Establishing Lecture-Based Learning Survival Skills in Med School

On the STATMed Podcast: Establishing Lecture-Based Learning Survival Skills in Med School

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Use these strategies to get the most out of lecture-based learning 

Between the speed of lectures, the excessive cognitive load it requires, and the possibility of disorganized learning materials, lectures in med school can be tough — even for smart students. On this episode of the STATMed Podcast, host Ryan Orwig is back with Dr. Jim Culhane, Assistant Dean for Student Academic Success Programs and Professor of Pharmaceutical Sciences at Notre Dame of Maryland University School of Pharmacy. They dig into some of the factors that can make lecture-based learning in medical school so difficult – and discuss some “survival skills” students can implement. 

“You can’t control the type of material that they’re giving you, or how they’re presenting it, or the speed at which they’re presenting it. But what you can control is how you interface with that material. And that’s really why I like a lot of the techniques and approaches that you teach.” – Dr. Jim Culhane 

If med school lectures have you feeling like you’re drinking from a firehose, check out the STATMed Study Skills Class for strategies to help you succeed in medical school. Learn more and apply for one of our upcoming sessions today. 

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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 with more than a decade of experience working with med students and physicians. In this episode, Ryan again sits down with Dr. Jim Culhane, assistant dean for Student Academic Success Programs and professor of pharmaceutical sciences at Notre Dame of Maryland University School of Pharmacy. They dig into some of the factors that can make lecture-based learning in medical school so difficult, and discuss some survival skills students can implement. Jim: For the students out there that are listening, is that you can’t control how that person is teaching you, right? Ryan: Yup. Jim: You can’t control the type of material that they’re giving you, or how they’re presenting it, or the speed at which they’re presenting it at. But what you can control is how you interface with that material. And that’s really why I like a lot of the techniques and approaches that you teach. Ryan: Hey, everyone, I’m Ryan Orwig with “The STATMed Learning Podcast,” where we talk about studying, time management, and board-style test taking for physicians, med students, and those in related fields, like veterinary medicine and pharmacy. Today, I’m back here again with my friend and fellow medical educator, Dr. James Culhane. Jim, go ahead and introduce yourself real quick. Jim: Hi, Ryan. How are you doing? Thanks again for having me on the podcast. I am the assistant dean for Student Academic Success Programs at Notre Dame of Maryland University School of Pharmacy. I’m also a professor of pharmacology and have been in pharmacy education, I’ll be celebrating my 25th anniversary next year. Ryan: Wow. Jim: So quite some time in the classroom. Yeah, it’s been an amazing 25 years educating a lot of really great students and helping a lot of people become pharmacists. So it’s a pleasure to be on. Ryan: Yeah. Yeah, and you and I, I don’t know if we’ve said this or not, but you and I met, it must be like almost 12- About 11 or 12 years ago, yes. Ryan: Years now. Jim: It seems a lot longer. Ryan: Yeah, well, you know, I started coming in up there, working with your faculty and your students, just trying to transfer and teach these learning and test-taking strategies at that level. And then your interest in this, you already had that interest, but it’s grown so much. So we come at this from similar places but two different directions. Ryan: And today, we’re gonna talk about just the nature of lecture-based learning in med school, in pharmacy school, in vet school, just the drinking from the fire hose. So much information so fast. And so many students that I talk to are just so, what should we say, bitter- Jim: Yes. Ryan: About the lecture-based learning experience at this level. So much so fast. Popularly called like drinking from the fire hose. What I call the speed-volume, is a big part of the speed-volume-density equation, where there’s so much so fast. You’re accountable for all of it. So I think we wanna talk about why it’s like this and maybe some survival skills that we can think of for the students, or maybe even people who are teaching on this side of the equation, right? Jim: Yeah, absolutely. Maybe I can provide you with some perspective from the opposite end of the classroom here from someone who’s been in front of the classroom and made many of the mistakes that we’re gonna be talking about today. Ryan: Yeah, yeah. Jim: I think, Ryan, I think your first question, I think, is a real excellent one that you asked is, why? Why does this kinda stuff happen? It’s a great question. And I think from, again, my experience in medical education, I think is that what we have in medical education today, both I think from the science perspective and also your clinical instructors as well, too, we have extremely intelligent, bright people who are content experts in a very specific area. And most of them, I think the clinical faculty, at least in pharmacy education, tend to have a lot more formal educational training than the science faculty, too. But just for example, for myself as a science faculty member when I first started teaching, I think before my first day in the classroom, I think I delivered like two lectures to nursing students when I was in pharmacy or in my PhD program and did a little bit of problem-based learning with medical students. I had no pedagogical, andragogical training at all. I just got thrown into a classroom and was told, “Okay, you’re gonna teach these 15 topics this semester.” Ryan: Yeah. Jim: Of those 15 topics, I probably had expertise in maybe one or two of them. And then the other areas, it was a lot of self-learning. And so, as a medical student or pharmacy student or veterinary student, when you’re sitting in a classroom, I think it’s really important to know who you’re dealing with. You’re dealing with people who are highly bright, highly intelligent, highly motivated. I don’t know that I would include myself in that category, but I did happen to make it this far. Ryan: You did make it this far. Jim: And they’re content experts, and so- Ryan: They are very specifically super deep content experts. And this speaks to… It’s kind of the thing that makes me frustrated when I listen to people talk about studying and test-taking. People do that like it’s their side job. It’s my main job, right? Jim: Right. Ryan: You’ve taken it on as like a main job. Jim: Yes. Ryan: But a lot of people moonlight on it. And I feel like it’s a real slap in the face to the art of teaching, the art of pedagogy. There’s no… How many tens or how many hundreds of hours were these people trained to teach dense, complex information to people that are sort of at the bottom of the learning curve? The answer is not hundreds of hours. Jim: No. Ryan: Yeah, it sounds like not even tens-

