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How ADHD Impacts Learning in Lectures in Med School

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On the STATMed Podcast: Conversations About ADHD in Med School

Lectures in med school: you know they’re essential. You know what’s discussed will be on the exam. And, vitally, it may be something you need to save a life one day. But, if you’re struggling, it might seem impossible to actually learn during lecture — especially if you’re also navigating medical school with ADHD. 

In this new podcast miniseries, Conversations About ADHD in Med School, host Ryan Orwig and Mike, a former STATMed student, discuss the various ways learning in med school is complicated by ADHD. In this episode, they dig into the potential difficulties of learning in lecture. They discuss issues with impulsivity, distractibility, and inattention, as well as strategies to mitigate them.

“You feel guilty because you just wasted a whole day. You know you’re going to have to get the information somehow, and you know how hard it is to catch up. You’re tired because you’ve been fighting to pay attention for six or eight hours. You’re angry and exhausted because everyone else just spent the same hours you did, but now they get to dinner, they get to go out and hang out with their friends. But you’re trying to catch up and finish that eight hours. And you’re not even close.” – Dr. Mike 

We’ll dig even deeper into various ways learning in med school is complicated by ADHD in future episodes. Be sure to stay up to date on our latest podcast episodes, videos, and posts by joining our mailing list!

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Announcer: Welcome to the STATMed Podcast, where we teach you how to study in med school, and how to pass board style exams. Your host is Ryan Orwig, a learning specialist who has over a decade of experience working with med students and physicians. In this episode, Ryan and Mike, a former STATMed class participant, discuss the challenges of learning and lecture, as a med student with ADHD. 

Mike: So once you know the structure of it, you can listen to… One you know it’s coming. And so, it’s much easier to listen for the things that are coming, and you know the information is coming, so you’re already familiar with it. And so, it’s much easier to stay engaged, because you know what they’re gonna talk about. You have basically a cheat sheet of the lecture, before you even get into it. 

Ryan: Today, we’re gonna talk about a series of issues. Med students with ADHD might experience in the classroom learning years. What I mean by that is like during the didactic phase of lecture based learning, usually those first two years, I’m Ryan Orwig, the learning specialist who created STATMed Learning, where we help med students, physicians, and those in related fields with studying time management, and test taking. I probably know more medical professionals with ADHD than anybody in the country. And I’m here with one of them right now, my friend, Dr. Mike. 

Mike: Yeah, I’m Dr. Mike. I went through Ryan’s program, and I have failed first year of med school, I failed board multiple times. I was diagnosed with ADHD my first year of med school. And this is kind of a journey through some of the issues we dealt with. 

Ryan: And did you say where you are now, in your career Mike?

Mike: I’m an ER physician, in Florida. 

Ryan: So anyway, so if you wanna hear more about my story, check out our two part interview with him, you can find that in our feed. So number one, the first issue, we wanna talk about with med students during those didactic years, which like I said, is traditionally the first two years, when you’re sitting in lecture drinking from that fire hose, we wanna talk about one of the classic issues, we think of with ADHD, and that deals with issues with attentiveness, distractability and impulsivity. And we wanna look at what that looks like, while you’re trying to learn from lecture. So I’m gonna talk about some of the pitfalls that the med student would, that ADHD brain, how the attentiveness, the distractability, the impulsivity, how that might manifest in that classroom learning environment. ‘Cause we’re gonna start off talking about what that looks like in a real physical classroom, and then we’ll switch it over, and talk about some of the things you might see, learning on demand, learning remotely, all that stuff. So, Mike, well, what’s one of the first things you think about, when it comes to just that ADHD brain in the classroom, what do you think a problem that might present itself would look like? 

Mike: So I think one of the big problems is first of all, you’re walking into a room. You know every med school is different, but anywhere between 50 and 400 students, all in the same room. My class was 180, 200 students. And so you’re sitting in a room, with one professor, and then 200 people. Everybody in there has a computer, most of them are open, everyone has a phone. And so, someone that gets distracted easily. 

