Discover our grand unifying theory on why learning in med school is so challenging
Without a solid foundation, even the sturdiest-looking structures will crumble. The same can be said for med students*. If you’ve excelled in your studies up to this point but are finding the speed and sheer volume of content you’re responsible for overwhelming, know that it’s not just you. As a society, we don’t teach bright students how to study. Most struggling students compensate in one of two ways, either by cramming and succeeding or overcompensating. And that can work. Until it doesn’t. If you find yourself struggling in med school, it can feel like you’re the only one failing. But you’re not alone. At STATMed Learning, we don’t believe “tips” or “tricks” will help when you’re struggling and overwhelmed. Instead, we focus on building your learning foundations and then create a wide array of skills to build on top of these foundations. Through the STATMed Study Skill Class, you’ll discover how to use these skills flexibly to meet the varying demands of learning in med school and for the boards.
We tear down the crumbling structure through the STATMed Study Skills Class and build back a brand new system. This video is the first unit of the class. In this hour-long segment, you’re not going to find solutions; those happen during the approximately 10-day course. This is the first step in a meticulous process to lay the right foundations as you continue your journey through med school.
This video is broken down into three sections. In part one, we break down our issues with medical school education, and part two shares key concepts and vocabulary for how learning works at the med school level that we will use throughout the class. In part three, we share what we believe as educators and learning specialists working with highly motivated, highly intelligent med students who are frustrated and trying to find the best way to learn medicine.
Issues with Medical Education
First, med school just isn’t built right. It’s no one’s fault, and I’m not saying it shouldn’t be difficult. Still, it’s an imperfect system in part due to what we call the “speed-volume-density equation,” where you feel like you are drinking from a firehose. Because there is just so much coming at your so fast, and you are accountable for all of it. This can feel like you’re drinking from the firehose and that med school and your lectures are actively working against you.
One of our core beliefs at STATMed Learning is that no one teaches bright students how to study. And for many of our students, that hasn’t been a problem — until they get to med school. Up until this point, most of the students we work with have simply outworked their peers, overprepared for their tests, and been able to succeed. Studying for med school is not “one size fits all.” One of the biggest cultural problems we face is trying to teach all med students the same way. This is compounded by the fact that students receive so much bad advice about the “right” way to study, and their old study methods stop working. This is why it is vital to understand the patterns struggling med students can fall into, so we can build and prescribe skills to offset these differences.
Key Concepts and Vocabulary
We are not designed to remember things; we’re designed to forget. But, that doesn’t help you when you’re pursuing your dreams of practicing medicine. So, we streamlined a basic circuit of learning that helps cleanly define how learning works in the simplest possible terms:
- You need to encode or enter the information into your memory.
- Storage is the act of retaining information over time. This step includes consolidation, reorganization, and stabilization.
- Retrieval is the ability to access the material from memory.
Review Versus Retrieval Practice, Revisiting to Learn.
Many students define “studying” by talking about how often they can “review” the material. But to me, “review” is a bad word that often means “passively re-reading already studied material.” We want to replace passive “review” with various skills that involve active recall or “retrieval practice.”
A lot of students we work with spend a lot of their studying efforts on the following popular but low-yield strategies:
- Massed Practice is the act of concentrating our learning over fewer, longer sessions over a short period; cramming is an example.
- Blocked Practice is the act of studying each topic in isolation before moving on to the next topic and not intermixing other subjects.
Fortunately, each of these strategies has a high-yield counterpart:
- Spaced Practice is when the student breaks the learning event into several shorter sessions over a longer period of time.
- Interleaved Practice is the process of alternating or toggling between topics.
One key study strategy to avoid is the trap of familiarity or any study-based activity that helps you be familiar with the material but not profoundly knowledgeable. Similarly, avoid the illusion of productivity or any study-based activity that requires time and effort but doesn’t help you actively learn the material. One method students can use to construct their foundation is frameworking. This strategy involves finding the hidden organizational schema of a lecture as early as possible. Basically, it’s the “big picture” or outline of a lecture.
What We Believe
As reading and learning specialists, it probably goes without saying but we believe that reading matters. We look at way more than “can you read” and “how fast do you read.” Knowing how you interact with text and how you process questions can help you optimize how you read, study and learn. The skills deployed while encountering and interacting with various “textual constructs” (aka PowerPoints, review books, lecture notes, board-style questions, etc.) make all the difference. Pretty much all of the STATMed skills address this in one way or another!
Time is your greatest commodity in med school and must be optimized. To make the most of the hours in your day, it’s vital to determine where you’re struggling. Is it in your daily or weekly scheduling when you transition between activities, or are you noticing that med school is creeping into other parts of your life? You’re sacrificing sleep, nutrition or exercise. Med school lectures can create problems for certain learners. Many students attend or otherwise watch the lecture, get lost, get frustrated, and feel like they’re starting from scratch at the end of the day. We teach strategies in the STATMed Class that allow us to get the most out of every lecture.
In the video, we dig into the importance of creating structure as you go through lecture and study sessions. We also highlight the benefit of approaching med school like an entrepreneur rather than an office drone. Punching the time clock just isn’t good enough at this level of educational demands.
Studying without a workflow is like trying to build a house without a blueprint. Similar to approaching med school like an entrepreneur, it’s essential to serve as your own “project manager” to effectively study and maximize your time. We teach a variety of tools that unlock your ability to be your own project manager.
Interested in learning more about the STATMed Class? Registration for Summer 2022 sessions are available now! Learn more and register today.
*Note – as with all of our blogs, podcasts and videos, when we say “med students” we also mean students in veterinary and Pharm D programs and related fields!
Hey, everyone, and welcome to our long-form talk on learning foundations in med school and medical education. My name is Ryan Orwig, and this is the first unit of the STATMed Class curriculum. And here, I’ve broken down the way I think about learning foundations into the following three categories. Part 1 covers the issues and, I don’t know, the grievances I have with medical education. Mainly, this means med school, but when I say med school, that also encompasses medical board exams and related fields, like veterinary medicine, PharmD programs, PA school, et cetera. This is true throughout the rest of this lecture and for the rest of the class, I don’t want anybody feeling left out, okay? And then we have part 2, and that gets into key concepts and vocabulary for how learning works at the med school level. This means I’m digging into what I want my students in the STATMed Class to know about the science of learning and reading, and what problems and profiles we can anticipate finding here in med school. And then part 3, we’ll pick up any loose ends as I talk about what we believe as educators working with highly intelligent, highly motivated med students and physicians who are frustrated in trying to find the best ways to learn medicine for the classroom and on boards.
Look, nothing in this unit provides the answers all of you are looking for, I know that. That’s why this is called foundations and not solutions. This is just the very first step in a long and exciting, and meticulously planned-out journey. The class itself is the solution.
