How to study. Effectively.

I started writing post number two as I sat outstretched in the enormity of row 23 on flight FJ915….. We were in the exit row. We were on the way back from our honeymoon.

Yep, life is pretty good sometimes.

I had a foggy head (the result of a lingering hangover from the final day efforts to sample all the wine on the list). I managed to start, and then place on pause, what will likely become three or four different blog posts in the coming weeks. Giving in to the dizzying effects of the turbulence, I vowed to write more successfully, more definitively (or maybe just manage to finish a post) when suitably caffeinated – en la mañana.

So to today’s post, a more effective and definitive post.

This is an adaptation of a short presentation I gave to a fresh-faced and eager group of medical students early in 2014. We affectionately refer to them as ‘Firsties’ and the title of the talk was ‘Firsties Formative Prep’ (aimed at their first medical school exam a few weeks – the formative). I hope to lay out in a few simple rules that I try to follow in my study. These are the rules that I’ve figured out/been taught/wished I’d started following sooner/am still trying to figure out how to do etc. They are rules that do not dictate the step by step of studying (add a comment if you want me to provide that information) and this is by no means as exhaustive list. I see merit in their application to learning medicine and hope some will suit your style.

Rule 1: Set informed goals (and do not do a single thing unless it falls under one these goals)

There is a buzz in our medical school about the concept of learning objectives, different levels of objectives, use of objectives to plan assessment items etc (and the Australian Medical Council uses these outcomes in decisions about the accreditation of our schools). I won’t go down that tangent except to say that learning objectives, for the most part, are given to us. These objectives go full circle when they are used to decide our exam questions.

To state it simply, set your goals (or write your questions – more on that soon) based directly on these objectives and if you find yourself working on things that are not encompassed in the objectives – STOP! Make a note of what you were doing and come back to it after exams.

I struggled early on when studying. I struggled mostly because the medical world is so full of cool sh^t. It’s all fascinating. I would catch myself buried in a textbook, in a chapter nowhere near the topic I intended on looking up for clarification. Do not get caught in this trap. Or if you do, acknowledge the interest, enable the fascination and then get back on track. There are quite literally hours of interesting reading that could come out of each lecture and when you add up the hundreds of lectures we sit through there is simple not enough time.

SMART goals (Specific, Measurable, Achievable, Realistic, Timely – http://en.wikipedia.org/wiki/SMART_criteria) are well known and effective so read into that if it is news to you. My point is not to lay that information out. My point is to remind you to be clever when setting your goals (base them on learning objectives and areas of weakness) and be honest with yourself about whether what you are doing is actually helping you achieve one of these goals (if not then stop).

Rule 2: Get your own routine (and be consistent, not crazy, it will pay off come stuvac)

I won’t preach to you about when to study in the day, how much time to poor into your study, when you review and revisit lectures etc etc. I have studied with a lot of different people so far and always tried to take note of how other people work. The single thing that can be distilled from all of these observations is that all people work differently. Further, all people change their strategies as they go, always looking for something more effective.

The point that I will stress here is consistency. No amount of cramming in the final week before an exam can make up understanding gained from consistent, and effective, study. Yes it will help (and I certainly still practice the 16 hour days of cramming before exams) but you cannot get the depth of understanding gained from consistent and progressive work throughout the semester. Decide a routine early on and stick to it. Assess as you go whether it is being effective. Change it if it is not. Map out the specifics as you go and tick them off once they’re done.

(A side note here for those with significant others – Medicine is all consuming. You will neglect your partner and become the inattentive person you probably made fun before UNLESS…. You communicate your plan, talk to with your partner about the upcoming busy weeks, book in date nights, put your exams on the calendar, ask for their support and encouragement, talk about what this should look like. You’ll figure out the specifics of this. It took me a long time to figure it out. Do it early. Do it honestly).

Rule 3: Question and answer ONLY (do not waste your time with summaries you will never read)

I spent the first six months of medical school writing lecture summaries that I was immensely proud of. They were detailed yet easy to understand. They had pictures and tables, they were brilliant. I spent hours writing them (on average probably two hours or so per lecture – sometime up to four hours), hoping they would set me up for effective study come exam time.

I never opened them again.

Despite being all the things mentioned above, they were simply not useful when it came to studying for exams. If I tried to open summaries and read through them I fell asleep, if I went looking for specific points I couldn’t find them. I always ended up just opening the lecture slides and reading through the more succinct (although never as clear) dot points they provided.

John in the year above me (the student we were all in awe of) put me on the right path. He preached question and answer format. For everything. This was a scary concept at first – ‘so I don’t even write a summary?’. But I took the plunge.

I dropped the summary format. I sat in lectures writing questions rather than taking notes. I went home and answered the questions rather than summarising the points. It was transformative. I realised within a few lectures that in answering my questions I got my summaries. By getting me head thinking in questions and answers it became clear what the main concepts within each lecture were. Perhaps most importantly, the two hours I had been spending summarising the lecture was cut down by half, or by two thirds, or even more.

I believe that each time you need to recall information you’ve been taught in medical school it will be in the form of a question (exam questions, questions from consultants on the wards, questions from patients). Not once will a consultant ask you to summarise a concept for them, they will grill you on details. I think it is more effective to do all your study in question and answers. I think it is more specific and more time efficient.

Rule 4: Do the uncomfortable things (effective study is more frustrating than fun)

Humans are described as creatures of comfort. We seek the comfortable in situations where we have choice. Applying this to study, when there is the choice between studying something that makes you feel good or something that makes you feel uncomfortable we will choose the former. Every single time.

The comfy topics are the ones we know. My background as an exercise physiologist means that I love muscles, I love talking about types of contraction. Holy sh&t do I get excited about anaerobic thresholds, VO2 etc etc. As a creature of comfort I would find my way to topics like this completely subconsciously. I would happily explain them to my classmates, happily review them again ‘just to be sure’. Moreover and more importantly, I would steer far away from that sick feeling I got when I opened the page to genetics, to histology, to anything to do with chemistry. Gosh do I hate chemistry. I frequently got frustrated and gave up because I did not know these things well (and still don’t). I did not know these things well cause I avoided them, I avoided their discomfort.

The uncomfortable topics are invariably the ones you need to study most.

I think I’ve made my point here. You need to police yourself. Be aware of how you respond to different topics (yes Mum I am eluding to some of the mindfulness you so love) and force yourself to work on the uncomfortable topics while not completely neglecting the feel good areas.

That’s it folks.

Blog number two done and the resolution still on track. Inevitably these rules will not suit everyone, they will likely be downright bad for some but I do I hope that some get benefit from these concepts that have delivered me safely through the first two years of medical school.

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