Addiction Medicine Made Easy | Fighting back against addiction

Medical Literature Matters: How Addiction Professionals Keep Learning

• Casey Grover, MD, FACEP, FASAM

Share episode

We discuss practical strategies for staying up-to-date with addiction medicine research in this collaborative episode between Addiction Medicine Made Easy and the Addiction Medicine Journal Club podcast.

• Featuring a four-person roundtable with Dr. Casey Grover, Dr. John Keenan, Dr. Sonia Del Tredici, and Thomas Bannard
• Understanding why evidence-based medicine matters in addiction care
• Incorporating lived experience into addiction education and combating stigma
• Developing personalized approaches to staying current with medical literature
• Various learning strategies from reading journals to podcasts to collaborative discussions
• Finding your motivation for continuing education in addiction medicine
• Strategies for making learning "stick" through teaching and knowledge application
• Making knowledge "count twice" by developing resources from what you learn
• The value of consistent, sustainable learning processes over ambitious but unrealistic goals

To contact the Addiction Medicine Journal Club Podcast: addictionmedicinejournalclub@gmail.com  

To contact Dr. Grover: ammadeeasy@fastmail.com 

Speaker 1:

Welcome to the Addiction Medicine Made Easy Podcast. Hey there, I'm Dr Casey Grover, an addiction medicine doctor based on California's Central Coast. For 14 years I worked in the emergency department, seeing countless patients struggling with addiction. Now I'm on the other side of the fight, helping people rebuild their lives when drugs and alcohol take control. Thanks for tuning in. Let's get started.

Speaker 1:

Today's episode is a collaboration between my podcast and the Addiction. Thank you. Research and scientific literature on addiction. I am proud to admit that I am an avid listener of their podcast and our two podcasts do episodes together periodically, and today's episode is one of those collaborative episodes. We discussed how addiction medicine professionals can stay up to date on the latest research and science in the field of addiction treatment to be able to provide the best care possible to their patients. The episode was actually a four-person roundtable. It was a discussion with myself, dr John Keenan, dr Sonia Deltredici and Thomas Bannard. Thomas works at Virginia Commonwealth University and coordinates their collegiate recovery program. We had an awesome discussion and I am so grateful to share it with you. Here we go, all right. Well, we have a meeting of the minds. It's afternoon my time and it's evening for all of you, but we are going to collectively geek out on how to keep up with the medical literature in addiction medicine. Tom, why don't you start by introducing yourself and tell us what you do, sure?

Speaker 2:

So my name is Tom Bannard. I am the assistant director for substance use and in addiction medicine. Tom, why don't you start by introducing yourself and tell us what you do, sure? So my name is Tom Bannard. I am the Assistant Director for Substance Use and Recovery Support at Virginia Commonwealth University. So I work with our collegiate recovery program. We work with students who are in recovery from addiction and also help students get into recovery. So we do that through a number of different things, including trips, that sort of thing, but also kind of some more formalized, structured seminars. And then part of our mission is to make sure that everybody that studies a health-related science at VCU so whether that's professional school or otherwise gets some exposure to people who are in recovery from addiction and kind of interacts with folks that have that lived experience of recovery so that when they go out and work in medical spaces they can hold that hope for their patients, which I think is a really important part of our work. And I'm a big fan of both y'all's podcasts. So I'm excited to be here.

Speaker 1:

Yes, so I'm Casey Grover from the Addiction Medicine Made Easy podcast.

Speaker 3:

Sonia and John you want to go next? Sure, I'll go, and I just have to say that Tom threw an awesome conference that we went to recently. So anyone else who wants to go to Rams and Recovery at VCU Health next year highly recommend. I'm Sonia Daltredici, one of the hosts of the Addiction Medicine Journal Club podcast, and I love talking about evidence-based medicine. I teach evidence-based medicine to our residents and I, of course, do it for our podcast, and I'm interested in how sort of the practicing doc stays up to date and stays current, so that's why I wanted to do this episode.

Speaker 4:

Yeah, my name is Dr John Keenan, so I'm Sonia's co-host for Addiction Medicine Journal Club and I'm a family doc. I do some medical education as well, though I'm not faculty like Sonia is, so she's the full-time acupuncturist here amongst us, but I do get to teach our residents. I also work inpatient, outpatient, have an admin role, do some other subgroups, so I also take care of HIV patients and so certainly high-volume outpatient practitioner, but enjoy these conversations very much so.