So part 1, our issues with medical education. Well, I think all my issues begin with the simple fact that med school’s not built right. Sure, from afar, it looks great. This destination so many people want to get to. But some students get there, and they quickly realize like, “Oh, no, this is a lot for me to handle. I’m not equipped for all this.” So when I say it’s not built right, I’m not pointing a finger at anyone. I’m not blaming anyone. It’s nobody’s fault. It’s just how it is. Becoming a physician is hard, and it should be. There’s so much you have to learn, and rightly so, but we’re all in this together. We all want students to succeed. But it’s a challenge and it might seem impossible for some students, especially if it’s you and you’re not wired for med school or equipped with the right tools. It might feel like the whole thing is, you know, going to topple over and crush you. People don’t want it to be this way. Like many things in this world, it’s an imperfect institution, and it falls on the individual to find a way to navigate, to balance, and find their way through. Look, I’m a reading and learning specialist. And as I record this, I’ve been working exclusively with med students, physicians, and those in related fields for 18 years. Thousands and thousands of hours, aggregating stories, discovering patterns, and building solutions. Med school isn’t built right, and that’s not gonna change. It’s fine. Instead, we have to recognize its imperfections and challenges, and figure out how to equip each and every willing student with the tools and the insights they need to become masters of their own learning so they can stay on top of school, whether it’s a traditional med school curriculum, a systems-based approach, a problem-based learning model. If it’s vet school, a PharmD program, whatever it might be. Equip the students, and the rest will take care of itself, regardless of how it’s built.
One of the main ways med schools built wrong is that there’s just so much coming at you so fast, and you’re responsible for all of it. Very few who arrive at med school are equipped to deal with this because of the way our school systems are built, and it’s what I call the speed-volume-density equation. People also call this drinking from a fire hose, which is sadly appropriate. We can’t slow down or regulate the violent flow of information, but we can learn how to receive and organize it in a way that’s survivable and sustainable and a way to unlock our ability to thrive. And indeed, acquiring these skills is super necessary for so many med students because, by and large, no one teaches smart students how to study, certainly not in regards to managing the speed-volume-density equation at this level. Look, what got you to med school will not necessarily keep working as you move forward. If it works, it works, great. But many people arrive at med school using some form of less-than-optimal approaches. That might mean, on the one side, you cram, or maybe you overcompensated with over-studying, or you’re relying on a lot of low-yield methods that gave you the results you needed. But I tell people is it’s not a problem until it’s a problem. And usually, for a highly intelligent, highly motivated student, they can get through undergrad programs, graduate programs, other professional programs, and it might not be a problem until they hit either the first year of med school, could be second year of med school, could be boards, could be down the line. And like I said, it’s not a problem until it’s a problem. But when it becomes a problem, then we need to know how to intervene and teach these highly intelligent, motivated medical students, medical professionals how to study. And it all starts with the fact that societally, we lack a common vocabulary for how learning works and what tools are best, and what methods are to be embraced and which methods are to be avoided. And the bottom line is students are often terrible judges of what actually works for them and what doesn’t.
So, a big part of you guys taking this class is that we’re gonna get rid of all the myths and misperceptions. We’re gonna tear it all down, and we’re gonna build up all new systems. And we need to know where we’re coming from, and we need to know what works and what doesn’t. Because another thing that I have a real problem with in medical education and these really high-end, competitive fields, it seems to me, people are often trying to treat all students the same, but I say you cannot try to teach all med students the same way. What works for some will not work for others. Understanding patterns of struggling students helps us here at STATMed, build and prescribe skills to offset the differences. So this is a really freaky image, and I sort of apologize for it, but this idea is our lady here on the left, she’s just showing her brain. It’s not built, it’s not wired the same. We’ve got to avoid the trap of trying to treat all students the same way and saying just because this skill works for student A, who’s thriving, therefore, student B, who’s struggling, should use the same strategies. That’s inane, that’s kind of insane to me, but that is what we often see. And it all circles back to that, I mean, there’s a lot of bad advice out there. I guess this avatar is supposed to represent like one of your med school peers. You know, so when we struggle, we’ll often go to one of our peers who are doing really well, and we’ll ask her like, “Hey, what are you doing?” And she might be like, “Yes, study like me.” But again, what works for her might not work for you. And they’re not experts in the way that the reading brain works or in teaching, or in pedagogy, or in the way that the reading brain processes text-based information. But they might try to just graft what works for them onto you, not factoring in the fact that you might be wired differently, you know?
There’s all kinds of like old advice rattling around out there like, “Make sure you see the material three to five times. If you can see it five times before the test, you’re gonna do well.” And you’re really struggling to see it two times or four times, and you’re like, “Well, I’m struggling. They said see it five times. I saw it three times, therefore, the fault is on me for not seeing it more times.” And then you try to see it more times, whatever see means. See can largely be a very passive activity. Reviewing, looking over. And then it becomes like you’re just checking these boxes. That’s not really giving you cognitive control of the learning. It just becomes this race. And, again, I think that advice is often not great. Again if any of these pieces of advice I’m gonna throw up here work for someone, that is great, wonderful.
The problem is every single example I’m gonna throw up here, I have heard from multiple people over the last 10 or 15 years saying this was told to me, and it didn’t work and it really frustrated me, or it really hurt me, or I spent all this time chasing it, you know? You know, the idea of like the myth of perfectly condensed notes. Again, somebody might do this, and it works well for them. Maybe the person that makes them and it works for them, the act of creating and making, that’s good for their process. Maybe somebody else you know just take somebody’s condensed notes and they can just read them three to five times and it works for them. Well, great for them, but that might just be how their brain works. But so many people come to me saying, “If I can just figure out how to condense these notes, then I’ll unlock my ability.” And I don’t really believe in that. If it works, great, but that’s not a skill that we overall teach because I think it’s all this illusion of productivity. You make the thing, but then, what are you doing with the thing? Sometimes we see, you know, find the right study group. Like, look, if at the end of the day, we’re like we go through this whole class, and I’m like, “Good luck to you all, and by the way, I hope you find the right study group.” Some people might have really thrived in other environments with study groups. Some people might thrive in med school with study groups. But the idea that your outcome and your fate hinges on finding the right study group is nauseating. Like, no, I mean, if you find a study group, that’s cool, that’s fine. But everything that we teach in this class should make you an autonomous learner. If you want to work within a group and it works for you in a healthy, productive, efficient way, great. But I don’t believe that you need to find the right study group to be successful, okay? But I know a lot of times people are sort of told to find the right study group. And then it’s this idea of like the universe is gonna dictate your fate by finding the right study group or not, and it’s not the case. Let me give you some tips. People call me all the time asking for some tips. “Just gimme some study tips.” I cannot give study tips. I mean, I can, but like I believe in wholesale end to end systems; study systems, time management systems, test-taking systems, and then you need to install those in the learner step by step by step by step. Tips are just enough to frustrate at this level, okay? And again, if tips are gonna work for somebody, again, great, but that’s not the business we’re in. And I think that the stakes are too high at this level in med school to say like, “Just give me the tips, and hopefully that’s gonna be enough to get me where I need to be.”