Not even tens of hours, really. Overlap: Not even tens of hours, right? Overlap: Yeah. Ryan: And that is a big part. I mean, this is everywhere. This is across the spectrum from all these institutions. I mean, we can’t speak for all, but I mean, I work with students from pretty much any school from like the absolute best schools in the country to mid-level to low-level to schools outside of the country. And you see it everywhere, right? There is not an emphasis on the art, just like there’s not an emphasis on the art of learning and the methodology of learning and how to operationalize and weaponize and implement intense, diversified learning strategies. On the one end, not teaching smart students how to study, which I’m always talking about, but I guess just immediately, you gotta shine a light on the fact we’re not teaching these bright, motivated people teaching at these institutions how to teach. Does that make sense? Jim: Yeah, absolutely. And I think to be fair to some of the administrators and deans out there, I mean, I think a lot of programs will invest time and money and energy, just like we did with you, bringing you in to do some faculty development. Ryan: Sure. Jim: We really try to organize and make available programs and other types of professional development that faculty can engage in. But it does take time for people to accumulate, especially if they’re teaching full-time, that knowledge and experience. And so I know, for example, my first three or four years of teaching, I’m certainly not proud of it, for sure, but I did learn an awful lot. I learned an awful lot about my discipline. I also learned a ton about teaching by reading about it, by watching other people that had formal training in it, and really incorporating a lot of the methodologies. A lot of it was trial and error. This worked and this didn’t, so I’m gonna stick with this. And as I’ve matured through my career, I’ve had a lot of opportunity to engage in faculty development, to read about teaching and teaching strategies and approaches. So I feel like I’m much more educated in this area than I was, but I know I still have tons to learn, so. Ryan: Well, this speaks to who you are as a teacher. And I mean, I’ve worked with a lot of your material. You are super, super organized. Right? Your content is super organized. And I’ll always take super organized over anything less than that. You can always work with something that’s super organized. And you’ve definitely made a mission to get there. And this isn’t about even disparaging those who are not, you know? Jim: Right. Ryan: This is just about the state of affairs where students are dealing with all this stuff. I will add that PowerPoint has likely been a culprit in some of this unintentionally as well. Jim: Yeah, and it’s kinda funny, I’ll mention something about that, too, because, and I’ll let you get back to the PowerPoint ’cause I’ll forget what I was gonna say. But one of the things that I do here now is I am a preceptor, essentially, for a teaching fellowship program that’s offered by Johns Hopkins University and University of Maryland. So I work with young PhD students and postdocs. Every year, I have a cohort that comes through. And so I spend about nine months with them, teaching the basic foundations for instructional theory, and how to put together a class or a lecture, and how to develop an effective PowerPoint presentation, how to mentor students, advising, all that kinda stuff. And one of the things I always tell these guys on one of the first days is that when you get into the classroom, you are not delivering a scientific seminar. You are teaching novice learners. And I think for new science faculty, and I did it myself, you immediately default on what do I refer to as seminar mode where you try to present 80 or 90 very dense, complicated slides to a group of students that have no idea what you’re talking about in a 50-minute period. So just getting them up to speed like that. And we’re one of the few programs that I’m aware of in the country that actually do this for postdocs and PhD students. And I think the fault isn’t with the people themselves. I think the fault is really with graduate education- Ryan: Yes. Jim: In that I know… And again, with the students that I work with, they’re all at research one institutions, their PIs are heavily invested in getting that next grant and publishing in good journals, and that’s their main focus, and I get that, but not all of your graduate students are going in that direction. And in fact, many of the students that I work with in that program that come out of those institutions tell me flat out they have no interest in getting into that kind of rat race. They want to get into a teaching type of environment where there’s a mix, kind of a healthy mix. But they know that they need training in how to teach. Ryan: Yeah, yeah. Jim: So that’s just a commentary. That’s just my soapbox on graduate education right now. And I think there needs to be more structured training in that way for grad students and postdocs who are interested in doing it. Ryan: That sounds exactly like where the process is breaking down, this idea that we, of… Nobody wants to go into the classroom and be not prepared. The biggest year of my life was the first year I was in a classroom. You can study this stuff all you want. But I was like 23 years old, dumped into a classroom, like this college prep high school for kids with reading and learning disabilities and ADHD in Baltimore. And it was so exhausting. I remember having no life. I would come home and try to get my plan together, crash, because it was so exhausting. Nothing can prepare you for it. Nothing can prepare you for it. I mean, being in my first few years of teaching med students learning strategies, I think you can just idle and let things go, or you can work and really build it up. And fortunately, I had the energy and the time to do that. But this idea of the PowerPoint is a big problem, I think, because people criticize, like, “Oh, your PowerPoints are too long.” So what are they gonna take out? They’re not gonna take out the content. They’re gonna take out the marker slides. They’re gonna turn that 100-slide lecture to 90 slides by taking out like the transition slides if they wanna be possibly- Overlap: Right, the support things, right? Overlap Yeah, yeah, if the slides are gonna be overloaded, they’re gonna take out like the headers and the footers that indicate the hierarchy. So finding hierarchy, which if anybody’s ever listened to me talk, know that’s what I’m all about is can we find the hidden hierarchy, the bones, the skeletons, the essence of PowerPoint seems to obliterate and obscure and hide it. Overlap: Well- Overlap: So I’ve had so many… Yeah, go ahead. Jim: No, no, I was just gonna say, when you take a look at PowerPoint, and again, don’t quote me on this ’cause I’m not 100% sure, but I think we’ve talked about this in the past, when you take a look at the history of that software, right, it wasn’t the developed, I don’t think, with higher ed in mind. Overlap: I don’t think so. Overlap: It was developed in the business world, right? And we just adopted it, this tool.

