Harvard Medical School for 12 years. It’s hard to become a well-trained doctor. But how to stay at the top of fast-changing medical science and practice? For 12 years you led the largest Continuing Medical Education enterprise in the world, as a Dean for continuing medical education at Harvard Medical School. How to become a competent and compassionate physician is a very large question. But then medicine is an “ever-changing science”. Every textbook says on its front page. Dr. Sanjiv Chopra, MD. How to best continue developing as a physician today? Dr. Anton Titov, MD. How to keep up with the avalanche of new information? Dr. Anton Titov, MD. sometimes it is contradictory or even biased information. How not to burn out? Wow, what a wonderful question! Dr. Sanjiv Chopra, MD. One of the things I articulated when I was a faculty Dean for CME. What a privilege and honor it was for me to be in that position for 12 years. It was that when our attendees come to our courses. We had 275 HMS postgraduate courses a year. In aggregate, about 80,000 clinicians were coming from 150 countries. I said, “We will be able to inform them, because we have such world-renowned faculty, they are brilliant, they are clinicians, they are scholars, they are great teachers. Dr. Sanjiv Chopra, MD. That will happen automatically no matter what kind of course it is. A cardiology course from the Brigham and Women’s Hospital, a renal course from the Beth Israel Deaconess Hospital, or a Children’s Hospital course. It doesn’t matter, we have amazing faculty. They will inform people and people will even be in awe of their knowledge and their teaching skills. But there is a second “I”. We should Inspire them and there is a third “I”, so I called it the three “I”s: We need to Inform, we need to Inspire. We need to help attendees Integrate what they learned into their day-to-day practice. Dr. Sanjiv Chopra, MD. Studies that are talking about the “integrate” part, have shown that if you test people before CME course, they had a certain score. You do a week-long course, a week later you ask them the same questions – the score goes way high. But if you test them a year later, they are almost back to their baseline. It is pretty sobering and it is almost depressing. There’s a very simple thing we can do. We do it in our medicine course. I’m privileged to direct with my colleagues Dr. Martin Abrahamson and Dr. Mark Zeidel, the Chairman of Medicine. Flagship CME course for the department of Medicine at BI Deaconess Medical Center, it is a week-long internal medicine CME course. At the end of every talk in the syllabus we have inserted one page and it says, “Sometimes this talk is relevant to my practice, I will now incorporate: one, two, three…” They write down and then they sign their name and they put the date. We published a paper some years ago that if people do that, calling it “commitment to improve”, that they are more likely to have integrated what they learn. Dr. Sanjiv Chopra, MD. Somebody hears our talk on Hepatitis C by me or one of my hepatology colleagues. At the end they say: “From now on every time I see a patient with hepatitis C, I will check for hepatitis A and B antibodies, Sometimes negative, I will vaccinate. Number two, I learned that marijuana smoking is a risk factor for hepatic fibrosis progression. Dr. Sanjiv Chopra, MD. I will ask each patient about marijuana smoking. Number three, I learned that hepatitis C is the cause of cryoglobulinemia Type 2. Dr. Sanjiv Chopra, MD. Every time I see a patient with chronic hepatitis C, I’ll ask them about arthralgias, purpura and peripheral neuropathy. Sometimes any of those are positive in the history, I will check for cryoglobulins, check renal function, check a rheumatoid factor.” They sign their name and date it. Dr. Sanjiv Chopra, MD. Inform, Inspire, Integrate. In the “Inspire”, what we do is we embed during our seven-day course six keynotes and we have even incorporated for many years a leadership symposium, six talks on leadership, quality improvement, raising the bar, leadership by example Dr. Alvaro Pascual-Leone is a colleague of ours, he’s a Professor of Neurology, considered one of the leading 50 neuroscientists in the world. He gives an amazing talk called “The neurobiology of leadership”. What do followers look for? What are mirror neurons? How do mirror neurons impact leadership? Dr. Anton Titov, MD. he would give that talk in our course for years in a row. Dr. Sanjiv Chopra, MD. That is the “Inspiration” part. One year, actually, for two years, I had an ex-prisoner of war in Vietnam, Captain Charlie Plumb give a keynote. He gave a talk “People with passion performing with pride”. He had a standing ovation and it was absolutely mesmerizing to watch this 74-year-old brilliant ex-prisoner of war give a talk about “packing other people’s parachute”. This is also one of the tenets of leadership. Leaders have to mentor, nurture other people.
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