Ryan: Yeah, it’s a recipe, that is distracting in and of itself, right? Just the idea of, I can’t imagine like, going to a movie theater, right. Going to a movie, with one person down on the left-hand corner with the computer screen open, that is by definition distracting. If you’re sitting in the middle or the back, of a giant auditorium, you’ve got a sea, of computer screens open in front of you. You’ve got people moving around and fidgeting. You’ve got people communicating with each other. I mean, it just sounds like a real nightmare for anybody to exhibit sustain focus, right? And you add in the ADHD cocktail, this is just not… It’s already a bad setup, right? 

Mike: Right, and you’re not at a movie that you’ve wanted to see for a while. You’re sitting in our six of biochem lecture, which is one of the most boring things in the entire world. And so, your brain is looking for anything else to focus on, besides what you’re there to do. 

Ryan: This painfully, it sounds painfully true. So, what exactly… So what are some… Give us some context here? What are some ways that you experienced some distractibility in this kind of environment? Like give us some real world samples here. 

Mike: So our school, the first week, you go, you meet everybody, you start making friends. And so then the beginning of the second week, first of all, you pick your seat for the rest of the year. And so of course you’re going to pick your seat around your friends, around the people you’ve met for the past week. And so right away, you’re sitting surrounded, on eight different sides by the people you wanna hang out with and your friends. And then, you’re watching what they’re doing. If they’re distracted, if they’re shopping for something, and then, you have literally 100 laptop screens in front of you, and you can see what everybody’s doing. And so, it’s flashing, its lights, people are getting up, moving around, people are talking. It’s impossible to focus on the one… 

Ryan: So Mike, you were telling me it’s hard to focus on what? Like the biochem slide that’s up on screen, right? And then what’s being said about it in depth, in what’s being connected. And is the person actually reading from the slide? Are they telling an anecdote or are they off topic? Are they on topic? But you were telling me something about somebody walking by, and something in their pocket, distracted you or something? 

Mike: Just sitting there, and you’re trying to focus on one thing. And so, I would have times where somebody will walk by and they’d have coins in their pocket. And so, instead of focusing on whatever lecture, I would count the times the coins would jingle in their pocket. And so, you watch them walk all the way out, and then sure enough, five minutes later, they’re gonna come right back through, and you’re gonna do it again. So you’re missing time focusing on something stupid, but that’s what your mind… That’s what your brain just focuses in gravitates towards. 

Ryan: It’s not a choice, right? You are just, it’s like that is the shiny object. This is auditory in this sense, right. And you are derailed from being connected to what’s being discussed, to following the change clinking in the guy’s pocket as he walks out, right. 

Mike: Right, and I mean, that was probably one of the most vanilla options. I mean, you’re watching what people are shopping for. And you’re listening to people make dinner plans, and what they did last night, and you’ve got your phone. And so, people are texting you, and you’re getting messages and you know. So, any of those things stop the process immediately. 

Ryan: And what happens? Soon, okay, so you’re in lecture, you’re in the third hour of lecture, you’re on some biochem thing. Let’s say you’re 20 minutes in. And the change guy, derails you, and then you’re watching him go down the bottom to the bottom right exit. And then you see somebody watching like Netflix, or something. And you’re like judging them for whatever terrible show they’re watching. That’s what I’d be doing. Why are you watching that of all things anyway? And now you’re distracted. You’re now disconnected from the lecture, you’re disconnected, you’re lost. You’ve now fallen off the wagon. Where does that put you 20 minutes in? You’ve got 25 minutes left, 45, 35 minutes left. What happens? 

Mike: For a while, you can try and get back on the wagon, or the train, it’s moving, it starts at the top of the hour, it goes for an hour and then it stops. The professor isn’t stopping, they’ve got the information to get through. They know their slides take an hour to get through, and they’re gonna finish, they don’t care that you aren’t paying attention. They don’t care that you’ve fallen off, they keep going. And so, then, you fight to get back on, you’re, “Oh,” you like slip flip through three pages of slides, and you catch back up. Or, you’re on hour three and you’re tired and you missed 20 minutes, or you miss the rest of the whole thing because you’re watching whatever Netflix show, even though you don’t care. And so then, you missed the entire lecture, or you just say, “I don’t know what she’s talking about. I don’t know what’s going on.” And you’re on… You just wait till the lecture is over, and then you can restart the next hour. And so, any of those things can happen. 

