How STATMed Learning Can Help Turn Down the Pressure
Let’s state the obvious: it’s pretty hard to succeed in med school when you feel like you’re drowning. All your attention stays on keeping your head above the water. We’ve always heard that if studying and learning in undergrad is like sipping from a water fountain, then learning in med school is more like trying to drink from a firehose. It’s a lot. It’s high pressure and overwhelming. Between the grueling hours and the amount of information always coming at you, it’s no wonder that even smart students get seriously overwhelmed and start struggling in med school. That’s why you need to be studying as effectively and efficiently as possible.
It’s important to remember that not all med students are built the same. So, studying and testing strategies that are successful for your peers might not benefit you at all. And that’s okay.
You’re Struggling in Med School Because There’s. Just. So. Much… Now What?
In this video, we break down the study habits of two first-year med students who felt like they were getting pummeled by the firehose. We take a look at their study habits — habits they thought were setting them up for success — and break down why popular studying methods don’t always work when you get to the med school level.
In Their Words: Study and Testing Habits Before The STATMed Class
“I (would) passively watch (lectures), holding on for dear life, trying to take it all in, drinking from that firehose. At best, I get some details, never enough. If I get lost, distracted, or zone out, it’s game over, and I might as well get on the internet or my phone or social media or whatever.”
“I’d walk into the test feeling like I’m walking into an execution. It’s brutal. I feel like I’m familiar with almost everything, but that’s just enough to really frustrate me. The test is a blur, I’m mostly predicting, and then getting frustrated on ruling options in instead of ruling options out, feeling like I don’t know all of it, so I can’t get it right. And I walk out sure that I failed even when I pass.”
Then, we explore the differences in their study habits — and success rates — after implementing the strategies learned in our STATMed Study Skills Class.
In Their Words: Study and Testing Habits After The STATMed Class
“I have a master plan to build off of, reflect on, and adjust as I go. I don’t have to keep it all in my head, allowing me to focus on what matters, and using my study methods to learn, connect, encode, retrieve and master what I need to master. It will also boost my confidence, give me feedback, so I can make smart adjustments and control my anxiety. Then every day I go into my daily study system.”
Over the years, we’ve seen scenarios like these for medical, veterinary, pharmacy, and physician assistant students. Everyone’s story is unique, but there are common patterns in studying and test-taking issues. Delineating and understanding these patterns can be an important step to getting better at managing the firehose.
Ryan Orwig: Hey, breaking news here. Med school is hard. It’s really, really hard. How hard are we talking? The commonly accepted metaphor goes like this. If learning in undergrad is like drinking from a water fountain, then learning in med school is like trying to drink from a fire hose. This bluntly illustrates the primary challenge of learning in med school especially in those early didactic classroom years where there’s just so much, so fast, and you’re accountable for all of it. This is what we call the speed volume density equation. Now regarding this fire hose drinking process, many med students will acclimate, adjust and learn to drink from the fire hose, some more elegantly than others, but not everyone will because not all med students are built the same. And if you are a med student getting drowned by the fire hose, it can be maddening because others are figuring it out, and you are not.
I generally accept this fire hose analogy, but it’s a super simplification to a massively complex issue. I mean, if I were drowning in the fire hose, I would want more than someone saying, “Yep, that looks painful. Try harder to drink from that fire hose or whatever.” So in this video, I want to demystify what this actually looks like in nitty gritty detail for real med students. And then, to beat this analogy to death, I want to illustrate how we can learn to drink from this fire hose. I’m going to present two stories from two different first-year med students showing the old way they studied during their first year of med school, then illustrate their new way of studying after taking our STATMed Study Skills class. Anyone struggling with the fire hose can learn from these stories and this process, even without taking our STATMed class.
