Effective Learning for Medical School and Life: How to Drink from a Fire HoseWith Amber Chess, Director of the Office of Academic Success and medical education learning specialist at the Zucker School of Medicine at Hofstra/Northwell With the 2020 COVID-19 public health concerns, medical education was rapidly transferred online and made accessible to learners everywhere. In fact, as a recent JAMA article noted, many faculty were already “flipping” the classroom to provide individualized instruction for asynchronous learning “anytime/anywhere.” However, this time outside of formalized instruction needs to be used wisely and effectively (Rose, 2020). Oftentimes, learning in medical school is compared to drinking from a fire hose. There is a lot of information to encounter, retain, and then finally apply for improved patient outcomes. In addition, science is rapidly updating, and students not only have to establish a solid foundation of knowledge but must be able to think on their feet while adding new knowledge to their existing knowledge base. Thus, whatever study method learners used in college may not work anymore, and students rapidly need to update their learning skills to keep up with the ever-growing amount of content they encounter. Is there a recipe to get it right? Well, maybe. In Make it Stick: The Science of Successful Learning, Peter C. Brown offers several methods for effective learning for students. However, don't forget …. reflection and awareness are the first steps to getting it right, and the first step to master learning is recognizing what works best for you. During the Brainterns 2020 Program, a webinar series offered by the Lenox Hill Neurosurgery Department during the summer of 2020, I had the pleasure to present a session on learning for medical school together with my colleague Amber Chess, director of the Office of Academic Success and medical education learning specialist at the Zucker School of Medicine at Hofstra/Northwell. Amber works with students to improve their learning skills and support their success in medical school. You can access the entire webinar here: Interestingly, polls from this webinar on individual study habits revealed that participants – learners from different institutions across the globe – used recommended effective strategies but were not consciously aware of their effectiveness. As Peter Brown mentions, “learning is deeper and more durable when it’s effortful.” The following outlines five learning strategies and frameworks – efforts to help you become a more productive learner, for study and for life. 1. Elaboration Did you ever wonder about how to pronounce the name of this weird disease? Even more, what about the individual name of microbes? Saccharomyces cerevisiae?* Staphylococcus aureus? If you cannot pronounce it, you will not remember it! So, go on, say it aloud! Ask yourself questions and explain the concept back to yourself, and pace around if that helps! Self-explanation involves clarifying concepts to yourself in your mind. Elaboration is the way to connect new content with meaning by expressing it in your own words and relating it to existing knowledge. Activating prior knowledge by thinking about all you already know about a topic as you are studying it is recommended. Similarly, explaining a concept to other learners also fosters retention of content. Talking about the subject increases the mental cues available for later recall and application. Basically, using elaboration activates your own schemas – clusters of “information, or neural networks, that get bigger and stronger as we add to them over time, through experience.” Thus, learning is stickier when we relate it to things we already know. 2. Spaced Practice Delayed re-exposure, a.k.a. spaced practice, to course material increases the amount of information you remember. Spaced practice is really the opposite of cramming before an exam and means spacing the intervals between reviewing the material. Of course, you need to have a fairly good idea about your time budget, so you can let time pass before you revisit the material. Hint: Plan your spaced practice using a calendar. With spaced practice, you will learn your material in an initial study, let some time pass before you review (but not too much!), and then review prior to the final exam. During the time when you not studying, you brain is working with the content and putting it in your long-term memory. When you let your brain “forget” the content after a few days or so and then retrieve it again, it is more effortful. We usually study in “massed practice”: cramming! Yes, cramming may be effective for the short-term memory, and you certainly may be able to ace the exam, but it will not commit the content to your long-term memory. However, when you use your time wisely and let time pass between review periods, you will be able to build long-term memory and do well on the exam. The same four hours used cramming is better spent one hour a day over four days. So go ahead and stop cramming and start using delayed re-exposure to course material, which often markedly increases the amount of information that learners remember. This is effective across different areas to increase retention: key facts, concepts, and knowledge. The spacing feels like a challenge – what we call desirable