Speaker 1:

So I'm going to tell you something funny, sonia. So when I was a pre-med, I remember they would assign us papers to read, and I thought to myself when I am a doctor, I am never going to read any papers, so why don't you start by telling me what I didn't know as a pre-med and why evidence-based medicine matters?

Speaker 3:

Right. Well, and I think just to acknowledge that evidence-based medicine is more than reading those like super dense papers. That is one of the foundations. But you can be a fully up-to-date doc without ever having to read those original foundational papers. Treatment Like our patients would be horrified if they realized that maybe we're offering them a medicine and there's a better treatment that we just don't know about because we didn't bother to learn. It's an expectation that you are up to date. You know.

Speaker 3:

I remember for myself I was kind of blown away. I had like a second year rotation with a family doc. You know you're like learning to do physical exam. You have a little internship thing with a practicing doc and he told me he got up at five o'clock every morning to read every day from five to six he read and this is pre it wasn't pre-internet, but pre-like online resources. So he had journals and books and he read them every single day and I was like, oh, is that what it takes to be a doctor, be a family doctor? That was very meaningful to me and I've always thought of that. And in addiction medicine it's even more important because our field is really changing a lot. The drug supply changes, the political climate changes. It's just constantly evolving, more so than some other fields, I think, and also we're a small field so the resources aren't as mature and well-developed, so I think it's hard to stay up to date in addiction medicine. But yeah, I think it's just super important for us.

Speaker 1:

So, tom, you put together an educational conference on addiction. What did you highlight? How did you make it interesting, how did you make it good?

Speaker 2:

So this is a conference. It's called Research to Recovery and we've been doing it for about eight years. I got into the field really from my lived experience. I got into recovery when I was 22, so about 18 years ago, and I didn't have any plans before that. While I was in active use, I didn't have any plans to work in this area and then got real passionate about it after kind of being helped by some folks that knew what they were doing a little bit. So when I started my career and this is kind of I come to this from a pretty different perspective as y'all, I was just thrown in.

Speaker 2:

I was working in a homeless shelter that had recovery, support and figure it out as you go along and that had a lot of consequences for the folks that we served in terms of we probably didn't serve them very well or as well as we could have and that weighed on me as I learned more.

Speaker 2:

And so when I moved over to university about a decade ago, one of the things that was apparent to me was I had access to all this knowledge just right next door. You know, I could go to a lunch lecture with these brilliant folks and learn more than I had access to when I was working in homeless services, the education that was so easily available to me now that I was in a university, setting back to folks that were providers, that were especially peer recovery specialists, that sort of thing. So that's been cool. It's been cool and part of that is we produce real high quality recordings. It was a little bit pre or beginning of the podcast era, so it was that kind of idea of let's record these brilliant people like Sonia and John and make sure that folks have access to them.

Speaker 1:

Yeah, I love that, and I love the fact that you're doing work with peer support. Peer support is a huge part of my practice, so, john, I'm going to pick on you next. You mentioned that you're a very high volume practitioner, so one of the wise attendings I worked with as a medical student talked about having to realize that just because you've seen it many times in clinic doesn't mean it's right, and his saying was the plural of anecdote is not data. So how do you reconcile all the things that you learn from your patients versus the medical literature and synthesize that into making the right decisions for your patients?

Speaker 4:

Yeah, I think I'm sure, like many people here, we read a lot. But I'll tell you, like practicing medicine with a living, breathing person, it's humbling, right. You read the literature as kind of a starting point and then there's always an X factor that maybe that person doesn't quite represent the sample of that study or what you kind of read about. So I think it's hard in that regard, because you know evidence-based medicine it's really kind of like evidence-informed right, because we always have to kind of tailor to the unique needs of each individual person.

Speaker 4:

As a family doctor we're kind of like the pluripotent stem cell of the medical system, right. We kind of move into whatever domain is needed and we saw that with COVID. We were redeployed to COVID for inpatient even though many of us didn't do that and actually like no-transcript to come up with an individual plan of like how you kind of like have a staying power. I like to say like you're still up to date, you still know what you're talking about, you're on the edge of what is coming out. And it's hard. The broader your scope of practice, the harder. That is right. Er is probably very difficult as well, because you touch every domain and how much the treatments change from year to year. It's appalling how quickly it moves right.

Speaker 3:

Well, and I really just want to emphasize something you said, john, which is that you learn about the things that are in front of you and the things that are put right in your lap.

