On the STATMed Podcast: Conversations About ADHD in Med School: Part 2
“One of the lesser-known issues that the average person might not immediately associate with ADHD, working memory is the aspect of your memory that everything has to pass through on the way in and pass through on the way out. You can think of it as a workbench — or a chalkboard. There’s limited room, and that space will fill up. When more information comes in, it pushes out the old stuff.” -Ryan Orwig
In episode two of our podcast miniseries, Conversations About ADHD in med school, host Ryan Orwig returns with Mike, a former STATMed class participant, to discuss issues with working memory and how this can impact med students with ADHD.
“I didn’t even know it [working memory] was a thing. You just kind of compensate through your life. You use sticky notes or write things down, or find ways to compensate without really knowing what working memory is, that it’s a problem, or that it can cause problems.” — Dr. Mike
We’ll dig even deeper into various ways learning in med school is complicated by ADHD in future episodes. Be sure to stay up to date on our latest podcast episodes, videos, and posts by joining our mailing list!
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Transcript
Announcer: Welcome to the STATMed podcast, where we teach you how to study in med school and how to pass board style exams. Your host is Ryan Orwig, a learning specialist who has over a decade of experience working with med students and physicians. In the second episode of our conversations about ADHD and med school mini theories, Ryan and Mike, a former STATMed class participant, discuss issues with working memory and how this can impact med students with ADHD.
Mike: Well, it’s just something nobody ever talks about and you wouldn’t know that’s what’s going on. And so you look at the students that are scoring well on tests, and you’re like, “Oh, maybe they’re smarter than you are.” But realistically, I think they’re just encoding the information faster and able to keep the information and in a more organized manner, which isn’t easy for someone with ADD.
Ryan: Hey, Ryan and Dr. Mike are back, talking more about issues med students with ADHD might experience in the first few didactic classroom years of med school. So when I personally think about med students with ADHD, one of the first big issues that comes to my mind deals with working memory weaknesses. For me, this is a hallmark of the med student with ADHD. One of the lesser known issues that the average person might not immediately associate with ADHD, working memory is that aspect of your memory that everything has to pass through on the way in and pass through on the way out. You can think of it as a work bench or a chalkboard, there’s limited room on the bench or the board and that space is limited and it will fill up. And when more stuff comes in, it pushes out the old stuff. And the simplest model says working memory is seven plus or minus two slots. So the average person has seven slots, which means they can hold on to like seven items. And on the high end, plus two, maybe nine, maybe a few more. And then on the low end five maybe, maybe less. The old idea was that the higher the IQ, the higher the working memory, like they were in a static relationship. Now, we know with issues like ADHD among other things, you could have a really high IQ and be otherwise extremely intelligent, but have an average or even below average working memory. They’re not static. So my theory about working memory, ADHD, and med school is this the way medical board exams here in the US have evolved with our super dense USMLE and COMLEX multiple-choice style clinical vignettes, I think somehow there was a blind presumption that, “Hey, all these med students, they’re super smart. They can hold onto a ton of information. Let’s pack every vignette to the gills.” This is a broad generalization that causes problems for those with average or below average working memories. And if you have ADHD, this is likely the case. This makes these folks lose key pieces of information while working questions, making wrong answers appear to be right. It’s like, if I say what’s 10 plus 10 plus 2, and you say, “Oh, that’s easy, 10 plus 10 equals 20.” I mean, that’s right, 10 plus 10 does indeed equal 20, but the question was 10 plus 10 plus 2. It’s really hard to get that equation right if you lose the plus two. That’s just a cartoony illustration of how working memory limitations can mess with your test taking at the medical boards level. And I think it can affect med students in all kinds of other ways as well. Mike, you have ADHD inattentive type, how’s your working memory?
Mike: It was pretty bad. Before we met and started going through all this, I didn’t even know that it was a thing. You just kind of compensate through your life to be there, write things down on sticky notes, or you find ways to compensate without really even knowing what working memory is or that it’s a problem or that it can cause problems.
