On the STATMed Podcast: Uncommon Pathways Episode 2
Host Ryan Orwig speaks with STATMed alumni who share their uncommon pathways to their dream careers in this podcast miniseries. In the first episode, Ryan and JT, a surgeon, discussed the challenges low boards scores could cause when pursuing a competitive field like orthopedic surgery.
How To Study Effectively In Med School and For Boards
In this episode, Ryan is back with JT, an orthopedic surgeon, who shares how the STATMed Doctor Study Skills Course changed the way he prepared for exams. Here, JT shares the biggest takeaways from his quest to learn how to study more effectively. From the importance of frameworking to transforming his study sessions with retrieval practice and managing workflow while studying, JT shares his top three lessons learned.
“I would say the overarching thing was that I was very passive in how I would study. So that meant just reading or rereading material that I had read a thousand times over and just thinking, okay, well, maybe it’ll stick this time. Or if I “I would say the overarching thing was that I was very passive in how I would study. So that meant just reading or rereading material that I had read a thousand times over and just thinking, okay, well, maybe it’ll stick this time. Or if I just keep reading this, it’ll get imprinted into my subconscious. I realized it’s not good because it’s not intentional. And so what the study skills course taught me was that you have to intentionally engage in the material, and the way you do that is by testing and retesting. So, instead of just reading through a passage, article, or review book, I had to framework it out. I would have a blank, and it would be “name these three things associated with this fracture pattern.” And instead of just rereading them, I would have to say, okay, I actually have to recall what these three things are.” – Dr. JT
If you’re struggling with how to study effectively in med school, we can help. Check out the STATMed Study Skills class or the Doctor Study Skills Course, or explore our blog and YouTube channel for more strategies and insights.
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– [Narrator] 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 over a decade experience working with med students and physicians. In the second episode of our Uncommon Pathways mini-series, we’re back with JT, a former Doctor Study Skills Course participant and Board’s Workshop participant who shares his journey to becoming an orthopedic surgeon. In this episode, Ryan and JT dig into study based issues and key strategies to mitigate them.
– [Ryan] Yeah, you’re preaching one of our big, one of the points we advocate, right?
– [JT] Correct.
– [Ryan] The fear of missing out is overwhelming.
– [JT] Yeah exactly.
– [Ryan] There’s so much information out there now. Now one of the bigger variables, the monkey wrench is that there’s so many options, so many resources that you see more and more students dividing their focus over multiple resources. So they’re familiar with a bunch of resources, but mastering, none of them. And through that conversation, we decide that yeah, test taking was a problem. So you had watched that five reasons why smart doctors and med students fail boards. And that really spoke to you. And I was like, yeah, definitely the test taking is definitely a problem. We gotta fix that. But then we talked about on the front-end where the information that’s coming to you, how that needed to be addressed as well. So, the front-end is study methods. The back-end is test taking. A lot of people… That’s why we have to have a conversation, sort of figure this stuff out, to figure out where the intervention should be. And what I think with you was that you’re one of these top-down learners, meaning you need structure upfront. You need to seek, find, build a structure, extract structure, build it, so that you can represented in your mind. And then as you work through the material, get to retrieval practice early and often and iteratively. And I think that, my hypothesis is, why was this not a problem for you earlier? Well I think you just have the bandwidth and the cognitive ability to get through it. I also think that, as rough as med school can be, the problems that are created from PowerPoint based lectures, which you hated as a med student, it was still structured enough that you could get through it. Even in rotations, as much as you didn’t like doing stuff like family med or OB-GYN, because it wasn’t surgery. As much as you didn’t like that, and as disorganized as those things are, there was still enough of structure, enough of a pocket. And for somebody else they might collapse in that first semester of med school. For somebody else they might collapse in that second rotation because it’s just too clinical and not enough structure. But for you, it was okay. But once you got to this like just surgery and the sheer scope of it and the sheer work rate of it, and you understood stuff that you didn’t have that large conceptual framework, the super frameworks, the specific frameworks. And that’s where the organization where you needed, where we needed to say, okay, we need to teach JT how to get in there, through one or two primary resources, extract, structure, and build off of that structure. And then we… I think in that first conversation we pretty much decided that was the problem. Therefore, we had to teach study methods first and then test-taking methods. We have our, this thing called the Dr. Study Skills Course where it’s a one-on-one like, hey, let’s get in there let’s rebuild this guy’s study methods. And again, I think your program was super generous with helping us structure your time so you could take that stuff on board. Although it is pretty fast, relatively speaking, remote, one-on-one online. And we got in there and we sort of re-engineered this study methods first. And then I think you what, use those methods for a few months or something like that?