Speaker 3:

But if you only do that, you actually fall behind. Like, I think there are a lot of us who really just learn about what we see, and our residents are always trying to do that. They're saying I'm just going to read about my patients, read about my patients, but like, if you do that, you end up with unrecognized knowledge gaps. So you have to read about your patients, but you also have to know that there's more knowledge out there, because otherwise you're not able to cope when an unfamiliar situation presents itself. Like there might be someone having some horrible to treat withdrawal syndrome and you don't know that tyaneptine is now a drug of abuse and I didn't know that and you wouldn't even know to know it. Like you don't even know what it is. And so if you don't do something that kind of takes you beyond that point of care learning, I just think that's a requirement, as well as just knowing about the problems that are dropped in your lap.

Speaker 4:

Yeah, it's easy to hit the first 90% right. It's like a diminishing returns. It's many, many more hours of studying and knowledge acquisition to get the last one or 2% of the interesting case right. I think most of us could treat like an asthma exacerbation or a COPD. But then when the person comes in your office with dress syndrome, you know, if you never saw that before, we're studying for it. You don't know what you don't know, so you have to have some plan. Your right to develop a familiarity with things you're not familiar with or you haven't seen.

Speaker 1:

Right the first day of medical school at UCLA, the dean walked into the room and drew a circle about the size of a tennis ball and he said this is what you know, you know. And then he circled around it about the size of a grapefruit and he said this is what you know, you don't know. And then he circled the entire rest of the whiteboard and said this is what you don't know, you don't know. I will never forget that. So, son, you brought this up. How do you work on maximizing your ability to learn what you didn't know? You didn't know?

Speaker 3:

Well, right, and that's the whole point of this discussion. And so I guess the first thing I want to say when we're talking about this is I'm a big believer in process and consistency. So we'll talk a little bit about the process as a group. But personally for me right now I actually I'm glad we're having this discussion because I need a little bit of improvement too. I listen to podcasts because I have a lot of commuting time, so I fill that with learning and I struggle to just sit down and study. So I need like a deadline or a project. So I often, with areas that I need improvement on, I force myself into a project that then I have to learn about. So, for example, I signed up to care for a bunch of transgender patients and that is forcing me to, you know, expand my knowledge of transgender healthcare. Or I'm about to pick what modules I want to do with our outpatient residents. We sort of divide up all the modules, so I'm going to pick modules that are areas I'm weak in and that will force me to learn about them. So I know I'm a project person who needs like an external deadline. And then I personally love email alerts. I sign up for like high quality email alerts, and then I get the emails and I try to keep up with them. There are a lot of them, but at least I feel like I see the highlights. If nothing else, I've seen the headline. You know tyaneptine will be on the headline of, like the ASAM weekly newsletter. So that's kind of what I'm doing now.

Speaker 3:

I just think I need more general internal medicine knowledge. I need to be more up-to-date on my general primary care practice. I'm always afraid I'm going to miss something. The residents help keep me up to date, but again it's like point of care. They tell me stuff that's right in front of us, but you know, like I don't know. Just a recent example this happened to me last year, two years ago. I think I didn't know that the standards of care had changed for diverticulitis, like you're actually not supposed to give empiric antibiotics anymore in the outpatient for diverticulitis. I didn't know that that had totally changed and the resident had to tell me it while I was telling her she should be prescribing like metronidazole and ciprofloxacin. So that's embarrassing. So I need more general internal medicine knowledge. That's what I think I need. So hopefully we can talk about what I will do as we go through this process.

Speaker 1:

Yeah, tom, for us as doctors most of us who have not lived with addiction it's kind of hard to actually understand what addiction is like and why it happens. Can you talk about incorporating lived experience when you do education, because that is so helpful? We actually did some presentations in my hospital where we had people in recovery come to speak to healthcare providers because of the value of lived experience. So I'd love your thoughts.

Speaker 2:

Yeah, absolutely. Like I said, I've been in recovery for 18 years, which you know is an N of one. You know I have to like understand that, like my experience is not everybody else's experience, but also that hope matters right For you. As an emergency medicine doctor. You are almost entirely seeing the patients that you see with addiction. You're seeing them at their absolute worst, right, and they're not coming back generally to thank you, right, for treating them because it was, you know, one of the worst days of their life when they saw you. And we can be difficult, right, addiction is a really does things to us that we pass on to other people.

