Study Skills for Medical Study Skills for Medical Students: Part IIStudents: Part II

Latha Chandran MD, MPHLatha Chandran MD, MPHAssociate Dean, Academic Associate Dean, Academic AdvisingAdvisingInterim Chair. Dept of PediatricsInterim Chair. Dept of PediatricsSUNY at Stony BrookSUNY at Stony Brook

Features of an MS1Features of an MS1

Intellectual self doubtIntellectual self doubt Workload anxietyWorkload anxiety Competition vs cooperationCompetition vs cooperation Loss of status!Loss of status! Difficulty with authoritarian Difficulty with authoritarian

hierarchyhierarchy What is the big picture?What is the big picture?

ExamsExams

Each course has small exams, Each course has small exams, quizzes, labs, NBME shelf examsquizzes, labs, NBME shelf exams

USMLE Step I before third yearUSMLE Step I before third year USMLE Step II before graduationUSMLE Step II before graduation USMLE Step III during residencyUSMLE Step III during residency Specialty boards after residencySpecialty boards after residency and thereafter………………..!and thereafter………………..!

Time ManagementTime Management

As a doctor, one needs to do lots of As a doctor, one needs to do lots of things!- see patients, teach, learn, things!- see patients, teach, learn, read, leadership roles, community, read, leadership roles, community, exercise, keep friends and familyexercise, keep friends and family

Give up the idea that you are a Give up the idea that you are a studentstudent

You are a professional MD in trainingYou are a professional MD in training Practice using your time WISELY!Practice using your time WISELY!

Final goalFinal goal

Pass USMLE Step I II and IIIPass USMLE Step I II and III Pace yourself like a long distance Pace yourself like a long distance

runner- practice, practice and runner- practice, practice and practice to build up endurancepractice to build up endurance

Each hour in class- spend two hours Each hour in class- spend two hours outside of classoutside of class

Take INTERNAL control of your timeTake INTERNAL control of your time Beware Ns and Ps- mngt by crisis!Beware Ns and Ps- mngt by crisis!

Memory curveMemory curve

Imaginary line illustrating the process of Imaginary line illustrating the process of remembering and forgettingremembering and forgetting

Try to create an optimal memory curve- Try to create an optimal memory curve- takes practicetakes practice

Reinforce and expand your learning style Reinforce and expand your learning style dimensions IMMEDIATELY after you learn dimensions IMMEDIATELY after you learn something newsomething new

Use other sensory modalities to Use other sensory modalities to rememberremember

Memory curve graphicMemory curve graphic

Long term memoryLong term memory

Break it down into small piecesBreak it down into small pieces DAILY routine of memory DAILY routine of memory

reinforcementreinforcement Guard against procrastinationGuard against procrastination

Common causes of academic Common causes of academic difficultydifficulty

Time Management issuesTime Management issues• travel, family, friends, other activitiestravel, family, friends, other activities

Material management issuesMaterial management issues• not preparing, no daily reinforcementnot preparing, no daily reinforcement• no CONSCIOUS system of studyno CONSCIOUS system of study• no “ own notes”no “ own notes”

Mental Health issuesMental Health issues• depression, LD, ADDdepression, LD, ADD

Tips for optimal learningTips for optimal learning

Create a schedule and follow itCreate a schedule and follow it It is your best friendIt is your best friend Skim read/ pre readSkim read/ pre read

• generate questions, new terms, charts, generate questions, new terms, charts, graphs, compare/contrast datagraphs, compare/contrast data

Attend lectureAttend lecture Sit in the front, away from Sit in the front, away from

distraction, good lightingdistraction, good lighting

Tips for optimal learningTips for optimal learning

Analyze dataAnalyze data Memorize- see, hear, say, apply, Memorize- see, hear, say, apply,

teachteach Mnemonics for physical objects Mnemonics for physical objects

courses ( Funny ones)courses ( Funny ones) Flash cardsFlash cards Create your OWN flow charts, Create your OWN flow charts,

compare/contrastcompare/contrast

Tips for optimal learningTips for optimal learning

Fit new material into existing infoFit new material into existing info Practice every day the first week of Practice every day the first week of

exposure, use all your senses, and exposure, use all your senses, and reinforce reinforce

You will be able to cut down on study You will be able to cut down on study time later for memory brush upstime later for memory brush ups

Add music to your environment if Add music to your environment if auditoryauditory

Schedule constructionSchedule construction

When are you most alert? AM, PM?When are you most alert? AM, PM? How much sleep do you need?How much sleep do you need? Do you need large blocks of Do you need large blocks of

uninterrupted time for work?uninterrupted time for work? Do you need a break after 1-1.5 hours?Do you need a break after 1-1.5 hours? How long a break, what to do then?How long a break, what to do then? When do you study alone? With others?When do you study alone? With others?

