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Table of Contents

Think

Assess

 Patient: Autonomy

 Practitioner: Beneficence & Nonmaleficence

 Public Policy: Justice

Conclude

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28. Life-Long Learning

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The doctor of the future will be a teacher as well as a medical practitioner. The medical practitioner’s real job will be to teach people how to be healthy.
~ D. C. Jarvis

Abstract

The patient-practitioner relationship is a special agreement between a medical practitioner and a patient that ensures confidentiality and privacy of protected health information. This relationship is based on the patient’s trust, the practitioner’s professional obligations, and societal expectations that medical practitioners engage in continuous learning to stay updated with the latest knowledge, skills, and ethical values in evidence-based medicine. The term “doctor” comes from the Latin word “docere” meaning “to teach” and reflects the role of a practitioner as a lifelong student and educator. Informed consent and patient autonomy are key aspects of this relationship. To act in the best interest of the patient and reduce the risk of harm, medical practitioners must engage in life-long learning. States require medical practitioners to earn a minimum number of Continuing Medical Education (CME) hours to renew their medical license. The medical profession also has a social contract with the community to maintain trust and receive more freedom in exchange for fewer regulations. Life-long learning is a medical and legal requirement, failure to comply can result in the loss of a medical license. Medical practitioners must embrace the importance of continuous learning to fulfill their responsibilities as educators, learners, and providers of quality healthcare.

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Think 

[28:1] The patient-practitioner relationship is a unique social contract between the patient and medical practitioner that establishes confidentiality and privacy of protected health information (PHI). This is based on the patient’s trust, professional obligations, and social expectations that medical practitioners will be engaged in life-long learning to stay up-to-date on the ever-changing knowledge, skills, and ethical values of evidence-based medicine.

[28:2] The term doctor comes from the Latin “docere” which means “to teach.” Doctor is a term of formal address that has been associated with being a practitioner because, in addition to being engaged in life-long learning as a lifetime student, practitioners are also responsible for being lifetime educators. The term preceptor comes from the Latin “praecipere,” which means “instructor.” Doctors educate each of their patients regarding prognosis, diagnosis, treatment options, and activities of daily living. As preceptors, doctors instruct and supervise the next generation of medical professionals, passing on clinical knowledge, skills, and ethical values to medical students.

Assess
Patient: 1) Autonomy

[28:3] Patient autonomy, as exercised through informed consent, is grounded in the patient-practitioner social contract. The patient trusts that the clinical diagnosis, prognosis, treatment options, risk assessments and benefits, and the answers provided will be up-to-date evidence-based medicine. Anything less than that questions the practitioner’s clinical competence and the legitimacy of the patient’s informed consent, especially if the patient’s consent is based on outdated and no longer relevant information. Informed consent as a shared decision-making process requires that the information provided by the practitioner is current and accurate. These conditions can only be met if the practitioner is engaged in life-long learning.

Practitioner: 2) Beneficence & 3) Nonmaleficence

[28:4] Professionally, medicine recognizes that if the practitioner is to maximize the patient’s best interests according to the patient’s reasonable goals, values, and priorities—beneficence (do good) and if the practitioner is to reduce even the risks of harm to the patient—nonmaleficence (do no harm) then that can be realized only if the practitioner is engaged in life-long learning. The patient-practitioner relationship exists with the assumption that the medical profession will take the necessary steps to ensure that their responsibility of life-long learning will occur universally among its members. 

[28:5] States require practitioners to earn on average 25 hours of Continuing Medical Education (CME) hours per year, for a total of around 50 hours biennially for the state medical licensing renewal cycle. The Accreditation Council for Continuing Medical Education (ACCME) accredits organizations that provide continuing medical education for practitioners, not individual educational activities. However, institutions must demonstrate that their Continuing Medical Education (CME) offerings comply with the Core Accreditation Criteria.

Public Policy: 4) Justice

[28:6] The medical profession has a social contract with the community in exchange for more professional liberty and fewer federal, state, and institutional regulations. These freedoms are dependent on the populace having trust that their health care providers are staying up-to-date with the knowledge, skills, and clinical practice of evidence-based medicine and ethical values, which can only occur through the practice and implementation of life-long learning. 

[28:7] Life-long learning is a medical and legal licensure requirement. Failure to attain the necessary Continuing Medical Education (CME) credit hours biennially results in failure to renew the state medical board license. Practicing medicine without a medical license is a prosecutable offense.

Conclude

[28:8] Although each state’s Continuing Medical Education (CME) requirements vary, the average state requirement for medical board license renewal is 50 AMA PRA Category 1 Credits™ biennially. Practicing medicine without a proper medical license is a prosecutable offense. It is imperative that medical practitioners have internalized the value and importance of life-long learning and sees themselves as learners, preceptors, and teachers.