Speaker 2:

I think one of the pieces for me with working with medical professionals is for them to kind of understand that you know there's hope for that person right, that a lot of us are here because you were there in that moment. And if you don't get to see the hope on the other side, if you don't get to see people that are in recovery which is made worse because there's so much stigma within healthcare that many people in my life don't disclose to their physicians that they're in recovery, so you don't see us on the other side, even when we do really well a lot of times because we're afraid of that. So I think that just kind of connecting to shared humanity is a really important piece of the kind of larger picture, without claiming that one of our experiences is all of our experiences, because it looks really really different, you know, based on life circumstances, socioeconomic, substance abuse etc. So that's really when we are in classrooms we're trying to kind of expand people's view of what addiction is and also what recovery can look like for folks.

Speaker 1:

John, what's your approach to staying up to date with medical literature and addiction?

Speaker 4:

The biggest things. I think you know I have my three primary journals I read every month. So I set aside like two hours once a month. So it's like the addiction medicine journal from ASAM, family practice and then also HIV digest as well. That one has a lot of overlap because that group tends to be overlyful for patients with substance use. But I'm a big fan of what Sonia said too. I love my like journal stream. So like Journal Watch from JAMA Evidence Alerts, I get these kind of updated briefs in my mailbox on a weekly basis and it picks like overviews of like the biggest 20 articles in that area and I can click on them and read in depth further. So it's a way of scanning the literature and then getting in depth more so with what I want.

Speaker 4:

And then the biggest thing too is it's hard when you start to practice. If you live in an island you kind of drift away from norm. I work with the residents every couple of weeks. I'm teaching them and they come out to my office. I have medical students and it's sort of like dad strength at basketball no-transcript space now. And it's interesting, some of the older attendings not so much, but the younger group, the residents, the new medical students. They like love this and they think it's amazing we take the ER residents rotating on toxicology. They come out for a day at the clinic and they really enjoy the experience because most of the time as Tom pointed out that they're interacting with this group, they're like overdosed, they're kind of not in their right state of mind. So like seeing them recover and do well like this person has been with me for three years, they got their kid back or in school it's a really positive experience to show the other side of that lens, which they probably don't get in their primary care area as ED residents, you know.

Speaker 1:

That is a hundred percent true. We actually would often message the ER doc that had taken care of a patient to let them know that they were doing well, just to give them the positive follow-up. Yeah, so you mentioned teaching and I'll share a little bit about what I do. So the whole reason I started my podcast, addiction Medicine Made Easy, is when I was a resident, when there was a difficult topic, I wanted that topic to be assigned to me as a resident, like the patient with a generalized weakness in the emergency department. It's so broad. I actually lectured on that my senior year of residency because I wanted to be able to understand the most difficult topics. I felt like if I could teach them, I had a really good understanding of them. So that's where this podcast came from.

Speaker 1:

I didn't want to be a clueless physician, so I was asking clinical questions, and so researching episodes is really helpful for me. And then I'm the medical director for a local drug and alcohol treatment program, and so researching episodes is really helpful for me. And then I'm the medical director for a local drug and alcohol treatment program and I'm required as the medical director, to give one educational lecture a month, and the one I picked for this coming month is on ketamine addiction, and I know a little bit about it. Thank you, elon Musk, for making it popular again as a topic. So, yeah, I'm going to put together a lecture for that and I pulled some papers and I'm going to review them and I'm going to do an evidence-based review of the topic. And then I mentioned that my lovely bride, the very intelligent, charming and beautiful Dr Reb Close, who's sitting behind me, she works with the California Bridge, which is a program that's designed to help clinicians innovate around addiction care, and so she's one of their regional directors, and so she will be asked to give a lecture and same kind of thing. You know she'll be like, hey, what are you hearing about tyaneptine?

Speaker 1:

And then locally, we have a lot of collaborative efforts. So I'm in central California, on the coast, and there's about four counties that we work together and we'll actually have quarterly meetings of like, what drugs are you seeing? What are you treating, what are your new protocols? And each county gives updates. So it's not really going to the medical literature, but it's more to your point, sonia. What is it that we don't know? We don't know, and we regionally will collaborate and talk about what drugs are people seeing? What new protocols do we have? What's the easiest way to get people on, you know, a direct-to-inject protocol? I will share that. I'm not great about reading any journal regularly, but it's more organic and because we work collaboratively, I feel like I'm able to not miss topics as much. But yeah, I probably need to find a good journal that I read regularly.

Speaker 3:

Well and the word regularly. So here's one thing I do believe strongly and you guys just everyone listening knows they made fun of my organizational email prior to setting this up, but you got to be sort of structured. I'm a big believer in process and consistency. I feel like if you have a consistent process, it's realistic and you can do it 80% of the time, 75% of the time, but you stick with it, you will get to your goal, whereas if either your goals are too broad or too unfocused or too ambitious, and then you don't have any kind of way to stick with it, then you won't get very far.