So here we have, maybe somebody come in, she represents more of a learning specialist, a resource counselor. Some of them are great, some of them are not so great, some of them are terrible, it runs a spectrum like in any field, right? A lot of bad advice out there can be represented here, like do more practice questions. Like some people can learn from practice questions, some people can’t full stop, okay? And I’m gonna talk later in these units about the bottom-up learners versus the top-down learners, low structure builders, high structure builders. This sort of explains why some people can learn from practice questions, and some can’t. But at the end of the day, what we need to understand is not everyone can learn from practice questions, okay? Maybe where the practice questions fit on your continuum of where you are learning matters more for you than for your peer, okay? But the idea of like everybody just being able to plug into practice questions and learn from practice questions is a major fallacy. You know, make a schedule. A lot of resource people will use scheduling as like a punishment tool. Like, “Did you make a schedule?” “No, I didn’t make a schedule.” “Well, you’re struggling and you didn’t make a schedule, but you’re saying,” “Well, yeah, I make a schedule but then I fall off the schedule, and I feel bad and I spend all this time making the schedule, but I’m not getting any corrective behaviors on it.” And all this stuff. I think that making schedules is actually a very important thing for med students to do. Not for everybody, but we don’t know who is gonna benefit from and who’s not. Most people do not wanna make a schedule, but it’s gotta be something that you’re using as a tool with feedback mechanisms built in to help you get a sense of where you’re being efficient and where you’re not. So scheduling can be a good thing, but I think it’s often taught wrong and used wrong.
And we’re not taught how to build and profit from schedules as professional students because we don’t value these things, but we can do this. We can do this, and we’re going to do this in the class. You know, study harder. What does that mean? What does that mean? “Are you studying hard enough? Am I studying hard enough? I need to study harder.” I don’t… Again, without breaking down what this amorphous term of study means, I don’t know how we’re supposed to get into this. We’re gonna demystify all this. We’re gonna take this concept of study and break it apart and build in all these sub-steps along the way that are flexible, and there’s various ways to go about it. And, again, try to understand what this gets into.
But, again, I think oftentimes, it’s leveled as an accusation of you’re struggling. We think you’re smart. Maybe you’re not smart enough, maybe you’re not studying hard enough. That’s like telling the sprinter to run faster or the painter to paint better. It’s not useful advice, and I’m not interested in useless advice. Oh, God. Use your learning style. “I’m a kinesthetic learner. I don’t like learning auditorily. I need to be a visual learner.” All this stuff, we’ve all been told about this. We all know about this. My daughter, who’s in high school, knows about these things. It’s a bad paradigm. The research doesn’t support it. We’ve all been sorta sold this whole thing. And really, if anything, what we don’t wanna do is only operate in a single modality. We want to operate in multiple modalities. I wanna bring in visual, I wanna bring in kinesthetic, I wanna bring in auditory, I wanna diversify and make my learning diversified as I’m working through it and all the STATMed skills are gonna get into this. But let’s just say I do prefer visual learning. Well, that might be the easiest way for me to learn. And so, if I only learn through a visual modality, that might make things too easy. It’s like I’m at the gym, and I’m working out a little bit. I’m like, “Ooh, I’m starting to sweat. I better stop doing these reps so my biceps don’t get too tired.” So I’ve just stopped like the actual act of building the bicep, right? You gotta be careful with some of those analogies, learning and physical exercise, but it does hold up. We actually want to engage in what are called desirable difficulties and get into sort of different aspects of exertion and effort and whatnot. And learning styles, it’s just not something we wanna build any sort of foundation on, okay? And then, you know, pre-read or pre-watch lecture. Many people have been given this advice. They’ve tried it. They don’t really get any benefit from it. They’re like, “Mm, what am I supposed to do?” And they feel guilty for not doing this thing that’s not giving them benefit and it becomes an ugly dynamic. I think there is absolutely extreme value to be founded doing something prior to reading or prior to watching a lecture but that has to have a very specific structure and goal and bandwidth, and we’re gonna get into that.
It’s one of the key skills we teach we call frameworking. But just pre-reading or pre-watching or rewatching videos, no, we’re not obviously going down that road, all right? But again, that’s a lot of advice that has been given to people. It’s something you can tell people to do, something that they can spend their time doing, but then not get benefit from. And then this guy is supposed to represent, I guess, like a preceptor, a dean, whatever. Somebody who’s advising you guys, you know, is like, “Review, review, review.”
In other words, like see this stuff again. See it again, see it again, repeat, repeat, repeat. Review’s almost a bad word to me. Like review often ends up meaning like looking over stuff passively and seeing it in a passive manner. And it gives you a false sense of familiarity and I just think it’s a dangerous thing and we’re gonna sort of try to blow that concept up here in the next few days and really get into what we should be orienting ourselves toward and how we should be spending our time. You know, the advice of hit the gym, you know, do ANKI, figure out if this is what you really want. Oh, God. So hit the gym. Of course, exercise is a good thing, but if you, what I heard a lot over the years is like people say go to the gym, but I don’t have time to go to the gym ’cause I’m studying every minute of every day. Well, that gets into the way we’re studying, the way we’re planning, the way we’re tracking, okay? So if we fix all the stuff on the study side and the planning side, that will give you time to go to the gym, but the idea that like you have to go to the gym to then fix the other things, which is often what’s being told to you is not great.
The idea of ANKI. ANKI is a, you know, it’s like a software that automates sort of note cards, detail-based skill drill type stuff. There are some good things that ANKI does and ANKI does work with a very specific set of the med student population, but like learning with practice questions, it’s not for everyone. And what I’ve seen is that people are trying to jam ANKI either onto other people or people or students who are struggling to see other students using ANKI and they wanna use it, but they’re not wired for it. And I’m gonna get into this specifically later in this unit why ANKI is not for everyone. And then, of course, the one of the more painful things people have heard over the years is like, you’re in the middle of the semester, you are struggling, you’re just trying to keep your head above water and they’re like, “Is this really what you want? You need to really figure that out.” It’s like this passive-aggressive way of saying like, you know, if you’re struggling, you know, maybe you’ve gotten to the wrong place. And that’s a really painful thing to hear, you know? And then also, like, of course, you’ll maintain a positive mindset. Like the reason you’re struggling is you’re not positive enough. And again, that’s a tough pill to swallow. Like I am not going to, I’m not a cheerleader. We’re not gonna be telling you like, I mean, I’m not gonna be like, believe in yourself ’cause that’s not what I would wanna hear if I were struggling or looking for better ways to unlock my ability. I want methodology. I want methodology, I want tools that I can then use to the best of my ability so that I can master the individual tools and that’ll unlock overall performance and then I can see what I can do and that’s kind of where then I’ll feel more positive. And that’s kind of my philosophy in the way that we build the class and teach the class.
So another issue that we have with like the way med school is built is that a lot of students are bringing in their old study methods and trying to then graph them on. I think if I, like I brought in like an old study method like cramming or spending more time than my peers or rereading, rewriting, recopying, if I brought some combination of those into med school, I would just say, “Well, there’s just med schools more so I need to do more of these.” That’s a logical conclusion, it’s just wrong. It’s just the wrong mentality, okay?