More tipsMore tips

Stay with one topic for at least 1.5 hoursStay with one topic for at least 1.5 hours Work with related materialWork with related material Intersperse difficult subjects with easy Intersperse difficult subjects with easy

onesones Use your highest energy time for the Use your highest energy time for the

most difficult subjectmost difficult subject Volunteer to teach in your group this Volunteer to teach in your group this

topictopic

Learning environmentLearning environment

Music/ food/ pleasant viewsMusic/ food/ pleasant views Vary sensory use- the more sensory Vary sensory use- the more sensory

input the more sustained memoryinput the more sustained memory Visual- different colors/ shapes/ Visual- different colors/ shapes/

sketches, spatial models, slant of sketches, spatial models, slant of writingwriting

Kinetic- use LARGE paper/chalk boardKinetic- use LARGE paper/chalk board

Time AccountabilityTime Accountability

Time log for sensorsTime log for sensors• Use a 15 mt block daily calendarUse a 15 mt block daily calendar• pay attention to your natural rhythmspay attention to your natural rhythms

Time pie- weekly pattern of time Time pie- weekly pattern of time use for Ns and Ps- like chunks of use for Ns and Ps- like chunks of time time

Using both is IDEAL for both groupsUsing both is IDEAL for both groups First create a personal time pieFirst create a personal time pie

Study sandwichStudy sandwich

Put in the difficult subject between Put in the difficult subject between two slices of easy onestwo slices of easy ones

Do not fall behind- if you do, catch Do not fall behind- if you do, catch up on the weekendup on the weekend

Work on the most current material Work on the most current material firstfirst

To kill time is to murder your To kill time is to murder your chances for successchances for success

Taking notesTaking notes

Ear to handEar to hand One sided; Leave other side of One sided; Leave other side of

page for text book notes, study page for text book notes, study group notes-differ color group notes-differ color

Leave large margins for LABELINGLeave large margins for LABELING

More on taking notesMore on taking notes

If unclear, leave gapsIf unclear, leave gaps Fill in spaces/ blanks after talking to Fill in spaces/ blanks after talking to

another reliable note taker ( use another reliable note taker ( use different color, need extra different color, need extra attention)attention)

This is YOUR permanent recordThis is YOUR permanent record Have a reliable note taking partnerHave a reliable note taking partner

each your colleagueseach your colleagues

Concept MappingConcept Mapping

Learning syndromes and Learning syndromes and their managementtheir management

Reference: Robert Burns, Medical Reference: Robert Burns, Medical Teacher Vol 28, No 3, 2006, pp Teacher Vol 28, No 3, 2006, pp 230-233230-233

Nine syndromesNine syndromes Peculiar predilection to affect early Peculiar predilection to affect early

medical studentsmedical students ManagementManagement

Six chambered heart Six chambered heart syndromesyndrome

Excessive analysis of test questionsExcessive analysis of test questions How many chambers does the heart How many chambers does the heart

have?have? Are the two auricles chambers? If so Are the two auricles chambers? If so

six is the right answersix is the right answer REMEDY: Come up with the answer REMEDY: Come up with the answer

WITHOUT looking at the optionsWITHOUT looking at the options

Slip and Slide syndromeSlip and Slide syndrome

Studying for the exam that is most Studying for the exam that is most imminent to the exclusion of the imminent to the exclusion of the other concurrent subjectsother concurrent subjects

Very commonVery common Fosters cramming and memorization Fosters cramming and memorization

versus actual learningversus actual learning REMEDY: Make a contract to study REMEDY: Make a contract to study

each course’s stuff THE DAY you each course’s stuff THE DAY you encounter it- not LATER!encounter it- not LATER!

