Tips in medical education

by Loren Deutsch

After the 4th of July, rising first-year medical students (M1s) are getting ready for school, and first-year residents (PGY1s) have already started their clinical training, on the path to becoming tomorrow’s medical doctors. With PBL assignments scheduled for M1s along with the next licensing and In-Training Exams for PGY1s, I wanted to share some tips about learning and achieving in medical education.

There is a lot to learn, a lot to remember, and a lot to do, with no shortage of resources, advice, and Anki decks. The following 3 tips are based on years of conversations with current and past students, residents, physicians, LAS Medical Coaches, teachers, faculty, and friends. The consensus is no magic formula makes up for hours of studying, organizing, and sometimes, stressing. Therefore, this article offers a perspective about rolling up your sleeves, doing the work, and being accountable with tips that include finding your passion, making a study plan, and being accountable with short and long-form options depending on your available time!

Tip 1: Find your passion (short form)

1. Think fast! When was the last time you enjoyed yourself? Not thrill-seeking, not going on a roller coaster at top speed for the tickle in your stomach, but enjoying the moment or the day, because of what you value, because of who you were with at the time.
2. Think about it. Try and remember where you were, who you were with, and what you were doing. What were the intangible variables?
3. If you don’t have an answer, that’s okay. The question provides an opportunity for self-reflection and conversation.
4. If you do have an answer, great! Designate time to plan and integrate what you love and who you love into your life. Do not squander those.
5. Plan and be open to change.

Tip 1: Find your passion (long form)

I was skeptical about including this tip because it can sound a little superficial. However, superficiality comes from some kernel of truth, and the more I thought about it, the more I realized that there’s nothing superficial about finding your passion. This isn’t a static process, at times, you may feel passionate about what you do professionally but other times, you may have to work to do what you love. Be open-minded.

Medical education is a long haul. Academically, you’re choosing to pursue higher education for many more hours of focused learning and training than others can imagine signing up for after high school or college. Regardless of your academic path, take time to find your passion and think about what gives you joy. This isn’t an academic goal, it’s not a theoretical construct, it’s personal. It requires making time to know yourself, to know what you like and what you love and to understand that those variables may require the stuff you tolerate but don’t like, with the people you tolerate but don’t love.

You may not know your passion and if so, take it down a notch. Start with what you enjoy. Start with who you enjoy. Pursue enjoyment before pursuing its more exhilarating cousin, and remember, finding your passion means designating time. If you neglect taking time to do what you love and be with the people you care about, it can quickly become a lasting habit.

One of the doctors I talked with said that when he entered medical school he thought about training in psychiatry. He had shadowed a psychiatrist and worked in a hospital between undergrad and medical school. He was interested in behavioral psychology. Yet, years later, now in his sixties and working in a hospital, this doctor is a board-certified obstetrician-gynecologist. He believes that psychology remains an important element in his OB-GYN work, and he shared how happy he is that he pursued a very different specialty than what he had intended. He acknowledged the differences in medical school today compared to when he attended, but also reminded me that being open-minded hasn’t changed.

Tip 2: Make a study plan for learning and achieving (short form)

1. Confirm the learning objectives and end goals before starting.
2. Clarify the timeline and resources for learning and practice.
3. Establish a baseline and weekly achievement goals for progress tracking.
4. Confirm a daily workflow for learning, recall practice, and personal time.
5. Set measurable goals not just completion goals.
6. Be consistent, assess your progress, and be patient. Modify if necessary.
7. Push pause and self-reflect.

Tip 2: Make a study plan for learning and achieving (long form)

Make a study plan, make a few study plans… Medical school is a set of complex, self-directed, asynchronous learning experiences. Just like finding your passion (see above, in case you’re reading out of order) it involves uncovering time to learn how to learn and achieve. This is personal time that allows you to explore and verify what works best for you, not your friends, not your frenemies. You. This is when a learning specialist or medical coach can help because it is that important to learn how to learn in adaptive and effective ways without a display of “road rage” episodes during a high-stakes exam.

Consider the resources and study skills you used for learning, before medical school. It’s possible you haven’t given much thought to either. However, this is a time when you need to cultivate a process to learn more in one year of medical school than you did in two or three years of undergrad, and that warrants some introspection. Despite the overabundance of learning resources in medical education, it is challenging to learn a substantial amount of new information when it is time-sensitive. This is why many M1s and PGY1s go through an adjustment period that can feel like they no longer know how to learn. Sure, the academic terrain is familiar, but the study skills that previously worked (yes, the very same skills that led to medical school admission or residency match) often do not work as well during the new sequence of courses, labs, and clinical training experiences that ensue.