Ryan: Yeah, so the way I describe it, I use like the train metaphor for some reason. But the idea is like the med student with ADHD, is basically clinging onto the back of that train. They’re not like in the comfy seats, I’ve never written a train in my life. I don’t know where this comes from, but they’re holding on at the back end of the train, because that is, you are holding on, as that student with ADHD in lectures. Is that a fair statement? You’re just like, “I know I’ve got to hold on. I’m here, I’ve got to hold on. I know I’m going to fall off at some point, but I’ve got to hold on as long as I can.” Is that a fair starting point with this convoluted metaphor?

 Mike: Oh yeah, you’re fighting to stay on the train as long as possible. So you don’t have to walk to the end, or, it’s not as hard to get to the end. So– 

Ryan: Yes.

 Mike: You’re trying to fight to the end. 

Ryan: Right, what’s gonna happen is you’re gonna fall off. You’re gonna see the kid with the change in the pocket, you’re gonna see the person shopping down here. You’re gonna see somebody watching something stupid on Netflix. And you’ve fallen off, and then you pick yourself up. You fall off the train, you’re standing on the railroad tracks. I feel like the majority of what my students have told me over the years is, they can just stand there, sort of forlornly, watching the train disappear down the tracks, right. Now maybe you sprint and catch back up to the train. That’s where you say, you jump ahead. You fight to get back on board. But so that’s… I think that’s like a losing game, it doesn’t happen a lot. I think mostly you’re just standing there watching it go then, yeah. You trudged down the tracks, ’cause you’re stuck there, and you wait to get back and catch it at the station, 30 minutes later. And that means you’ve just lost 30 minutes. So that that’s kind of the metaphor I use. What can you… Where do you go from there? 

Mike: More realistically, you’ve fallen off the train, you’re looking at a rock that is shiny. And then you look up and the train is nowhere to be found. And so, you don’t even notice it’s leaving, it’s already gone by the time you notice that it’s gone. 

Ryan: Yeah, and that makes it harder to get back on then, right? Because you have been distracted by the secondary thing. And this is a big problem. So now, you’ve spent four hours, six hours, however many lectures you have that day, falling off the train, losing giant chunks of it. How does that make you feel then? So you now, you’ve sat through lecture, and you’re coming at the end of that one hour, or at the end of say four, six hours, however long your school set up for. How are we feeling? How are we feeling? 

Mike: It was a couple of things. One you feel guilty because you just wasted a whole day. You know you’re going to have to get the information somehow. And so, you know how hard it is to be able to catch up. You’re tired, because you’ve been fighting to pay attention for six or eight hours. You’re angry and exhausted because everybody else now, they just spent the same time that you did. But now they get to go to dinner, they get to go out, and hang out with their friends. They get to go and take a break, relax. Whereas you’re trying to catch up, you’re trying to finish that whole eight hours, and you’re not even close. 

Ryan: You got to make it up, right. So my students will often say, yeah, they get to the end of the day. They feel like they’ve gotten very little out of the lecture experience. You don’t have to have ADHD to experience this, but a lot of our students do have ADHD, are going to say something like this, “You sit through there, it’s miserable. It’s hard work.” Nobody wants… I don’t want to sit through a series of movies that I like for four to six hours. I don’t want to sit down and watch several Marvel movies. I don’t want to sit down and watch the first two extended additions of a Lord of the Rings back to back. I don’t wanna do that, much less something like this, but the stakes are so high, and you’re there for a purpose. So, they’re trying to get the most out of it. They’re grinding through it, they’re falling off the train. They’re giant gaps, they get home at the end of the day, or they’re walking out of class, they are angry. They’re frustrated, they’re exhausted. And they get home, they sit down and study, and they feel like they’re starting from scratch. Now, Mike, does that speak to your experience in some capacity? 

Mike: Yeah, I mean, that’s probably a good day if you’re just starting at zero, or realistically, you’re starting from the negatives because you’ve already expended so much energy, to then have to either listen to the lectures again, or you’re having to like go through the notes without the lectures. Or, I mean, you’re just behind already after you just spent eight hours doing, “What you’re supposed to do,” and go to lecture and sit there, and be in lecture. 

