Learning - What Two Years of Medical School Have Taught Me

Lessons on Learning - First Two Years of Medical School

The best analogy I have heard to what learning is like during medical school is that it is like drinking from a fire hose. The first two years are traditionally when most of the classroom learning takes place, and students must learn the entire anatomy of the human body including the musculoskeletal, nervous, circulatory, and lymphatic systems; the pathology of hundreds of major diseases of each body system; the workings of hundreds of different infectious agents; embryology, biochemistry, genetics, and how to interview a patient, glean the important information, perform a physical exam, generate a list of possible diagnosis, and begin to make a treatment plan. And this is only scratching the surface! Although it is rigorous, the learning strategies I developed in undergrad and have refined over the past two years have helped me to excel, passing all of my exams and maintaining a 4.0 GPA in both undergrad and medical school. The learning insights I share below originate from two books that have become invaluable references for me: Make it Stick by Henry L. Roediger III et al. (1) and Ultralearning by Scott H. Young (2). 

Make it effortful. A common theme I see in some education apps and third party resources is to make learning as effortless as possible. While taking the path of least resistance is appealing, the best research on this consistently shows that it leads to weak and shallow learning. What does effortful learning look like? In Make it Stick, Roediger repeatedly emphasizes the importance of recall. The harder it is to recall something after learning it, the better it will stick. Like lifting a heavy weight, the act of striving to regurgitate information rewrites neural networks, making them stronger and more durable. One of my favorite ways to utilize effortful recall is to sit down with a white board 1-2 days after a lecture and try to map out every major concept from memory. It is messy and often feels counterproductive, but has led to some of the most effective and long-lasting "gains" in learning.

Spaced Repetition. Research (described in both Make it Stick and Ultralearning) shows that immediately after learning something, a certain amount is forgotten. The forgetting curve is steep at first - as much of 70% of a lecture may be forgotten within 24 hours - but it levels out over time. What if there were a way to prime a review of specific piece of information right before it was forgotten? This is the concept of spaced repetition. Each time information is reviewed, it delays the forgetting curve, pushing it farther back until it is stored as a durable, long-term memory. In medical school, the app that just about every student uses for this is called Anki. It utilizes an algorithm to predict when you will forget a flashcard, showing it just before then. As such, it is generally difficult to recall the information, however, this makes the memory of that card stronger. While Anki doesn't teach everything necessary to learn medicine, it has become an indispensable tool for me. 

Reflection. With the rapid pace of school, craziness of life, and nearly-overwhelming distractions, taking time to reflect is hard, yet, this is one of the most crucial elements to effective learning. Not only does reflection provide a space to recall information and lessons learned, but it fosters insights that improve learning moving forward. For me, that looks like daily journalling, prayer, and meditation. It also includes this blog! 

Why does learning matter? I recently spoke to a friend who was struggling to find work. She has tried a few side businesses with some success, but has struggled to find high paying work in her field of training, despite having a college degree and solid resume. She is not alone. One study found that nearly 50% of college grads don't work in the field of their education (3). Furthermore, we live in a rapidly changing world. Artificial intelligence is rapidly changing career fields and threatens to disrupt a large proportion of US jobs. Being able to learn efficiently, effectively, and intelligently is crucial to excel in our world today. Moreover, I strongly believe that learning is an inherent aspect of our eternal progression as children of God. In every experience of life, we learn, in the sense that it has an effect on our neural circuitry. When we use our agency to learn intentionally, with effort and reflection, that learning will help us on our journey to reach our divine potential. 

Why it has been a while since my last post and future directions for this blog. 

Since it has been over a year since my last post, I want to provide a brief rationale for my lapse in writing along with future directions for this blog. 

Medical school, with all its lectures, tests, and assignments is demanding. When you factor in extracurriculars like research and volunteering, success hinges efficiency. To put it simply, my original approach to this blog was very inefficient. I treated each post like a full-on research paper with multiple drafts, sources, and literature review. 

Moving forward, I need to make blogging more efficient to accomplish its purpose: helping me consolidate the most important information and lessons learned during medical school and disseminating this in a digestable format to others. Here is how I will do this going forward. 

• Write up to one draft, no more
• Write at least some posts with a medically-literate target audience, such as a resident on night call at 2:00 am
• Set a hard limit to time writing such as one hour per week
• Write over a specific high yield topic from the week
• Limit myself to 1-2 sources

Implementing these changes should make this a much more effective and sustainable project. 

Referneces

1. Brown PC, Roediger HL III, McDaniel MA. Make It Stick: The Science of Successful Learning. Cambridge, MA: Harvard University Press; 2014.

2. Young S. Ultralearning: Master Hard Skills, Outsmart the Competition, and Accelerate Your Career. New York, NY: HarperOne; 2019.

3. Robst J. Education and job match: The relatedness of college major and work. Economics of Education Review. 2007;26(4):397-407. doi:10.1016/j.econedurev.2006.08.003