Yeah. Yup. Jim: And I think abuse it and misuse it in so many ways. And I know I’m guilty of it, for sure. Ryan: Me, too. Oh, me, too. I write in PowerPoint now, you know? Jim: Yeah. Ryan: I write in that thing. And it’s like, well, I’m such an expert in what I do, I’ve gotta be careful of not skidding out and losing that super structure, which I know I can tell you right now like three or four of our lessons that need to be revised because that has happened, because I keep drilling down deeper and deeper, but I’m like, wait, can the person see the super structure of it? So PowerPoint in and of itself is a very big player in this. It’s multifactorial, but it is a piece of it. So I think just the overall reliance on PowerPoint, which hides structure. So I think part of the problem is if structure is hidden, it’s gonna make this learning in med school and vet school and pharmacy school that much harder. I think learning has to start with the learner being able to see and find, or even better yet, seek out and find the hidden structure. Even if somebody gives it to them, it’s fine, but it’s better for them if they have to seek and find it a little bit. Overlap: Oh, sure. Overlap: But at the very least- Overlap:There’s a lot of analysis in, yeah, there’s deconstruction analysis that goes on there, important part of the learning process, for sure. Ryan: Well, and part of that desired difficulty, right? Like let me find it. And you’re doing so much more with that cognitive experience with it, again, like a more direct route, an actual route of being active instead of just saying be more active. Jim: Mm-hmm. Ryan: So, yeah, I think that’s a part of this lecture challenge. What are some other things that you sort of are on your list? Jim: Yeah, so I’ve got a couple of things here that I wanted to, examples of, or problems that students have that I’ve seen face in the classroom. And again, I’ll say that I’ve been guilty of some or maybe all of these. I think the first one that I wanted to talk with you about is expertise blindness with instructors, okay? Ryan: Yeah. Jim: Or lecturers, right? Ryan: Yeah. Jim: So, as I said at the beginning, the people that you’re interfacing with, as a student in the classroom, these are highly intelligent content experts who if you look at learning in academic success as a bell-shaped curve, these are typically the people that are over on the one side of the bell-shaped curve with all the successful folks. And so when they come into classroom, many times, they think that their learners are exactly like them. So that students should think the way that they do, should learn as quickly as they do. And they get very frustrated very quickly when students aren’t able to learn what they want them to learn or as quickly as they want them to learn it. And then along with that frustration, it makes it very difficult for students then to interface with those instructors outside of class because they can be intimidating, you know? Ryan: Yeah. Jim: And so as an academic co-chair at my institution, sometimes we’ll have that issue, and I’ll have to work with students and help them to, all right, how should you interface effectively with this faculty member so that you can learn the things that you need to learn? Ryan: Along with expertise blindness, is that not also one of the culprits for the way that they build their lectures? Overlap: Oh, absolutely. Overlap: So in other words, when they transition from topic A to topic B, or they’re on the fourth example under 3A, they don’t necessarily need to, in their minds, they might not need to delineate that in that PowerPoint slide because the transition is so obvious to them. Overlap: Absolutely. Ryan: But to the novice learner, it’s not. And that’s where the novice learner comes into this thing and it all looks like disconnected pieces of information. They can’t see the hierarchy because the hierarchy has been scrubbed out and muddied by the expert because it’s so obvious to the expert. Jim: Absolutely. Ryan: To me, from where I sit, as I’m trying to help these students decipher and decode these PowerPoint lectures using frameworking, the skill we use to sorta untangle these, it’s really, that’s where it gets really frustrating. And I think that falls under this expertise blindness. Is that fair? Jim: Oh, absolutely. And I think another thing that causes it as well, too, is, especially when you’re dealing with new faculty that are coming in, and then this can, if you don’t change your habits or ways, it can transition into your mid-career, right? Ryan: Yeah. Jim: Is that as new faculty are coming into their teaching positions, they’ve spent the last six, seven, eight, nine years of their educational experience in a PhD program or postdoc, right? And the only time they get to teach or present in front of people is typically in a seminar. Overlap: Yeah. Overlap: Right? So you’re in a seminar room with every member of your department, national experts. You’re a brand-new scientist. You wanna impress people, right? So again, you’re gonna dazzle them with data. Overlap: Yeah. Jim: You’re going to blind them with massive amounts of information. And these people can handle it because they’re either content experts, or they’re so smart that they can navigate their way through it. And then they don’t know any better. They come into the classroom and they do the same thing, and it can be a mess. Ryan: And the audience is at the exact opposite end of their own understanding of this topic. Jim: Absolutely. Ryan: They’re at the bottom of the mountain. And these other people are already on the other side of the mountain they’re preaching to. Jim: And even if, I think even if young faculty recognize that they’re teaching, obviously, they do, right? Ryan: They know. Jim: You’re sitting in front of a group of students that don’t know anything about the topic that you’re talking about, sometimes, especially when you’re early on in your career, imposter syndrome can be a real problem, okay? Ryan: Sure. Jim: That you feel like, I don’t deserve to be there, or holy cow, I’m in front of this class, what do I know? Especially if your students are close to your own age, okay? It’s really easy. Like, okay, I really don’t know what I’m talking about here ’cause I’m teaching in an area outside of my expertise, which is really easy for that to happen to a faculty member. Ryan: Yeah. Jim: So again, I’m gonna blast them with lots of information, very dense slides, and try to navigate the process that way. So I’ve seen that happen. Ryan: And again, just for somebody on the outside looking in, trying to help the struggling student get on top of these dense lectures, I think a student can handle any degree of density if we can find structure. Jim: Right. Ryan: Learning has to start at the learner’s ability to seek and find and extract that structure. And if I can take a 100-slide deck of a PowerPoint and realize it’s like a stack of 10, a stack of 20, a stack of 20, a stack of 25, a stack of 15, a stack of 10, that’s your top layer, everything is so much easier from there. Jim: Yeah. Ryan: Or if I’m not sure, is that 20, or is it 30? Then I can at least speculate. Then in lecture, I can sort it out ’cause I’ve got this ability to seek and find. But when it’s all just impenetrable structurally, then where does the learner even begin? Jim: Exactly. Ryan: And I could tell you, it’s not- Jim: If they don’t have that skill, which most students don’t, automatically, they’re hitting a roadblock even before they start studying. Ryan: You’re playing catch up- Jim: Exactly. Ryan: From the beginning. And there’s just no time. Once you get into med school, pharmacy school, vet school, there is no extra time to then spin your wheels on this thing. So anyway, and I do think this expertise blindness is at the heart of a lot of stuff. And again, none of these, no lecturer, for the most part, wants to be that way. And I’ve had people bring me lectures, and they’re like, “This lecture is the worst. There’s no structure.” And then, but actually, through using frameworking, we find the structure. I’ll even be like, “Yeah, this is terrible.” Then all of a sudden, you’re like, “Wait a second. This one slide unlocks the whole thing.” Jim: Whole thing, yeah. Ryan: But we’re reading it. If you’re reading it linearly, you’re not gonna be able to find it. It gets glazed over, and then it gets buried by 20 slides in your head. You don’t know where the structure is ’cause you’re, again, going through it linearly. So I have multiple times in my life had either been told the lecture is terrible, and then we framework it, and the student’s like, “Oh, the structure is there.” Or I’ve been like, “This is terrible,” then I find the structure and it is there. Again, oftentimes, the lecture is not being willfully disorganized. Jim: No. And I’ve never seen that in my- Overlap: No, why? Why, right? Overlap: But I why do it? Ryan: But people will feel that way. Right, people feel antagonized and crushed. And again, the stakes are so high. And then it’s like, “Oh, no, it is there. I just couldn’t see it because they pluck, for whatever reason, that was lost in obscurity.” Could be as simple as like, it’s so obvious to them, it’s not there. Or they felt like they needed to tighten things up, and then inadvertently what they’re choosing to tighten are the road markers. It’s like, they’re taking all the road markers off the street, you know? Jim: Yeah. Ryan: So the street’s still there, but there’s no stoplights or stop signs. Jim: Yeah. Ryan: I’d rather prefer not to live in that world, so anyway. Jim: Yeah, so let’s turn back. Let’s move on to our second one here. Ryan: Yes. Jim: I think this is another favorite of mine. Again, I’m guilty of this and I’ve seen folks that are, and I really, really try hard with this, is excessive cognitive load. Now for your listeners out there that aren’t familiar with what cognitive load is, it’s really the amount of information that your brain can process at any given time that’s coming at you. So if you’ve ever… Again, a great experience for me where I get overload with my, my cognitive load gets overloaded is if I’m driving a car over the George Washington Bridge into New York City, okay? I always use this as an example. If you’ve ever done that without GPS, okay, there’s about 80 different green road signs in a row. And it’s just coming at… You’re moving at 55 miles an hour, and people are driving aggressively around you, and you’re trying to look for the right signs so you don’t get off on the wrong exit and get lost. Right there, that short circuits my brain. My brain just freezes. I can’t process. Which is why before GPS, I always had my wife drive into New York City ’cause she’s from that area. Now I can do it with GPS ’cause I just follow the, I follow the line and the voice, but- Ryan: It’s offloaded the cognitive burden. Jim: Exactly. Ryan: You’ve offloaded the cognitive burden onto the smart device. Overlap: Yes, yes. Overlap: Yeah. Overlap: Right. Or letting my wife drive, right? Ryan: Wife drives, right. Jim: So the cognitive load is something that I think instructors have to pay an important attention to when they’re developing their learning materials. And again, I’ll go back to my example of a brand-new minted, brandly new minted PhD or postdoc that’s coming into a teaching position. The default is to go into that seminar mode when you’re assigned a topic to teach, right? And so the two things that you will be tend to do is you’ll tend to load up your slides with lots of information, especially if you’re unfamiliar with the topic, because you wanna have that text up there, right? Ryan: Sure. Jim: As a prompt in case you forget what you’re gonna say or you can’t think of what the topic’s about. Or another thing is that you’ve got like, you’re trying to cover 80 or 90 slides in a 50-minute period, okay? And I always tell my teaching fellows that’s not teaching. That’s rapid information delivery. It’s not teaching. And so I’ve seen slides that are so dense and packed full of information that I don’t even know where to begin, you know? Ryan: Right, yeah. Jim: And even if I’m a content expert in that area, I’ve taught in that area and instructors using it, I’m like, where do I even go with this, right? Ryan: Yeah. Jim: Plus, they’ve got, on top of that slide, they’ve got 90 other that they’re trying to cover in a very short period of time. And what tends to happen with students is they just shut down in lecture then, right? Ryan: Yeah. Jim: They’re like, there’s no way I can follow this person. There’s no way I can learn all this. I’m just shutting down, and I’ll figure it out later. Ryan: Yeah. Jim: And then start over. Ryan: Well, and that can happen on a given slide. That can happen on a given slide. Jim: Exactly. Ryan: And then certain students will be able to then get back on board, but other students are done. Jim They’re done.

