Overcoming Obstacles from ADHD and Lecture-Based Learning
In this video series, STATMed founder Ryan Orwig examines life as a doctor or medical student with ADHD. He outlines how ADHD affects your ability to study, take tests effectively, and manage your time. And he shares common patterns he’s observed with ADHD-affected medical students and physicians.
Learning in med school starts with structure and organization. For many students, organizing facts and information from lectures or other sources is an automatic process. The information is obtained, filed away, and easy to retrieve later. But, that’s not how it works for all med students. For example, many medical students with ADHD struggle with this type of learning.
Medical School Lectures and ADHD: What You Need to Know
So, if there’s a breakdown between how the information comes in and your ability to retrieve it later, you’re going to have a more difficult time using that information. One STATMed student explained it like this:
Med students with ADHD can feel like they’re continuously playing “catch up.” The sheer volume of information delivered in lecture-based classes only amplifies that feeling. In this video, Ryan digs into methods and strategies that can help offset these issues. He shares how building the essential frameworks for mastering dense medical information is crucial to managing the effects of ADHD in med school. He also provides strategies for shifting priorities when it comes to studying or synthesizing information from lectures.
In future videos, Ryan will dig into additional ways ADHD manifests for medical students and doctors and offer strategies to overcome these challenges. Be sure to subscribe to our email list for updates!
Ryan Orwig: Hi everyone, Ryan Orwig with STATMed Learning here where we talk about the challenges of learning in med school and on boards — continuing our exploration of what it’s like to be a med student with ADHD. In this section, we’re gonna pick one very particular way ADHD can negatively impact studying in med school. Specifically, we’re gonna look at lecture and how learning from lecture can be so problematic for the med student with ADHD.
A few caveats before we start. Number one, while I am focusing on actual lecture-based learning here, please note that these insights and patterns can extrapolate to other formats like problem-based learning, the flipped classroom, independent study, textbook or review book reading, or board review programs.
Caveat number two, while I think these issues are likely present with ADHD, they can also be present without ADHD.
Number three, when I say “med student,” this also includes physicians, veterinarians, Pharm Ds, and those and other demanding medical fields.
Number four, keep in mind, these things are only problems if they are problems. If you have ADHD but you do not have these problems, then that’s great for you. If medication or exercise resolves these issues, again, that’s wonderful. We are focusing on those who still have unresolved issues in this arena.
And caveat number five, lecture is just one area of learning-based issues for med students with ADHD, many others exist.
So why is learning from lecture in med school so hard for some of us in general and even worse for those with ADHD? Let’s listen to what three med students with ADHD say about their issues with learning from med school lectures and identify some key underlying issues. This is what Ameera a first year med student with ADHD said to me.
“I sit through hour after hour of lecture, trying to focus and hang on and internalize as much as I can, but by the end I’m just absolutely frustrated and worn out. And then when it is time to actually study later that day, I feel like I’m starting from scratch except it’s worse because it’s so late in the day and I am dead exhausted.”
Look, we hear versions of this all the time. It’s a common story. As it turned out, Ameera was experiencing what I call executive function overload. If you have ADHD like Ameera, you likely have executive dysfunction, which, in part, means the way you receive and organize information cognitively is not as robust as other aspects of your cognitive setup. Learning in med school has to start with being able to organize the information in your head. And I think there is an expectation that you can handle this information load, but if you can’t, then that’s where the trouble starts. Also, another culprit here, for her, is the speed-volume-density equation. This is just a brutal fact of life in med school where there is so much thrust at you so fast and you’re accountable for all of it. This one-two punch is a perfect storm for students like Ameera because she is now always behind, always playing catch up, always inefficient, and it all starts with lecture.
Now let’s look at Joe, a second-year medical student with ADHD. He says, “If I get distracted or get lost during the lecture then it’s pretty much game over and I can’t get back on track. So, I just sit there and play around online until the lecture ends. Then I’m always behind, which is terrible because the flow of information never stops. And this happens to me a lot.”
First of all, this is ADHD 101. I mean, when you struggle with focus, distractibility, and impulsivity, these long lectures are a recipe for trouble. This means the ADHD student will get off track more than the average student which likely corrupts the learning experience. Since there is no extra time in med school this can quickly mushroom into a big problem for some students. Joe’s experience also illustrates what I call falling off the train. It’s a classic scenario for the ADHD med student. Once he loses his place in lecture he can’t get back on board. It’s like he fell off a train. Then all he can do is stand there on the tracks forlornly watching the train disappear in the distance. That’s how many students feel when they get distracted or lost in lecture. They need a way to like teleport back onto the train and that’s something that we can actually learn. Not, you know, teleporting, but being able to jump back into the lecture, to jump back on board the train and carry on with lecture even if you’ve missed a section. But regardless, if this sort of thing happens often, it severely limits the value of lecture. In my version of learning in med school, we have to unlock a way to get the most out of lecture. All of this can be done with realigned priorities and perhaps by adding the right methodology.
Then, for our third and final med student with ADHD, we have Jasmine who described her med school lecture experience like this.
“On the one hand, I feel like I have to start studying with lecture because otherwise, where do you even start? But on the other, I don’t feel like I get much from lecture. I have a really hard time seeing the connections and I mostly write down a ton of notes trying to remember as much as possible. I know big picture is important, but I can’t often see it so I focus on details because that’s what burns me on test day.”