So here we have the story of our first med student. She’s a smart, hardworking med student who churned through her first year, describing it as ugly, hard, but good enough to pass. But she was miserable. She decided to take our 10-day STATMed Study Skills class between her first year and second year to completely redesign how she studies and learns for the rest of her career. So here is how she studied her first year, her old way. So she would start by doing a flip through of the lecture to passively pre-read. Looking back at this now, she says, “This was dead, passive. It was not purpose or outcome driven, just doing it because this is what I’ve been told to do. Maybe see some words or concepts, but don’t really find structure or relationships, which I now know is key for me. I feel guilty when I didn’t pre-read, but don’t get anything from it when I do. Honestly, no real value here.”
Then she would watch lecture, and she says, “I passively watch, holding on for dear life, trying to take it all in, drinking from that fire hose. At best, I get some details, never enough. Don’t find relationships and hierarchical big picture, though, which is bad. This is exhausting in low yield. If I get lost distracted or zone out, it’s game over, and I might as well get on the internet or my phone or social media or whatever.” Common story.
Next, she would read the PowerPoint or some other primary resource. She would try to memorize as she read. She can see this as passive, boring, and low-yield now. She labels this now as overwhelming and a big part of that fire hose overload. Then her goal might be to reread, which she thought was what she was supposed to do, but for her she now realized this is diminishing returns, the illusion of productivity and creates a trap of familiarity. These are the things she wants to avoid in the future. She would also spend time worrying about how to focus on these high-yield material. She said, “How do I even know what is how yield.” She realized this devolved into passive rereading and passive reviewing, lots of directionless agonizing. And she felt like she was drowning. I just want to say, this is the kind of story I hear all the time.
She’s working hard. She’s motivated, she’s sacrificing. She is frustrated, and she just does not know how to study using the best tools for her needs. So she would also get sucked into looking for better videos, better resources, et cetera, which is a huge illusion of productivity trap. She knows she can get sucked into these rabbit holes, and adds a little levity because, I mean, sometimes we have to laugh, a little gallows humor to get us through. She then, accurately, I think, labels this phase the vortex of chaos, since she would get so tangled up here. I like how she then detailed how her process changed as her block exams got closer. She abandoned sleep, exercise and self-care. Most studying, at best, entrenched familiarity, which wasn’t her goal, but was the outcome of her process. And on test day in med school, familiarity is just enough to narrow down the two, but not know which one is right.
She was arbitrarily holding herself accountable for seeing the material three more times. Still very passive. And she described it as a carpet bombing approach, just seeing stuff, but not really encoding or assessing or retrieving or applying or connecting or determining what I know and don’t know. Oof. None of this is about blame, let me just say that, or pointing fingers. This is just honest reflection on what was happening. We have to understand our past to change our future.
Finally, test day arrives. And this is the first time she’s truly trying to recall and apply the information. This is when she finds out what she knows and doesn’t know, and it is all too late in the game. So this represents her old way. She says it is hard to look at to see what she was doing, but during the year all she could do was focus on survival, which is 100% right. So then she maps out her new study system, working in all the tools and rationale she learned in the STATMed class. So, she starts with her agenda check-in. First thing, make a plan for the day. So, every day she starts off making a plan, making it external and explicit, writing it down. Lists out all academic goals on one side, all non-academic on the other. She breaks large tasks into smaller tasks, which I think is a key for behavioral reinforcement.
She eyeballs urgent and important versus not urgent and not important because she knows that’s a trap she falls into. And again, she makes this external and explicit, instead of keeping it in our head. We want to offload these things so she can use her brainpower on what matters, which is learning. And then she’s going to check and update what we call the study manager, and that sort of a macro guide where she’s offloading all, how she’s managing her way through all the tasks required of her, probably lecture-based. It’s going to be different for each student. So then that leads to her first step for each lecture, which is what we call frame working. So she deploys this before most lectures or reading events, and this is a very specific skill we teach in the STATMed class.