Ryan: That’s what I tell people, it’s not a problem until it’s a problem. When I meet people, they have been compensating and it’s nothing. I mean that’s how we all get through, we all manage, right? And it’s not a problem until it’s a problem. But when these things become problems, that’s where interventions and strategies need to be implemented and adopted and mastered to help with this stuff. So Mike, give some examples maybe of your working memory being not so great.
Mike: Well, the big one that affected me most was I failed boards a couple of times. And so when we started really analyzing what was going on when I was looking at questions and going through questions and trying to figure out the information and why I was missing questions. I would read through a question and by the time I got through to the end of it, my working memory would be so overloaded that it would start dropping things that I saw and read at the beginning of the question. And so by the time I started going through the answer choices, there’s five answer choices. You have 3, 4, 5 different pieces of information in the question. If you’re working memory is only 3, 4, 5, it’s all gone. It’s all gotten pushed out for the next thing.
Ryan: Or key parts have been pushed out. So that’s like me asking you, what’s 10 plus 10 and you say 20. And I’m like, “No, Mike, you’re wrong. It’s 22.” You’re like, “How’s 10 plus 10, 22?” I’m like, “Mike, 10 plus 10 plus 2.” You’re like, “Oh, I lost the plus two.” That’s really hard to get that equation right if you’re trying to do 10 plus 10 plus 2, and you lost the plus 2. The only way you’re gonna get it right is by accident or by doing the math wrong. That’s a fair analogy, right? For what it felt like? Mike: Yeah. I mean, it’s just like phone numbers. If you would tell me your phone number right now, by the time it would get to put it in to the phone I would forget it. Ryan: Yeah. Yes. Too many slots. It’s too demanding of the working memory. And here’s the thing, that doesn’t make you less intelligent, that doesn’t make you less smart. It doesn’t make you a less good doctor. That’s the thing. It’s like, you might have to manage things. You might have to use a compensatory mechanisms for test-taking. We had to teach you a methodology that limits the burden on working memory all the way through. That’s the solution. And likewise, that means avoid strategies that heavily burden working memory. So those test taking strategies that are like, “Okay, A versus B, which one wins death match, bang, bang, bang. A defeats B. Okay. A versus C, which one is better? Bang, bang, bang, C defeats A.” That’s a method. I mean, maybe I’m caricaturing it a bit much, but that method is very burdensome on working memory because you’re trying to remember the clinical scenario and A and C and A and D whatever, at the same time, that’s burdensome. So yeah, you sort of build methodologies to sort of offload that. What about clinically, Mike? Do you think you do things clinically to help manage some of those limitations in your working memory, just sort of organically? Mike: Yeah. Well, I’m a list person at work and at home. I’m in an ER, it’s pretty busy, and so you’re getting three more people coming and asking you for something, a med, or for you to come look at someone before you finished doing whatever the first thing is. And so if you don’t have a list and you don’t write it down, and then you’re gonna forget the fourth thing that someone came in and brought to you. And so lists offload that working memory, so it’s on a piece of paper. And so I’m not trying to remember it, but I can still look down at the list, go down through the list and do the things one at a time. And that makes it much easier. I do the same thing at home. Even right now, I’ve got a whiteboard in my garage. It’s got a list of the things that need done at my house, because if not, I’ll forget it and I’ll forget until I see it, and then I’ll remember it again. And then I’ll have to think about not forgetting it and then forget it. And so list, grocery stores, I have to have a list. I can’t go to the grocery store without list because I’ll come out with half the things that I didn’t need and the other half I forgot. So that’s how I’ve gotten around the working memory problem, both at work and home. Ryan: It’s a fantastic solution. What we wanna do is we wanna offload working memory whenever we can, we wanna make it external and explicit. That should be a mantra for anybody with ADHD, make it external and explicit, trust that you’re going to put it on that list and that you’re gonna use the list because otherwise it leads to like anxiety and distrust and like, “Oh, did I forget that thing.” Either in the middle of a shift or on the way to the store or whatever it might be. So we really wanna offload these things. So I think of working memory issues often with regard to test taking, you can find all kinds of things on our podcast feed, on our