You know, highlighting, underlining, rewatching lecture, relying on robust familiarity. Maybe another program is being robustly familiar was enough to make you a good student. But the thing is, these skills are not good enough at this level anymore. Cramming, the volume is too great. Spending more time than your peers, there’s no more time. So those are sort of two ends of a spectrum. Rereading, rewriting, recouping, highlighting, underlining, those are some of the most common skills that students use that also happen to be some of the least efficient things you can do, least effective things you can do for robust learning. This is again a cultural indictment on the way we teach our students to learn. And people usually confess these things to me guiltily. “Oh, you know, in undergrad, I went to this really good program, and I, like I got a 3.9, and I crammed, I crammed!” They say like guiltily confessing it. I’m like, well, why wouldn’t you? You’re telling me you could, you know, go for 10 days and not study and then study hard for two to four days and get a 3.9 GPA? Why would we not do that? That’s not your fault. That’s the system’s fault, you know? Or it’s like, “You know, I never learned the best way to study, and I just studied all the time. For every one hour my friend studied, I studied four to six hours. It hurt, but I wanted it. And I got the grades that I needed to get here, to get to where I am.” I mean, you know, if it worked, then it worked, right? There’s no shame in that, and it’s impressive that you have the work ethic and the willingness to suffer but methodology has to replace it now, okay? We have to. We can’t, right? This idea of rewatching lectures, that is such a low-yield game.
The idea of being overly familiar again in other environments might have been enough to be a really good student, but now it’s not. I ask my med students all the time, how well does being robustly familiar with a topic serve you on test day? And you know the answer, I think. It’s like enough to narrow down to two or three notes and one of those two or three, but now which one is ’cause you’re level, familiarity means you’re a good two, one, maybe two or three levels deep. But these questions are asking 3, 4, 5 levels deep. So what does that mean? Well, so I think some of these skills are like, like every skill is like a lifeboat. So say a lifeboat is built to hold three people, okay? A lifeboat holds three people, you put three people in it, you know, they’re good to go. They sail off, you know, to shore. But then what happens when you take that same lifeboat, that same skill, every study skill has a capacity and if you overload it, it will sink. So we’ve got our three people in the three-person lifeboat. This is good news, right? Three to three. But then you put somebody else in it. Uh-oh. You put somebody else in it, and now the thing has sunk. You have now lost the viability of that skill. Look, guys, the bottom line here is methodology matters. The methodology you use when studying absolutely matters. The quality, the precision, the deployment, are you overloading it or underloading it? Are you using in the right sequence?
This is what we’re gonna get into in the class. You don’t have to remember any of this. This is just foundations, guys. So that’s the end of like my sort of, you know, my issues with med school writ large, okay? So I want you to identify two bullet points from the preceding section that resonated with you. You know, maybe an old method or two that no longer works for you. That’s always fun to talk about in our first day. Bad advice you’ve been given. Maybe it resonates with something I’ve said, maybe it’s something different. Issues you have with medical school in general, with your experience with it, what, it doesn’t matter. So, you know, see your final class email, the same way you logged in to watch all this for the format for submitting this. You’ll pick out two from this section, two from the next, two from the next, six total. So that takes us to our second section, key concepts, and vocabulary. So I wanna think about the basic circuit of learning. So the first thing we wanna think about is the active encoding. This is a great little vocabulary word. This is the process of entering information into memory. Then the second thing is storage. It’s the retention of information over time. This involves consolidation, reorganization, and stabilization. You might hear those words come up as well. And then the third piece is this act of retrieval. And this is the ability to access material from memory so if we really boil it down, the basic circuit of learning is encoding, putting it in, storage, making it stick and stay and be organized and then retrieval, being able to pull it out with random access in the future. So look at this, this is a horrifying thing called the curve of forgetting. We are designed not to remember stuff, guys. We are designed to forget.
So look, if I had learned something, whatever that might be, imagine this is a lecture or something. So just say like my max learning of that lecture, my initial learning experience, I immediately start to forget it. This is happening fast. Maybe within days, probably more like within hours, we’re losing what we learn. This is like the Ebbinghaus Curve of Forgetting it. It’s horrifying. And then I got this thing I call the cramming window. So we go up here, we have our initial learning event. That cramming window lasts a brief period of time, but then it starts to drop off. The forgetting curve illustrates by cramming works in that short-term window, maybe two days, maybe a day, you know, 24-48 hours. I don’t know. It’s gonna be different for different people. But does not work over time and volume. We can usually cram a limited amount of information that will last one or two days only to then lose that information over the following days and weeks. We can all think back to like undergrad courses, maybe master’s courses where that stuff really worked, where we really drilled it in, drill, drill, drill. It’s there, we regurgitate. Then it’s gone. This is why. So the speed-volume-density equation of med school and board study, it overloads the viability of cramming. So I’m gonna start laying some groundwork as well as how we can get away from this, all right? But again, it’s all gonna come down to the skills we’re going to be learning as the class progresses once we start meeting, okay? But this is one of the key concepts that I really want you guys to all understand. Review versus retrieval practice, okay? Revisiting to learn. So review is a common word we all use when it comes to learning and studying. So I define review is anytime a learner re-experiences material they’ve already studied when it is in front of their face, okay? This often happens in the form of rereading or skimming or looking over. People say they do this all the time. It is a very low-yield game. It’s passive, it’s inefficient, and it creates a false sense of mastery. This should be the thing you’re most scared of is this idea of a false sense of mastery. Reviewing, looking over stuff. Does very little to consolidate memories, and it’s doing nothing to facilitate the act of retrieval. Remember we talked about encode, storage, retrieval. We wanna get away from reviewing.
The flip side of this is called retrieval practice. This is one of the things that where everything’s going toward this, we’re gonna talk about this so much as we progress through the class. Anytime the learner forces themselves to try and recall material they’ve already studied. So after that initial learning experience, we wanna engage in what’s called retrieval practice. The fact that we’re not teaching this to kids at a 3rd grade, 5th grade, 8th grade, 10th grade, 12th grade level all the way through college is a huge failure on our part. This is one of those things where the literature is just stone cold on how this all works. So this requires a student to struggle, to blindly recall information, the material that you’ve already studied. It makes the learner feel bad. You’re gonna feel bad like, “I’m trying to recall this stuff, and I can’t remember it.” So the learner is less inclined to engage in this activity even though it’s superior. It can be called self-testing. It can be called the testing effect. You don’t need practice questions or practice tests to engage in retrieval practice. And we’re, again, a huge thread that will run throughout the class is going to teach you guys how to do a variety of forms of retrieval practice at various waypoints along the way with your study sequence.
So we wanna activate the curve of learning to offset that horrific forgetting curve we saw earlier. Here’s that initial learning experience, right? And I showed you how it starts to drop off. How do we offset that? Well, every time you come back and re-experience it, ideally through some sort of retrieval practice, you’re gonna spike that memory back up, but what’s gonna happen, it’s gonna drop off again. You revisit again, spike it back up. It’s gonna drop off, but that now, I mean, it’s getting less extreme so we’re revisiting as time progresses. We’re revisiting, and now we’re seeing that spike drop off less and less. Revisitation should come in the form of retrieval practice and avoid passive review. Okay, let’s talk about how we structure the way we study and learn stuff. We’re gonna try to briefly introduce and discuss massed and blocked practice and contrast them with spaced and interleaved practice. Here let the term practice mean the same thing as studying or learning. This is the heart of learning theory 101. I don’t want you to obsess over this, but I want you to know about it. So two of the most popular ways student study are also often the least effective ways to study. The first one is called massed practice. With massed practice, when we’re studying a topic like say, a med school lecture or a specific concept, this means we concentrate the learning over fewer, longer sessions over a condensed short period of time. Usually, this means we’re using a single-minded, rapid-fire study by repetition attempt to burn that information into memory. Repeat, repeat, repeat.