It’s like once they disconnect, so the metaphor is like they’re on the train, they fall off the train. And all they can do is stand there in the railroad tracks, watching that train disappear in the distance. Overlap: Yeah. Overlap: And they’re like, well, here we are. Overlap: Here we are now. And I’ve got, I’ve got 40 minutes left in class. I’ve got 20 minutes left. And for whatever reason, they can’t teleport back onto the train. I think strategies can be learned to do that, but it’s tough. It’s tough. Overlap: I do. Ryan: And again, we’ve gotta think about that. So I guess the solution there is like, yes, sometimes you’re gonna get bumped off. What you need to do is then scroll down a slide or two and wait for the train to come back around and jump back on then, and be okay with losing that as opposed to being like, look… Especially, I mean, if you’re in lecture, you’re in there physically watching it, maybe your school requires it, maybe you’re just there for whatever reason, maybe you wanna get something out of lecture, you don’t have to then say, I’m just lost. Just cut it out and say, okay, I did lose that stuff. Let me get back on board now and at least carry on with it. But man, yeah, getting blasted with some of these slides is very tough.

Yeah. Ryan: And again, maybe the person is, maybe the instructor is just, it’s just poor design on their part. Or maybe they are not really worried about teaching. And these people probably do exist, as much as we don’t wanna admit it, and they’re like, yeah, I’m dumping this on you, and you’re responsible for it. ‘Cause there are still some of those old school, like I suffered, you suffer, we all suffer. Overlap: We suffer, right, exactly. Right, I mean, look, and what I tell people is- Jim: Or I know all of this stuff in these slides and I expect you to know it, too, even though you’ve been a content expert in this area for 30 years, right? And these guys are just starting learning. And I think one of the things you said was really, really important, too, for the students out there that are listening is that you can’t control how that person is teaching you, right? You can’t control the type of material that they’re giving you, or how they’re presenting it, or the speed at which they’re presenting it at. But what you can control is how you interface with that material. And that’s really why I like a lot of the techniques and approaches that you teach because it helps students not only prepare for that contingency before class starts, but if they happen to fall off the train by mistake, okay, which can happen to any of us- Ryan: Sure. Jim: The skills and methodologies allow you to get back on the train.

Overlap – And so that you don’t lose the rest of that material. You can’t. Jim: Because what a lot of students will do is they’ll just, they’re recording it, or their school’s recording, they’re like, look, I didn’t get this, but I’ll just listen to the lecture again later on. Well, that’s crazy. Overlap: Terrible strategy. Why sit for another two-hour lecture that you don’t have to? Overlap: Terrible strategy. Right? Right. Jim: You’re spending four hours learning material that, if you were-

Experiencing it, right.

Experience, right. I love that way. You’re not learning. We’re experiencing. We have four hours of experiencing-



That is not a good… So time is the current… Time is the most scarce resource in life, of course, but certainly, when you’re in these programs. There’s not enough time to do everything you want. This idea of like rewatching a bad, any lecture, I mean, strategically, sure, whatever, but like, if your strategy is like, okay, I’m gonna ride this train till I fall off, then just be stuck there and waste an hour, or hour and a half, or whatever it is, 40 minutes, and then do it again, that’s not a good investment, right? Yeah, you don’t have control over this stuff. And what I tell people, ’cause people wanna complain about their professors and I’m like, “I’ll listen to it for a minute. Vent your stuff, but then you gotta roll up your sleeves and deal with it.”