YouTube channel, on the blog with me talking about working memory and with test taking, this is just one of my central tenants, just to make sure we’re clear. If you have ADHD, there are likely, very likely, if not definitively, working memory weaknesses, even if it’s just average. If you’re a super-intelligent and you have average enough working memory, then that could be big enough for that diagnosis. Or certainly a lot of our ADHD learners have even below average with that working memory. But you know, Mike and I were talking about this and like I said, I think about it more like he was talking about with lists clinically or for his life, or we think about with test taking, but then Mike, you came up with some example about how the working memory overload was negatively impacting you in the classroom years too, not even counting in the test day. What was it were you sort of realized this working memory thing was getting you just in like the first year of med school? Mike: Well, I had a group that I would study with, there are a couple of people that were top five, 10% in the class. And so we were friends, we’d study together, and we would come to the same thing, bones of the foot. And so we’d come to the same thing all at the same time. And I would watch them look at it, go through it one or two times, try and memorize it, and they’d have it, they’d be good and they go. I would go through it and by the time I got to the other side of the foot, I would have forgotten what I just knew 20 seconds earlier. And so I would have to then start over and kind of go in the circle and eventually you get it, but you have to put a lot more energy into it. You have to put a lot more time into it, where they have already gone onto the next thing. And so the time that they spend was much less, just because they were able to unpack the information and keep it in their brain longer than I could. Ryan: But Mike, that let them transfer from working memory to short term and then continue to iterate and eventually short-term to long-term. And so to me, it sounds like the problem here is they were moving at an asynchronous rate compared to what you needed. So as they’re wanting to move on before you are doing your own cycling, or maybe they’re cycling too with too much information and your circus needed to be smaller. Solution wise, what does that solution then? Mike: And then you’ve got to go to frameworking and connecting the people that are professional, memory people that can memorize a whole deck of cards. Ryan: Okay, the memory champions. Mike: Those people are grouping 10 cards in one, or they’re connecting them somehow, or they’re making a story based on the cards. And so then, you make a story with the bones of the foot and you go through it that way, which doesn’t work well when you’re trying to study with other people. So you kind of have to pull out of that group, you have to put it in your brain, the way that your brain works, then go back and then retest with the group. Ryan: There you go. There it is though. I think, that’s what I was looking for. I think that the key here is don’t train with those people. Like you can’t be at the early formative stages of learning with those people. That’s like training like you’re trying to play a sport. If you’re playing with people that are so much, like it’s good to train with people above your level but if they’re so much above your level, it’s no good. If they’re so far below your level, it’s no good. It’s like anything. So my mentor in my master’s program, Dr. Barbara Walker would talk about the interface. I think it was a phase, I don’t know if this is like a real thing or if it was just part of her schema. The interface is that space in between training was something that’s too weak and too strong. You wanna be right in the middle straddling, one foot in an area of strength, one foot in an area of weakness. I think this is true when training was sports. I think it’s true when training, even at like the way that Mike’s talking about bringing this information on board, if it’s too fast or too slow, it’s not right. You got to find it somewhere where you can be right in the middle and it sounds to me Mike like the way that these people were learning, they were too far above where you were, and therefore you needed to either just pull out of that group or just you and the one person that’s more on your level pull down. You guys get it in foundationally, like you said, and then if you want to rejoin the group later in the circuit where it’s more quiz based, self quizzing based, that’s better. Is that a fair solution there? Mike: Yeah. So that’s how we kind of ended up doing. It was the one to two days before the test. Once you’ve had a chance to encode all the information, then you could go back in the group. You could run through everything with them. So that way you’re picking up stuff that you may have missed or picking up stuff that they’re catching. And so then you’re