There is always a session at Converge that stays with you. Not because it was the most data-heavy or the most clinically urgent, but because it held up a mirror and you weren’t entirely sure you liked what you saw.
For me at SHM Converge 2026, that session was “And the Band Plays On: Tips on Continuing to Improve Your Knowledge and Clinical Reasoning,” presented by Kieran Patel, MD, Vasundara Singh, MD, FACP, SFHM, and Daniel Steinberg, MD. I was expecting a thoughtful talk on continuing education strategies; I walked out with a short list of commitments and the slightly unsettling feeling of someone who has just been told, very gently, that maybe they have been coasting.
The speakers opened by drawing a distinction I have been thinking about ever since: operational mastery versus clinical mastery. Operational mastery is the ability to move through a shift efficiently—smooth handoffs, familiar order sets, the flow that comes with years of practice. Clinical mastery is something harder and more perishable. It demands ongoing recalibration of diagnostic reasoning and a genuine willingness to be wrong.
As a nocturnist, I know operational fluency well. At 2 a.m., when the board is full and the emergency department has five more waiting to be admitted, efficiency is survival. But the speakers asked a more uncomfortable question: When did efficiency quietly replace growth? When did the reflex diagnosis start doing work that deliberate reasoning should be doing? It made me think about how we get to that point. Efficiency can start to feel like mastery, but over time, it can quietly harden into automaticity—less deliberate effort, less reflection, and ultimately less growth.
When Did I Last Set a Real Learning Goal?
The speakers asked the audience to consider: When did you last set a specific clinical learning goal, not a continuing medical education checkbox, not a quality metric, but a genuine self-directed goal about your clinical reasoning? Something you wanted to understand more deeply? A presentation that still gives you pause?
I have worked for 34 years in hospitals and healthcare, the last 18 years in hospital medicine. By any reasonable measure, I have seen a great deal. And yet, sitting in that room, I had to admit that I could not remember when my last genuine self-directed clinical learning goal was. The shifts get done. The patients are cared for. The documentation gets signed. And you feel good that all the boxes are checked. But the deliberate, structured pursuit of getting sharper? Somewhere along the way, that had started to feel optional. It isn’t. As the speakers emphasized, deliberate practice is what turns experience into real mastery.
The Science of Learning Smarter
The session covered three evidence-based learning strategies that most of us are systematically underusing, and the one that landed hardest for me was retrieval practice. We default to reading when we want to learn—UpToDate, guidelines, a quick literature search. These have real value. But retrieval-based learning, actually forcing yourself to recall what you know before consulting a reference, encodes knowledge more durably than passive review. The speakers made the point that the struggle itself is part of the learning.
Spaced repetition and interleaving rounded out the framework. The speakers reviewed evidence showing that mixed practice sharpens diagnostic discrimination and that blocked learning often feels more productive than it actually is. It is easy to nod along in a conference session. It is harder to build it into a real work week when going deeper into what you already know feels more comfortable.
Making a Prediction Before the Consult
The most clinically actionable moment of the session was this: Before you call for a consult, commit to a leading diagnosis. Write it down if you have to. Not the differential, but what you actually think is happening right now. Then go back to see what the consultant’s assessment was. Where do you align? Where do you diverge? Did their thinking align with accepted guidelines, and if not, what were they seeing that led them in a different direction?
I have been doing this informally for years without naming it. But there is a difference between a vague sense of what you think and an explicit committed prediction that you can then compare against a specialist’s reasoning. The gap between the two, whether it confirms your thinking or challenges it, is where real learning lives. After the session, I started being more deliberate about it. The first time I was wrong in an instructive way, I was glad I had written it down.
Closing the Loop
The speakers also made the case for calling patients back after discharge to find out what actually happened. Did the diagnosis hold? Did something you missed come to light? This practice, closing the feedback loop on your own clinical decisions, is one of the most available forms of deliberate practice we have, and our current systems make it remarkably easy to skip. We discharge the patient; the next admission is already waiting, and the outcome becomes someone else’s data.
As a nocturnist, I often see the patient at the very beginning of their hospitalization. Too often, though, that is where my visibility ends unless I make a point of looking back. Not because I expect to find errors, but because the information is valuable either way, because the habit of seeking that information is the point.
The commitment I made to myself was simple: to approach my own practice with more intention. I left with a short list, not a grand plan, not a committee proposal. Three minutes spent looking back at three recent patients from memory. One clinical learning goal per shift, stated before the shift starts. An explicit prediction before every consult call. And one honest question at the end of the night: What could I have done better?
That last one is the hardest, especially for those of us who have been doing this long enough that “I think I handled that well” has become the default conclusion. Recalibration is not beating yourself up. The speakers were clear about that. It is simply treating your own practice as data and being willing to look at it clearly. After 34 years, I am still practicing. Dr. Patel, Dr. Singh, and Dr. Steinberg made me want to mean that more literally.
Mr. Facklam
Mr. Facklam is an adult hospital medicine nurse practitioner and nocturnist with First Physicians Group at Sarasota Memorial Health System in Sarasota and Venice, Fla., and a member of SHM’s NP/PA advisory council.