Critical thinking and Lifelong Learning

Learning is never finished. This is particularly true in the field of medicine. Medical school is only the beginning. Doctors must commit themselves to a lifelong of learning.

Why lifelong learning is important

Lifelong learning completes medical training - Medical schools emphasize the pharmaceutical and surgical management of acute medical problems. Unless a doctor practices exclusively in the hospital setting, this leaves considerble knowledge gaps with respect to chronic disease and wellness. Lifelong learning fills in these gaps and helps to provide patients with a comprehensive approach.

Lifelong learning updates obsolete knowledge. Medical knowledge grows at an exponential rate. In 1950, the knowledge doubling time was about 50 years. Presently, there are one million biomedical scientific papers published per year, the knowledge doubling time is 73 days, and most medical knowledge is obsolete after 5 years. This makes lifelong learning essential.

Lifelong learning leads to intellectual humility - Doctors that continue learning after medical school will invariably witness many of their most cherished ideas become obsolete. In fact, they may have caused harm - a humbling realization. However, this is the nature of scientific discovery. Ideas are generated and, over time, they are tested with progressively more rigorous tests. What initially looked promising is eventually disconfirmed. Learning to let go of wrong ideas - unlearning - is as important as learning new ones.

Lifelong learning leads to good medical decisions - All the above traits (comprehensive knowledge, updated knowledge, and the ability to discard obsolete knowledge) lead to an accurate knowledge base - the prerequisite of helping patients make good medical decisions.

The seeds of Lifelong Learning planted in medical school

Medical education is not only about memorizing facts, it’s about being inspired to learn, and learning how to think. As the Roman philosopher Plutarch wrote,

"The mind is not a vessel to be filled, but a fire to be kindled."

The general principles of how to think are:

• Question authority - Inquiry is a good thing. Scientific progress is achieved when anomalies are identified and paradigms are challenged.

• Critical thinking - The mind is prone to error; such as: cognitive bias and logical fallacy. Be aware and try to correct these errors in yourself and others.

• Scientific integrity - The truth is more important than being right.

• Learn from your past - The history of medicine, our past performance, is important to help predict the future.

• Intellectual humility and flexibility - Science is an imperfect process. It can never to be “right”, it can only be “less wrong”.

These general principles equip a doctor with the tools to address any medical problem they encounter. I was fortunate enough to train at excellent medical institutions with mentors that shared these principles (click here for my biography). If you want to learn more about your doctor's training, it is available here. Including: license status, board certification status, malpractice claims, etc.

Lifelong Learning continues with Case-based Learning

The most natural way for doctors to learn is through the cases they see every day in practice. This is known as Case-based Learning. It is so powerful that some medical schools, such as McMaster University in Canada, use it exclusively from day one of medical training. There are several advantages to case-based learning, including:

• Improved understanding of knowledge

• Improved retention of knowledge

• Stimulation of interest

• Promotion of responsibility and accountability

• Teaching problem solving skills and critical thinking

• Promotion of self-learning behavior

• Enhanced resourcefulness - where and how to access information

Deliberate practice

However, simply seeing case after case is insufficent to become an expert. Contrary to popular belief, “10,000 hours” on its own, is not enough to become an expert. HOW one practices their skill is crucial. This is a difference between "practice", and "deliberate practice". A good musician, for instance, doesn’t practice the entire piece, they practice the part they’re bad at, over and over again. Likewise, just seeing a high volume of cases is insufficient for a doctor to improve, they must follow up on those cases, and find out where they went wrong. This is deliberate practice.

Obstacles to lifelong learning

There are several obstacles to Lifelong Learning. The greatest of which is excessive work loads, where the shear volume of cases make it impossible to follow up and learn from them. This is compounded by the problem of physician burnout. Over 50% of doctors are so disenchanted with the practice of medicine they simply lack interest in learning. Other obstacles to lifelong learning include:

• Poor initial training - Educated at schools interested only in students passing board exams.

• Overconfidence - Lacking awareness of one’s own ignorance and limitations. A cognitive error common in doctors.

• Conflicts of interest - A doctor’s ability to learn may be clouded if it conflicts with their ability to earn. As American author Upton Sinclair famously said,

"It is difficult to get a man to understand something when his salary depends upon his not understanding it."

Is your doctor a Lifelong Learner?

It may be difficult to determine whether your doctor is engaged in Lifelong Learning. A good sign is if they reference information DURING your visit. For example, "I don't know what the latest research shows, let me look that up", or "Let me see what the current recommendations are". Ironically, in the past, looking up something in front of a patient was viewed as a sign of ignorance. Now, it’s a sign of intellectual humility, and a deep understanding of how modern science works - knowledge becomes obsolete very quickly.

A sign of a lifelong learner is a doctor that references information during and after your visit.

Another sign of a Lifelong Learner is seeking follow up on your case. Misdiagnosis and failed treatments are commonplace in medicine. Instead of being defensive or evasive, Lifelong Learners view them as opportunities for improvement.

Concierge Medicine and Lifelong Learning

The Concierge Medicine model is ideal for incorporating Lifelong Learning. With a low patient volume, I am able to devote approximately one third of my day to learning, most of which is Case-based. With almost every patient and case I see, I will review of my knowledge on that topic. Over the decades my knowledge gaps have been filled, and I can now provide a comprehensive approach. Furthermore, without conflicts of interests, it’s easy for me to adopt what's new, and discard what's obsolete. To consolidate my learning, I share what I've learning with my patients in educational emails and lectures. Essentially, with every case, I get to learn, and my patients are guaranteed of receiving the most up-to-date care. Case-based Learning is certainly a win-win approach for everyone.

.