actually functionally studying with them instead of them just kind of having to pull you along and then it’s not effective for them or for you. Ryan: Yeah. Yeah. I’m really wary of study groups because I think oftentimes we’re putting the wrong criteria into why we wanna be in the group, but it has to come down to what works for you individually. Right? Are you getting something out of it, getting the most bang for your buck? So a lot of people ask me, “Well, how can I fix my working memory?” And I’m like, “No, I’ve never seen anything that makes me believe that at this point in where we are.” I think you wanna make things external and explicit. I think you wanna force recall as much as possible, track what you’ve been able to recall. Force recall, get into retrieval practice, making adjustments in your studying environment like Mike’s talking about. And then in regard to test taking, I mean if this is a concern, use an approach for test questions that’s gonna be less burdensome on your working memory. In your thoughts on this whole working memory piece for you Mike, in regards to certainly like ADHD overall, but then especially maybe with learning in those first few years. Mike: Well, it’s just something nobody ever talks about and you wouldn’t know that’s what’s going on. And so you look at the students that are scoring well on tests, and you’re like, “Oh, maybe they’re just smarter than you are.” But realistically there, I think they’re just encoding the information faster and able to keep the information in a more organized manner, which isn’t as easy for someone with ADD. Ryan: Well, right? Again, we always wanna throw around that person’s smarter than me. Like, that’s such a vague word, right? We don’t know what that means. But what we can see is their outcomes are better. So is that happening earlier in the circuit? Like you’re talking about right now with the organization is the first layer of this thing, the encoding, the putting it in, is it going in, is it sticking? Is it going in a way that’s organized? The accessibility and retrieval the next phase. And then the ultimate interface on the back end is the test taking, right? Working memory glitches can affect anything along this continuum. And maybe you’ve even fixed the front end like you did Mike in the classroom years. But then if we don’t fix the test taking side where working memory can rear its head again, that can cause problems as we’ve seen. Right?
Mike: Right.
Ryan: So just because somebody scores better off than us doesn’t mean they even know, it doesn’t even mean they’re “smarter”. It doesn’t even mean they know more. It just means they know how to show more on these very specifically burdensome working memory, burdensome constructs that we call our board style questions. These are the things you see COMLEX, USMLE specialty boards, shelf exams, all that stuff. Now, classroom exams I can’t speak for, because who knows. Those are often generated by professors who knows what those things are written like, but working memory can rear its head here. And that’s a great point that Mike makes, let’s just be aware of it first. Let’s be aware that if your working memory is less robust than the average med student, that it can definitely cause problems and there are things that you can do to offset these issues and not have your fate dictated by it. And I think if we look at your history, Mike, a lot of the trouble you probably did experienced were because you hadn’t yet figured out how to manage those working memory limitations. That’s a new thought I’m having just as we’re talking here.
Mike: Right. I mean, the different parts of the studying, lecture, testing, working, all require a different solution to the same problem.
Ryan: But it all has to start with understanding that this working memory weaknesses are part of the ADHD profile so we can start with that. All right. Well, thanks for listening. And we’ll be back with a third part where we talk more about ADHD with the med students in those first years of med school. Thanks for listening.
Announcer: Thanks for tuning in to this episode of STATMed podcast. In future episodes, Ryan and Mike will continue that conversation about ADHD and med school. If you like the show, be sure to rate it on iTunes, Stitcher, Spotify, or wherever you listen to your podcasts and be sure to subscribe so you don’t miss future episodes. You can find more test taking and studying strategies specifically designed for med students and physicians over at our blog, statmedlearning.com. Thanks for listening.
s 10 does indeed equal 20, but the question was 10 plus 10 plus 2. It’s really hard to get that equation right if you lose the plus two. That’s just a cartoony illustration of how working memory limitations can mess with your test taking at the medical boards level. And I think it can affect med students in all kinds of other ways as well. Mike, you have ADHD inattentive type, how’s your working memory?