This touches on what we can call death by PowerPoint. My main issue with PowerPoint is their format often inadvertently obliterates the markers that tell us the hierarchical organization of the material being disseminated. So all the are sort of flush and seemingly equal which makes finding the big picture and thus relationships harder. I think people should be accredited to teach in PowerPoint like a license, but that’s not gonna happen. So we need to teach students how to crack open and decode these PowerPoint lectures to find the hidden substructure. Because, as I said earlier, learning starts with understanding the organization of the material. And this is even more important for our students with ADHD. I do think the ubiquity of PowerPoints makes this issue worse but they’re not going anywhere. So again, the onus has to fall on the learners to take control of their learning.
It also turned out Jasmine is a top-down learner in a bottom-up world. Top-down learning means she needs the organizational superstructure first and fast. It’s fine if it is given to her I guess, but ultimately she needs to learn how to find it herself to put her in control of all learning required of her from first year of med school for the rest of her career, through rotations, board study, residency, on and on and on. I think most ADHD med students are top-down learners. They will function better once they build the superstructure then start learning details. She’s trying to amass details without the superstructure and that’s where it’s breaking down for her right at the start. Conversely, I suspect most med students overall are bottom-up learners. What that means is they can learn from amassing details that will then convert to the organizational big picture pretty much subconsciously, autonomously as a by-product. For this type of learner, they can sit in lecture and soak up the information or they can hammer away at practice questions and learn the matrix of how it all fits together. Or they can iterate, iterate, iterate on Anki and the information not only sticks but it’s applicable.
Someone like Jasmine however is basically hoarding a ton of details and hoping they like poof, combust into an organized big picture, but for her that happens too late, too inconsistently, or not at all. Methods need to be learned to offset these issues.
So these are some of the main patterns we see for med students with ADHD struggling with lecture-based learning. And this doesn’t even factor in issues with learning remotely using on-demand lectures. All of the above listed issues will apply but then you have to factor in issues with time management, organization, completion, and prioritization. All of which can be worse when you have ADHD. I think learning in med school starts with structure and organization. I think med students with ADHD likely struggle at the very fundamental initial stage of learning due to executive dysfunction which manages this sort of organization. To simplify, they don’t build what I call the frameworks to house the details as well as their peers.
When it comes to lecture-based learning in med school, I think we can sort students into two main groups. We have dual-trackers on the one hand and single-trackers on the other. Dual-trackers can sit there in lecture and absorb both the organizational framework at the lecture and at least some of the details from lecture. These are the ones who come out ahead of the game after lecture. These are the bottom-up learners. These students possess some high level executive functioning skills. I think most med students, whatever that means, are dual-trackers. On the first track during lecture they are delineating the hierarchal organizational framework. On the second track at the same time, they are putting the details on the proper shelf, so to speak. So after lecture, they have both a sense of structure and have started encoding details within that structure, putting items where they belong organizationally, hierarchically, possibly subconsciously automatically.
On the other hand, some students are single-trackers. This applies to many med students with ADHD. These are top-down learners who need the organizational big picture first. These students may lack robust executive functioning skills in this area. Since med school lectures are so incredibly dense, single-trackers get overloaded because they only have the one track and have to choose between the big picture framework or all of the details. As they’re sitting there in lecture receiving all this information, they have to make that choice. Usually they’re going to choose details of course because on exams they can’t recall the nitty gritty details and they are getting shellacked for not remembering the tiniest bullet point. This makes sense but it’s just not the optimal way to learn where hierarchies are essential for encoding and retrieving and applying the vast amounts of information required of med students. Hopefully this image illustrates the pile up that occurs when you’re learning without frameworks.
Here’s the secret. If you don’t stone cold know the hierarchy or the framework for where the tiniest bullet point belongs, organization-wise you’re going to have a tough time encoding it on the front end of the learning circuit and a tough time retrieving it later to apply on medical board exams. This is true for anybody, but I expect to see this phenomenon more frequently with the struggling med student with ADHD. I like to visualize this using a closet as a metaphor. The student with the ADHD brain is just scribbling details on post-it notes and slapping them haphazardly into the mental closet of their brain. Yes they might get in there maybe, but who knows how to find them when needed. That’s what counts. On the other hand, the student with robust executive functioning skills, the dual-tracker, that med student firing on all cylinders, they automatically build the framework while streaming in the information. They put the information where it belongs as they are learning it. This is sort of happening on the back burner for them in many cases, just an innate aspect of how they receive and store information. The difference is obviously quite stark.
And while this is an extreme illustration, it does underscore the difference between one single-tracker and one dual-tracker. The dual-tracker is obviously way ahead. So under this theory, the med student with ADHD is always behind from the outset which is a terrible burden. This isn’t the only thing happening to impair performance for the ADHD learner. But this is an example of one of the main issues that really wipes out med students with ADHD right from the get-go.
Many people ask me, “Can you teach me how to turn my single-track brain into a dual-track brain?” I say, no, unfortunately I can’t. I might be wrong, but in my experience these tracks are hardware-based and you have what you have. But I think you can learn methods and strategies to offset the single-track issues to emulate dual-tracks. I think you have two paths to address this particular issue.
Path one is this, shift your goals and objectives in lecture. Emphasize the value of finding the organizational framework first and fast, either before a lecture or during lecture. This would be a value change, a priority shift. Some students can do this on their own, some need guidance which leads to path number two, which is rebuild your study methodology with specific detailed tools that, among other things, teaches a way to seek out and extract the hidden frameworks in lectures and other medical content so you can then progressively build along your single track and stay on top of your learning. We do this in our STATMed class so look into that if you’re interested. I’m not saying anyone has to take our class. It’s just that the class is great and it is designed to address these issues.
In our next video, we will look at a very specific way ADHD might manifest with issues with time management and workflow while studying in medical school. With all that said, make sure you like and subscribe below so you can easily find more of our videos exploring learning and test-taking in medical school, on boards, and in related medical fields. Thanks for watching.