How doctors learn has changed dramatically

Any doctor seeing patients has had to field questions unrelated to their specialty.

Although patients know our specialty, they don’t think of us as just their gastroenterologist or their endocrinologist — they think of us as their doctor and believe we’re supposed to know everything. Patients place a tremendous amount of trust in us, and I am always concerned about providing the best guidance on a medical condition that is outside my area of expertise.

I’m a gastroenterologist. I care for patients with GI issues and perform endoscopic procedures. I recently encountered a situation where a patient was about to leave my office after a routine checkup and asked a question about a non-GI issue.

Fortunately, I’m participating in the internal medicine Longitudinal Knowledge Assessment (LKA) from the ABIM, where I also serve as chair of the Board of Directors, and had just come across a question with a similar presentation of symptoms. The clinical scenario and symptoms matched those of my patient. The answer to the LKA question and the rationales behind it were invaluable because I had answered the question incorrectly and I identified a gap in my knowledge.

As a result, I was confident in knowing that I was providing the best advice to the patient and maintaining his trust in me.

Now in its third year, the LKA — ABIM’s newest way of assessing physician knowledge — is proving to be an overwhelmingly popular way for doctors to maintain their certification over the traditional 10-year maintenance of certification (MOC) exam.

Other doctors have had similar experiences and said the immediate feedback and rationales they receive after answering test questions have paid dividends in the exam room because they are able to put knowledge gained from the LKA into practice.

Today, 80% of eligible physicians are choosing the LKA over the traditional, 10-year MOC exam to meet their MOC assessment requirement. More than 72,000 certificates are being maintained through the LKA, and it is being chosen at a rate of four to one over the 10-year exam. Physicians like Laura E. Evans, MD, MSc, chair of the ABIM Critical Care Board Medicine, said she hated going to a test center after cramming for the 10-year exam for 6 to 8 weeks.

Now, Evans, the quadruple-certified medical director of critical care at the University of Washington Medical Center, deliberately answers the requisite number of LKA questions “cold.” She said she doesn’t stress about incorrect answers because it spurs her to follow up on gaps in knowledge, giving her a broad base of information needed to treat her patients.

Echoing Evans, Pennsylvania oncologist Suresh G. Nair, MD, said the LKA gave him the opportunity to refresh his knowledge and regain his certificate in hematology. Nair said he felt more confident ruling out acute promyelocytic leukemia while on call one night and was more comfortable managing autoimmune hematologic complications of immunotherapy as a result of information he picked up on the LKA. Nair is currently the chair of the ABIM Medical Oncology Board.

A 2023 ABIM survey of general internists participating in the LKA found that Nair and Evans are like the 98% of takers who said they learn from the immediate feedback that LKA provides.

Evidence suggests that a well-trained, regularly tested doctor will save lives and keep patients out of the hospital. A BMJ Open study of 13 conditions published in 2021 concluded that doctors who received high MOC exam scores on diagnostic-related questions made fewer diagnostic errors, resulting in a 30% lower risk for all-cause mortality and about a 40% lower risk for hospitalization or ED visits for conditions at risk for diagnostic error, from pulmonary embolism and congestive heart failure (CHF) to sepsis and spinal cord compression.

Texas internal medicine physician Nagendra Gupta, MD, SFHM, CPE, said questions on the LKA help him with clinical decision-making.

While studying for the LKA, Gupta, a medical director at Texas Health Arlington Memorial Hospital, said he learned about the inclusion of SGLT2 inhibitors in guideline-directed treatment for CHF before it was formally included as a standard component of the CHF order set. Recognizing the potential benefits for patients with CHF, this new recommendation was promptly adapted into his routine workflow.

Similarly, while taking LKA exam questions recently, Evans said she learned about a nerve block that she ended up prescribing for a patient with pancreatic cancer, as well as a newer class of medicines associated with an unusual form of diabetic ketoacidosis that she didn’t often come across in her practice.

Evans’ experience is not unusual. Seventy-three percent of respondents to the ABIM survey of general internists said what they learned while taking the LKA has led them to make or plan on making changes to their medical practice.

On average, doctors spend around 4 hours a year answering LKA questions, receive immediate feedback and have the flexibility to answer questions before or after work, between appointments or wherever suits them.

What they may not have counted on is how timely and relevant the information would be to their daily medical practices.

References:

• Gray BM, et al. BMJ Open. 2021;doi:10.1136/bmjopen-2020-041817.
• Longitudinal Knowledge Assessment. https://www.abim.org/lka/. Accessed May 10, 2024.
• Maintaining certification. https://www.abim.org/maintenance-of-certification/. Accessed May 10, 2024.
• Roswell RO, et al. JAMA Netw Open. 2024;doi:10.1001/jama.2024.0374.

For more information:

Rajeev Jain, MD, can be reached at rjain@tddctx.com.