Mike: It was pretty bad. Before we met and started going through all this, I didn’t even know that it was a thing. You just kind of compensate through your life to be there, write things down on sticky notes, or you find ways to compensate without really even knowing what working memory is or that it’s a problem or that it can cause problems.
Ryan: That’s what I tell people, is it’s not a problem until it’s a problem. When I meet people, they have been compensating and it’s nothing. I mean that’s how we all get through, we all manage, right? And it’s not a problem until it’s a problem. But when these things become problems, that’s where interventions and strategies need to be implemented and adopted and mastered to help with this stuff. So Mike, give some examples maybe of your working memory being not so great.
Mike: Well, the big one that affected me most was I failed boards a couple of times. And so when we started really analyzing what was going on when I was looking at questions and going through questions and trying to figure out the information and why I was missing questions. I would read through a question and by the time I got through to the end of it, my working memory would be so overloaded that it would start dropping things that I saw and read at the beginning of the question. And so by the time I started going through the answer choices, there’s five answer choices. You have 3, 4, 5 different pieces of information in the question. If you’re working memory is only 3, 4, 5, it’s all gone. It’s all gotten pushed out for the next thing.
Ryan: Or key parts have been pushed out. So that’s like me asking you, what’s 10 plus 10 and you say 20. And I’m like, “No, Mike, you’re wrong. It’s 22.” You’re like, “How’s 10 plus 10, 22?” I’m like, “Mike, 10 plus 10 plus 2.” You’re like, “Oh, I lost the plus two.” That’s really hard to get that equation right if you’re trying to do 10 plus 10 plus 2, and you lost the plus 2. The only way you’re gonna get it right is by accident or by doing the math wrong. That’s a fair analogy, right? For what it felt like?
Mike: Yeah. I mean, it’s just like phone numbers. If you would tell me your phone number right now, by the time it would get to put it in to the phone I would forget it.
Ryan: Yeah. Yes. Too many slots. It’s too demanding of the working memory. And here’s the thing, that doesn’t make you less intelligent, that doesn’t make you less smart. It doesn’t make you a less good doctor. That’s the thing. It’s like, you might have to manage things. You might have to use a compensatory mechanisms for test-taking. We had to teach you a methodology that limits the burden on working memory all the way through. That’s the solution. And likewise, that means avoid strategies that heavily burden working memory. So those test taking strategies that are like, “Okay, A versus B, which one wins death match, bang, bang, bang. A defeats B. Okay. A versus C, which one is better? Bang, bang, bang, C defeats A.” That’s a method. I mean, maybe I’m caricaturing it a bit much, but that method is very burdensome on working memory because you’re trying to remember the clinical scenario and A and C and A and D whatever, at the same time, that’s burdensome. So yeah, you sort of build methodologies to sort of offload that. What about clinically, Mike? Do you think you do things clinically to help manage some of those limitations in your working memory, just sort of organically?
Mike: Yeah. Well, I’m a list person at work and at home. I’m in an ER, it’s pretty busy, and so you’re getting three more people coming and asking you for something, a med, or for you to come look at someone before you finished doing whatever the first thing is. And so if you don’t have a list and you don’t write it down, and then you’re gonna forget the fourth thing that someone came in and brought to you. And so lists offload that working memory, so it’s on a piece of paper. And so I’m not trying to remember it, but I can still look down at the list, go down through the list and do the things one at a time. And that makes it much easier. I do the same thing at home. Even right now, I’ve got a whiteboard in my garage. It’s got a list of the things that need done at my house, because if not, I’ll forget it and I’ll forget until I see it, and then I’ll remember it again. And then I’ll have to think about not forgetting it and then forget it. And so list, grocery stores, I have to have a list. I can’t go to the grocery store without list because I’ll come out with half the things that I didn’t need and the other half I forgot. So that’s how I’ve gotten around the working memory problem, both at work and home.
