In medical education, barriers can result from inadequate technology that makes learning unproductive and inefficient.
Last month, a colleague interrupted our conference call to apologize. She was having trouble taking notes on our discussion because she recently switched to using her mouse with her other hand. She found that the active process of training her non-dominant hand and brain to work together kept her sharper and more focused and engaged with her work.
That sounded too interesting not to try. So the next day at work I switched my mouse to my non-dominant left hand. I became immediately annoyed. Typing and editing was drastically less efficient. My mental efforts were drained by having to focus on adjusting to using my left hand to do basic maneuvers like placing the cursor. I thought learning some new keyboard shortcuts would help, but that just took more time and I never could remember them. By the end of the day I had enough.
The thought of spending the week frustrated was demoralizing and I was eager to go back to my easy and efficient way of working. When I went back to work the next day, I tried it again and found myself slightly better at manipulating the mouse. By the third day, I was getting even better at it, being less conscious of my hand-eye coordination, and more productive at work. I thought I was making real strides, but when I returned home that night, I noticed that my mouse was designed for right-handed users and thus could not be used with my non-dominant hand. Tired and ready to give up, I recognized that I have had this feeling of exasperation before.
Many times throughout my career, I have felt frustrated when trying to learn new ideas, concepts, or medical procedures. These challenges started in medical school, continued during residency, and still occasionally dogs me today. Presented with the need to adapt to medical advancement, I have often resisted and tried to offer justifiable excuses for my resistance. I have told myself the newer way is unnecessary, less efficient, a fad, short-sighted, or even wrong.
Change has always been hard, but, for physicians, learning is an ongoing process. Although learning during medical school and post-graduate training was explicit, coordinated, and paired with evaluations and feedback, practitioners must continually learn over the course of their careers, often with less formal structure.1 Physicians also have an ethical obligation to learn continuously because this ensures acquisition of knowledge about the safe and effective practice of medicine that promotes competency and public trust in the profession. These professional obligations are so vital to the practice of medicine that they are codified in law and policy for professional licensing and board certification. Continuing professional education and maintenance of board certification all require that practitioners provide documentation of continuous learning to keep current with changing medical knowledge and practice.
Even without the regulatory and licensing requirements for continuing professional education, it is likely that many physicians would continue to pursue regular learning opportunities to stay current and competent in their field. Internal motivation is inherent for many practitioners, and the field of medicine draws those with a love of learning. It is difficult to get through medical school and residency without enjoying the learning process at some level. Physicians who are engaged with continuous learning often find that this process enables an active commitment to their profession and to their patients. Some of them also probably find it fun.
Possessing internal motivation or a recognition and commitment to the ethical obligations to continuous learning, however, does not ensure that such learning comes easy. As the analogy with my mouse suggests, there are significant barriers to adult learning that may keep more practitioners from continuous learning.
First, learning requires an openness and willingness to change that might entail a retreat from the comfort of routine. Leaving the safe harbor of one’s regular practice and experience may be a significant barrier for some to even attempt new learning. Second, learning requires both diligence and persistence. Learning something new, as many physicians have heard, requires at least 3 separate attempts (i.e., see one, do one, teach one), but in reality, requires much more than that. Developing new habits and changing practice patterns for the better can take time. Finally, structural barriers can thwart learning opportunities. My right-handed mouse was an unexpected, though remediable barrier.
In medical education, barriers can result from inadequate technology that makes learning unproductive and inefficient. Thankfully, structural barriers in conventional continuing professional education offerings are adapting to the ever changing needs of practicing medical professionals. Educational offerings are now more likely to incorporate available technology and basic principles of adult learning theory.2 More useful and effective web-based interactive technology, simulation-based education, and directed offerings for specific learning cohorts help self-directed learners make better use of available options.3
What keeps physicians from advancing their learning? If they have the motivation and the desire, perhaps there is a “right-handed mouse” that is holding them back.
David J. Alfandre MD, MSPH, is a health care ethicist for the National Center for Ethics in Health Care (NCEHC) at the Department of Veterans Affairs (VA) and an Associate Professor in the Department of Medicine and the Department of Population Health at the NYU School of Medicine in New York. The views expressed in this article are those of the author and do not necessarily reflect the position or policy of the NCEHC or the VA.
1. Brandt K. From residency to lifelong learning. J Craniofac Surg. 2015;26:2287-2288.
2. Kokemueller P, Osguthorpe JD. Trends and developments in continuing medical education. Otolaryngol Clin North Am. 2007;40:1331-1345.
3. Sehgal NL, Wachter RM, Vidyarthi AR. Bringing continuing medical education to the bedside: the University of California, San Francisco Hospitalist Mini-College. J Hosp Med. 2014;9:129-134.