Now here’s the trick. This sort of works. It does encode new information quickly, so we like that. But here’s the bad news. These gains are lost quickly. And this method of massed practice does not promote storage consolidation or retrieval, which are the big goals of sustained long-term study. Cramming is an example of massed practice. It’s an example of pumping the info in right before the test, regurgitating it on the test day, then losing that info. Most of us have been rewarded for exploiting massed practice like this. The arena allowed it. Either high school or grad school or undergrad, wherever. But when we get to med school or boards, this likely stops working for many of us. And the research is stone-cold on this as to why so we want new learning methods to avoid the inherent perils of massed practice. Then the other popular yet less effective method is called blocked practice. This is when you master one topic in isolation before moving on to the next topic. Repeatedly hitting that one topic, then moving on to the next and never coming back to the previous topic so we can say you might study topic A, hitting AAAA then you go on to topic B, hit BBB, never going back to A. This is blocked practice. It’s extremely common, super easy to implement, but also low yield. It does not promote the main thing we want, long-term learning. But don’t worry, these two common but less effective practices have effective counterparts. So that’s good news. They’re just a little less intuitive and a little more challenging for the learner to implement. So rather than massed practice, we have spaced practice. This is when learning is broken into numerous short sessions, spaced out over a longer period of time.
And then, rather than blocked practice, we have what’s called interleaved practice. Here we alternate between topics en route to mastery. So instead of mastering topic A before moving on to topic B, we toggle between the topics. So we go like ABC, ABC, ABC. So here is the biggest thing with all of this, though. When we think about the appeal and the superiority of spaced and interleaved practice, it is impossible to use these concepts perfectly in med school and on your board exams. I’ve seen people lose their minds over this. It’s not worth it. It’s not doable. Instead, let’s just try to mix in some spaced and interleaved when we can, and let’s keep it super simple. So here is an illustration of massed and blocked practice with the three concepts designated A, B, and C. It’s massed because each topic is focused on exclusively AAAAA burning it into memory without taking any breaks. It’s blocked because they only focus on one topic exclusively, then move on to the next, never revisiting previous topics. So our goal should be to do this less.
We can turn this into spaced practice by adding breaks between the topic and adding some time between improves encoding, storage, and possibly retrieval. We can turn the spaced practice into interleaved practice by mixing the topics. We can look at this simplistic illustration of what a week of massed and blocked study would look like and see again, simplistically and cartoonishly, how we might convert this into spaced and interleaved learning. Again, you’re never gonna perfectly actualize this. We just wanna be aware that spacing and interleaving is always better and we want to mix them in when we came without overly agonizing about it. And finally, here’s some good news. The skills you’ll be learning in the STATMed Class will facilitate making spaced and interleaved practice a central part of your new study system.
Okay. Let’s switch gears to something more basic. Let’s talk about internal and implicit versus external and explicit. Basically, you have too much going on in med school and in board prep to hold everything in your head. Did you use this with success in the past? Sure, maybe, but that doesn’t matter anymore. Why? Because the game has changed because of our old friend, the speed-volume-density equation. We need to be constantly looking for ways to offload cognitive burden, to free up as much bandwidth and processing power as possible. So we wanna make things much more of what we call external and explicit when it comes to studying, managing, and even test-taking. You’ll see how many of the STATMed skills inherently do this, but I wanna plant the seed now so we can start valuing the importance of making things external and explicit. And then we have to consider when studying and the learning science tells us about desirable difficulties. That’s a term coined by Robert Bjork and his work at UCLA. This means that not all studying is equal. You have to find the Goldilocks zone of not too easy, not too difficult. The bottom line is this. If you’re just cruising along while studying and not feeling some sort of cognitive exertion, you’re probably not engaging with the material in the right way. To me, the effort has to tie into what you’re studying strategy-wise, tool-wise and goal-wise. This makes me think about getting caught in a riptide. I can tread water, you know, which is work, but that’ll let me get swept out to sea, that’s no good. I can try to swim back to shore. That takes effort, but it’s the wrong kind of effort because I’m swimming against the current. Swimming against the full force of the ocean. It’s intuitive but wrong. It’s ineffective. Or I can swim parallel to the shoreline, which will take effort and might be counterintuitive because primally, I want to get back to shore as fast as possible, but strategically, this is your best bet since this is how you get out of that invisible riptide current, then you can turn toward the shore and get to safety. This is the right kind of effort, the right strategy to unlock our goals.
So using the right effort with the right strategies based on what we are learning matters. This is just important for you guys to know this idea of how to unlock effort, how to maximize desirable difficulties when studying and again, all the skills that we teach in the class are gonna unlock this for us. And what we wanna watch out for, and this is where it’s like you think you’re putting in effort, but it’s the wrong kind of effort. The trap of familiarity. Okay, it’s the any study based activity that entrenches familiarity; likely using the wrong methods and the wrong kind of effort. This is why we’re studying for familiarity. A lot of us might have been really rewarded for that in the past, but it’s a trap and we’ve gotta learn to see it and feel it, sense it and move on from it. And then it’s closely related to what I call the illusion of productivity. This is any study based activity that requires time and effort, but does not progress your active learning of the required material. I mean, I can’t tell, you know, like again, like let me rewatch the video. It’s an illusion of productivity, right? Maybe trap of familiarity. Let me take this PowerPoint and copy-paste it all, all the word boxes into a single word document. So I took the hundred slides and turned it into 10-15 pages. And that’s a lot of work, but it’s an illusion of productivity because you’re doing all this work and you’re not actively engaging with the material in a way that’s moving you forward from encode, organized, storage, retrieval, okay? And we’re gonna get into how to debug all this stuff.
None of this is really, this is not answers. I’m not giving you guys answers right now. What we’re talking about are understanding some of these important underlying issues, okay? So executive functioning, this is a huge umbrella term, and I could talk about it for an hour, but I’m gonna try to keep this really short. But this is an important concept you guys need to understand as you’re trying to understand how the learning brain works and where learning science is, okay? So think of this as the cognitive management system of the human brain. It can be considered the cockpit or the control center. How much are, do you know how to use the readouts and all the different controls? Weaknesses in any of the executive functioning sub-skills can impact academic performance and other aspects of life.
