How to continue to be the best doctor? Top Harvard physician and educator
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”, as every textbook says on its front page. So how to best continue developing as a physician today? How to keep up with the avalanche of new information? And sometimes it’s contradictory or even biased information. How not to burn out? – Wow, what a wonderful question! So one of the things I articulated when I was a faculty Dean for CME, – and what a privilege and honor it was for me to be in that position for 12 years, – 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’ll be able to inform them, because we have such world-renowned faculty, they are brilliant, they are clinicians, they are scholars, they’re great teachers. So 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’s a second “I”, and we should Inspire them and there’s a third “I”, so I called it the three “I”s: We need to Inform, we need to Inspire, and we need to help attendees Integrate what they learned into their day-to-day practice. So 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’re almost back to their baseline. It’s pretty sobering and it’s almost depressing. There’s a very simple thing we can do. And we do it in our medicine course. And I’m privileged to direct with my colleagues Martin Abrahamson and Mark Zeidel, the Chairman of Medicine. Flagship CME course for the department of Medicine at BI Deaconess Medical Center, it’s a week-long internal medicine CME course. At the end of every talk in the syllabus we’ve inserted one page and it says, “If 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. And we published a paper some years ago that if people do that, calling it “commitment to improve”, that they’re more likely to have integrated what they learn. So somebody hears our talk on Hepatitis C by me or one of my hepatology colleagues, and 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, If negative, I will vaccinate. Number two, I learned that marijuana smoking is a risk factor for hepatic fibrosis progression. So I will ask each patient about marijuana smoking. Number three, I learned that hepatitis C is the cause of cryoglobulinemia Type 2. So every time I see a patient with chronic hepatitis C, I’ll ask them about arthralgias, purpura and peripheral neuropathy. If 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. So – Inform, Inspire, Integrate. In the “Inspire”, what we do is we embed during our seven-day course six keynotes and we’ve 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 top 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? And he would give that talk in our course for years in a row. So that’s the “Inspiration” part. One year, actually, for two years, I had an ex-prisoner of war in Vietnam, Captain Charlie Plumb give a keynote. And 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”, which is also one of the tenets of leadership. Leaders have to mentor, nurture other people.