Be open-minded. This can be a difficult task, particularly when something so natural has become something so difficult. It’s difficult to tolerate and persevere during times that feel a lot like failure. Try. Before investing a lot of time and money in study resources and test prep tools, consider the interconnected parts and actionable steps of an effective study plan. The important parts include identified learning objectives, some amount of reading or video watching, recall practice, spaced repetition, and progress tracking. The actionable steps translate these parts into daily assignments ranging from reading and/or video watching to assessing recall and comprehension of newly learned information, maintaining previously learned information, and implementing comprehensive tests to assess progress. Below is a defined workflow for learning about heart disease, specifically heart failure. This is an example and does not include specifics. It is not intended for use without further information.

And what about Anki?

Anki is a widely used resource in medical education. If you’re not familiar with Anki, it’s an open-source, digital flashcard program. Love it? Hate it? Not the point. Anki can be helpful if you understand what you learned and are trying to enhance your accuracy and efficiency of recall about that information, particularly, when it is detail-rich. Some people use Anki as a point of entry for learning new information. I wouldn’t encourage that method because it requires you to recall something you haven’t learned and that seems more arduous than necessary.

Tip 3: Show up, be accountable: Make changes and ask for support               (short form)

1. Show up and be accountable.
2. Deal with setbacks.
3. Ask for support.
4. Incorporate support.
5. Modify or change a habit that interferes.

Tip 3: Show up, be accountable: Make changes and ask for support               (short form)

A well-designed plan may ensure a well-defined deadline, solid workflow, and clear goals. It does not guarantee usage. Study planning presumes implementation. Right or wrong, it may presume deep knowledge or strong study skills. Designing a good study plan, even a great study plan, isn’t necessarily difficult. Designing a plan that gets used, to completion, is a lot more challenging. The reality is a lot of good study plans never come to fruition. The first hint of this involves frequent restarts, do-overs, and modifications to a study plan.

It’s fair to say that a good study plan should be adaptive, for greater utility over time. As course material changes or professional demands increase, the framework of a good plan can be reused. However, a study plan’s framework is not intended for weekly modifications. When that issue emerges, it usually signals a setback, and the setback often involves change and frustration.

There is a recurring theme in our weekly Team Meetings that involves the difficulties students and residents often face as their plans to study for a class or prepare for a high-stakes exam go awry. When a study plan becomes challenging to implement or maintain, we look to answer why. The reality is that change can be hard and there is a lot to learn. Consider what it takes to deepen knowledge, modify an approach, shift a perspective, or upgrade a skillset. The complexity of knowledge increases and change is nuanced. After all, a little change can make a big difference and most don’t think about learning how to learn unless there’s a problem.

Making a change often means changing a habit. Even when change results in a positive outcome, it can be difficult because it feels difficult. Try holding a pen in your non-dominant hand. Not difficult. Try writing your name with your non-dominant hand. Probably harder but manageable. For the next 24 hours, do everything you normally do with your dominant hand using your non-dominant hand. Difficult and probably, frustrating, and for some, a deal-breaker.

It is expected to tolerate feelings of irritation or annoyance that may activate when a task is effortful. However, if these feelings persist or dominate because a task remains effortful, it becomes increasingly challenging to be in a persistent state of frustration. This state is what often leads students and residents to abandon their plan, reinvent it, or go rogue. If this happens enough times, in enough places, abandoning a plan begins to look like laziness and low motivation. This is when it’s important to show up and be accountable. Showing up is about showing up for yourself, your family, and your friends, and being accountable, is about being accountable to yourself, your goals, your family, and your friends. This is when it’s important to ask for support.

In medical education, student learning is often asynchronous and self-directed. It is implicitly understood that foundation knowledge will be needed in a variety of sciences and other classes. When that knowledge is underdeveloped, students need to learn how to learn and backfill quickly. It helps to consider mastery learning, a self-paced model that involves achieving a certain level of mastery in prerequisite knowledge before advancing to learn subsequent material. Whether gradual and loping or more direct and succinct, unless there’s a problem, most don’t consciously think about their learning process. However, this often becomes a hot topic for M1s and PGY1s and can indicate that it is time to ask for support.

Keep in mind, medical education requires learning how to learn in adaptive and effective ways and a learning specialist or medical coach can be very helpful, particularly if it means mitigating “road rage” on an exam. So, roll up your sleeves, show up, take responsibility, and remember to find your passion.