So, you know, here are some selected STATMed executive functioning categories. So number one, this is where we wanna think about cognitive flexibility. This is like getting into your ability to control your ability to shift, to switch from one thing to another, to track what you’ve done, how to prioritize tasks, how to make sure you take things all the way through to completion, how you engage with problem-solving when the variables change on you. This is called cognitive flexibility. So the ones who are really robust here are gonna thrive more in med school. This might be a weaker subsystem. This could cause problems. Planning is an important piece here. Time management falls under this, workflow generation falls under this, goal setting. I think so many of my students coming in don’t know how to generate workflow or set goals, much less the time management piece. Organization, now this ties into physical organization on the one side, okay?
If we’re not physically organized, it’s gonna cause problems, but also conceptual organization. And this gets into understanding the structure and organization of the content we’re learning. If you’re weaker here, surely that’s gonna make med school harder for you than the person who’s sitting right next to you who has the same IQ or maybe lower IQ than you, but they’re robustly skilled at that kind of organization. It’s gonna make that better for them in the act of learning; learning in med school, learning for boards, learning in your veterinary program, whatever it might be, right? Doesn’t necessarily mean they’re gonna be a better physician, right? Self-monitoring, this is a key concept, you’ll hear me talk about later. This is like task monitoring. Where am I in the act? Self-reflection, let me look back at what I did and see what I can learn from it. Self-evaluation, what can I do to get better? These are important skills. You can get better at all of these things. If you are weak in these things, you can absolutely get better especially when we demystify and break this stuff down and give it specific tools that name it. So I hope you guys feel empowered by the idea. “Wait, if any of these things are problems for me, I can actually get better at these.” I mean, emotional control is a piece of the executive functioning categories as well. This is where, you know, you recognize, manage, and modulate your emotions. Again, I can’t help as much with that overall, but I think if we offload cognitive burden and we break down some of these things into specific subsets and sub-skills, that will help regulate some emotions on one side. Initiation, think about initiation for some of you how big of a problem that can be. Starting tasks and maintaining focus throughout the activity. Effort, I’ve talked about effort before just now.
Exerting the right effort the right way at the right time is a part of executive functioning. And working memory, this is where we store and access and process information. I can tell you right now at the heart of my test-taking philosophy. When we talk about test-taking at a medical board’s level, I believe a big part of it is executive dysfunction, but specifically working memory impairment. And again, we’re not gonna fix your working memory, but we can talk about ways to read test questions in a way that limits burden on working memory and works around some of these executive functioning issues. If you have ADHD, you have issues with executive functioning, okay? That’s just part of the diagnosis. But you could be extremely robustly intelligent and otherwise successful and some of your problems might be rooted directly in executive dysfunction.
That’s okay. That’s okay. We’re gonna use tools and skills and strategies to help you manage and navigate and offload and bridge around all these things. This is an important vocabulary word, metacognition. Maybe you guys have heard of this, maybe you haven’t. It’s very broad concept. It’s thinking about how we think. Awareness of how we think, an awareness and understanding of our own thought processes. I think a lot of times, we think of things like test-taking and time management and studying as these vague, ill-defined concepts. So by robustly populating each of these things with various skills that can work in various configurations, they’re all metacognitive strategies at the end of the day. You could say that the STATMed Class is a class about metacognition for studying, managing your time, and taking tests in medical school and on boards, okay?
So metacognition is just an important word to be aware of. Then we have self-reflection and self-monitoring. You saw this sort of reflected in that executive functioning piece. And, again, I talk about this all the time. I’m always thinking about self-reflection and self-monitoring. So self-reflection is looking back at how we used a specific skill that’s gonna grow our ability to use that skill in the future. Professional athletes, high-end athletes, recreational athletes at this point. They’ve studied the game film. You study the game film, that’s an act of self-reflection. What worked here, what didn’t? what was I doing right, What was I doing wrong? You always have to look at in both channels. What was I doing well, what was I doing right, What was I doing wrong, and why was I doing? Always wanna think about in terms of why and because. You have to have some thick skin with it. A lot of the skills we’re gonna teach inherently demand self-reflection on the one hand and then self-monitoring on the other. So self-monitoring, you know, this is the more we reflect on a skill after the fact, the better we’ll be at monitoring ourselves in the run of play using that skill so now the guy’s back in the test and he’s keeping his system going. Self-reflection will grow our ability to self-monitor. So the more we look back, the more we self reflect on the skill, we grow the ability to regulate and monitor ourselves in the run of play, in the run of studying, in the run of test-taking, in the run of planning, in the run of tracking and all the things we’re trying to do to become better performers on testing.
Self-reflection will grow self-monitoring. And again, all of our skills are gonna weave through this stuff. Linear versus non-linear learning, okay? I think most of us are, by default, linear learners. I compare linear learning to a snowplow. We learn to read linearly. We learn to read narrative stories first, second page, third page, fourth page to go to the end. So some things are built to be read linearly, some things are not. Studying and learning should not be bound by the glass ceiling of linear learning. So I compare that to a snowplow. It’s like your plowing down the street. You’re only gonna clear the road as much as it’s cleared in that one go ’cause you got a lot of other roads to hit, I guess. Snowplow is gonna mass your study. You’re cramming. You’re trying to burn the information into memory slide by slide, page by page. It’s very massed, it’s very blocked, okay? This is not optimal. Instead, I want it to be more like a helicopter. This represents non-linear learning. So it’s gonna distribute our learning via multiple end-to-end passes, some really high up, some really down low. So this idea of non-linear learning is gonna be the key for unlocking so much of what we’re gonna do so our goal should be to get away from linear learning, and use new skills to unlock non-linear learning. One of the hearts of the STATMed system is this notion of framework, so I wanna put this vocabulary word in here too. Frameworks are the foundation. Learning must start with finding the hidden organizational schema of a lecture as early as possible. We call this the framework. Framework is the underlying schema, hierarchical organization, the quote-unquote big picture or outline of the lecture’s information.
We’re trying to think about this like through lecture-based learning first, and then we’re gonna open it up and show you how it applies to textbooks, review books, board study, boards re-study, independent learning, you name it, okay? While most med students are naturally adept at finding the framework. I think there’s med students that thrive from day one, or they figure it out within the first few weeks, they are just naturally adept at finding the framework but I think many struggling students are impaired at finding these hidden skeletal structures. They’re impaired, it’s not easy, it’s not automatic.
