Learning to Learn in Med School

Learning in medical school is quite different from learning in a undergraduate setting. The concepts of medicine themselves aren’t that hard to grasp or different from the biochemistry, physiology and general biology in a typical premed course.

Simply put, each individual concept in medicine is easy to understand; connecting all the ideas and knowledge together is the more challenging part and is what makes a doctor. The increased volume of knowledge, need for long term retention and integration with clinical skills is what makes learning in medical school different, but not necessarily more difficult. Although, I have only studied medicine for a short time, I have begun to notice what works for me and what doesn’t and would like to share my own lessons on learning medicine.

1. Be an Active Learner, not a Passive Student

Learning is fun! As a medical student in preclinical and clinical years, your main responsibility is to learn, doing so in a respectful and enjoyable manner. No one is as responsible for your education than yourself. It’s your job to make sure you acquire the knowledge and clinical skills needed to become a competent doctor, not your school, not the licensing board, but YOU!

Do you still remember your transition from high school to university and how nobody was there to hold your hand anymore when it came to learning? Same goes in medical school.  Luckily, there is no shortage of things to learn and do in medicine. Don’t feel obliged to just stick to just whatever the professor or lecturer says in the classroom, medicine is a far broader field than most know. Shadow, get clinical exposure, talk to physicians and learn outside of the classroom. Don’t spend all your time just focusing on material that you will be tested on, take time to learn what is important and essential to the practice of medicine! You would be surprised how poorly what is tested and what is important correlate, just ask a practicing doctor.

Remember that you are not in medical school to get good grades so you can get into the residency of your choice. That may have been true in your undergraduate studies, but it shouldn’t be in medical school. You are studying to become a doctor and you should ensure that you take the necessary steps to become a good one. Never let school get in the way of your education.

2. Nobody Remembers Everything their First Time Around

There is a lot of memorization in medicine, there is no avoiding it. But even the brightest students don’t remember everything their first time through. Spaced and constant exposure to the material is needed for any long term memory to be created.

Cramming may work to pass an exam but I highly doubt you will learn anything in the end. That is why I have found frequent reading and continual exposure critical to acquiring and retaining large amounts of knowledge. You may not remember all your antibiotics and bugs the first time through, but the more you repeat it, the better it sticks.

However, I must caution against repeating a lecture over and over again. Many schools record their lectures for student convenience and I think it is a waste of time to attend a lecture and then to go home replay the same lecture. Not only are you spending twice the time to cover the content, you are also becoming a passive learner who is hoping to absorb all the information by osmosis. It is the same as glazing over lecture notes repetitively but never taking the time to grasp the concepts. That is why focused and active learning must always take place.

3. Build a Basic Skeleton, then Fill in the Details

With the vast amount of knowledge to be learned, it’s quite common to get caught up with memorizing minutiae. After all, most exam questions tend to be focused on specific nitpicky facts. However, if a skeleton of knowledge isn’t built for each topic before these details are learned, it becomes hard to keep track of all the information floating around.

For any disease, I try to approach it in a systematic and consistent way. I like to start with a good definition or summary sentence for each new term. Using a good medical dictionary (and acronym and abbreviation dictionary) can make a big difference. Mondofacto, MedTerms, Medline, MediLexicon, Taber’s or even a dictionary or wikipedia are good sources.

Always start with the basics if you do not know them. Normal human physiology, anatomy, biochemistry, etc should be understood first before learning about the abnormal pathophysiology and disease states.

Apart from Etiology, Epidemiology, Clinical Signs, Diagnostic Tests, Treatment, Prognosis, etc  I try to summarize the main points for each disease on one page of paper. Often a review book such as Toronto Notes or First Aid can be an excellent resource to learn the key and essential facts. Once you have the main points down, feel free to fill in any additional details.

4. Learn from Multiple Perspectives - Peers included

It would be a shame if your entire medical education was based on just your class lectures and recommended readings. Sure, the material you will be tested on will be from these notes but there is also a lot of material that will be left out that is important! Furthermore, class notes are often poorly organized and sometimes even incorrect.

Better yet, once you begin learning from multiples sources (and not just wikipedia) you will be able to differentiate what is important and what is not. The key concepts and facts will be repeated in multiple books because … they are important! Even comparing your class notes with a textbook will help you organize the information better and in turn you will spend less time with irrelevant material.

This applies to more than just textbooks. Learn from different teachers, learn on the wards and learn from your peers. There are a lot of nifty learning aids and tools that you may be unaware of.

5. Make the Knowledge Your Own

Take ownership of the things you learn about. If that means rearranging lecture slides into something you can understand, do it! Mark up your textbook with multi-colored highlighters and side notes if it will help you learn. If you want to learn the difference between multiple diseases, creating a comparison table is an excellent exercise and quick visual aid you can use.

Similarly, creating your own mnemonics or finding ones you will remember can make dry material more interesting. Create songs, rhymes and dances when possible.

Every time you create your own notes, you are reorganizing the information in a way that you can understand and digest. However, I would caution against just copying out notes mindlessly. You must organize the information to suit how you learn.

6. Ask Questions

There is no quicker and effective way to find your gaps of knowledge than by asking questions. That is why tests are such a practical tools in learning and that is why pimping by attendings can be beneficial to you.

The pursuit of knowledge begins with a good question. After going over a topic, I like to turn over my notes and ask myself some questions. What did I just learn? Why is such and such important? How does this relate to this other condition? How can I differentiate between this and that? In doing so, not only do I come to realize what I don’t know, but I also create links between different concepts which further solidify my base of knowledge.

7. See one, Do one, Teach one

The old adage of seeing one, doing one and teaching one holds true when practicing clinical skills. It combines the best of repetition, active learning, different perspectives and taking ownership to help you learn and remember.

All students will observe, proactive learners will do, few will teach. I guarantee that if you take the time to teach somebody else a topic or a technique, you will end up benefiting from the experience. Even though I am not a big fan of group studying,  one type of group work I do enjoy is when every group member first does their own reading and studying and then comes together for a review session. Every member is assigned a topic to go over and teach; they are to be the expert. By teaching in front of your peers, you get to know your topic inside and out because you will need to outline and explain all the concepts clearly. Furthermore, your peers will ask questions that can identify your weaknesses and similarly, they can contribute to the discussion if details were left out.

8. Practice Makes Perfect

Finally, I’ve come to realize that the journey I am on is a long one and everything doesn’t always come easy the first time around. I often forget my anatomy or confuse two different things for each other. I mispronounce drug names and many times I just don’t know. But luckily, I am still in the early stages and there is much more to go and with dedicated practice, I will improve. It’s important to set high standards but not to be too hard on yourself. Rome wasn’t built in a day and neither were doctors in days, weeks or even a year. It takes 10,000 hours to become an expert in a field (Outliers, Gladwell) which roughly works out to be somewhere after medical school and in residency. And even though I feel as if I have learned a lot, I know that there is still much more to learn ahead of me. So I look forward with optimism and excitement because I am slowly getting better at learning and I find learning medicine fun. =)

If you have any tips on how to learn, please leave a comment. I would love to hear how other people approach their learning!