Correspondence  |   January 2015
In Reply
Author Notes
  • University of Pennsylvania, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania (A.J.S.).
  • (Accepted for publication September 23, 2014.)
    (Accepted for publication September 23, 2014.)×
Article Information
Correspondence   |   January 2015
In Reply
Anesthesiology 01 2015, Vol.122, 219-220. doi:
Anesthesiology 01 2015, Vol.122, 219-220. doi:
Dr. Kempen’s Letter to the Editor provides his perspective on the study by Hand et al.1  and our accompanying Editorial2  recently published in Anesthesiology. Kempen asserts that medical knowledge changes rapidly and as such, “This may directly compromise the utility of any DST [Decision Support Tool], especially if failing to update rapidly-while physician’s lifelong learning does facilitate updates.”
Were it so easy and simple! How wonderful it would be if physicians were able to conduct their own lifelong learning in a dedicated, systematic, rigorous, and comprehensive fashion. We all wish we could faithfully read all of the pertinent journals in a most timely manner; ideally, we would also perform critical appraisals of each manuscript and incorporate only the appropriate results into our daily medical practice. Of course, this theoretical physician would also attend to patient care’s long hours while balancing all of life’s outside demands. Professional and personal life just do not allow for this ideal vision of lifelong learning.
Lifelong learning is essential for effective and efficient patient care. Teunissen and Dorman3  remind us that medical schools do not adequately prepare new practitioners to assume the responsibilities of patient care and simultaneously be the best lifelong learners. Panda and Desbiens4  present a strong case for incorporating lifelong learning concepts into undergraduate and graduate medical education. Becker et al.5  studied stress and burnout among physicians and attribute difficulty in staying current with new knowledge as one contributor to the problem. Perhaps most importantly, Burden et al.6  have studied the use of cognitive aids during simulated anesthetic emergencies (and specifically a designated “Reader” to assist the “Leader” during these events). They found that whereas none of the subjects performed all of the critical actions in the control group, introduction of a “Reader” with a cognitive aid resulted in execution of all described critical actions.
As aptly pointed out by Li et al.7  in their analysis of and suggestions for lifelong learning strategies, multiple barriers stand in the way of physicians attempting to reach their self-directed learning goals. “Five themes emerged that characterized barriers to achieving learning goals: difficulty with personal reflection, environmental strain, competing demands, difficulty with goal generation, and problems with plan development and implementation.”7  To assist physicians genuinely wanting to be current in their knowledge and practice (this is the overwhelming majority of practitioners), Li et al. suggested strategies to offset the barriers, including the development of external mentorship and accountability. Experts in specific medical practice areas and in medical education are the mentors from whom we all benefit when they guide the content to learn and suggest our learning expectations to gain that education. Recognition of this is one of the key messages from the study of decision support tools by Hand et al.
Kempen claims that our Editorial promotes, “… the unproven utility of recertification …” and supports, “… transferring simulation and OSCE [Objective Structured Clinical Examination] applications for medical student/resident education onto Recertification …” As educators, we champion a very different message than claimed by Kempen; we asked a question and provided our answer, “How best then to teach and learn safe provider autonomy? … provide … ‘perfect practice’ via simulation and use of decision support tools …”2  We champion simulation, decision support tools and other cognitive aids, and all types of hands-on experiences for their ability to facilitate relevant lifelong learning. We are especially supportive of utilizing the Internet to make the transmission of new information instantaneous. We make no assertion that these learning tools enhance any certification/recertification program, but decreasing practice variability and improving adherence to published guidelines are beneficial to our patients, and there are data to support the role of cognitive aids in these goals.
Competing Interests
The authors declare no competing interests.
Justin L. Lockman, M.D., Alan Jay Schwartz, M.D., M.S.Ed. University of Pennsylvania, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania (A.J.S.).
Hand, WR, Bridges, KH, Stiegler, MP, Schell, RM, DiLorenzo, AN, Ehrenfeld, JM, Nietert, PJ, McEvoy, MD Effect of a cognitive aid on adherence to perioperative assessment and management guidelines for the cardiac evaluation of noncardiac surgical patients.. Anesthesiology. (2014). 120 1339–53 [Article] [PubMed]
Lockman, JL, Schwartz, AJ Learn it-memorize it! Better yet–open your smartphone and use the information!. Anesthesiology. (2014). 120 1309–10 [Article] [PubMed]
Teunissen, PW, Dornan, T The competent novice lifelong learning at work.. BMJ. (2008). 336 667–9 [Article] [PubMed]
Panda, M, Desbiens, NA An “education for life” requirement to promote lifelong learning in an internal medicine residency program.. J Grad Med Educ. (2010). 2 562–5 [Article] [PubMed]
Becker, JL, Milad, MP, Klock, SC Burnout, depression, and career satisfaction: Cross-sectional study of obstetrics and gynecology residents.. Am J Obstet Gynecol. (2006). 195 1444–9 [Article] [PubMed]
Burden, AR, Carr, ZJ, Staman, GW, Littman, JJ, Torjman, MC Does every code need a “reader?” Improvement of rare event management with a cognitive aid “reader” during a simulated emergency: A pilot study.. Simul Healthc. (2012). 7 1–9 [Article] [PubMed]
Li, ST, Paterniti, DA, Co, JP, West, DC Successful self-directed lifelong learning in medicine: A conceptual model derived from qualitative analysis of a national survey of pediatric residents.. Acad Med. (2010). 85 1229–36 [Article] [PubMed]