difficulty – which helps retention as well. 3. Interleaving Content frameworks such as sessions, texts, and even our minds work in a chronological order. To prepare for exams, we mostly also attack the content in the same chronological order. Here is an innovative idea: Interleave the content with different but related topics. In other words: Mix it up! Interleaving is the idea of reviewing the content in a different sequence as initially learned. The idea is that already solved problems support retention of new content. Frankly, this is really an invitation to play with your study topics and mix them up as you review them. As an example, you could alternate the topics of study or review (easy vs. new, etc.) or alternate between worked-out problem solutions and solving similar problems. Interleaving could even be combined with spaced practice, such as planning out the study of several topics and returning to it periodically over time in a different sequence. This is another example of a desirable difficulty, but even though this can be challenging, it is great for retention and deep learning. 4. Retrieval Practice Do you ever catch yourself reading and rereading new content? You may be wasting your time. Odds are, you spend a lot of time putting information into your head, but how much time do you spend pulling it back out? Retrieval practice involves recalling facts, concepts, or events from memory. Well-known aids and methods for retrieval practice include, e.g., flash cards, quizzes, or writing down what you remember. In a nutshell, retrieval practice includes any active work you do with the content, even speaking content material loud with your eyes closed. However, retrieval practice also functions as formative assessment for yourself, as it gives you feedback about how you are doing and if you really mastered the content. Any opportunity to practice retrieval from memory, e.g., discussions, group work, quizzes, reinforces learning, provides feedback about your progress, and inspires motivation. 5. Dual Coding Do you doodle when you take notes? Or do you perhaps love to watch videos and take notes to support your learning? These are all examples of dual coding, which simply means to support the written word with an image. Dual coding can be done in many ways, such as drawing a schematic when you take notes or drawing out a pathway. At the Zucker School of Medicine, we recognize the importance of visuals in learning; the walls in our small group rooms can be used for drawing, which is a significant method for collaborative learning in study groups. Also, many of our medical students turn to videos first for learning. Some students even use doodles in their concept maps. You, the learner, is called upon to be proactive and look for images and videos. It will help you understand and retain the content. Our working memory (the type with limited capacity and stores information as long as it's being used to complete a task) is formed by verbal and visuospatial components. In fact, many successful students choose study materials that reflect their preferences. Closing Reflecting on these five learning strategies, which of these methods resonated with you most? Other than re-reading, they all involve effort and planning. I invite you to try them out on the next occasion. Perhaps next time you read a text, close your eyes and speak it out loud from memory, and then compare the content with what you memorized. Try this at different times during the day and see when you remember best. Expand your mind and your potential as a learner, for lifelong benefit. *…and finally: Saccharomyces cerevisiae is brewer’s yeast. It is used in producing beer and will usually not cause disease – unless you drink too much, of course. Questions 1. Which of these strategies resonate with you most/least? 2. Which of these strategies are you going to try next, perhaps with a study group? References Andreatta, B. (2016). Wired to Grow: Harness the Power of Brain Science to Master any Skill. 7th Mind Publishing. Kindle Edition Brown, P. C., Roediger III, H. L., & McDaniel, M. A. (2014). Make It Stick.: The Science of Successful Learning. Harvard University Press. Clark, J. M., & Paivio, A. (1991). Dual Coding theory and education. Educational Psychology Review, 3, 149-210. Kang, S. H. (2016). Spaced repetition promotes efficient and effective learning: Policy implications for instruction. Policy Insights from the Behavioral and Brain Sciences, 3(1), 12-19. Pashler, H., Bain, P. M., Bottge, B. A., Graesser, A., Koedinger, K., McDaniel, M., & Metcalfe, J. (2007). Organizing Instruction and Study to Improve Student Learning. IES Practice Guide. NCER 2007-2004. National Center for Education Research. Rose, S. (2020). Medical student education in the time of COVID-19. JAMA, 323(21), 2131-2132. Sumeracki, M. (2020). Elaboration as Self-Explanation. Retrieved from https://www.learningscientists.org/ blog/2020/2/20-1?rq=elaboration The Learning Scientist. Weekly Digest #132: Dual Coding, Visual Note Taking, and Sketchnoting. Retrieved from https://www.learningscientists.org/blog/2018/11/11/weekly-digest-132?rq=doodle The Learning Scientist. Self-explanation [https://www.learningscientists.org/blog/2020/2/20-1?rq=elaboration Images: Shutterstock
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