Category: All|Leadership & Mentorship|Learning Resources|Student & Physician Success|Study Skills & Memory

Are you using evidence-based study methods for your medical training? Medical students frequently ask each other which resources are used and how one studied for the last test. However, it’s infrequent they find useful information. The problem with this method, though it seems intuitive to begin here, is the significant difference between anecdotal and scientific evidence. In medicine, we often have to combat anecdotes about this vaccine causing that side effect or that holistic treatment curing this disorder. We understand how confirmation bias and the placebo effect can sway public opinion. Yet, when it comes to our own studying we often fall victim to the same lack of proper methodology in our study strategies. Here are the top study methods for medical students (and other healthcare students) according to the research. Mental Contrasting with Implementation Intention (MCII) Though the scientific description of this method requires a course just to say it properly, it is more colloquially known as the Wish-Outcome-Obstacle-Plan method or WOOP. This is a bit newer to the playing field than the others to be described, but early studies are promising. This method involves: Proper goal setting (wishes and desired outcomes). Imagining potential obstacles that may derail your plans (obstacle). Having a plan in place in case these obstacles arise (plan). Medical students shouldn’t take important board exams without running a few simulated exams. Similarly, we should also not wish to leave your life’s journey up to chance. If you have a preemptive study strategy already in place, these inevitable hurdles are less likely to derail your ultimate goals. Early studies showed WOOP to be beneficial in helping schoolchildren increase academic achievement. A more recent study involving anesthesiology residents demonstrated that WOOP significantly increased their study time compared to the goal-setting group. Though few studies have been done in medical education, setting and keeping goals in a very difficult process that requires constant maintenance. Any study method that may assist in monitoring in this process and keeping students on track is definitely worth a deeper look at. In my interview with Dr. Saddawi-Konefka, a co-author of the anesthesiology research above, he depicts the benefits of having a study habit in place. He also admits that the research is still pretty young, and WOOP may work better in some scenarios than others. He recommends the WoopMyLife website for more information and examples of how to implement this study technique. Education Trends Anyone that has listened to or read about mastering a topic has likely heard the misrepresented “10,000 Hour Rule”. It states that anyone can gain expertise in any topic with 10,000 hours of practice. Though the rule was based on a misinterpretation of the study, the actual research performed by Anders Ericcson regarding gaining mastery of a topic is quite powerful. He termed this method “deliberate practice”. Deliberate practice has achieved great recognition in many academic realms. Dr. Ericcson also has a particular interest in improving medical education. Luckily, this has been an area with a decent amount of research we can review. This evidence-based study method is more of a process than a singular action. It, too, involves goal setting, monitoring and self-assessment, pushing one’s boundaries, and mentorship. When using simulation-based education in medical education, follow up with deliberate practice was shown to be superior to traditional clinical education. Another study of internal medicine residents demonstrated a “dramatically increased” skill in advanced cardiac life support (ACLS) compared to the American Heart Association (AHA) course. Even high achieving pre-med students seemed to show stronger correlations to the tenants of deliberate practice. For any student struggling with overcoming plateaus in their studies, this is a great exercise for guidance. It also stresses finding a mentor when needed and getting out of one’s comfort level in order to achieve greater advancements. You can listen to this interview in which he speaks to the usefulness of this practice in medical education and as a study strategy. Interleaving The technique of interleaving has been expressed in several recent reviews of evidence-based study methods. In Make it Stick, the authors point out several scenarios where interleaving is superior to massed study (i.e.: cramming similar material). Megan Sumeracki of the Learning Scientists Podcast also discusses how different approaches of interleaving may be used by medical students and instructors. Interleaving has also been shown to increase long-term recall and help discriminate between concepts. So, what is interleaving? This is the process of “mixing up” your materials during a study session. For instance, instead of studying only anatomy topics on Mondays, Tuesdays for physiology, etc. a learner would interchange multiple topics. This can be described as going from AAABBBCCC materials to an ABCACBCA pattern. The exact combination can be experimented with but the point is to mix up the study materials each day. This may help to prevent a learner from assuming an answer based on the discipline being studied at the time. The exact scenarios and methods to optimize interleaving are still questionable. There