And what you’re going to do is specifically extract the hidden structure in the chapter or in the PowerPoint or the word-based handouts. She gonna do it fast and non-linear, and she must write it out. This way, she says, “I always have the structure first.” Because what we identified with her is she needed that structure to be found first and fast, and then everything else can build off of that. Now, when she goes into watch lecture, she’s going to keep that framework off to the side, orient herself, predict, revise as she goes, and then get back on track if she gets lost or distracted. We’re not even worried about details yet. A little counterintuitive, but this is what a lot of our students end up needing. She says, “Don’t sit there and try to transcribe everything.” That’s a trap because you’re doing that, then you’re not listening, and you’re not connecting, and you’re not finding those relationships.
“Actually listen,” she says, “And make those connections. Don’t obsess over details,” which is obviously extremely enticing, but that’s the trap we have to avoid. And so what she wants to do by coming out on the other side of lecture is to solidify her understanding of that framework, that organizational hierarchy. She will start to learn details and relationships as a by-product, but we’re flipping the script for her because she’s a top-down learner, not a bottom up learner. And she needs that framework, superstructure first. Then she’s going to go into reading and what she calls the agenda check-in. What does reading, what are we talking about? This is much more nuanced than we think. Ideally she wants to read it one time and only one time. She’s going to have specific goals like marking it to express or delineate structure. And she says, “Set myself for self testing in the future.”
These are very specific goals she’s going to have while reading and marking. She’s going to emphasize understanding, but not raw memorization. She sort of splitting those two, and she’s on a connected all back to the framework. She’s always going to be tying it back to structure and organization. And then what does this agenda check-in? She’s like let me stop. Even for just a few minutes. Let me see where I am. Let me orient myself. Check my agenda, see where I am, where I’m going. Revise the plan, a plan has to be constantly revised. This may mean breaking large sections into smaller units. It may mean assigning certain skills to certain pages or slides or sections. Might have to make hard choices due to time because time is the ultimate governing factor. Not worried about making the plan perfect, but must have some kind of plan in mind.
I really liked that. Then she says, “Make stuff.” Now this is sometimes luxury stuff, but it’s an option. She says, “As I watched lecture and I read, I selected and mark stuff I might want to,” quote, unquote, “Make stuff out of.” This could be tables, notes, maps, memory palaces, voice flash cues, Anki cards or something else. Depending on time and my needs, I might make something here at this phase, or at least I have this list for later if time permits. The key is don’t plan on this and don’t get upset if I can’t make stuff. This is where a lot of people sort of go overboard because they want to do everything that’s in their agenda, everything in their plan. And one of the things we’re really preaching here is you can’t do everything that you’re going to want. There’s too much information, there’s not enough time. So part of the skill set of managing this is learning how to prioritize and sort of ruthlessly cut things that are more luxury based, not essential.
And then she’s got these three phases of retrieval practice. Retrieval practice, coupled with the structure, that’s kind of the secret recipe for her and for a lot of our students. So she’s sort of breaking it out, and this is gonna have to be flexible because it’s gonna change from lecture to lecture, from topic to topic. Phase one, do something immediately after the study session or even during that day in that moment for that topic. Phase two, do dedicated retrieval practice on weekend or dedicated time during the week. She might actually build that into her schedule. Phase three, hit during dedicated time before test. The rules are you won’t do everything. You won’t do enough. And that’s okay. She’s going to probably track this in her study manager.
And then on test day, she’s got some things she really wants to keep in mind. She wants to use the STATMed test taking process. This is something that you can find on our website, parts of it, or obviously we go into it in greater depth in the class, and then an even greater depth than our workshop. But for her, she always wants to start with that last sentence, and then to keep it in mind and check back to it throughout the process. She wants to weigh each option one by one. So her working memory doesn’t get overloaded, and she doesn’t put her finger on the scale. She wants to rule out, instead of rule in, looking at for that partial false, instead of falling for the partial true bait. She says, “I do not have to know everything to get a question right.” I really want our first and second-year students to really start to grow this now. Because most likely that’ll grow you into a better test taker by time boards come around. So obviously we want to foster these kinds of paradigm shifts now.
