In a learning environment, such as when listening to lectures, engaging in clinically focused discussions with colleagues, or reading articles or books, there are three types of information that one is exposed to.

First, there is new information. This information is almost always recognized by the learner as being new and potentially valuable. Thus, the learner is primed to attend to it and consider how it might change his or her understanding of a topic and be applied in clinical practice.

Second, there is information provided that is not new to the learner. However, although already known, this information has never been fully applied. This is the type of information that may be the most common. This known-but-not-applied information remains a rich source of applicable knowledge, that is, it waits in its availability to finally be applied. If we assume for the moment that this information was appreciated in its value to the learner when first learned, then the question is why it was never applied and often nearly forgotten. Perhaps the answer is that he learner does not have the habit of assertively applying what is learned. Another reason is that information, even when incorporated into one’s knowledge base, is valuable only for certain conditions or under certain circumstances. These conditions or circumstances may be uncommon and, thus, may not arise for an extended period of time. The more time elapses, the more likely it becomes that this newly acquired knowledge fades into the background. Even if not fully forgotten, it becomes dormant, as good as forgotten.

Third, there is information that is well-known and well-applied. Even here, reading or hearing it again can be valuable in that it confirms and strengthens the learner’s knowledge and ways of applying it. Such confirmation, or even strengthening, can be helpful for clinicians who are tasked with making life and death decisions. Decision-making of such gravity takes a toll on the decision-maker. It is normal in such situations to question oneself on whether such grave decisions made have been the correct or reasonable ones. After all, all clinicians work under conditions of inherent uncertainty. Even good decisions can result in bad outcomes. Thus, receiving confirmation from an expert on a given topic can be a welcome reassurance. It is welcome because it builds the learner’s confidence and, by doing so, it may extend that clinician’s career lifespan. This latter point needs some explanation: my belief is that every clinician tasked with making life and death decisions and/or carrying out complex operations, each having potential life and death consequences, eventually burns out. The clinician’s tolerance for making such grave decisions and bearing the consequences varies among individuals. Some clinicians may be so resilient to this ‘burden’ that they never reach their limit, no matter how long they practice. Other clinicians (the majority perhaps) can and do reach their limit and then may either retire early or change jobs or careers to ones associated with fewer life and death consequences.

Now, with that as background, my message to every clinician is that if something is worth learning, it’s worth applying. Because new information that is incorporated into one’s knowledge base remains at risk of never being applied and of lying dormant and eventually forgotten, the goal of every learner should be to apply that newly acquired knowledge as soon as possible. The learner-clinician should remain on the lookout for patient cases in which the new learning can be applied.

A helpful approach to aid in application is to make contact with the expert speaker or author and with the colleagues one attended a lecture, conference, or course with in order to seek clarification, support, and feedback when applying the newly acquired knowledge.

It can even be said that to truly learn something requires deploying it and doing so skillfully. Exposure to information and incorporating it into one’s knowledge base is the first half of a two-part process. The second half is deploying it skillfully. It is this second part that can never be fully learned from a lecture or even from viewing a demonstration. Application can only be achieved through one’s own attempts at application. This is the relation between knowledge and skill: knowledge is a prerequisite for skillful application, while skillful application is the fulfillment of knowledge.

The learning that occurs in listening to a lecture or attending a conference is the ‘sitting on one’s rear end’ part of learning. The attempts at skillful application are the ‘getting off one’s rear end’ part of learning.

Through what I just presented, another reason becomes clear on why new learning often remains unapplied: it is because deploying it requires having the confidence to make an attempt at application. To take a simple example: to prescribe a new medication that a clinician has never prescribed before, even after listening to lectures or reading about it, still seems fraught. The clinician needs to act from a condition of a lack of experience and a history of skillful deployment.

Even knowing a lot of information about a new drug does not seem enough for many clinicians to take the leap to attempt application. And an attempt it is: even though most medications, when guidelines are followed, are relatively safe to use, the clinician who is new to that medication is likely to make more mistakes than they would make after gaining a lot of experience prescribing that medication. Usually, these ‘mistakes’ lead to no harm, though sometimes they do.

And that’s the rub: if a clinician is to continue to keep up and grow, they must continually act with a lack of experience with new treatments. This takes an emotional toll. It is this that contributes, I think, to the ease with which we all fall into not applying some of what we learn. Application of new knowledge in the face of a lack of experience is draining to a certain degree. That’s why having colleagues around from whom one can get ‘curbside consults’ is so valuable.

To conclude: to truly use what we learn, we need to apply it, and to apply it means to start off from a condition of lack of experience. This hurdle is more easily overcome when one has access to experts and to colleagues with whom one can have a mutually supportive and consultative relationship.

Let me know what you think and any ways you think American Physician Institute can be helpful to you.

Yours in skillful deployment,
Dr. Jack

Language Brief

“An investment in knowledge pays the best interest.” — Benjamin Franklin

“Knowing is not enough; we must apply. Willing is not enough; we must do.” — Johann Wolfgang von Goethe

“The great aim of education is not knowledge but action.” — Herbert Spencer

“Tell me and I forget, teach me and I may remember, involve me and I learn.”— Xunzi

“Education is not the learning of facts, but the training of the mind to think.” — Albert Einstein