– [JT] Yeah. Yeah. So, I’ll backtrack just a little bit. I spoke with you in the fall of my chief year and I said, look, I think I’ll probably gonna use y’all, but let me just kind of continue with this. Because I had what I thought was a pretty good study schedule leading up to the intern exam in my fifth year. And so I said, let me see kind of how I do with this process and then I’ll let you know after I get my score back. So anyway, finished my own schedule or whatever and I just, I did terrible on the intern exam that year. And every year it gets harder to do well just because everybody else is studying and has accumulated knowledge of the… More knowledge and then more knowledge of the tests. So, I did bad. I did not do well and I was really freaking out. So I called y’all shortly thereafter. I was like, all right, we’re doing it. So, I started the Study Skills Course, I believe in like January. So that’s kind of a little background to how I got there.
– [Ryan] So, going through the study stuff, the Study Skills Course, part of that is also teaching you just to be an expert in your own learning. Teaching you to be an expert in your own learning needs and where does learning breakdown for you? What are the things you need? What do you think were… Let’s just say three of the biggest like insights that you gained from the study skills course. Like this is what I was doing wrong and then this is how I fixed it. What can you say about that stuff?
– [JT] I would say the overarching, like kind of the biggest thing was that I was very passive in how I would study. So that meant just reading, re-reading material that I had read a thousand times over and just thinking, okay, well maybe it’ll stick this time. Or if I just keep reading this, like it’ll get imprinted into my subconscious. And that… I realized it’s not good because it’s not intentional.
– [Ryan] Yeah.
– [JT] And so what the study skills scores taught me was that you have to intentionally engage in the material and the way you do that is by testing and retesting. So, instead of just reading through a passage or an article or a review book, I had to framework this out and on those key points, I can say, let me just rereading that key point. Like, I would have a blank and it would be name these three things associated with this fracture pattern. And instead of just rereading them, I would have to say, okay, I actually have to recall what these three things are.
– [Ryan] The problem is once you read something and you reread it, you are getting diminishing returns. That is what I call the illusion of mastery. Because you are looking at it and it’s right there in front of your face. I feel like it’s like looking at gym equipment. It’s like hanging out at the gym. Like I was at the gym for two hours why am I not ripped? I go to the gym every day. What are you doing at the gym? And so this idea of look… And in your mind, you’re like, man, that was terrible, I hated it. Rereading this boring stuff over and over again that you recognize when it’s in front of your face but you’re not building the retrieval mechanism. See, we think about… I don’t think we think enough about building the pathway, the retrieval pathway. Like if you’re walking through the woods, if you walk through the woods once it’s not gonna make a path, it’s the back, forth, back, forth, back, forth that builds the pathway. When we study, we need to be thinking about retrieval pathways. We need to… And every time we hit that memory, we’re solidifying that memory and making it more accessible.
– [JT] Yeah.
– [Ryan] And when we think about this act of retrieval, You’re sort of, you’re saying both at the same time. I think on the front-end, you’re also talking about seeking and finding and extracting that framework. That’s one of the secrets to this, right? That’s what your brain doesn’t build as organically as many of your orthopedic surgery…
– [JT] That is so true.
– [Ryan] And so I’m assuming that was also a part of your study going into your primary source or your article seeking and finding and extracting the framework, correct?
– [JT] Oh, yeah yeah, for sure. And so this kind of a… Two things you say kind of dovetail with the other my big mistakes and studying. So I’ll start with this, talking about going to the gym just looking at gym equipment. I realized that my studying was… I would just go into a study session and just be like, okay, well, I guess I’ll just read for an hour or whatever. And it’s like, it was just reading for an hour. And it was this… There wasn’t any goal of saying, okay, I’m gonna get through this and I’m gonna read or I’m going to retest these three things. Like it wasn’t intentional it’s just kind of haphazard thing of like, all right, I’ve got some time on Saturday morning, I’m gonna read for two hours. And then you get to the end of two hours and you’re like, well, did I read enough? Like, did I do anything? So, you just kind of have this… You’re just stuck in this mire of self doubt of like, did I even do anything for the past two hours.
– [Ryan] You suffered. You suffered for two hours.
– [JT] Yeah. Yeah. And so there was an illusion of studying and it wasn’t things that were active. So a lot of times it was just kind of going in and looking at the gym equipment rather than actually working out on it. And then the other thing too in terms of the structure and the framework, I realized that I didn’t have a great primary source. So residency is just… And I imagine people across our recency would attest to this, but it’s difficult to have a structured curriculum because you’re busy. You may only have one didactic lecture a week or something like… Or one didactic day a week or… It’s hard to say, okay, this is what I’m gonna study today. And so, there’s a real need for everyone to have one or two primary sources that they use as like their Bible for recency. And I realized that I kind of jumped around a lot in recency in terms of my primary sources. I would read review articles and things like that from journals. There’s a fantastic website that is available to orthopedic residents called Orthobullets which has everything like a bulleted format, but there’s not a lot of depth to it. They have questions that are associated with it. Like every orthopedic resident knows what Orthobullets is and they all work the Orthobullets questions. It means like 7,000 questions or something in their bank. So everybody knows about it. And it’s a great resource, but there’s not a lot of depth, not a lot of depth to it. So what I ended up realizing was I just didn’t have a great primary resource and I would just jump around between different things and there was no, like you’re saying, structure for me to hang everything, all of my knowledge on. Whereas in undergrad and in med school, like you had a text, you had a hard copy textbook, or you had this PowerPoint, but in residency, you’re just kind of left to your own devices. So, one thing that I did that I think just completely changed my understanding and particularly how I approach the way I accumulated knowledge for the test was I got one review book and I started in January with Millers. I said, you know what, I’m gonna get all the way through this book, and this is gonna be my structure for how I organize things in my head. And that was huge for me.