Speaker 3:

I used to be more of a perfectionist and then I would get bogged down. I'm like I'm going to read, you know, 10 pages a day, and then I would skip the 10 pages. I'm like, okay, tomorrow I'll read 20 pages, and I wouldn't do that either. I'm like, okay, I'm going to read 30 pages so I can stay on schedule. That's like med school, you know. So it just didn't. It didn't work. You get behind, you get bogged down and then everything implodes. So having a consistent process and designing a plan that is realistic enough for you but actually does push you a little bit and you can stick with, I think, is the way to do this. So do you guys want to start hearing about my sort of framework for figuring out how to stay with the literature?

Speaker 1:

I'm going to try to be funny here. Do we get a choice?

Speaker 4:

It's as organized as the pre-discussion email we got.

Speaker 1:

Would you like to give us a really organized overview of how you're approaching evidence-based medicine and addiction?

Speaker 3:

That sounds like a great topic. Everyone listening part 1A you're lucky you can't see the PowerPoint. No, there's no PowerPoint yet. But the first thing I think actually is most important and I really want to hear what you guys have to say is motivation Is why? Why are you doing this? What's your unique personal goal? Because I think if you know your motivation, it's a lot easier to figure out a plan that will work for you.

Speaker 3:

And I think, like being a good doctor is not specific enough, keeping current not specific enough, Not embarrassing myself in front of the residents it's getting a little closer, but you know, some examples of sort of good motivation would be I want to give good lectures, like you said, casey. I want to give good lectures that are true to colleagues. I need to pass the boards. That might be a good motivation. Or I want to add a new skill to my clinical practice, like John, when you did your HIV training, you're adding a new skill. Or I need to work with med students and develop a new curriculum. So motivation, I think, is really important. So what do you guys think about motivation for staying up to literature? Why would you bother? Why not just do what you know, see what you see, and if you don't know something, you look it up and up to date as you go along. John, you want to go first?

Speaker 4:

Yeah, I really like doing new things. So like new things and like pushing the scope of my practice. I'm not kind of like niched into a specialty, so I so I kind of like to take it as far as I can go and I've really kind of been lucky in life to date. I really only kind of operated with like two goals in mind. Since I've become an attending, it's like do things that interest me and always try to do the right thing and actually everything else is kind of followed behind nicely. So the number one thing I do is I just want to learn more about these different topics. They interest me and it's easy to kind of put time into something you like to do and that you're interested in.

Speaker 2:

Tom, yeah, so I guess my is a little different because I'm not trying to treat all these different things, I'm just interested in addiction and recovery and that's like been very clear to me for a really long time that that was going to be the thing that I was dedicating my whole life and career to. The bottom line for me is like the stakes are too high and we're not good enough. And you know, I just lost so many people, so many people that I've worked with so many friends in recovery spaces over the last I don't know 16, 17 years that I've been working in the space. That's a real motivator. And actually the thing that always comes up for me with this is early in my career I was working at a long-term recovery space and I kind of switched roles and started to just work on our emergency shelter side as a large organization.

Speaker 2:

So I was running a 120-bed homeless shelter and I didn't really know anything about homeless services, especially as compared to recovery and addiction, and I just had a couple of situations with clients where basically our policy was if folks came in intoxicated that we would ask them to.

Speaker 2:

Sometimes we'd just be like, okay, just chill out.

Speaker 2:

But if this happens again, you're going to either have to go to treatment or you can't stay in the shelter anymore. And I mean it wasn't like there was not enough shelter beds in the first place, but working with kind of vulnerable women who had terrible addiction that couldn't not drink, right, not use before coming in, kicking them out of shelter, was the worst thing, right, but I didn't know that because I didn't have any formal training in the work that I was doing and I didn't know the research, and so I just had this really kind of upfront experience with seeing one of the women that we asked to leave the shelter for years afterwards living on the street, and while that was happening I was learning what we should have been doing and I was making the changes to our programs that we should have been doing. But I just don't want to be that right, and so there's real consequences to the folks that we serve when we don't have the knowledge that we need and so just want to be better, you know.

Speaker 3:

How about you, Casey? What's your motivation? I'm going to try to be funny again.

