Collateral learning means doctors learn to use computers while addressing some problem they find appreciably more compelling than learning to use computers.

How can doctors who are unfamiliar with computers be brought into the fold? Doctors have five approaches to computer literacy.

Let 'em Wander

The first comes from Exodus in the Torah. Recall that Moses led the Hebrews through the desert for 40 years until the former slaves died off so those born free could enter the Land of Israel. Pursuing this, there are some already-practicing doctors who are unwilling to learn to use computers and so will never enter the promised land of computer-based CME.

Just Following Orders

The second approach comes from the military where, for example, all doctors were ordered to learn to use computers — and, by gory, they did! This approach applies to recently trained residents and students who were told to learn to use computers. Unless clinics or hospitals order physicians to learn about computers, few additional doctors will learn in this way.

Barrel Jumping

The third approach has doctors behaving as “barrel jumpers.” Think of speed skaters who line up barrels to see who can jump over the largest number of them. There is a point in a doctors' careers (about 10 years out), when they've seen all the red throats, listened to all the noisy chests, and palpated all the hot bellies they want — and they are bored. They find ways to make their practices more interesting; some learn about computers.

Computer Competitors

Fourth, there are those doctors who look around and see others using computers — including patients who look things up before coming into the office. They want to remain up-to-date and competitive, and seek out someone who can teach them how to use computers. We needn't worry about them.

Am I Having Fun Yet?

Fifth and finally, there is collateral learning, which has doctors learning to use computers while addressing some problem they find appreciably more compelling than learning to use computers. Pretend, for example, that I am such a physician in need of some nephrology information. I call my favorite nephrologist and ask for help; she tells me to meet her in the physicians' lounge so we can use the terminal there to get my answer. So I'm off to the lounge.

We sit in front of the terminal, and she pulls up PubMed, shows me where to find the MESH headings, and helps me select those most appropriate to my needs. We enter them, hit Enter, read the abstracts that appear, and select articles that look useful.

“This is fun,” I tell her. “Can you do this for problems outside of nephrology?”

Yes, she tells me, and suggests I try another problem that's on my mind. She turns the keyboard over to me and looks over my shoulder as I work. She answers questions, helps me through beginners' blunders, and is generally encouraging. I soon have the articles I need to address two problems, and more important, I've realized a collateral learning; I can use the computer to address issues of import to me.

Soon I'm surfing the Web and hearing about CME activities. I try them for no reason other than because I can, and feel good about myself for having so much temerity.

The Collateral Route

If I were to recruit doctors to computer use, I'd be inclined to use the collateral learning route. I'd set up a computer in the doctors' lounge, recruit a local opinion leader and have her show doctors how they can get answers to the problems they already have. This will, I'd hope, encourage them to ask whether they can't solve other problems of import to them on their own, problems such as how to get CME credit without leaving the comfort of their homes or offices.

Will this work? Why don't you pull up a chair and we'll see what happens as we use the computer to solve some problem of interest to you.

Henry B. Slotnick, PhD, PhD, professor of neuroscience at the University of North Dakota in Grand Forks, conducts research on how physicians learn. He has been recognized by the Alliance for CME with several awards for his contributions to CME. Send your questions or ideas to