Ryan: It’s a fantastic solution. What we wanna do is we wanna offload working memory whenever we can, we wanna make it external and explicit. That should be a mantra for anybody with ADHD, make it external and explicit, trust that you’re going to put it on that list and that you’re gonna use the list because otherwise it leads to like anxiety and distrust and like, “Oh, did I forget that thing.” Either in the middle of a shift or on the way to the store or whatever it might be. So we really wanna offload these things. So I think of working memory issues often with regard to test taking, you can find all kinds of things on our podcast feed, on our YouTube channel, on the blog with me talking about working memory and with test taking, this is just one of my central tenants, just to make sure we’re clear. If you have ADHD, there are likely, very likely, if not definitively, working memory weaknesses, even if it’s just average. If you’re a super-intelligent and you have average enough working memory, then that could be big enough for that diagnosis. Or certainly a lot of our ADHD learners have even below average with that working memory. But you know, Mike and I were talking about this and like I said, I think about it more like he was talking about with lists clinically or for his life, or we think about with test taking, but then Mike, you came up with some example about how the working memory overload was negatively impacting you in the classroom years too, not even counting in the test day. What was it were you sort of realized this working memory thing was getting you just in like the first year of med school?
Mike: Well, I had a group that I would study with, there are a couple of people that were top five, 10% in the class. And so we were friends, we’d study together, and we would come to the same thing, bones of the foot. And so we’d come to the same thing all at the same time. And I would watch them look at it, go through it one or two times, try and memorize it, and they’d have it, they’d be good and they go. I would go through it and by the time I got to the other side of the foot, I would have forgotten what I just knew 20 seconds earlier. And so I would have to then start over and kind of go in the circle and eventually you get it, but you have to put a lot more energy into it. You have to put a lot more time into it, where they have already gone onto the next thing. And so the time that they spend was much less, just because they were able to unpack the information and keep it in their brain longer than I could.
Ryan: But Mike, that let them transfer from working memory to short term and then continue to iterate and eventually short-term to long-term. And so to me, it sounds like the problem here is they were moving at an asynchronous rate compared to what you needed. So as they’re wanting to move on before you are doing your own cycling, or maybe they’re cycling too with too much information and your circus needed to be smaller. Solution wise, what does that solution then?
Mike: And then you’ve got to go to frameworking and connecting the people that are professional, memory people that can memorize a whole deck of cards.
Ryan: Okay, the memory champions.
Mike: Those people are grouping 10 cards in one, or they’re connecting them somehow, or they’re making a story based on the cards. And so then, you make a story with the bones of the foot and you go through it that way, which doesn’t work well when you’re trying to study with other people. So you kind of have to pull out of that group, you have to put it in your brain, the way that your brain works, then go back and then retest with the group.
Ryan: There you go. There it is though. I think, that’s what I was looking for. I think that the key here is don’t train with those people. Like you can’t be at the early formative stages of learning with those people. That’s like training like you’re trying to play a sport. If you’re playing with people that are so much, like it’s good to train with people above your level but if they’re so much above your level, it’s no good. If they’re so far below your level, it’s no good. It’s like anything. So my mentor in my master’s program, Dr. Barbara Walker would talk about the interface. I think it was a phase, I don’t know if this is like a real thing or if it was just part of her schema. The interface is that space in between training was something that’s too weak and too strong. You wanna be right in the middle straddling, one foot in an area of strength, one foot in an area of weakness. I think this is true when training was sports. I think it’s true when training, even at like the way that Mike’s talking about bringing this information on board, if it’s too fast or too slow, it’s not right. You got to find it somewhere where you can be right in the middle and it sounds to me Mike like the way that these people were learning, they were too far above where you were, and therefore you needed to either just pull out of that group or just you and the one person that’s more on your level pull down. You guys get it in foundationally, like you said, and then if you want to rejoin the group later in the circuit where it’s more quiz based, self quizzing based, that’s better. Is that a fair solution there?