Ryan: I think that’s a really good point. I think maybe it’s hard to appreciate, like imagine like a little video game, with like an energy bar, right? You’ve got like a hundred energy cubes. And the fact of the matter is you’ve spent, a large percentage – over half, maybe more, of those energy cubes. Well, number one, just your own energy and for your mental focus, whatever bandwidth you have, you’ve already maybe run that thing dry. And also time. There’s only so much time in the day, and you’ve spent a third of the day already, right? So you now have depleted energy stores in less time, to make something of this material. And it just sounds so crushing, honestly. So what I mean, is that sort of a way to sort of summarize what you’re talking about Mike? 

Mike: Yeah, I mean, you’re way behind everybody else, on an already difficult thing. 

Ryan: You’re always behind. You must always feel behind in this model, because you’re punting a huge, highly productive part of the learning circuit, right. 

Mike: When you’re spending the time when you’re most effective, early in the day before you get tired, you’re spending it on the least effective thing you can do, by sitting in class, might not be able to get the information in. 

Ryan: And you also mentioned guilt. I think guilt is a really powerful thing to talk about here too. Because you’re saying you feel guilty walking out. Can you unpack that a little bit? 

Mike: You know you have to get the information, but you spent eight hours. And so you’re trying to focus. You get distracted, you try to focus again, you try to get distracted. And so, as it snowballs down the hill, then you’re like, “I just wasted a whole day.” And so then, you feeling guilty because you weren’t productive, you didn’t accomplish anything, but you just wasted all this time. And so, it’s almost worse than going out and walking your dog, or going to the gym, or anything like that, because you’re trying, you’re actually trying to put in the effort, but it’s actually working against you. 

Ryan: So, I just think this idea of the guilt is an important thing to put out there. Because it’s like, “Oh, I’m supposed to be doing this.” And I think people… I think a lot of the, like, professors and resource people inadvertently, maybe inadvertently put guilt on the learner, for like, “Well, you’re not working hard enough. You don’t want this badly enough,” and all that stuff. So I think that that’s a big problem with it. So this is like, I think this is a common problem with our med students with ADHD. Now what about remote based learning? So this is watching lectures on-demand, watching lectures live stream remotely, obviously, with COVID, this became more popular. It was already a thing that existed though. And we’ve seen a shift over the last 10 years, toward more students choosing to learn on demand, or choosing to learn, to watch via live stream, or whatever the school has available. I wanna say in the old days, there were more like technology, logistical concerns. Like what if the recording didn’t work? What if it doesn’t get uploaded for four hours, or 10 hours? And those things might still happen. So every school has got its own problems, right? So, those are considerations. I know Mike, after you and I worked initially way back when you did your first year, you failed, you worked with me, you went back. And there’s not a single right answer here, right? Some people it’s better for them to go to live lectures. Some people it’s better to work remotely. You did both because, when you repeated your first year, didn’t you do more sort of like an on-demand style. You watch lecture from home, how is that, do I have that right? 

Mike: Yeah, so, again, I couldn’t stay at home because I would get distracted. So I had a room at the school, or I would sit by myself in a conference room, and would listen to lectures as they came up. But, our school, it was just audio, no video. And so, you would have to have to download them when they came up, but then download them every hour as it was live. So you were, again, you were a four to eight hours behind, once they finally uploaded the stuff, to listen to it. So you would kind of be a day behind, doing it, but it was much more efficient and effective because, there was less distraction in the room by myself. 

Ryan: Yeah, you had to do some cost benefit analysis, right? What’s the right trade-off for these things? And for you, yeah, it was definitely not being in that crowded auditorium, but I think there’s pluses and minuses too, for everybody doing this. Now, I look during COVID, maybe the way your school set up, perhaps it’s not a choice, perhaps you have to be remote. Perhaps your school requires you to be there live in person. But, let’s talk about this as if it’s a choice. There are pluses and minuses, just like Mike was talking about pluses and minuses for him, right. What are some of the minuses, of choosing or being forced, to watch lectures at home, either on demand or live stream? Well, I mean, number one, you’re at your house. If you’re watching, if you are choosing to watch from your house, Mike you said you couldn’t do it from your house, why? 