Slip and slide syndrome Slip and slide syndrome experimentexperiment

University of Arkansas- Three University of Arkansas- Three courses running simultaneouslycourses running simultaneously

Every third Monday – two exams, Every third Monday – two exams, and every third Tuesday- one examand every third Tuesday- one exam

Courses rotated as to which exam Courses rotated as to which exam came firstcame first

Did the students like it?Did the students like it?

Slip and slide experimentSlip and slide experiment

Results:Results:• Students did better than predicted in Students did better than predicted in

all three courses!all three courses! Why?Why?

• Never allowed to slip and slideNever allowed to slip and slide KEEP UP should be your mantraKEEP UP should be your mantra

Oh Yeah syndromeOh Yeah syndrome

I have seen this beforeI have seen this before So I don’t have to pay attentionSo I don’t have to pay attention Depth of understanding required by Depth of understanding required by

medical school faculty very differentmedical school faculty very different Oh Yeah turns into Oh No at the time Oh Yeah turns into Oh No at the time

of the exam!of the exam! REMEDY: Be aware, pay attention to REMEDY: Be aware, pay attention to

the detail and the focusthe detail and the focus

Too many books syndromeToo many books syndrome

Buying lots of books will NOT Buying lots of books will NOT translate into learningtranslate into learning

REMEDY: Buy only the required REMEDY: Buy only the required course materials and USE them course materials and USE them wellwell

Post Genius syndromePost Genius syndrome

Prior outstanding academic recordPrior outstanding academic record Now receiving a C for the first timeNow receiving a C for the first time Bell shaped distribution for gradesBell shaped distribution for grades REMEDY: C in a med school course REMEDY: C in a med school course

is an acceptable place to start is an acceptable place to start fromfrom

Irrelevant material syndromeIrrelevant material syndrome

““I will never need to use this when I I will never need to use this when I become a physician- so why do I become a physician- so why do I need to learn this?”need to learn this?”

Very common Very common REMEDY: Crucial to understanding REMEDY: Crucial to understanding

clinical relevanceclinical relevance Also understand principles of life Also understand principles of life

long learninglong learning

Alternate SyndromeAlternate Syndrome

I was on the waiting list, so I can’t be I was on the waiting list, so I can’t be as good as the othersas good as the others

Motivation is keyMotivation is key 2727thth alternate admitted as the bottom alternate admitted as the bottom

most rank in the class- ended up most rank in the class- ended up graduating first in class in four yearsgraduating first in class in four years

REMEDY: know that the playing REMEDY: know that the playing ground is level when you startground is level when you start

Old Test Question SyndromeOld Test Question Syndrome

Variant of the Oh Yeah syndromeVariant of the Oh Yeah syndrome Slight rewording of the stem results in a Slight rewording of the stem results in a

different answer being correctdifferent answer being correct Failure to detect the change in the stem Failure to detect the change in the stem

results in incorrect answersresults in incorrect answers Eg: Masson- trichrome stained section of Eg: Masson- trichrome stained section of

tongue: Identify the organ, identify the tongue: Identify the organ, identify the blue staining material, identify the germ blue staining material, identify the germ layer of origin of the surface epitheliumlayer of origin of the surface epithelium

70% error rate!70% error rate!

MEUL syndromeMEUL syndrome

Memorize Everything- Understand Memorize Everything- Understand LittleLittle

Very common and very problematicVery common and very problematic If you got away with rote If you got away with rote

memorization in college, you can’t memorization in college, you can’t now with soooooo much material!now with soooooo much material!

REMEDY: verify understanding after REMEDY: verify understanding after each major concepteach major concept

MEUL syndrome treatmentMEUL syndrome treatment

Divide content into “bite sized pieces”Divide content into “bite sized pieces” After each bite ( max 30 mts) use the split After each bite ( max 30 mts) use the split

brain study method, where the other half of brain study method, where the other half of the brain poses questions and challenges to the brain poses questions and challenges to your understanding- see if you have TRULY your understanding- see if you have TRULY understood what is going onunderstood what is going on

Delayed ignition study method- in the car, Delayed ignition study method- in the car, understand it before you turn on the engineunderstand it before you turn on the engine• Brief and IntenseBrief and Intense

General counselGeneral counsel

Get ahead and stay aheadGet ahead and stay ahead• Prereading and reading the SAME dayPrereading and reading the SAME day• Mental participation during lectureMental participation during lecture

– Core content guessingCore content guessing– Active listeningActive listening