Mike: Yeah. So that’s how we kind of ended up doing. It was the one to two days before the test. Once you’ve had a chance to encode all the information, then you could go back in the group. You could run through everything with them. So that way you’re picking up stuff that you may have missed or picking up stuff that they’re catching. And so then you’re actually functionally studying with them instead of them just kind of having to pull you along and then it’s not effective for them or for you.
Ryan: Yeah. Yeah. I’m really wary of study groups because I think oftentimes we’re putting the wrong criteria into why we wanna be in the group, but it has to come down to what works for you individually. Right? Are you getting something out of it, getting the most bang for your buck? So a lot of people ask me, “Well, how can I fix my working memory?” And I’m like, “No, I’ve never seen anything that makes me believe that at this point in where we are.” I think you wanna make things external and explicit. I think you wanna force recall as much as possible, track what you’ve been able to recall. Force recall, get into retrieval practice, making adjustments in your studying environment like Mike’s talking about. And then in regard to test taking, I mean if this is a concern, use an approach for test questions that’s gonna be less burdensome on your working memory. In your thoughts on this whole working memory piece for you Mike, in regards to certainly like ADHD overall, but then especially maybe with learning in those first few years.
Mike: Well, it’s just something nobody ever talks about and you wouldn’t know that’s what’s going on. And so you look at the students that are scoring well on tests, and you’re like, “Oh, maybe they’re just smarter than you are.” But realistically there, I think they’re just encoding the information faster and able to keep the information in a more organized manner, which isn’t as easy for someone with ADD.
Ryan: Well, right? Again, we always wanna throw around that person’s smarter than me. Like, that’s such a vague word, right? We don’t know what that means. But what we can see is their outcomes are better. So is that happening earlier in the circuit? Like you’re talking about right now with the organization is the first layer of this thing, the encoding, the putting it in, is it going in, is it sticking? Is it going in a way that’s organized? The accessibility and retrieval the next phase. And then the ultimate interface on the back end is the test taking, right? Working memory glitches can affect anything along this continuum. And maybe you’ve even fixed the front end like you did Mike in the classroom years. But then if we don’t fix the test taking side where working memory can rear its head again, that can cause problems as we’ve seen. Right?
Mike: Right.
Ryan: So just because somebody scores better off than us doesn’t mean they even know, it doesn’t even mean they’re “smarter”. It doesn’t even mean they know more. It just means they know how to show more on these very specifically burdensome working memory, burdensome constructs that we call our board style questions. These are the things you see COMLEX, USMLE specialty boards, shelf exams, all that stuff. Now, classroom exams I can’t speak for, because who knows. Those are often generated by professors who knows what those things are written like, but working memory can rear its head here. And that’s a great point that Mike makes, let’s just be aware of it first. Let’s be aware that if your working memory is less robust than the average med student, that it can definitely cause problems and there are things that you can do to offset these issues and not have your fate dictated by it. And I think if we look at your history, Mike, a lot of the trouble you probably did experienced were because you hadn’t yet figured out how to manage those working memory limitations. That’s a new thought I’m having just as we’re talking here.
Mike: Right. I mean, and the different parts of the studying, lecture, testing, working, all require a different solution to the same problem.
Ryan: But it all has to start with understanding that this working memory weaknesses are part of the ADHD profile so we can start with that. All right. Well, thanks for listening. And we’ll be back with a third part where we talk more about ADHD with the med students in those first years of med school. Thanks for listening.
Announcer: Thanks for tuning in to this episode of STATMed podcast. In future episodes, Ryan and Mike will continue that conversation about ADHD and med school. If you like the show, be sure to rate it on iTunes, Stitcher, Spotify, or wherever you listen to your podcasts, and be sure to subscribe so you don’t miss future episodes. You can find more test-taking and studying strategies specifically designed for med students and physicians over at our blog, statmedlearning.com. Thanks for listening.