Make the most of time spent at Internal Medicine 2014

Learning is a progressive, contextual, social and active process. Time spent at ACP's Internal Medicine 2014 meeting is well spent.

I am still relatively new to the Internal Medicine meeting. As an academic physician with extensive teaching responsibilities, my daily work life is an intensive CME experience. Even in the dark ages, teaching exercises that I was expected to participate in, such as noon conference and Grand Rounds, gave me more than enough credits to satisfy the California Board of Medical Quality Assurance. It's gotten even easier now that point-of-care resources like ACP Smart Medicine award us CME points for answering patient care questions.

Through the mid-1990s, I came to the Internal Medicine meeting, then called Annual Session, only if I was asked to give a talk, and I usually left soon afterward. It wasn't until the late 1990s when I ran, unsuccessfully the first time, for Governor-elect for the Northern California chapter that I began to pay more attention to the meeting. Right away, I noticed what an impressive event it is. What really struck me, even more than the high quality of the presentations, was the quality of the audience. I was awed by the attendees, practicing internists seeing patients 9 or 10 hours a day. Without the benefit of my academic environment, they were all over the literature, engaging with the lecturers and each other. It made me proud to be an internist and a member of the College.

Internal Medicine 2014 will take place April 10-12 in Orlando, Fla. As we look forward to the College's premier educational event, I'd like to explore from an educator's standpoint how we can capitalize on what the meeting offers for our professional growth and the benefit of our patients.

The “learning sciences,” an amalgamated discipline synthesizing the perspectives of such diverse fields as educational psychology, anthropology and computer science/artificial intelligence, has confirmed what many of us have already experienced:

  1. 1. Learning is an active process;
  2. 2. It is developmental and progressive;
  3. 3. It is highly contextual; and
  4. 4. It is a social experience that is ultimately about capacity and identity.

How might these fundamental attributes of learning inform our approach to Internal Medicine 2014?

Learning is an active process. Many of us grew up with the “full pitcher-empty glass” mental model of teaching and learning. This conceptualization is all about the contents of the pitcher and its skill in pouring; the glass just sits there. But learning is hard work. If we just sit in a lecture we won't learn much, even if the lecturer is skilled and the experience is pleasant.

Lecturers can use several approaches to help engage and activate learners, and you will see several in use at Internal Medicine 2014. Audience response systems (ARS) are a now-familiar technique for creating an interchange between the audience and the material. However, you don't need technology to activate yourself. If a lecturer asks a question, even if it is rhetorical, focus on it, answer it, ideally in writing, and of course, take notes.

Learning is progressive and developmental. Your child has to learn to walk and run before you try to introduce her to soccer; likewise, we need to have a good grip on the fundamentals of acid-base disorders before tackling the “triple ripple,” that combination of respiratory alkalosis, metabolic alkalosis and metabolic acidosis. The trick is to know what we don't know and to find what a forefather of the learning sciences, Lev Vygotsky, called the “zone of proximal development.”

If you plan to attend the Friday session “Best Strategies in the Work-up and Management of Resistant Hypertension,” take 10 minutes beforehand to think about questions that have come up for you. Even better, pull up the records of a couple of patients and refresh yourself regarding the details of their situations (This one is a “two-fer”; I'll talk about the second reason to do this in a moment). If you had 20 minutes to talk over your patients with an expert, what would you want to talk about? And if you are planning to attend the Update in Cardiology or a Multiple Small Feedings of the Mind and you have MKSAP 16 installed on your iPad, consider taking 20 self-assessment questions first. You are likely to discover a zone of proximal development you didn't know you had.

Learning is contextual. It is very difficult to access and apply facts, concepts and skills that were learned in one context in another context. The refractoriness of this “transfer problem” is, in part, driving medical schools to put students in patient care settings in their very first week and to teach basic sciences, such as biochemistry and pharmacology, in a clinical framework.

It is also why so many of us link large blocks of knowledge to individual powerful episodes. I can never think about epiglottis without recalling the night I spent in the ICU with a 7-year-old boy who had stayed home from school that morning with a mild sore throat and who would be taken off life support the next morning. I encourage you to look for ways to create some context for the sessions you will be attending. Many speakers will do this for you by organizing their presentations around cases, but if you go to a session with specific patients of your own in mind, I guarantee it will be higher-yield.

Learning is social. This is the most important element and the one least well served by the glass-and-pitcher model. If you think about your most exciting learning experiences, it is likely that there were other people involved, that you were figuring something out in a community.

At Internal Medicine 2014, consider finding a meeting buddy or forming a study group. Get together each evening and preview the sessions you plan to attend the next day. Apply the strategies I have already discussed, but across a larger group. If you are going to “New Therapies for Hepatitis B and C” and your buddy is going to “Practical Orthopedics—The Knee,” send each other out with questions. Make sure your notes cover your buddy's area of interest, and ask his questions if the lecturer hasn't covered them.

Also, consider Tweeting as a way to connect with a virtual community. If you are experienced, you don't need this suggestion, but if you are new to Twitter, Internal Medicine 2014 would be a great place to start. Tweeting is a great way to focus your attention on finding the essential, novel or unexpected elements of a presentation and sharing them with a broader group. You can follow your peers' tweets and share your own by using the hashtag #im2014.

One penalty of College leadership is that our numerous meetings don't allow us to take advantage of everything Internal Medicine has to offer. Next year, when I am out to pasture, I look forward to joining you all. In fact, I volunteer to be a “meeting buddy” with a couple of ACP friends I haven't met yet. Until then, you'll have to enjoy the meeting for me. Please, if you see me in the hall, decorated with the fancy ribbons the College has us wear, grab me and say hello. I know I speak for all College leaders when I say we love to hear from you and to learn what you think the College does well and how we can serve you better.