– [Ryan] So that was using our methods, using the methods we taught you. Yeah, you’re preaching one of our big… One of the points we advocate, right?
– [JT] Correct.
– [Ryan] The fear of missing out is overwhelming.
– [JT] Yeah exactly.
– [Ryan] There’s so much information out there now. Now one of the bigger variables, the monkey wrench, is that there’s so many options, so many resources that you see more and more students dividing their focus over multiple resources. So they’re familiar with a bunch of resources, but mastering none of them.
– [JT] Yeah. It is a real problem. And this is something I started to realize in medical school. And if we’re backtracking a little bit counting to my step studying, I used DIT to study for step one and that gave you a structure. But even then, like I still have this, like you’re saying this FOMO of like, oh, well, this person is using this. Maybe they’re getting a better like study experience. Looking back I realized I never really like fully sold myself to DIT because I always had to thing in the back of the mind. I was like, oh, this may not be good enough.
– [Ryan] Yeah.
– [JT] That’s such a mistake now looking back on it. And I did the same thing with step two. I wasn’t super organized. I used online med ed was just getting started when I was studying for step two. So I used that a lot. But even then, I was kind of jumping around between various things. And, you realize you spend more time jumping around trying to decide what you should study rather than actually studying the material.
– [Ryan] That’s like when you’re sitting down to study, nobody wants… Cleaning your bathroom or organizing your closet is never more appealing than when you’re in that second hour of studying. Right? Like that really needs to happen and it doesn’t. Likewise, I think this chasing various resources.
– [JT] Yeah yeah.
– [Ryan] Let me research this, let me look into this. Let me dip in from one resource to A to a resource B to resource it C. It feels like you’re being productive.
– [JT] Yeah.
– [Ryan] But it’s not, it’s not. So you can say like I studied for three hours, but really how many of those hours were spent toggling between or researching or looking. And like you said, this idea that maybe they’re having… What you said was so salient cause you’re like, what if they’re getting a better experience over there? Just pick one and master it. And if you have to supplement here and there, that’s fine. But, I think that’s a big part of what you did and what Dave and I talked about, whenever you’re doing the study skills course, it’s like, look, pick one, pick one or two and just work through it, mechanistically. And just bang! Bang! Bang! Work through it, framework, extract, structure, read it once and get to retrieval practice that we call like the self test, the retest. Whatever you wanna call it, right? It’s not… None of this has to do with practice questions.
– [JT] Right.
– [Ryan] None of it has to do with practice questions. I really wanna silo, studying on the one side test-taking on the other. Obviously test taking is super important. I mean, that’s where you and I start, that’s what we started off talking about. But you have to organize in code and retrieve the stuff. So, you’ve talked about the power of adding the framework and adding the retrieval practice, getting out of just passive rereading. What’s another big mistake you might’ve identified that you then rectified by working through with our system?
– [JT] Yeah. So what you said about siloing things out. That was kind of an aha moment for me because I realized that, y’all program made me realize that test-taking and studying are two different things.
– [Ryan] Absolutely.
– [JT] And so often what I would do, and again, this is one of the things I would ask people like that do well in the OIT. Like, how do you study? Like, what are you doing to hit this 95th percentile every year?
– [Ryan] Yeah
– [JT] And they would just be like, I just work questions. So I would just work questions. And so, I’ve realized that for me that did not work because I didn’t have a good structure for understanding and organizing the material in my head.
– [Ryan] Yep.
– [JT] And so when I would go work questions, I would get just these random tidbits that would just be thrown into my brain and just kind of rattle around for forever.
– [Ryan] Yep.
– [JT] And I may or may not be able to get it back. And then I was also, what I come to find out, I was not taking… I was not reading questions, not working questions in a very effective way. So I was just doing this like halfway studying and halfway working questions and I wasn’t getting benefit of either one of those things because they’re two separate things.
