So Much to Learn

Hi everyone,

There are so many smarties around here. I learn from everyone, from attendings to interns.

I used to be intimidated by the reminders of how much I didn’t know, but with time and maturity, I realized what a privilege it is to work with colleagues who had so much to teach me. Eventually, I discovered I was also teaching them.

I was drawn to internal medicine because I love learning- on rounds, in conferences, and on my own. Internists need to know a lot, and knowledge helps us ask the right questions, make sound decisions, and solve medical mysteries.

It can be hard to fit learning into our overloaded days, when we barely have enough time to eat, sleep, and exercise. But we all need to study, so here’s a realistic plan for all you busy people:

1. Look it up: Questions arise everywhere and always. Which antibiotic? One anti-platelet agent or two? Transudate or exudate? We can always ask colleagues and consultants for help, but nothing beats seeking answers ourselves, in textbooks and online. UpToDate is a great starting point, providing links to original sources when you have the time and interest to dig deeper.
2. Know the latest: Practice changes rapidly- new vaccine schedules, new biologics, and new technologies. To keep up, I subscribe to NEJM Journal Watch, which provides concise summaries and critiques of new publications with links to full articles. I also subscribe to alerts from general medicine journals such as NEJM, Annals of Internal Medicine, JAMA, and JAMA Internal Medicine, as well as PCCSM, medical education, and ethics journals (you can sign up on their website). I don’t have time to read journals from cover to cover but I do read abstracts, perspectives, and editorials, while diving into full length research articles, reviews, CPCs, and guidelines when I can.
3. Question Banks: UWorld is a popular resource to prepare for Step 3. To expand your internal medicine knowledge, I recommend MKSAP. Many residents use MKSAP’s well-written, concise text to prepare for specialty rotations. MKSAP’s questions are targeted, elegantly presented, relevant to clinical practice, and track closely to questions on the In-Training Exam (ITE) and Boards. I try to answer 3 MKSAP questions every day, and I advise residents to complete the whole question bank before graduation, which is an entirely attainable goal.
4. Media: If you like podcasts, check out The Curbsiders and The Clinical Problem Solvers, journal podcasts, and Yale’s very own Health and Veritas, hosted by Drs. Howard Forman and Harlan Krumholz. On X, you’ll find great content on #MedTwitter. If you like medical apps, try Journal Club, which features an extensive collection of landmark articles (H/T to Sanju Garimella for introducing me). I’m sure this list is incomplete, so please share resources with friends (and me).
5. Learn at work: We learn from doing. Work rounds, teaching conferences, procedures, and every patient encounter is a learning opportunity. Try interpreting images and EKGs yourself before seeking help. Ask questions when you don’t understand- you’re not the only one. We learn from each other.

Devoting even a modest amount of time each day to learning will make you a confident, knowledgeable internist. You’ll never know everything, but with time and effort, you’ll know a lot, which is what makes internal medicine so much fun.

Enjoy your Sunday, everyone. I’m headed out into the sunshine for a long bike ride.

Mark

P.S. What I’m reading:

• The Happiness Curve: Why Life Gets Better After 50 by Jonathan Rauch
• Age of Revolutions: Progress and Backlash from 1600 to the Present by Farid Zakaria

P.P.S. Final vacation pics: