Lifelong Learning

Becoming an orthopaedic sports medicine specialist is a prolonged exercise in delayed gratification. Throughout long years of medical school, residency, and fellowship, trainees study hard, looking forward to the day when they will finally finish their education and begin to practice. When that day arrives, however, they quickly realize that they have only completed the initial phase of a lifelong career of learning and relearning. When one of our fellows is approaching the end of his tenure, we sit down together to talk about the future. ‘‘I hope that you will take many of the methods that you have seen me use and incorporate them into your practice,’’ I tell them. ‘‘However, if 5 years from now you are still doing everything exactly as I have taught you, I will be very disappointed. ’’ Orthopaedic sports medicine is in a constant state of flux and evolution. New theories and techniques are continually emerging, some ordained to be canonized as landmark innovations, others to be cast ignominiously onto the compost pile of knuckleheaded ideas. Individual practitioners, deeply enmeshed in patient care, are hardpressed to find the time merely to become aware of new theories and techniques, much less to distinguish the worthwhile from the worthless and incorporate the former into their routine. To try to keep up with this tidal wave of information, they turn to the eclectic amalgam of reading materials, seminars, congresses, instructional courses, and cybernetic experiences collectively known as Continuing Medical Education, or CME. Medical education specialists have devoted considerable attention to studying the efficacy of CME. In 2007, the Agency for Healthcare Research and Quality of the US Department of Health and Human Services published a massive systematic review of the effectiveness of CME prepared for them by the Johns Hopkins University Evidence-Based Practice Center. The report bemoaned the generally low quality of the component studies, a deficiency the authors attributed to the lack of rigorously validated outcome measures for evaluating the efficacy of CME programs and instruments. Nevertheless, the report concluded that ‘‘the literature overall supported the concept that CME was effective, at least to some degree, in achieving and maintaining the objectives studied, including knowledge, attitudes, skills, practice behavior and clinical practice outcomes. ’’ Most reviews of the effectiveness of CME have focused on methods such as live presentations and workshops, personalized practice audits known as educational detailing, and interactive computer programs. This is perhaps not surprising, since many authors have concluded that live media are more effective than print and multimedia are more effective than single media interventions. However, the reading of journal articles, whether on paper or online, remains one of the most easily accessible and economical ways to encounter novel ideas. In one of the relatively few recent studies that specifically examined journal reading as a form of CME, Cole and Glass asked 138 physicians how reading journal articles for CME credit had helped them to progress along the following 3-stage learning paradigm: Stage 1, initiating awareness of a gap in their knowledge base; Stage 2, prompting them to learn more about the topic from other sources; and finally, Stage 3, leading them to incorporate this new knowledge into patient care. The authors concluded that journal reading was helpful at all 3 stages, but particularly in the first stage—introducing the reader to new information. Cole and Glass pointed out that effective CME should not always be expected to induce a change in physician behavior, as sometimes it serves to reinforce correct practice methods that are already present. Every time you read an article in AJSM or any other journal, you are engaging in an educational activity. However, reading alone is a relatively passive way to access knowledge. Reviews of CME efficacy have generally shown that interactive methods are more successful than passive ones at leading to the incorporation of new information. With the goal of introducing an interactive element to its readers, AJSM has begun offering monthly electronic CME courses based upon its Current Concepts review articles. Not only are the Current Concepts among the most widely read AJSM articles, but studies on physician CME have emphasized that review or overview articles are more likely to produce a commitment to change a physician’s practice routine. We hope that their interactive design will maximize the learning value of these courses, which can be accessed via a quick link embedded in the electronic version of AJSM (http://ajsm-cme.sagepub.com). Journal subscribers will automatically receive complimentary ‘‘tokens’’ that will entitle them to take 2 CME courses; additional tokens can be purchased by subscribers or any other reader for a nominal fee. Participants will start each course by taking a pretest to assess their baseline knowledge on the subject covered in the review article. They will then be able to read the article in print or online, according to their personal preference. Next, they will proceed to retake the test and see what they have learned from their reading. Clicking another link will reveal the preferred responses and also highlight the text in the article that supplies the relevant information for each question. Readers will also be asked to answer a few questions about the quality of the teaching exercise that will help the staff at AJSM continually improve the CME learning experience. On The American Journal of Sports Medicine, Vol. 38, No. 2 DOI: 10.1177/0363546509360181 2010 American Orthopaedic Society for Sports Medicine