Enough people pass that you can either figure out a way to ride it or get run over by it because that’s what’s gonna happen.

‘Cause they’re not changing.

You can say it’s unfair. No, no.

Right, they’re not changing. Ryan: You can complain about this and that. Jim: Even if big clumps of their students fail exams, usually, they’re just like, “Well, they didn’t study long enough or they didn’t study hard enough, and so it’s their fault. It’s not my issue.”

Yeah, kids these days, you know?

Yeah, right, exactly. Ryan: I mean, look, or the faculty, the administration can know it’s a problem, but it’s not gonna change for you.

Right. Ryan:- You don’t wanna get caught up under that. So be mad about it for a minute, vent your, air your grievances, and get on with it. And I’m not saying this is great, but- Jim: And I’ll tell you, also, too, Ryan, another thing, too, that came to my mind that I think is really important for your listeners to hear, too, is that there’s a lot of research out there that supports the idea that if you’re one of those students that can actually make sense of a lecture that’s a mess, okay, versus, and really engage, you’re actually learning more effectively than if you’re a student sitting through a very well-organized lecture where things are kinda laid out structurally. Again, you said before, and I take great pride in how well-organized and structured and outlined my lecture notes are, but I also understand, too, that part of that is not conducive to learning because students don’t have to necessarily work as hard at that.


And remember, we’re talking about-

Your stuff’s super dense. Your stuff’s so dense, though, they’re still working plenty hard.

Okay, great, all right. Then I’ll take your word for it. But I think for others-

It is, it is. No, I was relistening to “Make It Stick” today because as one does.

Yeah. Ryan: “Make It Stick” is the best book on learning theory out there. It’s great just for all the stuff. And it was talking about, right, like a little bit of that desirable difficulty that goes with it. But I was listening to that thinking like if the listener has to work a little harder, you’re gonna get better retention, better engagement.


And I was listening to that, thinking about like, it doesn’t matter how well-organized the lecture is at this level, it’s still difficult.

Yeah, you’re right.

I was having that thought earlier today.

‘Cause there’s a lot of things that add difficulty, right? It’s the content itself. It’s the amount of material. It’s the speed.

Yeah, yeah, yeah, yeah. Yeah, all of it.

Your point’s well-taken.


And I think that… But yeah, so that is definitely really, the whole cognitive load thing is definitely interesting. And unfortunately, students out there, you’re just gonna have to learn strategies to deal with it.

You gotta manage it.

And fortunately, there are strategies out there.

Mm-hmm. Yeah, it’s more manageable than people think, even when it is poorly designed.


You can do, and you can work through it in various phases, depending on how well-organized the lecture is or how poorly organized the lecture is, and still get benefit on the other side. And then the simplest thing is, if you can only focus on one thing, focus on hierarchical super structure, so that you come out on the other side of lecture with a sense of structure, and organization, and number of topics, and subtopics, and stuff like that. And that’s counterintuitive because you’re not gonna get tested on that. You’re gonna get tested on the things that are four or five, six layers deep. So that’s where the grind is on it. And I hear you. I know, I get it. But I think learning at this level has to start with awareness of structure. Build the structure. If you come out with structure on the other side, you’re gonna be better off than if you’ve got like a few armfuls of a bunch of random disconnected details.

Yes. Ryan: ‘Cause if you’re trying to sit there and memorize, memorize, memorize, that is not gonna pay off. That’s a fair statement, right? Jim: Yeah, absolutely. I would agree 100%.

Yeah. Jim: So my next, I guess, issue with lecturing and classroom instruction is the speed of the lecture. And I think we’ve already touched on this a little bit. And I think that every instructor has their own personal style of teaching, right? So the way that I would teach a class or present in a class might be different, Ryan, than how you would do it or many of my colleagues here.


But I think that if I were speaking to any instructors out there, what I usually tell my teaching fellows is, “Look, if you’re presenting much more than 20 slides an hour, okay, you’re starting to really get into that…” Again, a lot of it, too, depends on the density of information in the slides and things like that. Right? Okay? But just as a starting point, “If you’re planning on, again, covering 70 or 80 slides in a 50-minute period, I don’t care what the density of your slides are, okay? That’s just way too much, okay? Your students are just going to be overwhelmed by that.” So I think the key piece here is that being mindful of the amount of information that you’re teaching, making sure that you give your learners enough time to digest information, and to ask questions, to formulate questions. Sometimes, as instructors, were guilty of not giving our students a chance to just stop and think about what we just said. Or giving them an opportunity to practice applying something that you just taught them in class, right? And so we’re all about like, okay, we just gotta get to the next slide, click, next slide, click, next slide. And it just seems relentless. So again, this is where I think what you talked about before, interfacing with that material in specific ways before class, pulling out the super structure, the hierarchy, so you’ve got a sort of a basic roadmap that you can follow as you go through, even a rapidly delivered, dense lecture. You’re gonna be able to follow along. And if you fall off the train, you can get right back on and you know where you’re supposed to be.

So, yeah, speed of lecture. I mean, that’s the first word of my, the crux of my assessment and condemnation of medical education, speed-volume-density equation, right?


The speed is furious. And I mean, I see… I mean, I’m sure most people, if anybody’s listening to this, they’re gonna be like 20 slides an hour. They’re gonna be like 80 slides an hour.


90 slides.

And I’ll tell you… And I am known for working at a snail’s pace. I am probably the slowest lecturer at our school. I know I have colleagues that I teach with, and I’m gonna apologize publicly to them right now.