Speaker 1:

It's usually that my wife has some lecture that's due tomorrow and she needs me to research it for her and I want to just be able to like answer the question and not have to take 20 minutes looking it up for her. Okay, all kidding aside, I think it is that the more I learn, the more I can help, and particularly, I'm doing a lot of education personally around mental health. Kind of my niche is becoming the intersection between PTSD and addiction, and so I am a little bit like John. I'll find something that I'm interested in and just dig into it more, and dig into it more and get more expertise in it, and then that translates into my work being easier in clinic. Mm, hmm.

Speaker 3:

All right. So now that we have our motivation, the next thing I want you guys to think about is the what and the when, and this is where the kind of realistic thing comes out. Like you might aspirationally be like I'm going to read this giant textbook or you know, Casey, you're going to change and you're going to read journals lots of journals, you know, but no, it's realistically how much time do you have? When is that time and what kinds of things do you like to learn from and that actually work for you? So probably zero time is not a good answer. If you have zero time for learning, you need to adjust your work such that you have some dedicated time if you're in a field that changes.

Speaker 3:

But some people say their whole education is one full week a year to a conference. That's what they do and that's a full week's worth of time. That's pretty good. Or 15 minutes every day. For me it's at least an hour a day of commuting time as an educational podcast, because I commute two hours a day, you know. So, realistically, what time will you spend on it and when? And then, what type of learning do you like?

Speaker 3:

And it's easier to stick with things you like. So videos, podcasts, emails, books, journals, conferences, other people Do you need to chat in person? Can you just read all by yourself? And just to sort of choose a gateway, because, dealing with medical knowledge, there's an entire industry that helps people deal with medical knowledge Abstracting services, board prep resources, conferences, YouTube channels, you know and a lot of them are pretty expensive, Like there's a whole industry out there. So just sort of to choose a gateway, but don't don't try to do it all. Again, like med school, which is, of course, our firehose of learning, I remember thinking maybe if I buy like a different textbook or another textbook I'll like no more, and eventually I was like you know what, just choose one textbook and stick with it. It probably tells you what you need to know in that textbook. Don't get a second one, Just read that one. So the what time and what's your resources that you like is the next question.

Speaker 1:

I'll take this one first. So I have not found it yet. In addiction medicine, in emergency medicine, there is an Australian ER doc named Mel Herbert who figured out that if you made education funny it stuck better. And so when I was practicing emergency medicine I had a subscription to this service called EMRAP Emergency Medicine Reviews and Perspectives, and it was humor soundtrack, funny songs the host would banter. It was beautifully done and I was about two and a half hours per month of topics they rotated. There was a very wide breadth, because emergency medicine you have to know a little bit of everything. And then they additionally had a second program called Emergency Medical Abstracts. Two physicians who actually did residency with my wife would banter over journal articles and they covered between 20 and 30 articles a month. And so I loved to exercise and so whenever I was exercising I was learning. I have not found that yet in addiction medicine. So my primary favorite addiction medicine resource is the Addiction Medicine Journal Club podcast.

Speaker 3:

Oh, you flatter us, shave, it was your blog.

Speaker 1:

saying that oh and that's actually part of the reason why I created my own podcast is I wanted to create interesting education in the addiction space. So I'm still looking, but for me it's usually something audio, because I can exercise and I can drive.

Speaker 3:

Yeah, and can I just point out, you did something I don't know if you ever put this name to it. We call it pleasure bundling, whereas you like to exercise, and so you bundled your learning with your exercise, and sometimes, if there's something you have trouble doing, you bundle it with something that you like to do and that helps you get it done. So like, do it with a friend if you want to hang out with friends, or you said, do it while you exercise. So I just want to point out you did that strategy.

Speaker 1:

I just feel like I'm fitter and smarter at the end of a workout and it's just, it's cool.

Speaker 4:

Every time we talk with you you're off to a like a fit class of some sort, like a hit interval training class. I feel like you're the most fit position in this audience, at least today. We did two hours of Taekwondo this afternoon. I am beat more policy related, which are very interesting reads, but it's hard to translate that to the exam room or the hospital room. So I tend to find that the best one are articles that are covered incidentally and other ones that are more like overview type articles. So those are kind of great for like the HIV journals and also family medicine journal.

Speaker 4:

I like ASAM weekly just like 10 minute read, read the highlights stories there. A lot of that is policy and also the same overlap. But I would say that I'm kind of guesstimating here. Maybe 10 to 20% of those articles could be applicable to like the exam room, but still not the majority of it. A lot of it's more policy types information. If I'm being honest, I bet you specific to addiction medicine on a weekly basis. I'm probably doing anywhere from 30 minutes to an hour a week just on that topic and I think it's probably broken up into small blocks of like 10 minutes at a time. So maybe like 10 minutes a day just down the rabbit hole in some article that comes across my desk, often those kind of review articles that come up in your email that give me 20 or 30 articles to highlight.

