The Case for Digital Notes

Officially done medical school!

And if studying for the LMCC last week taught me anything, it’s the importance if having a learning system in place. I’m now doing my big academic purge in preparation for residency. I almost feel guilty for throwing out so much stuff.

There are binders and binders full of notes. Anatomy diagrams that I once knew, important tables and flowcharts. The only reason I feel at ease for destroying these notes is that I have a digital copy of them.

Why Do We Take Notes?

It’s important to understand why we take notes and what is their purpose. When we learn something new, the first step is information capture. To insure that all important ideas, thoughts and facts are captured there needs to be a ubiquitous and consistent system.

Taking notes is a basic form of information capture. It can be transcribing a professor’s lecture or jotting down some points on an index card.

After all the data is gathered, it has to be processed through reflection and creation. We write our own notes in a way that makes sense to us. Through spaced repetition we remember the key concepts, synthesize knowledge and apply it.

Advantages and Disadvantages of Electronic Notes

Having been in school my whole life, I’m surprisingly a late-adopter to electronic notes. But since medical school, I have been using a hybrid approach of paper and electronic notes. Moving forward towards  residency, I believe a digital system is the best way to go.

Advantages of Electronic Notes You can type much faster than you can write Your notes are much more legible Your notes are searchable and indexable It’s more eco-friendly and space-saving It’s easier to edit and revise them - changing fonts, colors, adding sidenotes It’s easier to organize large amounts of information Accessible anywhere with an internet connection, on your laptop, tablet or phone

Disadvantages of Electronic Notes Not as portable - You always need a device to read your notes Not good for diagrams, flow charts, mindmaps Harder to capture knowledge in on-the-go settings (eg. not always practical to have a laptop)

How to Learn in Medical School

If I had to start medical school over again, I would strive to create a more organized knowledge database from the start. I would focus less on regurgitating lectures notes and more on understand how key concepts relate to each other. Using this method, I probably would have done worst on my tests but my knowledge would have been more solidified. Understanding the material you learn is the key to long term knowledge.

Most medical schools use a lecture based format with problem based learning interspersed during pre-clinical years. What I did was print off the lecture slides and studied off of them almost exclusively, memorizing all the fine details.

What I should have done was to summarize each lecture into just the key points (about 1 page). I should have then stored these notes in a comprehensive electronic system where I could easily retrieve them later. So that during clerkship, I wouldn’t dread having to go through old binders of notes to refresh my knowledge, but would have an accessible and personalized database to go through.

It’s through this repetition and rethinking of the same topics that finally lead to true knowledge. For example, I thought I understood the basics of heart failure the first time I learned about the anatomy and pathophysiology of the heart. I gained a new appreciation for this topic when I began seeing patients with heart failure. But it wasn’t until I combined the knowledge I had gained from the basic sciences with the clinical picture that I really understood it.

Potential Tools for a Digital Age

It doesn’t matter what tools you use as long as you use them consistently.

Your system could be as simple as properly labeled folders for each subject. Every time you learn about a new topic or read a journal article, you file away that knowledge in the right folder. I recommend using Dropbox (read my review) to make this simple system even more powerful, as your files can be accessible anywhere with an internet connection.

The system I used during medical school was to use Toronto Notes as a basic foundation. I would read up on specific topics and jot down additional information in the margins of TO notes. I would also try to incorporate class notes, clinical pearls and primary literature whenever possible. Clearly, it won’t be sufficient in residency.

At the start of third year, I started using Microsoft’s OneNote to keep track of all the pieces of information that didn’t quite fit in with TO notes. An alternative free option is EverNote. I made a notebook for each major specialty and found it a simple way of having all my notes in one place. I also found it useful because I could add new info to old topics. Using this method, I was able to keep track of stuff learned in teaching and bedside rounds. For residency, I plan to make condensed notes from a primary textbook that I can add on to my “knowledge database”.

Other tools I use include Mendeley which I use to keep track of journal articles I have read. What’s awesome about it is that it’s accessible anywhere. I can read a paper at the hospital, bookmark it or save it using just the browser, and have it accessible on my computer at home.

Organizing your browser bookmarks with something like Xmarks is another way to better manage information. Most of my go-to-sources are online now, including UpToDate and eMedicine. Similarly, there are so many good websites of knowledge out there for ECGs, Clinical pictures, and medical calculators that it’s important to keep track of your tools.

Furthermore, there are neat things you can do with electronic notes like make digital flashcards with programs such as Anki. You can even sync these cards to your phone.

There is also some really cool technology like Livescribe (15% off), which is a pen that digitally records everything you write. There’s even a built in voice-recorder.

Conclusion

The way doctors learned medicine thirty years ago is very different from today. Especially now when medical knowledge is expanding so quickly, there will always be too much to know in too little time. It’s time we use new methods and tools to enhance our learning.

In a time when medical information is changing so quickly, it doesn’t make sense anymore to use something as outdated as pen and paper. The dynamic nature of electronic notes plus the fact that it’s syncable and accessible anywhere, makes it the ideal format for learning medicine in the 21st century. With the abundance of portable laptops, tablets, and smart phones, I hope I have convinced you that electronic notes is the best way to go.