[28:9] In summary, life-long learning is essential for medical practitioners to fulfill their responsibilities as educators, learners, and providers of quality healthcare. Practitioners must internalize the value and importance of continuous learning to maintain their medical license and uphold the trust placed in them by their patients and society. By doing so, they can ensure that they provide the most up-to-date evidence-based medicine and ethical values, ultimately improving patient outcomes and preserving the integrity of the medical profession.

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28. Review Questions

1. The term doctor comes from the Latin “docere” which means “practitioner.”

2. The term preceptor comes from the Latin “praecipere,” which means “advisor.”

3. Informed consent as a shared decision-making process requires that the information provided by the practitioner is current and accurate. These conditions can only be met if the practitioner is engaged in life-long learning.

4. The Accreditation Council for Continuing Medical Education (ACCME) accredits individual educational activities, not organizations that provide the education.

5. Life-long learning is a medical and legal licensure requirement. Failure to attain the necessary CME credit hours biennially results in failure to renew the state medical board license.

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28. Clinical Vignettes

1. Dr. Wilma Jenkins is a 35-year-old oncologist who has been practicing medicine for 10 years. She is committed to providing the best possible care to her patients with cancer and wants to ensure that she is up-to-date on the latest treatment options. As a medical practitioner, what is the most ethical approach for Dr. Jenkins to stay up-to-date on the latest advancements in cancer treatment and ensure patient safety?

2. Dr. Cedric Wallace is a 45-year-old practitioner who has been working in a busy emergency department for over a decade. One day, he is presented with a patient who has a rare and complex medical condition that he has never encountered before. He is unsure of the best course of action and how to treat the patient effectively. What is the most ethical approach for Dr. Wallace to ensure that he has the knowledge and skills to provide the best possible care for his patient?

3. Dr. Dakota Henderson is a 40-year-old OB/GYN who has been practicing for over 10 years. She has recently noticed that her patients are increasingly asking her questions about alternative and complementary medicine, and she feels ill-equipped to provide them with accurate information. How can Dr. Henderson ensure that she is providing her patients with the most up-to-date and accurate information regarding alternative and complementary medicine?

4. Dr. Oskar Zabrousky is a 55-year-old primary care practitioner who has been in practice for 25 years. He has noticed that his patients are increasingly asking him about medical marijuana and its potential benefits and risks. Dr. Zabrousky received his medical degree before medical marijuana was legalized in his state, and he feels ill-equipped to provide his patients with accurate and up-to-date information. What is the most appropriate approach for Dr. Zabrousky to ensure that he is providing his patients with accurate and up-to-date information regarding medical marijuana?

5. Dr. Darian O'Brian is a 40-year-old emergency department practitioner. She has noticed that her colleagues often rely on clinical intuition and prior experience rather than keeping up with the latest research in the field. Dr. O'Brian believes that this approach can be dangerous, particularly in emergency medicine where decisions must be made quickly and accurately. She is concerned that her colleagues are not engaging in enough life-long learning. What is the most appropriate approach for Dr. O'Brian to promote life-long learning among her colleagues?

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28. Reflection Vignettes

1. Dr. Sarah Dabrowski, a 35-year-old medical practitioner, is struggling to meet the state requirement of earning 50 AMA PRA Category 1 Credits™ biennially. Ms. Lee finds this requirement to be time-consuming, inconvenient, and expensive. She is a busy practitioner with a hectic practice and finds it challenging to take time away from her patients to attend conferences and workshops. She is also frustrated with the high costs of attending these events and feels that the financial burden falls solely on practitioners. The differential diagnosis includes the importance of continuing medical education for maintaining competence, staying up-to-date on the latest research and treatments, and improving patient outcomes. Ms. Lee recognizes the importance of continuing education but feels that the current system may be too burdensome and potentially discriminatory against practitioners who are unable to take time away from their practice or afford the high costs of attending these events.

Think

Assess

  Patient: Autonomy

  Practitioner: Beneficence & Nonmaleficence

  Public Policy: Justice

Conclude

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2. Mr. John Smith, a 42-year-old medical practitioner, is dedicated to pursuing lifelong learning in his profession. In addition to meeting his state’s CME requirements, Mr. Smith engages in various other learning activities to keep his knowledge and skills up to date. He regularly attends local medical conferences and grand rounds, reads peer-reviewed journals, participates in online medical forums, and engages in case-based discussions with his colleagues. He also mentors medical students and residents, stays up to date with clinical practice guidelines, and attends webinars and podcasts on emerging medical topics. By engaging in these lifelong learning activities, Mr. Smith ensures that he is providing the highest quality care to his patients and keeping pace with the ever-evolving medical field.

Think

Assess

  Patient: Autonomy

  Practitioner: Beneficence & Nonmaleficence

  Public Policy: Justice

Conclude

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