Blog | Wednesday, November 5, 2014

Learning medicine and some principles for teaching


This New York Times article stimulated thoughts about teaching internal medicine: Better Ways to Learn. It reads: In the new book, “How We Learn: The Surprising Truth About When, Where, and Why It Happens” (Random House), Benedict Carey, a science reporter for The New York Times, challenges the notion that a high test score equals true learning. He argues that although a good grade may be achieved in the short term by cramming for an exam, chances are that most of the information will be quickly lost. Indeed, he argues, most students probably don’t need to study more—just smarter.

For most students, first 2 years of medical school are a survival hurdle of cramming, with a mad dash to pass step 1. Many third year students transform from memorization to learning. The principles of learning concepts in various ways come more naturally during the clinical years.

We must not conflate learning medicine with memorization. While we sometimes have to memorize some facts, most excellent physicians succeed through careful thought processes and understanding of physiology, anatomy, pharmacology, etc.

We who teach medicine have a responsibility to help our learners through a careful explication of our thought processes. Sometimes we should make our thought processes explicit; sometimes we should help the learners “discover” the thought process through Socratic questioning.

We must not assume that when we give a wonderful summary of a topic, that the learners have absorbed that topic fully. Again, the article states: Understanding how the brain processes, stores and retrieves information can also improve your study habits. For some people, cramming for a test can work in the short term, but by studying only once in a concentrated fashion, the learner has not signaled to the brain that the information is important. So while the initial study session of French vocabulary words starts the process of learning, it’s the next review session a few days later that forces the brain to retrieve the information—essentially flagging it as important and something to be remembered.

“When you are cramming for a test, you are holding that information in your head for a limited amount of time,” Mr. Carey says. “But you haven’t signaled to the brain in a strong way that it’s really valuable.”

If we want to help our learners, we must remember that they do need repetition. We have several ways to help them. One is a trick that Dr. Kelley Skeff taught me almost 25 years ago. At the end of a learning session (rounds, morning report, etc.) ask all the learners to write down their 2 most important points. The act of writing it down on a piece of paper enhances retention.

Perhaps more important, and difficult for many educators, we must willingly repeat our teachings. Our repetition may seem boring, but it is not to most learners. As an example, I regularly give several chalk talks during morning report. Having had some learners as third year students, fourth year acting interns, interns and residents, they tell me that each time I present the material they learn something new. They do not find the repetition boring, so neither do I. The purpose of teaching is all about the learners. We must do whatever helps them learn, and repetition works.

Finally, we should recommend that our learners read some each day. I tell students to write down a couple of things they heard or observed during rounds, and read about those topics. When the topic has relevance to patient care, the importance becomes obvious. And we do tend to remember things that we regard as important.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.