Speaker 3:

And is that enough, do you think, for you? Sounds like, given everything else you have to know, it sounds like a pretty big chunk of your learning time actually. Yeah.

Speaker 4:

I think where I'm at right now it's decent. I mean, there's always new things to learn. This kind of also reflects the infancy of this kind of field a little bit right. I think that there's a lot of learning comes from shared learning. I feel like we went to ASAM conference. The best parts of that was people just talk in the room about what they're doing and a lot of it's not super high level research, right. A lot of it's like anecdotal, like I'm doing this, really, you're doing that, and like that's interesting to try. That. I might try that.

Speaker 4:

I don't feel like we get these large RCTs that we get for other things. I mean, how many trials have we seen about cholesterol statins for heart disease? I mean we've studied that. We know it's good. So many, so many. Yeah, I'm like why are we still studying that? And then we can't even answer the basic questions for addiction medicine and I don't know. Maybe a question for Tom when do you think we sit? Do you feel like we've just entered this space as like health professionals? Because I feel like we've talked a little about this offline before that. You know, I feel like recovery community has been somewhat independent of the medical community for a long time.

Speaker 2:

Yeah, and certainly treatment has been separated out from the rest of medicine for a very long time and with some really substantial consequences. So it's interesting, I mean. I think it's obviously a huge addition from a quality of life standpoint. But the other thing that I was reflecting on that having more physicians really heavily involved is you'll have a lot more accountability than we have historically had around addiction treatment and recovery. So that's a reason that a lot of folks that work in this space haven't historically done a great job of keeping up with what's on the edge and that sort of thing.

Speaker 2:

Obviously there's a lot of great clinicians out there and a lot of great addiction medicine people, but the accountability hasn't been there and so it's not like as clear when somebody is doing something they shouldn't be doing as it is.

Speaker 2:

For you know, when you all are prescribing things and it's all documented and has historically been documented. No-transcript is just to prove our worth, just to prove that we belong in the space. In Virginia the peer profession is nine years old, right. So you can't possibly have any robust data to say this is definitely working and to try to track that in this rapidly growing space and be able to say anything definitive about any of that is basically impossible after such a short period of time. So especially the peer recovery space is very much a build the plane as we're flying it from a research perspective, even though we have a long, long history of robust peer-based healing from addiction and we have a fair amount of literature specifically about, you know, 12-step and 12-step facilitated, but we don't about this whole kind of peer recovery field, which really pushes beyond that. So I love, in terms of research sources, recoveryanswersorg is done by the Recovery Research Institute.

Speaker 3:

I love them. Excellent email newsletters.

Speaker 2:

They are great, john Kelly and their team, brandon Bergman and Emily they're just awesome up there in Boston and then I listen to y'all's podcast and then for me, organizing these events so organizing our research collaborative and then organizing our spring conference is just huge for me to stay up to date because that kind of other person, accountability is important for me, and the community connections as well.

Speaker 1:

So, sonia, I think the last two points we were going to go over is how do you make the learning stick once you found your resource and set aside the time to do it, and then how do you make the learning that you do count? How is it useful? How does it help you? Do you want to start? And performance improvement?

Speaker 3:

And it's got to be active. So, whatever that means for you, something to make it stick. For me that's either taking notes or turning it into a project, like I said before, like I turn it into a lecture or a unit I'm doing for the residents and sometimes I write lecture slides on topics, even if I don't have a lecture in mind. I just make slides and that's my kind of making it stick. And then someday maybe I'll use them, someday not. And then engaging with other people in person I think is really important For me. Talking about something with other people I feel like is key. So that's the one thing in terms of making it active for me. And then I'm just a huge believer on like make it count. I say make it count twice or make it count three times, so you learn about something and, like I said, you turn it into lecture slides. Or you learn about something and you turn it into a research project.

Speaker 3:

Or for us, you know we have the podcast, so all of my reading of the addiction medicine literature goes towards I have a goal, which is finding articles for the podcast, and so I actually like read through all these journal table of contents looking for articles for the podcast and so I actually like read through all these journal table of contents looking for articles for the podcast. So I do something with that knowledge and I think that's the problem. That's why I need help with my general medical knowledge is I do have my teaching for the residents, so that helps, but it's like what am I doing with that studying? If I'm just like reading a textbook or scanning New England Journal of Medicine articles, I really need to do something with it. So I will turn it into epic smart phrases for those of you who use epic like handouts for patients, anything. I have to do something with the information. And then I feel like I've sort of done two things I'm smarter and I have a product that I can deploy in any other kind of setting.

