Study Skills for Medical Students: Part II

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Study Skills for Medical Students Part II

• Latha Chandran MD, MPH
• Associate Dean, Academic Advising
• Interim Chair. Dept of Pediatrics
• SUNY at Stony Brook

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Features of an MS1

• Intellectual self doubt
• Workload anxiety
• Competition vs cooperation
• Loss of status!
• Difficulty with authoritarian hierarchy
• What is the big picture?

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Exams

• Each course has small exams, quizzes, labs, NBME
  shelf exams
• USMLE Step I before third year
• USMLE Step II before graduation
• USMLE Step III during residency
• Specialty boards after residency
• and thereafter..!

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Time Management

• As a doctor, one needs to do lots of things!- see
  patients, teach, learn, read, leadership roles,
  community, exercise, keep friends and family
• Give up the idea that you are a student
• You are a professional MD in training
• Practice using your time WISELY!

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Final goal

• Pass USMLE Step I II and III
• Pace yourself like a long distance runner-
  practice, practice and practice to build up
  endurance
• Each hour in class- spend two hours outside of
  class
• Take INTERNAL control of your time
• Beware Ns and Ps- mngt by crisis!

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Memory curve

• Imaginary line illustrating the process of
  remembering and forgetting
• Try to create an optimal memory curve- takes
  practice
• Reinforce and expand your learning style
  dimensions IMMEDIATELY after you learn something
  new
• Use other sensory modalities to remember

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Memory curve graphic
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Long term memory

• Break it down into small pieces
• DAILY routine of memory reinforcement
• Guard against procrastination

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Common causes of academic difficulty

• Time Management issues
• travel, family, friends, other activities
• Material management issues
• not preparing, no daily reinforcement
• no CONSCIOUS system of study
• no own notes
• Mental Health issues
• depression, LD, ADD

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Tips for optimal learning

• Create a schedule and follow it
• It is your best friend
• Skim read/ pre read
• generate questions, new terms, charts, graphs,
  compare/contrast data
• Attend lecture
• Sit in the front, away from distraction, good
  lighting

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Tips for optimal learning

• Analyze data
• Memorize- see, hear, say, apply, teach
• Mnemonics for physical objects courses ( Funny
  ones)
• Flash cards
• Create your OWN flow charts, compare/contrast

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Tips for optimal learning

• Fit new material into existing info
• Practice every day the first week of exposure,
  use all your senses, and reinforce
• You will be able to cut down on study time later
  for memory brush ups
• Add music to your environment if auditory

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Schedule construction

• When are you most alert? AM, PM?
• How much sleep do you need?
• Do you need large blocks of uninterrupted time
  for work?
• Do you need a break after 1-1.5 hours?
• How long a break, what to do then?
• When do you study alone? With others?

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More tips

• Stay with one topic for at least 1.5 hours
• Work with related material
• Intersperse difficult subjects with easy ones
• Use your highest energy time for the most
  difficult subject
• Volunteer to teach in your group this topic

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Learning environment

• Music/ food/ pleasant views
• Vary sensory use- the more sensory input the more
  sustained memory
• Visual- different colors/ shapes/ sketches,
  spatial models, slant of writing
• Kinetic- use LARGE paper/chalk board

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Time Accountability

• Time log for sensors
• Use a 15 mt block daily calendar
• pay attention to your natural rhythms
• Time pie- weekly pattern of time use for Ns and
  Ps- like chunks of time
• Using both is IDEAL for both groups
• First create a personal time pie

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Study sandwich

• Put in the difficult subject between two slices
  of easy ones
• Do not fall behind- if you do, catch up on the
  weekend
• Work on the most current material first
• To kill time is to murder your chances for success

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Taking notes

• Ear to hand
• One sided Leave other side of page for text book
  notes, study group notes-differ color
• Leave large margins for LABELING

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More on taking notes

• If unclear, leave gaps
• Fill in spaces/ blanks after talking to another
  reliable note taker ( use different color, need
  extra attention)
• This is YOUR permanent record
• Have a reliable note taking partnereach your
  colleagues

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Concept Mapping
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Learning syndromes and their management

• Reference Robert Burns, Medical Teacher Vol 28,
  No 3, 2006, pp 230-233
• Nine syndromes
• Peculiar predilection to affect early medical
  students
• Management

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Six chambered heart syndrome

• Excessive analysis of test questions
• How many chambers does the heart have?
• Are the two auricles chambers? If so six is the
  right answer
• REMEDY Come up with the answer WITHOUT looking
  at the options

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Slip and Slide syndrome

• Studying for the exam that is most imminent to
  the exclusion of the other concurrent subjects
• Very common
• Fosters cramming and memorization versus actual
  learning
• REMEDY Make a contract to study each courses
  stuff THE DAY you encounter it- not LATER!

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Slip and slide syndrome experiment

• University of Arkansas- Three courses running
  simultaneously
• Every third Monday two exams, and every third
  Tuesday- one exam
• Courses rotated as to which exam came first
• Did the students like it?

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Slip and slide experiment

• Results
• Students did better than predicted in all three
  courses!
• Why?
• Never allowed to slip and slide
• KEEP UP should be your mantra

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Oh Yeah syndrome

• I have seen this before
• So I dont have to pay attention
• Depth of understanding required by medical school
  faculty very different
• Oh Yeah turns into Oh No at the time of the exam!
• REMEDY Be aware, pay attention to the detail and
  the focus

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Too many books syndrome

• Buying lots of books will NOT translate into
  learning
• REMEDY Buy only the required course materials
  and USE them well

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Post Genius syndrome

• Prior outstanding academic record
• Now receiving a C for the first time
• Bell shaped distribution for grades
• REMEDY C in a med school course is an acceptable
  place to start from

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Irrelevant material syndrome

• I will never need to use this when I become a
  physician- so why do I need to learn this?
• Very common
• REMEDY Crucial to understanding clinical
  relevance
• Also understand principles of life long learning

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Alternate Syndrome

• I was on the waiting list, so I cant be as good
  as the others
• Motivation is key
• 27th alternate admitted as the bottom most rank
  in the class- ended up graduating first in class
  in four years
• REMEDY know that the playing ground is level
  when you start

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Old Test Question Syndrome

• Variant of the Oh Yeah syndrome
• Slight rewording of the stem results in a
  different answer being correct
• Failure to detect the change in the stem results
  in incorrect answers
• Eg Masson- trichrome stained section of tongue
  Identify the organ, identify the blue staining
  material, identify the germ layer of origin of
  the surface epithelium
• 70 error rate!

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MEUL syndrome

• Memorize Everything- Understand Little
• Very common and very problematic
• If you got away with rote memorization in
  college, you cant now with soooooo much
  material!
• REMEDY verify understanding after each major
  concept

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MEUL syndrome treatment

• Divide content into bite sized pieces
• After each bite ( max 30 mts) use the split brain
  study method, where the other half of the brain
  poses questions and challenges to your
  understanding- see if you have TRULY understood
  what is going on
• Delayed ignition study method- in the car,
  understand it before you turn on the engine
• Brief and Intense

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General counsel

• Get ahead and stay ahead
• Prereading and reading the SAME day
• Mental participation during lecture
• Core content guessing
• Active listening