Managing your feelings when a patient has a bad prognosis or outcome is an important part of self-care for doctors.
I can always tell who has recently racked up CME hours studying for board exams. They're the physicians who know the most obscure facts about any presentation. Looking over your shoulder in the emergency department, they say things like, "I see your patient's X-ray shows a Pellegrini-Stieda lesion! Presumably that came from a Stieda fracture of the medial femoral condyle!" This goes on for about six weeks, after which they revert to normal behavior: "Hey, that femur looks ... different."
This is a normal pattern of behavior. We learned it in undergraduate and medical school when we studied for tests, then purged the information to make room for more. When we obtain CME hours, whether it's for our initial boards, our recertification exams or for our own professional growth, there's a strong tendency to cram in a lot of knowledge in CME courses, then slowly but surely forget it over the weeks and months that follow. Despite that, it's critically important that we learn how to apply the skills and knowledge CME offers.
The cornucopia of continuing medical education
I was cleaning out my office recently and found many CME course handouts. As I thumbed through, I found pages and pages of handwritten ("hand-scratched," I should say) notes on blank sheets and in the margins of the printed text. Apparently, in planning how to apply skills and knowledge from those courses, I had high hopes that I would review these notes in the future. They gathered dust for years, and many of them recently helped us build a nice evening fire in our fire pit.
Twenty-seven years into practice, I've learned a few things about learning. I know I need to keep learning to provide quality care to my patients. Medicine is in a constant state of evolution, and new information comes at us fast. I know that I have to learn in a way that's relevant and that leaves me with useful, accessible information to improve the health and safety of my patients. Finally, I see that thanks to my memory and the wonders of technology, I don't have to write down everything I learn.
The internet has obviously changed the availability of CME hours. When I was first in practice, much CME was obtained in person at meetings or through print material or recordings mailed to the physician. Now, live conferences are only one option, since we can learn via livestreaming, downloads of lectures such as those provided by AudioDigest and downloads of previously recorded conference lectures and print material.
We can also learn (and obtain CME hours) using podcasts or even products like UpToDate. UpToDate not only allows the clinician to learn as they look up relevant information for patients while treating them, but it also offers CME credits for the time spent searching and reading. In this format, a physician can easily apply CME information to patient care. Particularly in acute care settings, when looking up medication side effects, critical care treatment pathways or information on COVID-19, the ability to learn and directly apply information simultaneously is wonderful.
How to apply CME to practice
How do we retain and use the information from CME courses at the bedside? It may be the conference we attended last month with our family (while trying to entertain the kids as well as learn), the CME mailed to us, the AudioDigest lecture we enjoyed or the podcast we listened to on the way to work yesterday.
One critical way to ensure we learn is to look for CME that's relevant. While it may be fun to learn about areas only tangential to our practices, we learn best when we find material within our area of practice, interest and previous expertise. What we're doing with our CME hours, then, is adding new information while honing our existing knowledge and skills. As an emergency physician, conferences on general emergency medicine, pediatric emergency medicine, resuscitation or ultrasound are likely to stick in my memory.
Next, I've found that it's important to use that skill we learned when we became physicians: We have to listen. When I go to conferences or enjoy recordings, I listen carefully. I used to feverishly take notes, but now I try to focus on the most important points. If I do take notes, they're limited and focused on points I can remember and use. Given that most conferences have relevant information available online to attendees (or subscribers), it's easy to revisit when we're prompted by a patient encounter or dilemma. This also makes it much easier to apply knowledge from the CME hours we completed. Still, it may be useful to take some notes on paper or create a file on a tablet, computer or smartphone to refresh your memory in relevant cases.
CME can present us with overwhelming amounts of information, which isn't a surprise since medical practice is often overwhelming, too. However, most of us use smaller bits of information on a daily basis and then look up the rest. CME courses, however we access them, provide us with new facts or remind us of old ones. They offer us reminders of things that are, were and will be important. Most importantly, they give us the information we need to provide the best care to the patients who trust us with their health and their lives.