are likely many nuances we have not yet studied. The goal of a medical student should be to study a broad range of topics frequently. Seeing similar topics viewed from different subject lenses may help them to distinguish easily confusable materials. Dual-Coding As far as evidence-based study methods go, dual-coding is an interesting one. It is less based on the method of studying and more on the method of study resource creation. Dual-coding is a method of encoding verbal and visual information independently, yet synergistically. The Learning Scientists state that the image should be meaningful to the material. For example, tables, charts, and graphs of the subject matter can assist medical students in making connections with the verbal material and data-based images. Though not always associated with the same evidence-based skills, medical mnemonics might fall into this category as well. Mnemonics have always been important as a study skill in medicine due to the quantity of information. However, most students rely heavily on acronyms to remember lists. Only in recent years have visual mnemonic techniques and mind palace study skills become more predominantly emphasized. Concrete Examples Using concrete examples (aka Concreteness Effect) may seem obvious, but it is an often-overlooked study skill. This study skill involves using specific examples to conceptualize abstract ideas. For instance, it may be difficult for early medical students to understand the complex functions of all physiological processes. Educators might use more obvious examples to explain the concept to and increase student comprehension. Instead of thinking of a lung inflating in the vacuum of the thoracic cavity, one might visualize a balloon inside of a two-liter bottle. If negative pressure is acted on the balloon, it will inflate inside the bottle as a lung does inside the body. For a demonstration of this example, watch How To Make Simple Lungs With Balloons. Spaced-Retrieval The term “spaced-repetition” is very common in medical student vernacular when discussing study habits. Though it actually means spacing out study reviews, this term is incorrectly used in combination to describe the Spacing Effect and Rehearsal practice. A more concise term would be “Spaced-Rehearsal” as they are often used in conjunction. Also, some programs, such as Anki Flashcards, incorporate both spacing intervals between studying and the recall of information into their design, which may lead to student confusion. This is why we have so named these as one study skill. Here are the parts of this powerful study combo. Spaced-Repetition The Spacing Effect is an evidence-based method that involves spacing out the distance between each review session of material already learned. For instance, a medical student may learn material today in class and review it once when they get home that evening. This is insufficient for proper long-term recall of information. Multiple repetitions will be needed for most medical students in order to retain the information until their board exams in the distant future. Using Ebbinghaus’ Forgetting Curve, we can see that the learned material is rapidly forgotten if not reviewed several times. Not only must there be multiple reviews, but there can be longer periods of time between each review. Each subsequent review strengthens the memory of the past allowing for more time to pass before the next is required. For this author’s preferred method, listen to the 11311 Method for spacing your review sessions. Rehearsal Practice Though not mandatory, the repetition portion of “spaced-repetition” is commonly done in the format of Retrieval practice. Rehearsal (aka Retrieval practice, Testing Effect) requires a learner to recall information from memory as opposed to reviewing notes or other materials. A flashcard, mind map, memory palace, or any other form of information storage can be recalled to stimulate the knowledge attached to that device. The key is to not allow triggering the information beforehand. A medical student should be able to recall the information or process with their eyes closed. No notes or study materials are allowed to assist the student’s recognition memory, which hampers true recall memory. This also can help one avoid the Illusion of Competence. Rehearsal practice can be used after each of the above-mentioned techniques for added strength! The strength of these skills has been made clear in several studies. For example, medical students that self-initiated in rehearsal practice outperform their peers on medical licensing examinations. Retrieval practice is also best utilized with multiple repetitions. This is why retrieving information at spaced intervals (Spaced-Retrieval) is one of the strongest combinations of learning strategies medical students can implement. Optimization There are few set-in-stone rules when it comes to learning, only solidified theories. Each individual will learn slightly different, have different resources, and better understand different topics. Each learner should only compete against themselves, not against their peers. To be your best self, it is important to stay healthy and maintain sleep hygiene. For some other great tips to maximizing your newly learned evidence-based study methods, I recommend Combining Effective Learning Strategies. With these tools, you can now better overcome personal learning obstacles and reach new levels of academic achievement.