These are things that can absolutely be taught and learned. And that should be very exciting to all of you guys. And that’s gonna be one of the big things we start cracking first on day one of the STATMed Class. So I think a lot of the problems we see are bottom-up versus top-down learners. So what’s a bottom-up learner? These are students who are cognitively wired to learn from fragmented details and will subconsciously construct the framework for the lecture, for the topic, for the chapter. The majority of med students who just get it in lecture, these are bottom-up learners. They’re considered to be high structure builders, okay? That’s not the majority of STATMed Class students. Most STATMed Class students are what I call top-down learners. They need to explicitly find and build the organizational framework before being able to rapidly encode, store, and eventually retrieve the details. Since they get hung up on not finding that organizational framework, everything comes apart. They often struggle to get consistent value from lecture. They’re considered low structure builders, so this idea of a high structure builder can sit there in a lecture and just build the structure. The low structure builder, they’re just like they’ve got all these random factoids and details rattling around, and they can’t make heads or tails of it. So top-down learners face predictable struggles. What are they? Well, I get nothing from lecture is was one of them, right? That might be like, “I go to lecture. I sit through it. I hope I don’t get distracted, but if I get distracted, then it’s game over, and I’m stuck there for 40 more minutes.” Or, “I go to it, and I’m trying to memorize. I’m just trying to hang on and I do it lecture after lecture after lecture all day. And then I come outta lecture, I’m worn out, I’m exhausted mentally, the day is halfway over and I feel like I’m starting from scratch.” This is most likely a top-down learner. They get lost in all the details and can’t see the structure. They might say, “ANKI doesn’t work for me. It works for my friend. I think I’m every bit as smart as my friend, if not smarter, and they are killing it on ANKI and it doesn’t work for me, why?” Their friend who’s killing it is probably a bottom-up learner, a high structure builder. They can take all this random information, disconnected pieces, jam ’em in their head and poof, it gets organized. If it doesn’t get organized, it’s not gonna stick so I think something’s happening subconsciously there that’s organizing it, allowing them to benefit from ANKI because they are high structure builders. They are bottom-up learners. You, struggling, the person who says this, they are top-down learners, they are low structure builders. And they might also say, “How can I learn from just doing practice questions? Everybody’s like, do practice questions, do practice questions, do practice questions. I do a bunch of practice questions.” There’s a lot of time and energy for the person that’s not getting anything from it. It becomes an illusion of productivity. But for somebody else, they’re just cranking away at practice questions and getting benefit because they’re learning and showing it on exams. Again, they’re building the structures subconsciously and you’re not. So what does that mean? It means we need to install methods in sequence that work around these weaknesses, okay? So that’s the end of this unit with our talking about key concepts and vocabulary.
Again, I want you to identify two bullet points from the preceding section two that resonated with you. Maybe learning term or a concept that was interesting or confusing or something you wanna know more about. Say, “Hey, what does this mean?” Or, “How do I work around this?” It might be a learning pattern; top-down, illusion of productivity that you recognize in yourself. It might be observations about lecture-based learning or issues you have with lecture-based learning, whatever. Just two easy little bullet points there. This should not be hard. See that final email for the format for submitting these. You’re gonna submit two from each of the three sections. You can do ’em all together, and you can watch this lecture in sections. You don’t have to watch it all in one go. You can come back and rewatch it later. I think rewatching this whole thing, once you’re midway through the class or at the end of the class or after the class would be really illuminating because so many of these foundations I’m laying out will have so much more context in the future when you actually have the skills that plug into all that stuff. And then finally, we have part three of our foundations, what we believe? And one thing that we believe is reading matters. David and I are reading and learning specialists.
Remember, we are looking at how everything passes through the filter of tech the way you process text-based information. Of course, everybody we work with is highly literate, of course, but reading is more nuanced than the average layperson thinks. I think a lot of people say, “Well, can I read? Yes or no? Do I like it? Well, it depends on what I’m reading. Do I remember what I’m reading? It depends on what I’m reading.” You know, what’s my speed, What’s my retention rate, stuff like that. But reading, we deploy specific subconscious strategies based on the specific construct we’re reading, okay? So that’s a big deal. Most medical learning and evaluation comes in the form of textual constructs you must plug into and interface with, right? A test question is a textual construct. A PowerPoint slide is a textual construct. A review book that’s just an outline is a textual construct. Reading fragments off of review programs, review books, review videos comes in the form of text, even if somebody’s talking about it. If you do not process text-based information as well as the average medical student, if you’re a med student and as your average physician if you’re a physician, as the average veterinarian, as the average vet student, as the average PA student, et cetera, et cetera, right? If you don’t read as well as the peer group, that can expose you to problems, the challenges that we don’t want you to be exposed to, the risk, okay? So most strategies that we teach and that you should be learning should factor in the way we, as the learner interact with these specific and unique constructs, guys.
Reading, it matters, it matters, okay?
Time is your greatest commodity and must be optimized. Time is the most scarce resource in med school and must be optimized in the area of need for each individual. So what is that area of need? Is it the broad weekly schedule or daily scheduling, maybe? Is it transitioning between activities? Is that where problems are happening? Is it distributing and regulating all your life activities with your academic activities? Is it some sort of problem there? Or is it more like getting enough done during study sessions? Some people say, “No, no, no, my scheduling’s fine. It’s just when I’m sitting down, I just can’t navigate and do my own flow through the thing and keep track of what I’ve done and be efficient and effective, and that’s all time management too.” So solutions should involve a variety of augmented study methods and customized time management, study management and workflow tools that involve and include feedback. And we’re gonna take care of all this, okay, guys? I just want you to really underscore, time is the greatest limiting factor here. And I’d ask you this. How do you hope to optimize your time management if you don’t know how you would ideally spend your time in a given day or a given week, okay?
And we’ll help confront and solve that question here in a few days. Med school lectures create problems for certain learners. Most lectures have a hidden organizational framework that is often obscured by any combination of the following for these students. Maybe the problem somebody has with lectures is the speed-volume-density equation, the aforementioned speed-volume-density equation. It’s just so much so fast coming at us, I’m drowning in it. And then I can’t see the skeletal structure because of the volume where I can’t retain anything ’cause there’s so much coming at me. It might be the nature of PowerPoint itself. We have a PowerPoint problem in this country.
We have a PowerPoint problem in medical education. Everybody’s teaching with PowerPoints. PowerPoint, by its nature, fragments and disconnects information. We can’t see the relationships within PowerPoint. Like you should have to like take like a serious qualifying test to be able to teach with PowerPoint, and you know that’s not happening. So this is a big deal. Like the nature of PowerPoint itself makes finding structure and lecture harder because, remember, I believe finding structure and lecture is the key to unlocking lecture. Maybe the lecture is just poorly designed by the professor. I mean, how much pedagogical training have our professors in med school had, you know? And what they’re doing is they’re just cramming so much information into these things. So poor lecture design is a thing. Do people wanna talk to me and air their grievances with their professors? They do, and I’ll listen to it for a few minutes, and I’m like, you know what? That’s like if you’re in the game and it’s a championship game, and you don’t like the refs, you don’t like the fans, you don’t like the field, you either walk off the field and don’t play or you play and try to win against those adverse conditions. And I’m a believer, and you play the game. I don’t like it, but I gotta do it. Sitting there complaining about the ref, complaining about the field’s not gonna help. You guys are in the game. You’re in the mixer when you’re in your programs, in your school with the test coming up, whatever it might be, we have to deal with it. And here’s the good news is we can learn the tools. We can learn the tools that we’re gonna teach you in the STATMed Class that are going to help you hack and crack into poorly designed notes by the professor. Maybe part of the struggle is just like the utter lack of expertise in the area. If you come in and some of your friends have like a lot of background in anatomy or biochemistry, and you’ve got limited background in anatomy or biochemistry, that’s gonna make it harder for you for sure. So we just have to learn how to work with that, work around that limit, like the fact that you’re coming in at a deficit, okay? Maybe the pressure to know it all is what’s really crippling us. We’re trying to memorize every word on every bullet on every slide. And that’s not how retention works. We have to start big picture and working our way inward instead of just trying to jam and see all that information. And so that’s a bit of a strategy shift.