Mike: I even had a room, that was just for studying. I had a desk, a computer, but I would look around and see stuff I need to do. I see stuff I need to clean, I have to mow the grass, I’d want to trim the trees. I want to take my dog for a walk, I’d want to fix something to eat. And so, that takes other people being around out of it, which is good. But also it’s bad because no one can see that you just wasted four hours cleaning your house when you should’ve been studying, or you went outside. 

Ryan: And that grass is never more appealing to be mowed, or reorganize the closet, or fix that toilet. Those are never more appealing than as opposed to like, “Oh, let me watch this fourth hour of biochem.” So it does make those things look more appealing. And I think that just with the ADHD brain that this opens up other pitfalls, right? The ability to stay on task, the ability to get distracted, the impulsivity of decision-making. You might say, “I’m gonna sit here and watch these two lectures,” but impulsively, get up and go start trimming the tree. Or what is that? Is that fair? Is that a fair thing to say? 

Mike: Yeah, and also there’s no one saying, “Oh, it’s eight o’clock, the lecture starts right now. So, because you have it recorded, you can listen to it anytime, but you have to listen to it, and you have to make yourself sit down. And so the self-accountability, which is also a problem, becomes much more of a problem when there’s no one forcing the lecture, and no one’s scheduling it for you. 

Ryan: Right. 

Mike: And so, you’re… You can listen to it at 2:00 AM if you want, but you have to do it. 

Ryan: But what happened with, let’s say that lecture went live at noon, right? And then, you don’t watch it till 2:00 AM, what happened in those intervening 14 hours? Was that a good use of that time, or was it a wasteful use? And the way that these things tend to add up with our ADHD brains is, a lot of it is just junk food time. Let me flip that back to you, is that a fair way to think of it? 

Mike: Yeah, I mean, junk food time and also very literally junk food food. I mean, you’re sitting at home, you’re stressed, you have all the food that you’ve gone to the store and bought, you’re stressed that you eat more. And so, it’s just, it affects everything you do, because you’d rather do literally anything else besides sit down. And lecture, let alone, sit down and study what you’ve just listened to a lecture. 

Ryan: Yeah. 

Mike: Sitting there and listening to lecture is probably the easiest part of the whole thing.

 Ryan: Right, it should be. If our learning is being putting forth the right effort, and all this stuff, right. With workflow and prioritization are key weaknesses with ADHD. When you are left alone, as you’re describing, you’re just alone in the wilderness. And this idea of being able to build workflow, and to ma manage and maintain prioritization. These things are gonna get overloaded and fail first with the ADHD brain. So you can see all these pitfalls from just being like, “Hey, we have to go study from home.” And that’s not even counting in things like, what if you have family there, but if you have kids, what if you live with other family members, or roommates that might not be on the same schedule? I mean, there’s so many potential built-in distractions, and I’m not saying that you can’t do it, you can, but we need external locus of control type things. We need external rules and tools, to help manage all this stuff. We can’t solve all that in this conversation, I think that we have to start by acknowledging these problems. Now, Mike, what are some of the benefits from on-demand remote learning? We just talked about all the horrible things to it. What are some of the good things about learning remotely, especially with your ADHD brain? 

Mike: Yeah, I mean, so you have the freedom to go through things when you’re most, I would get out person in the morning, and start listening to lectures, and studying earlier versus later. Some people wouldn’t get up until noon. They wouldn’t get started until the afternoon. And then they would go till 1:00, 2:00 in the morning, because that was when they were most efficient with their studying. 

Ryan: So, you’re saying you were able to optimize it to your brain’s best time to work? 

Mike: Right, and so, when you’re most efficient and you can pick whether, “Okay, am I gonna study first thing in the morning, and then am I gonna listen to the lectures in the afternoon when I’m a little bit more tired, but you can still make it through?” Or, do you have to do the lectures first thing in the morning, before you get tired, and I’ll be able to go through it that way. So, the freedom is a positive and a minus. It’s a great thing if you can make yourself do the things at the right times, but if you can’t make yourself through them, then it’s the worst. 

Ryan: Well, I guess the individual room, just less distractions, but you also had acquired some skills from me, that also probably helped with finding structure, finding framework, and all that jazz. But we will. And we’ll sort of talk about that when we get to solutions. I guess a plus minus could be the ability to pause, the ability to go faster, the ability to rewind. I think those are probably double-edged swords? 