Partial false is all false. Just again, really growing some of these key tenants. Don’t worry about predicting. Again, predicting, I think, is preached heavily to a lot of people, and I think it’s actually really bad, certainly once you get to like the USMLE, COMLEX level. She says, “Be consistent, and you’ll be fine.” Again, sort of preaching this sort of mantra. She also makes daily utility tool lists up here, where these are things she just wants to make sure she’s doing and keeping in mind every day. “Every day,” she says she, “must check how I’m managing and regulating myself. Consistency and efficiency lead to better outcomes. If I don’t pay attention to this stuff, I will get in trouble.” I do think this falls under that time, time management, time maximization window. Executive functioning. You need to sort of have some skillsets that you’re growing there as well. Those tie in with study skills. And I really liked that she sort of built that into her new way of studying plan.
So, moving onto our second med student case study, he’s a smart first year med student with great work ethic, high standards and impressive pre-med credentials. He took the STATMed class after failing his first year of medical school. The first thing he ever struggled with, much less failed, in his life. He took the class to figure out what went wrong, how to fix it and to avoid doing the same thing upon returning to med school late in the summer. So he starts off delineating his old way of studying, which, as he points out, definitely did not work.
So, at the start of the block, there’s no overall game plan. He just kept large goals in his head that were often so large and amorphous that they were impossible to achieve, but when he failed to generally achieve this impossible thing, then he’d be upset. His standard was master each lecture, which meant he was always going to feel like a failure. He said, “This is a poison pill of my own creation.” So there was no true schedule or structure or plan. And when he’d get behind, he would tell himself, “I’ll make it up tomorrow.” But that never happens because the fire hose never stops, and he’d fall behind and feel guilty. So phase two for him was where the learning supposedly starts. And it started with downloading the PowerPoint while sitting there in that first lecture. He said, “There was no real prep happening here. I’d have no idea what was happening or what to expect during lecture.”
He reported that he felt mild guilt for not pre-reading, but got nothing out of it, so guilty for not doing something that didn’t give him any value. Phase three was during lecture where he was lost and anxious. He said, “I basically write down as much as possible. I believe, hey, this is hard work. And I’m a hard worker, and it’s miserable and it makes me suffer. So if I’m suffering, surely I’m learning something, right?” This he says is where, quote, unquote, “I immediately start to get washed out by the fire hose.” He says, “When the lectures are on-demand, I constantly pause to write stuff down, making it take even longer.” Or he says, “I get frustrated because I was missing so much. So start focusing on marking what I didn’t get, which leads to me re-watching the lectures later.”
Phase four for him was after lecture where he says, “I’m exhausted from watching so many lectures where all the stuff starts to blur together. I’m mad and frustrated with myself for not doing better in lecture,” whatever that means. “So I grind out studying by passively rereading and highlighting the slides, trying to rewrite stuff to feel active, but rarely if ever doing actual retrieval practice.” It’s definitely part of the fire hose. Sometimes I re-watched lectures, which is not efficient, but I feel like I have to, then justify it with watching them at like a faster rate, but not getting much out of it, to be honest. I try to do practice questions, but then I would do poorly on them. So I wrestle with feelings of discouragement, and beat myself up saying I have to study harder.” Again, whatever that means. “I try to do other life stuff, but always have a cloud of guilt hanging over me when I’m not studying.”
So that brings us to the phase five when the test gets close, he said, and this is when he feels manic and scared. He says, “I freak out and panic and berate myself for not doing better every day before this. Then I try to cram in as much as possible, re-watching lectures at two and a half speed, rewriting, rereading everything as much as possible. I’m crushed by imposter syndrome, feeling like I don’t belong here.” Then that brings him to phase six, the dreaded test day. He says, “This was mainly a combo of frantic review, just looking over stuff, and beating myself up for not studying harder or studying better all along. I think I’m starting to see a theme,” he says.