Yeah. Ryan: When they teach with me, they’re cringing because they know it’s, ah, Jim’s starting to teach now. It’s gonna take him a while to get through this stuff. But I really try to be mindful of the learners that I’m working with. I’m looking at body language. I’m asking them questions, seeing where they’re at in the learning process. And that will tell me, that’ll drive me when I move forward on the next slide versus just like-

Wow. Jim:- Gotta get through this, gotta get through that, so. But I move at more of a snail’s pace than some of my- Ryan: You’re an exception to the rule, I think. But also, well, I mean, again, I can’t speak for everybody. I mean, my sample size is gonna be contaminated ’cause people are bringing me the things that are really troubling them. I don’t see the stuff that’s not giving them trouble. So I don’t know what my representative sample size, how that translates across the board. But I bet you most students in most schools have at least one professor, if not a few, that are just blazing through super dense material. What you’re describing is empathetic teaching design. Jim: Mm, yeah. Ryan: I think you have a high level of empathy that you’re projecting onto the students sitting in those seats. But you struggled some as a student, though. For somebody in your position with your PhD and all that stuff, you weren’t like the typical- Jim: Oh, no, no. Yeah, we’ve talked about that. I really, as an undergraduate, I really had no clue about how to be an independent, effective, independent learner outside of class and manage my time effectively and productivity. And despite those setbacks, I did well enough to get into a graduate program and PhD program where I learned some very basic learning strategies, evidence-based learning strategies from one of my first-year physiology professors that transformed my learning, which is why I’m such a big fan of this today.

Yeah. Jim: Again, we’re talking about, this is the early ’90s we’re talking about, so.

Yeah. Overlap But it was enough.

Dark Ages. This is the Dark Ages, as far as some are concerned.

But it was enough, right? It was enough structure for me as a student to say, holy smokes, now I’ve got some tools. Ryan: Methodology goes a long way. Methodology, a little bit of methodology goes a long way. But I would think in the ’90s, early ’90s, we’re talking like infancy-

Yeah. Ryan: Of this kind of thing. But I just think it’s interesting to think about like, maybe that is a chicken or egg whatever, the genesis of some of your empathy toward the learner. Jim: Oh, I think so. Yeah, without a doubt. I’m sure a psychologist could spend years analyzing my past experiences and how that translates into my teaching today. But we all do that. We all bring our past experiences- Overlap Yeah, of course. Yeah, it’s all part of…

Right. Ryan: I mean, this is such a multifaceted tool that we use as we communicate with our learners. But I do think it’s a high degree of empathy that you do display and that you’ve wrapped into your approach. But also, the way you teach, you’re not like, I’ve gotta get through these 50 slides today, right? You have like a whole body of work and you sort of progress into… And you’ve got your benchmarks you want to get to. Overlap Yeah, exactly.

But you gotta get to where- Jim: I know where I’m gonna get to. I’ve designed my materials to fit in a certain time period, right? So-

Yeah. Still at a pace that works. Jim: I know by day one, I need to get through these first 15 or 20 slides or whatever it is, right?

Right. Jim: And I know what my pace is, and I know. And so even if I’m asked to teach a new topic area, I’ve got a pretty good idea now what I’m capable of getting through as an instructor, and so I’ll work within those confines. Ryan: Yes, yes, and that’s good teaching in- Jim: Yeah, I always feel I always… The other thing I always talk about is fundamentals. I think sometimes as instructors, we have this kind of Venn diagram where, at the middle, we have must-know concepts that students absolutely have to know when they get out of class. We have very important concepts that are kind of outside of that circle, right?

Right. Jim: And then we have interesting on the outermost circle, right? And so the must-know are like those fundamental things. And so I really do try to spend a lot of my time in that must-know area and important area. But a lot of instructors will get outside of there, and they’ll start talking about things that are interesting to them, maybe tangential research that they’re doing that’s connected to the subject, but not really. And all of a sudden now, as a student, you’re totally, you’re overwhelmed and you’re lost.

You’re overwhelmed and lost and you don’t know. And again, it’s kinda skewed your ability to plug in. I remember working with your faculty about a decade ago, trying to teach them this, like how to build structure into their lectures. And some of the ones that didn’t wanna do it were more into the art of… I mean, one guy, I don’t remember who it was, but he’s like, “I wanna tell a story.” And I’m like, “Oh, yeah. That’s not what students are needing.”

Storyteller, right. Ryan: They don’t need a storyteller. Look, if you can make it interesting with stories, that’s all fine. But it was like story versus explicitly embedded structure.


He was like, “Oh, I’m going story.” I’m like, “Ooh, that narrative is not, that’s just not, they need structure.” If you can embellish it with stories and make it better, I mean, more power to you, but-

Oh, absolutely. I think concrete examples-


Like I said, my partners do that all the time. I think it’s phenomenal.


They’re talking about a particular drug in class, and they’re like, “Oh, yeah, and by the way, last Wednesday, I had a patient who had this exact issue.” And I think it just, it brings so much relevance when you use it appropriately. But you’re right, it is a big difference in that than just kinda meandering through a classroom. Ryan: Yeah, like I’m weaving a narrative. Like, oh, man, I don’t even know what that means. So ’cause the framework, the lecture was unframeworkable because it was all hung on. I was like, yeah, but if you lose somebody in a narrative, there’s no getting back. There’s no getting back and there’s no way to discern it. So again, everybody… It comes down to how are we approaching this stuff? But again, speed of delivery. I think if we can think about putting ourselves in the seat of that novice learner and focusing on structure is gonna be better. What else? What else you got for us? Jim: Yeah, so here’s another one that I love. And this is disorganized learning materials. And this is a great segue into what you just said, right? So you have lecture notes or PowerPoint slides that don’t have any apparent organization whatsoever. It just kind of meanders along. In fact, the whole class is kind of unstructured where you don’t really know what you’re gonna be learning from one day to the next. I had a biochemistry class like that when I was an undergraduate. I loved the professor. He was such a great guy. Super nice. You could talk to him. Brilliant guy. But from what I remember, he’d walk into the classroom every day and open up the biochemistry book to some random page and start teaching. At least-

My gosh. Jim: For me as a student, that’s the way I perceived it. Maybe there was a plan or a structure behind that I don’t remember. But I’m like, okay, what are we doing? It was always a surprise. What are we gonna be learning today? We had no notes. And this is the before PowerPoint or- Ryan: Right. Jim: We’re talking late ’80s here, early ’90s. But so the disorganized learning material, I think this is something I know you mentioned you deal with your clients and your students a lot. And I see it a lot as an instructor. And one of the ways that I’ve worked to combat that is, you and I have talked in the past about top-down versus bottom-up learners, right?

For sure, mm-hmm.