– [Ryan] Well, and I do think there’s a large percentage of the med student population that can just rip through questions and get profound benefit. Those are what are called bottom-up learners. They can take all these fragmented details. And I imagine they’ve got like these elves living in the back of their brain is like the cartoony metaphor. And so you’re throwing all these details into the room of your memory and they’re in there organizing it, putting it where it belongs. Whereas you don’t have any elves.
– [JT] Yep
– [Ryan] I don’t have any elves. If I throw the stuff in there, it’s just gonna rattle around cause I need structure first. Yeah.
– [Ryan] And without that, it doesn’t work. But I think it happens because so many people are so successful with it. So when somebody… If you go to your med student advisor, they’re like, you’re probably not doing enough practice questions. But this goes back to what you were saying. Like, let’s think about this a little more sensitively. Let’s think about this a little more discreetly and not put everybody in the same box. Then you gotta figure, once you get to the realm of orthopedic surgery, I bet you, the majority of people who make it there are bottom-up learners. They can learn organically through experiential learning, through just doing volumes of questions and they’ve got elves. They’ve got the workforce that’s doing this stuff. And just because you don’t have those elves has nothing to do with your IQ, has nothing to do with your aptitude, has nothing to do with your ability to be an amazing surgeon. It’s just a matter of, we need to flip this around and figure out a way to learn better.
– [JT] Yeah, and that’s… I’ll have to have to brag on my wife a little bit. My wife is a recence as well in a very, very competitive field and she is like the definition of that, like bottom-up learner because she can just sit there, crank out questions and make it 265. Done step one and two. And she just has all these like random facts in her head about like medicine. And it just drives me crazy cause I’m like, how do you remember? Like, how do you remember that? And it’s funny, but I mean, we’re so completely different in that regard. But I think to your point about structured learning to kind of put it in another way, like I love concepts. I love big, broad picture things that you can then… That guide your understanding of more details. And so for me, if I don’t feel like I have a good understanding of like these broader, bigger picture stuff, it’s not even worth me going into the details because I don’t have this broad understanding of these concepts. So I’m 100% a very much a top-down learner. And that’s something y’all’s program has helped me really realize about myself that has helped me in a number of ways.
– [Ryan] Yeah, and well, and giving the tools to then actualize that is the key. Like for some people you can just maybe shine a light on that and they’re like, okay, I’ll go fix it. But for, I think for somebody like you then giving them the tools to do it I think is a big deal.
– [JT] Yep.
– [Ryan] And then what about this other point we have here about being intentional with what or how long you study?
– [JT] Yeah. So, using the review book that I decided like, look, this is what I’m gonna do, this is gonna be my resource for studying for the boards. As I worked to framework that book, it became so much easier to say, all right, in two weeks, I wanna have this section completely framework and have tested and retested. And so it gave me a very discreet point to be like, okay, if I get through this, like I’ve gotten through this and this is something that I have learned a framework. It may not be perfect, but it’s something that I can build on. And so in a way, it kind of gives you this peace of mind of like, oh, okay, I’ve gone through the foot and ankle section. Like I have a framework for that kind of stuff. I need to reinforce that at some point, but I’ve got it. And so being intentional every time saying setting the big goals. Saying, all right, I wanna be through this section in two weeks, but then even on a day-to-day basis saying, okay, I need to framework this page and I need to go back and retest this stuff right here. That was huge for me because it gave me a concrete thing to say, okay, I’ll study today and this is what I’ve done.
– [Ryan] As opposed to what was it like before? I think you’ve mentioned this, but just to underscore.
– [JT] As opposed to, all right, I’m gonna study foot and ankle, I read this review article on a flat foot deformity and then work a few questions on it. And then you’re like 45 minutes into reading about flat foot deformity and then you’re like, oh shoot, like I don’t… They mentioned bunions. I don’t really know much about bunions. I should go back and like, read that. And then all of a sudden you look up and you’re reading about calcaneus fractures and you’re like, how did I get here? Yeah it was just a shotgun approach of like, oh, well, I looked at all of these things, like it’ll stick eventually. It just doesn’t work.
– [Ryan] Well, and again, I think what you’re talking about is maybe falls under the category of workflow generation. This ability to sit down, generate your own workflow, break large tasks into smaller tasks, cross items off when you know you’ve done it so that you can walk away at the end of the day and say yeah, I know what I’ve accomplished. You also can do multiple things in a given sitting down to study instead of just one big vague nebulous cloud of like stuff that I have to do. And again, it all adds up day by day, week by week, month by month. So that’s sort of where you work through some of your study skills things. And I think the big umbrella this falls under is getting more bang for your buck every time you sit down to study. And it’s really invaluable.
– [JT] Oh yeah, absolutely.
– [Narrator] Thanks for tuning into this episode of STATMed Podcast. In the next episode, Ryan and JT will dig into test-taking issues and strategies to fix them. 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 student positions over at our blog statmedlearning.com. Thanks for listening.