And maybe inability to determine what’s important. I mean, that’s something we hear from everybody like, “My friends are better at figuring out what’s important and I’m not as good at that.” That’s more, again, let’s start structurally and I think everything else will flow appropriately from there. But I don’t think you can come in from a lecture perspective and say, “Once I learn how to figure out what’s important test wise, then I will do well.” I would say once you learn to identify structure first and build around structure, everything else is gonna open up for you. And so some profiles for those who struggle in lecture might be those top-down learners, people who need structure first. Okay, big surprise. That means our low structure builders. If you are innately a low structure builder, you’re probably gonna struggle more with lecture-based learning. And most people in the STATMed Class would fall into these categories even if you’re in a PBL program. If you’re in a PBL problem-based learning program, no lectures, independent learning, all the stuff still applies. It’s just different, and we start by teaching how to crack these lecture-based learning modules and then we flip it over to how to then go into your own independent reading, independent learning that works for those PBL students, that works for board study, that works for independent learners of all variety.
But if you’re a top-down learner or a low structure builder, and you might not know that, and that’s what you might say, “I don’t know if I am.” Don’t worry, we’ll figure all that stuff out if we haven’t already for you. If you have executive dysfunction. In other words, if you’re executive functioning skillsets are not fully robustly aligned, right? A lot of people in this class are. Either they know it, most people are, they have weaknesses in executive functioning and they just don’t know, and that’s okay. If you have a diagnosis of ADHD or suspected diagnosis of ADHD, I don’t really care about like the medication side, the I’m impulsive, I’m, you know, I’m inattentive, that’s not as important. I mean, it’s something to know but it’s more about if you have that diagnosis, that means you have weaknesses of executive functioning, especially within the working memory. So at the end of the day, these profiles all will say the framework, the hidden organizational structure of a lecture, of a chapter, of a learning event often comes into focus too late, too inconsistently, or not at all for these students. And that’s a problem, and we can definitely change that as we move forward in the class. So let’s see what it looks like for someone who has trouble finding framework in lecture like our guy over here in the corner. So this guy is sitting in lecture, and he’s just trying to hold on, just trying to burn all this information into his head. There’s no structure. It’s just a flush line of bullets of topics, subtopics, sub subtopics, some are categories, some are subcategories, some are details, some are factoids. It’s just like that’s really hard to learn that way. It’s really hard to learn that way, and this is, at best, what he’s getting out of it. So that guy is a low structure builder, but here we have her. She is someone who gets a lot out of lecture. She’s a high structure builder. So she is listening to the same lecture and she’s finding the structure, her brain is building that structure out, starting to add details, maybe, maybe not. But if she comes outta lecture understanding the structure, she’s so far ahead of the game, she’s not exhausted and burned out and fried like our first guy, okay? What’s the difference? The difference is what I call the magic elves. Let this closet represent your brain storage system. So some people, those who learn from fragments like our second person in blue, they’re bottom-up learners, she’s a high structure builder, robust executive functioners. They’re able to build frameworks innately. They can build the framework and add details at the same time they can run on two tracks. So look at the clothes or the details, they’re throwing stuff in there. Just chucking it in there like let me just grab all this information, let me grab it, and then they close it, and what happens? These high structure building bottom-up learners, they can jam in loads of details that get organized by robust subconscious organizational skills here represented by the magic elves. They come in, they do their stuff, they do their magic, and ta-da, they open it up and look, everything is beautifully organized and they go away ’cause their job is done. But what about if you’re a top-down learner and you don’t have the magic elves? So, on the other hand, those who do not learn from fragments, they’re top-down learners, low structure builders, they lack robust executive functioning skills, they’re unable to innately build frameworks. So when they close the door and they open it up, there’s no magic elves coming to organize the details into a structured system. So they can keep closing it and opening it again but nothing’s happening. The details are not magically getting organized here. They’re just sort of decaying and atrophying, right? So for these learners, we must teach skills that will bridge these deficits because learning starts with structure and see the structure’s not happening innately for them. So another thing I always wanna think about is I want you to learn like an entrepreneur, not an office drone. You can’t just come in and act like you’re punching the time clock and be like, “Yeah, I did my eight hours, let me get the payoff.” I have people talk to me all the time and say, “I don’t understand it. I worked hard, I put in x number of hours, why am I not getting good grades?” I can’t even talk to you about that ’cause I don’t know what you’re doing when.
The opposite of that office drone mentality is the entrepreneur attitude where they’re accountable for all aspects of the business, of the enterprise, of their career as a med student, as a physician, as a veterinarian, as they’re working their way through their program. They’re the ones that have to account for everything. Just because they work eight hours doesn’t mean it’s gonna be profitable. So a lot of my thoughts on learning, especially when it comes to time management does come more from the entrepreneurial writing. So just because I’m logging the time mindlessly as a drone, that’s not gonna cut it. I’ve gotta be in control, I have agency, I have to be doing the stuff that gets the payoff. That is what we’re looking for. Workflow generation is a key skill we all need. So building workflows is a critical skill for success in med school and beyond. Studying without a workflow is like trying to build a house without a blueprint, without a workflow or a project manager. There’s no workflow here. There’s no project manager. I mean, what this house is, I mean, it’s getting put together, but it’s not getting put together right. So we need to be able to build workflows and be our own project manager to effectively study and maximize our time in med school and during board study. So here with workflow, with a project manager, we actually get to build the thing we’re trying to build. Proper study skills and management tools should unlock our ability to create these workflows. Feedback loops are required to change study behaviors. It’s one thing to learn new skills. It’s another to foster their growth and adopt best practice usage.
Many of the best methods are not rocket science, but they can be counterintuitive. You must lean on the right kind of feedback. Bad studying, bad test-taking, bad time management are bad behaviors. If we use the feedback tools that we’re gonna teach in the class, you guys will absolutely get better at all this stuff. So we need tight feedback loops, deliberate practice, and self-testing. Do this using self-testing and self-checking for feedback loops will get us where we need to go. We don’t know what that means yet, and that’s okay. You will know that here in a week, two weeks down the line. And finally, all roads lead to retrieval practice. Learning should always start, like I said, with finding that framework organizational scheme first, but then everything we do should be about getting to retrieval practice sooner than later. We have to resist the many temptations we’ll face to not engage in retrieval practice ’cause it doesn’t feel good, but instead, figure out ways to get there and engage in it early and often.
So one last time, I want you guys to identify two bullet points from the preceding section that resonated with you. You know, do you relate to the top-down or the no-magic-elves or struggling to find structure profile? Can you see yourself being like an office drone? How so? Do you want to build better workflows? Do you see why that might be so important? Feel free to ask questions or note other points of interest here, it can be anything. So send all six bullet insights, two from each of the sections, but that’s not a super rigid rule to your STATMed instructor. Submission details are in that final email. So don’t watch any more of these on-demand videos until you’ve been instructed. Thanks for listening, and we’ll see you guys in the class soon.