Okay? And I think I’m much more of a top-down learner where I need to develop a scaffolding or super structure. So when I’m writing a lecture or developing some learning materials, I’ll map it out first. I’ll outline it out first. I’ll use a concept map or get an idea of what I’m gonna be doing and structure it that way, and then fill in from the top down versus I think what a lot of people do that have all that information in their heads already. And this is especially true for me when I’m teaching something new that I’m not necessarily an expert in. Super important to do that, right? But if you’re a content expert, you may be more of a bottom-up learner where your head’s fully crammed with all this information and you’re just putting it down on a slide. You’re not really…

Yup. Jim: I’m just getting it down. We’ll get it out there. And there’s no organization or structure to it. And I see that a lot. You know what, I’ve seen it in a lot in the past. I think a lot of faculty do a really good job at this, especially if they’re thoughtful about it. And I think instructors who are reflective, and work from year to year, and they look at their material each year and like, what could I do better? Or how did this go last year? When I’m lecturing, I’m taking notes about how things are going. If something didn’t work or if I’m like, boy, this was confusing to them, I’ll make sure I make alterations and adjustments for next year. And I think that’s how my lecture material first started out. It was pretty disorganized. But over the years, it’s evolved, so. Ryan: Well, I think it’s interesting. I think a lot of people that do get into teaching might be more bottom-up.

Yeah. Ryan: Where there’s certainly a strong slice of the pie is.

Yep. Ryan: And I think those people are gonna be more likely to have fragmented, disconnected lecture material because that’s how their brain works. The elves of the executive functioning section of their brain put it all together for them. So if they are bottom-up learners, they see things in a bottom-up way. And it’s not even like they’re not… It’s not as straightforward as them not caring and being empathetic to the people in the chairs.


They don’t know.

They just don’t know at all. Ryan: They don’t know that those students need that structure so obviously and so explicitly. Because this is, I mean, like I said, I see this problem across the spectrum. People think it’s like, oh, my school, they do like this. I’m like, no, it’s like every school. I see people like this at every school. It’s a law of nature in some sorts because I’ve seen it from too many places from too many people of too many different backgrounds where they’re coming in like this. And I do think it’s probably related to, especially as you say that, the bottom-up learner who sees things detail-oriented, not super structurally. And those are the ones that are really hard to work with framework-wise. And so what I tell my students in that situation is make an ugly… Your framework is more of a hypothesis ’cause you’re like, you’re just totally guessing.

Right. Ryan: You’re like, I think maybe this is this, and I think maybe this is this. And then you go into lecture, and all you’re doing is using the narrative threading of the lecture to correct the framework and reconfigure it, so that on the other side of lecture, you now have had two experiences with the material and you’re coming out with maybe a rudimentary framework. If it were better structured, you would’ve had something akin, if not better to, better than that rudimentary framework going into lecture. And you would come out of lecture farther down the sequence of learning and encoding and connecting. But in this situation, you’re coming out still better than you otherwise would and you’re at least going down the right road. Because usually what happens with that bottom-up learner instructor is that certainly by the end of the lecture and they’ve narrated it and filled in the gaps and they’ve physically jumped the gaps between these things and connected the information. Or you might realize these five slides in the middle of slides A, B, C, and D, E, F are like you can excise them, and then as A, B, C, D, E, F. They go together or what have you. And then you can realize it, and that’s the game you’re playing in lecture. Not worrying about the details. Not worrying about, quote unquote, learning because the students are learning that learning starts with structure.


So there are ways you gotta work around the disorganized learning material. The other alternative is, I don’t know, you take the objectives. It gets ugly doing this. And this is not as necessary as people often think it is. ‘Cause people wanna press the eject button really early on a bad lecturer or a lecture they don’t like. You gotta be really careful to do that ’cause you’re going down an inefficient road.

Yes. Ryan: But worse comes to worst, I mean, worst, worst, like truly eject button, is like you take that to like a BRS book or like a board review book, or a textbook, and you say, okay, here are the objectives. These objectives are covered in this chapter, I can then… ‘Cause the science is the science.

Yeah. Ryan: But you gotta be real careful doing that. Because then all of a sudden, you’re opening up Pandora’s box and it gets really dicey. But that is an option. Jim: It’s an escape route that you don’t wanna have to take, but you can if you have to. Ryan: Yeah, right. Or you could even framework like from like a BRS review book or some board review book and just get like a broad sense of the framework. And then it might give you… It’s not gonna occur perfectly overlap, but you’ll understand more. Like if I was doing like a chromosome abnormalities lecture that I was working with from one student, really messy, I could go to a review book. Remember, I know nothing about the science. I could then framework that first day, that board review chapter, or from maybe like, not just like a four-page or maybe like a 12-page chapter on it, so it’s still not down in the weeds, but it’s still not sort of a mid-level view. And if I framework that, it would bring rhyme and reason and structure to the things that this disorganized professor is teaching. Now again, I’m just using it as a framework. I’m not getting down into the details. And then I’m gonna use the information from the lecture because that person’s, I’m assuming, writing the test questions. So I don’t wanna get too far. Now again, I think there’s a million caveats with this, so tread carefully, but that is a way to plug in and find ways around disorganized learning materials. Is that fair? Jim: Yeah, absolutely, I think so. Definitely, definitely. I think the last thing that, the last item I have are instructors who are teaching in areas that they’re not content experts in, which happens a lot, especially at mid-sized to smaller institutions where you might have a limited number of faculty. I know for me, okay, I was trained as a cardiovascular pharmacologist. And my particular area was hypertension. My sub-area was a specific adrenergic receptor that’s involved in vascular function in the signaling pathway, so really minutia stuff, right? So when I was a first-year faculty member, again, coming in with this very specific area of training out of my PhD, I was certainly assigned to teach cardiovascular diseases ’cause my PhD was in cardiovascular pharmacology, but I was teaching things like arrhythmias, and heart failure, and anticoagulation that, frankly, I knew very little about other than what I learned in my medical physiology, my medical pharmacology course that I had for one semester with the medical students, and so-


Jim: There was a lot of self-learning even within my discipline area. Even teaching in hypertension, right, which is what my area of research was in, okay, I knew a small fragment of what I was teaching ’cause I was using a specific type of drug in my research that’s only used in, calcium channel blockers, which are used certainly as first-line agents for treatment of hypertension. But there are a lot of other drugs that I frankly wasn’t very familiar with. So I’m learning an awful lot. And I think that can be a double-edged sword for students, right? And again, I am guilty of both things here. I’m just gonna say it right up front. You have faculty members who if you’re well-prepared and you’ve dug into a topic that you’re not familiar with, it can actually be a really great learning experience. Because I’m looking at the subject area as a non-content expert. So I’m able to, in a lot of ways, if I’m teaching something like that, I’m able to eliminate a lot of the excess stuff, the baggage, that a content expert may be not so ready to let go of. Right? Okay? Ryan: Or it might… Because of the expertise blindness almost, right?