Speaker 4:

John how about you? I think similar. I think I got to make it come alive somehow, so it's either apply it to a patient, which is probably often one of the reasons that I'm actually doing the research. I got to talk about it with my peers. So we have a doc meeting every Friday with my partners and often I bring up some interesting stuff just for kind of group sharing, which we have some interesting discussions or teaching with the residents. So those three and the medical students, which is kind of a captive audience whoever will listen.

Speaker 3:

They're forced to nod and show a great interest.

Speaker 4:

It's the closest thing to a yes man I'll ever get. I could say anything. The medical students kind of like nod and shake their head. I could be saying some really crazy stuff and they're like oh yeah, that's great, dr Keenan.

Speaker 2:

Tom, how about you? I like that idea of make it count twice. I hadn't conceptualized it as such, but I always try to work on like one talk a year. That's really a stretch for me. So, like last year, it was cannabis and I hung out with all these wild cannabis researchers, which is, you know, if you want to dig deep into a funny topic, all the different ways they measure how high a mouse is is a really entertaining subtopic of research. But you know, that area of developing a talk for new area that I don't know a lot about in terms of addiction, and then also the conferences. I'm always looking for great speakers. So watch out, casey, for our conference and that kind of thing. So that really keeps me fresh. Just, you know, spending some time listening to people I admire is great.

Speaker 1:

So I have to say and I'm going to try to be funny again is I think we just all need to marry the right person, because for me, being married to another addiction medicine doctor is great, it really helps. But yeah, for me it's all about teaching. So, as I mentioned, you know, when I was a resident, I wanted the hardest topics because I had to understand them to be able to teach them, and so for me it's like oh, this would make a great podcast episode. Or I'll have a casual conversation with a colleague and they'll say something like wait, I need to know more about that, can I interview you? Same thing with my patients.

Speaker 1:

I've got a couple of patients that I've interviewed on the podcast, and it has always been one of my life goals to find what I don't know, I don't know and try to learn about it. So I think it's fun. My daughter I can hear her rolling her eyes from the other room. I love trivia, I love learning and facts and knowledge. It's enjoyable to me to expand my brain and that's been very motivating for me. But in terms of using it and making it count, I totally agree Taking notes, turning it into a handout or a smart phrase, or for me oh gosh, that would make a good podcast episode, and I've actually started now. Anytime I lecture, I record myself and use it to make a podcast episode, just because it saves time.

Speaker 3:

So yeah, making it count twice Well, this was awesome. I feel like I definitely got some good ideas from you guys. I mean, to me it seems like all of us and maybe this is just us or maybe this is everybody are kind of project people. Like to force ourselves to learn. We'll pick something that makes us learn. So sort of sitting quietly by yourself and reading the textbook from cover to cover doesn't seem to work for any of us. But that's fine. That's fine because I think all of us are doing good work and I know for myself I'm always striving to find a process that will keep me being the doctor I want to be.

Speaker 1:

Yeah, this has been a great topic and love the collaboration. Truly Addiction Medicine Journal Club is where I get most of my medical literature.

Speaker 3:

Oh, now, that's like a lot of pressure, uh-oh.

Speaker 1:

Well, I give you guys shout outs, like the most recent one I did on anti-methamphetamine addiction. I referenced the podcast episode you guys did on the Vyvan study. Anyways, love the collaboration.

Speaker 3:

That was all John and I'll put in the show notes. I'll put links to these various resources that we mentioned on the podcast and a few more that I like, and that's it.

Speaker 4:

I, everyone has an awesome night. Well, you guys are at bedtime.

Speaker 1:

I've got to go make dinner for my family, so, all right, good night everybody. It was great chatting with you. Before we wrap up, a huge thank you to the Montage Health Foundation for backing my mission to create fun, engaging education on addiction, and a shout out to the nonprofit Central Coast Overdose Prevention for teaming up with me on this podcast. Our partnership helps me get the word out about how to treat addiction and prevent overdoses To those healthcare providers out there treating patients with addiction. You're doing life saving work and thank you for what you do For everyone else tuning in. Thank you for taking the time to learn about addiction. It's a fight we cannot win without awareness and action. There's still so much we can do to improve how addiction is treated. Together we can make it happen. Thanks for listening and remember treating addiction saves lives.

Speaker 4:

Bye.