Mike: It’s different for everybody. So, I found that if I had it sped up a little bit more, than you don’t have the time for your mind to wander as much. You’re trying to, because it’s going faster, you have to focus, and you have to catch it before you miss it. But if you do miss, then this train is going faster, and you are even further away. Then, it’s catching it in time to then back it up, start where you missed it, and then continue forth. Instead of having to wait till the next lecture, even starts to catch back up. And so, it could provide some more control.

Ryan: So it’s right. So, can you use that to get back on the train? Or are you just lost off the train, altogether? I mean, are people gonna rewatch the lecture because it’s on-demand, or they’re going to let it go, like go fast and then just check it off the box. Like, “I listened to it,” but did you really? It all does come down to that self-awareness, and I think oftentimes adding proper study tools does help with this, but again, I think there’s pluses and minuses to all these things. And I think just keeping it organized, keeping yourself on time, these are just challenges. Whenever it’s untethered from the real world, I’ve got to be there in person at this time. Before we finish this up, let’s think a little bit about solutions. What kind of solutions are out there, right. I think learning at this level, learning when you’re dealing with an especially dense, construct like med school. Drinking from the fire hose, so much, so fast responsible for all of it. I think learning has to start with structure and organization. That means you, the learner, understanding the organizational hierarchy, the skeletal structure, underneath all the details. I think that’s where learning has to start. I think if you are unable to find that structure consciously, or subconsciously on the front burner or the back burner, that’s where things will fall apart first and fast. If you have ADHD, you have weaknesses and executive functioning. And I think this is a subset of that executive functioning. I think a lot of our students that will collapse on that because they’re what we call top-down learners, you need to find structure first. A lot of these high achieving that students, the ones that can sit there and soak it up, with good attention, good focus, good executive functioning, they’re bottom-up learners. They can just take all those details, and jam them into their brains. And I think of like these elves in the back of the brain, subconsciously, building the closet, the organizational hierarchy, a lot of our med students with ADHD do not have that. So, I think the solution in some capacity, the simple answer is, focus on finding the organizational hierarchy, this the closet, the shelves in the closet, the labels on the shelves in the closet. Focus on finding that first, either before lecture, before going in, without even worrying about the details, or during lecture, and come out of lecture with the structure discover. This can get super complex on how to do this, but I mean, it’s a podcast, right? What are we gonna say? But this is definitely a key. Now, Mike, because this is what we did with you, we taught you how to do this. Do you agree from your perspective as one struggling med student who learned how to thrive, and get his way through and now a physician, does that resonate with you? What I’m saying about this whole idea about how learning has to start with finding that structure, and that starts in lecture? 

Mike: Yeah, because you’re getting the lectures ahead of time. And so, you know what’s gonna happen, you know the information that’s gonna be given to you. And so, if you know the base of the path that the train is gonna take, you know that it’s gonna… It may loop back around, and you can get back on it much quicker. 

Ryan: So you’re saying like, if you know, it’s topics, A, B, C, and D, and you get lost in the middle of B. You know you can just, “Well, I’ve got topic C coming up here eventually.” So then you just wait until C rolls around, and then you’re on, that’s getting there, getting back to that train station faster. Is that sort of what you’re saying within this convoluted train metaphor we’re using? 

Mike: Right, I mean, you can preview through the lectures and you know the structure. And so, once you know the structure of it, you can listen to it. One, you know it’s coming, and so, it’s much easier to listen for the things that are coming. And you know the information is coming, so you’re already familiar with it. You know it’s coming, they’re gonna talk about whatever thing it is. And so it’s much easier to stay engaged, because you know what they’re gonna talk about. You have basically a cheat sheet of the lecture, before you even get into it. 