Yeah, exactly, right, exactly.

It could work around that.

So I’ve taught, and I’ve taught with a lot of faculty members, especially clinical faculty members, who are teaching in areas that are outside of their practice areas. And I know sometimes they’re very nervous about doing it because like, wow, I don’t really practice in this area, or I don’t deal with this disease state. But as long as they’ve done their homework and their well-prepared, they do a really bang-up job. And I think the students get a lot out of it because it really, I think it forces elimination of a lot of detail and complexity that maybe students don’t really need. On the flip side, okay, let’s say you’re asked to teach… And again, my first semester teaching, I mean, I must’ve been assigned 20 lectures to do, okay?


20 two-hour, so it was like 40, 50 hours of lecturing, all right? And it takes, especially when you’re a beginner, I remember it taking anywhere from 10 to 20 hours to put together materials for a topic that I was teaching it. Now, 10 hours on the side-


Jim: Where I was familiar with the information, maybe more on the 10-hour side. 20 hours in an area I, ’cause I had to read, I had to learn.

Oh, yeah.

Jim: I had to talk to the people I was teaching with to make sure my information was congruent and connected with what they were doing. So were there moments where I fell short with that? Absolutely.

Of course. Jim: And as an instructor, I feel awful because I know I’m not doing the subject material justice, and I know the students are lost. So apologizing to all past students out there that I did that to. Jim: Well, but I think it shines such a powerful light for the people like where I sit or where our students sit. Overlap: Yeah.

Looking behind the curtain-


Of what’s happening on the other side of things.


Ryan: And that probably ties into, also, even if you’re an expert, but you aren’t really trained in pedagogy and teaching, all the entanglements and the time that goes into that. And maybe it’s like you did a really good job on lectures one, two, and five. Jim: Right. Ryan: But three and four got short shrift and cut some corners. These things happen. And how much time is there to reflect and adjust and all that stuff? So I think it’s all very… It’s insightful for me. I’m sure it’d be insightful for my students to think about.

Oh, yeah. A situation that happened to me probably seven or eight years into my career, I had one of my colleagues in my department, unfortunately, one year, had a heart attack and was hospitalized for months afterwards. And again, it was sudden. It was unexpected. The next day, my department chair comes in my office and says, “Guess what, Jim? You’re teaching medical physiology or physiology for the rest of the semester, anatomy and physiology.” And this was like September, October. “And probably through the next semester as well, too.” Now, fortunately, for me as an instructor, the person who taught the course was extremely well-organized, had really good materials put together, so it was really… But it was difficult for me because I was trying to interface with their learning materials. Overlap: Oh, yeah, that’s-

Right? ‘Cause when we develop slides and that. We talk about that super structure and the way things are organized and flow. It’s really, really important to develop that yourself. And so I found myself all the time-

You’re right ’cause it’s the connective tissue.


But the way that you slide through and jump the gap and draw these connections, that’s a…

It was crazy.

And this probably happens way more often than we think. Jim: Way more than you think. Or someone leaves suddenly, departs. This happens a lot, too. And then you’re a faculty member and you get saddled with a bunch of brand-new lectures that you’ve never had before, and you’re up in two weeks. Right?

Wow. Jim: So the default mode is, are you going to recreate all of this stuff? You don’t have time in two weeks. So you end up using the other person’s materials. And what can happen then is it’s never as effective-

It can’t be. Jim: As if you take the time to really dig into the material, develop your own material. So there’s a lot that goes on behind the scenes with teachers and faculty that maybe some of your listeners don’t know and don’t worry about. Now, again, that’s not an excuse, right?

No, but it’s real. It’s real. Overlap: But it’s real. So, and I think, like I said, I think you said this a couple times and I wanna reiterate it. I’d say 95% of the time when I see these things in instructors, it’s either they just don’t know that they’re doing it, they don’t know any better, or they’re forced into a situation where they don’t have a choice. And so for students out there, they don’t hate you. They’re not trying to get you. They’re not trying to destroy you.


It’s just, it’s, unfortunately, a part of the experience. And I think that’s why it’s really important for students to learn how to navigate these particular situations and learn skills that they can use to effectively navigate through these things and to learn effectively. Ryan: Yeah, because that’s one of the catchphrases that I think I’ve already said in this episode, methodology matters. I meet so many people who don’t think methodology matters when it comes to studying in these programs. It’s crazy to me. We think methodology matters in every other walk of life but not in pharmacy school or med school or veterinarian school?

Right, right. Ryan: It’s like, if you’re smart, you’re smart. You do it. You figure it out. That’s one of the most like asinine mentalities, but that’s a real mentality that’s out there. Jim: It is. I mean, I always tell my students, and you and I have talked about this analogy. I mean, you look at like professional athletes, professional musicians, right? I mean, the way that they practice and they learn their instrument and the sport that they’re playing, it’s incredibly method-driven and structured and deliberate.


And yet we ask students to come into professional degree programs where they have to learn at a professional level, but you have no training at all or help to-

Where the stakes are so high and the stakes are so high.

Or stakes are so high, are so high and you don’t have any training at all in how to be an effective, independent learner. And you’ve either picked it up naturally through the years, or maybe you were like me and just use whatever raw talent that you had, raw intelligence, or work ethic. You just bulldozed your way through it using whatever you had.

And that’s right.

And it was a miserable experience and you didn’t get much out of it.

And risky, I would say, risky, right?

And risky, yes. Terribly risky.

Because the risk, the risk is what really bothers me so much is like, yeah, you made it, but what were the risks? How close were you ever to the edge where something could’ve knocked you over, you know?

Right, right.

Where you needed somebody else, right?


That’s what’s just… Like near-death experience, like, gulp, just missed it right there. So yeah, this is very informative and this, yeah, this is more it than I expected it to be. ‘Cause again, everybody always thinks, oh, I know this, but we’ve never really deconstructed as much what goes on behind that curtain.


Ryan: And I think it’s always a good idea to know what the other side of the aisle is doing, and that can influence our prep and our flexibility and our mentality as we work through it. So, well, very good. Thanks for walking us through that. And we’ll be back with more conversations like this in future episodes. Thanks for listening.

Jim: Thanks, Ryan. Appreciate it.

Announcer: Thanks for tuning in to “The STATMed Podcast.” If you like the show, we hope you’ll subscribe. You can find more test-taking and studying strategies specifically developed for med students and physicians over at our blog, Thanks for listening.

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