Study Skills for Medical Students: Part II

1. Study Skills for Medical Students: Part II Latha Chandran MD, MPH Associate Dean, Academic Advising Interim Chair. Dept of Pediatrics SUNY at Stony Brook

2. Features of an MS1 • Intellectual self doubt • Workload anxiety • Competition vs cooperation • Loss of status! • Difficulty with authoritarian hierarchy • What is the big picture?

3. 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………………..!

4. 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!

5. 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!

6. 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

7. Memory curve graphic

8. Long term memory • Break it down into small pieces • DAILY routine of memory reinforcement • Guard against procrastination

9. 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

10. 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

11. 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

12. 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

13. 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?

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. Concept Mapping

21. 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

22. 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

23. 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 course’s stuff THE DAY you encounter it- not LATER!

24. 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?

25. 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

26. Oh Yeah syndrome • I have seen this before • So I don’t 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

27. Too many books syndrome • Buying lots of books will NOT translate into learning • REMEDY: Buy only the required course materials and USE them well

28. 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

29. 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

30. Alternate Syndrome • I was on the waiting list, so I can’t 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

31. 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!

32. MEUL syndrome • Memorize Everything- Understand Little • Very common and very problematic • If you got away with rote memorization in college, you can’t now with soooooo much material! • REMEDY: verify understanding after each major concept

33. 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

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