“I’d walk into the test feeling like I’m walking into an execution. It’s brutal.” He says, “I feel like I’m familiar with almost everything, but that’s just enough to really frustrate me. The test is a blur, I’m mostly predicting, and then getting frustrated on ruling options in instead of ruling options out, feeling like I don’t know all of it, so I can’t get it right. I feel like everything I don’t know for 100%, and that makes me feel even worse. And I walk out sure that I failed even when I pass.”
And finally phase seven after the test. “Constantly upset with myself even when I now realize I was upset about failing to meet goals that were impossible to meet. And I had no real idea I was doing this to myself. I’m filled with shame and regret for not studying, preparing better, but I don’t even know how, because I feel like I poured everything into it. I crash for a day or two, then slowly get back to the study wagon grind, then slowly get back at the speed, but by Wednesday, I’m already behind. I try not to lose my mind when an advisor or a friend suggest I study more, or that my problem is I need to make a schedule or the passive aggressively question if this is what I want. Because I’m working myself to the bone, and this is my lifelong dream. And despite all of it, I believe I’m smart enough, but these results make me question everything, and I hate it.”
Oh, let me just tell you. You know, I hear these stories every day, every week, and it’s truly gutting. So, you know, what we do here is we flip this around, and at the end of the class, he presents me with his new study system, which will actually put him in control of his learning. Now everything will start the day before the new block begins. This is where he builds out his big picture plan, which is two parts. The study manager which is a list of all the lectures with check boxes he will use to track progress, and his time tracker schedule, which is a type of schedule that provides feedback data. He will also fill out his personal to-do list, and offload everything else into his calendar.
Now he says, “I have a master plan to build off of, reflect on and adjust as I go, and I don’t have to keep it all in my head, allowing me to focus on what matters, using my study methods to learn, connecting code, retrieve and master what I need to master. It will also boost my confidence, give me feedback, so I can make smart adjustments and control my anxiety. Then every day I go into my daily study system.” He says, “Every day now starts the same, which feels good. Since I am in a lecture-based learning mode, I use the lectures to guide me, but could adjust to a non-lecture-based approach just as easily as long as I make a plan for it.” Then he says, “I’ll use my new sequence of tools, being flexible, but always knowing why I’m using a tool. Rationales are the key to ownership and success for me.” You can see his main tools here, but these would be customized to each student’s needs.
Next comes the week of exam where he notes, “My main plan is to maintain core methods for remaining lectures while also working in more self-tests, especially revisiting any maps and important slides, multiple times, which I have tracked and prioritized in my study manager.” “The STATMed process,” he says, “taught me how to read and mark in a way that sets up retrieval practice instead of passive review.” So this is exciting. I know there will never be enough time to do it all, but this will make a huge difference even in limited use. He says, “I to foster earned confidence, revisiting through active recall from both details up and big picture down to help me make connections and give me more confidence.”
Then we have exam day where he says, “My mentality has to be about accepting there will be things I don’t know well enough and rely on using the parts of what I do know. I want to rely on STATMed’s test taking process when reading each question mainly trying to adopt the basic shape of the process and really embracing my partial knowledge and avoiding the binary all-or-nothing mindset.” Finally, post exam. He says he will take the rest of the day off guilt-free. He will reflect Saturday morning and build out his plan, starting strong for the next block. He will try not to beat himself up, and instead try to find a few insights from the previous block to get better at on the next block, always focusing on receiving all the information shooting at him through the proverbial fire hose, emphasizing organization of stress to streamline it and manage it as he works through the semester.
So that concludes our two case studies on drinking from the fire hose in med school. The same scenarios could apply to board study or for those in related fields like veterinarians, PAs or Pharm.Ds. Everyone’s story is unique, but there are common patterns hidden below the surface. Delineating and understanding your own pattern can be an important step to getting better at managing the fire hose. Hopefully this chat illustrates some of those patterns for you.
If you would like to find out more, please explore our website, our social media channels, our YouTube channel and our blog. If you’d like to chat, feel free to reach out so I can hear your story, answer any questions you might have or see if our services might be what you need. Thanks for watching.