Ryan: If Mike, if, we focus only on structure, not on details, right? Because the details are what you get tested on. And you know this, you’ve told me this. You’re getting tested on like fifth, sixth, seventh layer details. So, that’s what you’re gonna obsess over. So this is kind of counterintuitive what we’re proposing. Don’t worry about those details, there’s fifth, sixth, seventh layer details, yet, instead focus on structure. Now, what I recommend is that you physically delineate, physically write it out, or physically mark it on the document, so that you’re not holding it internally and implicitly in your head, but that you physically have something written out. Now, look, the complex answer is, we teach this in our STATMed study skills class, right? That’s what Mike did years ago, to sort of teach him how to do this stuff. But I have given this advice to other students I’ve met at conferences, or who’ve called me, I’m happy to say like, “Yeah, just do this.” And if you can do it on your own more power to you, right. But if there are complex ways to learn this complex skill, but again, I think that learning does have to start with structure. I think that’s the main thing. And that we can expect structure to crumble and collapse on the student, the medicine with ADHD first. Therefore we want to sort of help put this out there, just so people are aware, “Oh, this is a pattern. It’s not just that you’re inattentive and distracted.” Yes, those are those contributes, but it’s where the struggle is. So the fire hose is so fast, so furious, there’s so much you’re accountable for all the density of it. That’s where it collapses on people. And then you come out of lecture, tired, exhausted, right. To feel like you’re starting from scratch as Mike said, starting from below scratch because you’re exhausted. And Mike, originally, before we sort of had this sort of rebuild with you, doesn’t it make more sense that if I were in trouble, I’m like, “I’m gonna get tested on the details. I’ve got to learn these detail.” Instinctually, you gravitate to that, right? 

Mike: Yeah, but you can’t see the details. You don’t even know the structure of the details. 

Ryan: Right, just jammed in there, that’s what I’m saying. Like can’t encode, a vast array of details, without hierarchy and organization and structure. You can try, you can jam that stuff in there, but it’s not gonna be permanent, it’s not gonna be applicable, it’s not gonna be retrievable. You’re not gonna be able to apply it to any kind of contextualize work situation. And that’s what I think with the ADHD brain, the instinct is jam it all in there and try to sort it out later. What we know is that’s not going to work at this level, because there’s just so much information. And I think that that is one of the big pitfalls for the ADHD learner at a lecture based learning model, is that they’re just gonna try to jam those details in, and it’s just making everything harder downstream, fair? 

Mike: And it’s interesting because you can’t tell while you’re in school. You can’t tell what other people are doing, and why it works, but this is what the people that do outlines are doing. They’re making a structure out of the lecture, and the people that are concept mapping, and the people that are doing the room and rooms. And the different things they’re building a structure for themselves, off of the lecture slides and the information. And so, you don’t know what they’re doing, you’re watching them, and you’re trying to figure out what they’re doing, and how it works, and how it works for them. But you have to build a structure for yourself to then be able to go through the information. 

Ryan: Right. 

Mike: You have to build it yourself, and you have to build it the way your brain works. So that way you can see that like, all the questions are coming from the fifth, and six layers of the structure. And so then, you can go to those layers, and you can know that information. You can know the comparisons between one thing versus the other, because the questions are coming from that layer. 

Ryan: Yeah, yeah, and again, I think one of the key things that Mike’s saying there is seeking and finding the structure yourself, is an act of active learning. Seeking and finding demands inquiry. Let me see, it’s a puzzle for me to solve, it’s a way for you to learn. And this is what we wanna do, it will engage you and it’ll make you active. People say like, “I want to use active study methods.” Well, it’s such an abstraction, until you actually contextualize it, within the type of learning arena you’re in, and then how do you do it. And one thing you can do, if you’re sort of getting wiped out by lecture, if you feel like it’s just being distracted, and inattentive, and all that jazz, the solution is to seek and find structure. It gives you something to hold on to, it is the key ingredient, that has to be discovered first, and that’ll lead to better things. So that’ll wrap up this phase of this conversation. We’ll be back talking about another way, ADHD, will impact you, while you’re in the classroom, didactic learning years. Thanks for listening. 

Announcer: Thanks for tuning in to this episode of the STATMed Podcast. In future episodes, Ryan and Mike, will continue their conversation about, ADHD in Med School. If you like the show, be sure to rate it on iTunes, Stitcher, Spotify, or wherever you listen to your podcasts. And be sure to subscribe, so you don’t miss future episodes. You can find more test-taking and studying strategies, specifically designed for med students and physicians, over at our blog on Thanks for listening.

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