I like to think of my ability to study as B.C. and A.C. – before child and after child. For the past 4 years (one in medical school and 3 in residency), I’ve juggled patient care and scholarship and spending time with my husband and our energetic son.
Once our son arrived, I had to become more efficient than I ever could have imagined. Having more than 4 hours at a time to study became a luxury, but I realized that I had mastered my personal method of studying and if I remained true to it, I could study in the time that life allowed.
Here are the top four things that I use to make my studying meaningful, efficient, and effective:
1. The Patient Comes First
I learn something new every day. Caring for patients is a privilege and an honor. Becoming a parent has made this point even more salient. Before most encounters with patients, I often pause and reflect to myself by thinking, “this is someone’s baby, cherish this child, be good to this family.” I let the patient guide my learning so that I can better care for him or her. I try to figure out what the most pressing needs of the patient are and if they are ones that I am not as well-versed in (for example, a new Down’s Syndrome patient with no regular annual follow-up and no prior imaging records), I start by reading the guidelines on caring for that patient and I often bring them into the room with me to show the family what I am using to guide my recommendations. I augment my basic understanding with resources such as Up-to-Date and a mobile app Epocrates for quick diagnosis and management pearls. For location-specific microbiology and drug resistance patterns, I use Epocrates Bugs + Drugs. During down time between patients I learn from and teach from Peds-In-Review articles on specific topics.
2. Learning Efficiently Means Learning the Way You Learn Best
Although lecture-based or didactic learning can be effective for some people, this type of passive learning doesn’t work for me. I often find my attention wandering and fatigue setting in during more formal didactic sessions, and at the end I find that I have retained very little. However, this is the main form of scheduled learning during medical school and residency.
During my first years of medical school, I experienced academic challenges because this method of education didn’t work for my learning style. I asked for help from one of my medical school deans at The George Washington University School of Medicine, and she sent me to Dr. Gigi El-Bayoumi, who taught me the science behind best practices in learning. She suggested that I assess my needs before I begin studying and do significantly more practice questions than I previously had been doing. I answered all of the free questions and modules on the USMLE website, and I purchased USMLE World.
Questions don’t just assess your understanding of a topic, they also assess your ability to read long question stems efficiently and answer targeted requests. Dr. El-Bayoumi helped me understand that I had been doing questions incorrectly. Prior to our meeting, I had been reading the entire question stem and then moving to the question – instead I should have been reading the question first and then skimming the stem, focusing on the pertinent information only. This practice greatly enhanced my studying and test-taking efficiency. I continue to start my studying with a personal “needs assessment.” Peds-In-Review articles are a great way to test self-knowledge, and they act as a swift kick in the pants if I don’t know as much as I need to. I start by doing the questions first, then reading the summary section and the article content – this is an effective way to split up the reading.
In contrast to my experience at medical school, my residency program at the University of North Carolina has included more interactive learning. At the daily morning report, when residents present a patient case to teach about the diagnosis or management of a particular condition, the presenting resident provides the history and physical exam and the audience of medical students, residents, and attending physicians asks questions and develops a problem list and differential diagnoses. I have done morning reports on topics such as pyelonephritis and ethical challenges in primary care such as obesity and dental caries. I have found that I remain more engaged during these sessions when I actively participate by chiming in, taking personal notes, or volunteering to be the official note-taker.
When I have eager learners to teach (such as medical students and interns), I find that their questions add another layer to my needs assessment. At any given moment, a team is composed of learners at varying stages of their training, for example, a senior resident going into primary care, an intern resident applying to cardiology fellowship, and a third year medical student with a PhD in Epidemiology. Each learner may ask questions about patient care from their vantage point, leading to additional questions for us all and highlighting knowledge gaps. I find using practice questions and answering them first individually and then as a group a great way to engage everyone, because each of us can explain why we chose a particular answer. This exercise allows us to augment our own understanding and ultimately care for the patient more holistically. It’s important to not just teach students and interns random facts but to focus on relevant topics and to teach them a very effective form of self-learning that they may not previously have been exposed to. At the end of these sessions, I ask everyone, “What is one thing that you have learned?” and it is always interesting to see what the different levels of learners absorb.
3. Enlist a Study Team
A theme you will by now have picked up on is that I ask for help before I need it. I became successful in medical school when I studied with similarly motivated students and when I vetted my study plan with a physician-educator who knew how to teach to learners with different styles.
In medical school, my study partners were two fellow students who are now both family medicine doctors. We would meet at our favorite small lecture hall every weekend and study from 7 AM until dinnertime. We would arrive with buttery breakfast sandwiches in hand, study separately, break the monotony with dance sessions, take nap breaks stretched out on rolling lecture chairs, teach each other topics we excelled in, and then go our separate ways at dinner time.
Motherhood added additional challenges to my already rigorous plans. I studied for USMLE Step 2 during my first trimester of pregnancy, and having study partners was crucial to my success. My study partners helped me focus and distracted me from my constant fatigue and nausea. They felt that I was a constant support and motivator. When we passed our exams, we celebrated our achievement together.
As I prepare for my pediatric boards in October, I’ve assembled a new study team, which includes two friends who completed residency last year, a friend who just finished residency with me, residency program administrators, and my husband.
This year, my residency program enlisted the assistance of our institution’s new Director of Medical Education, Dr. Carmela Meyer. In a small group setting, Dr. Meyer broke down our most recent In-Training Exam and provided general feedback for preparing a study plan. I reached out to her separately and reviewed my personalized study plan with her. She provided some great feedback and identified holes in my plan; for example, she liked that I had planned to do questions daily, but she suggested that I dedicate time for both timed randomized questions every week and then untimed periods to learn content-specific information. That leads me to my next tip.
4. Set Aside Time to Study
Coordinating time off from work, children, and quality time with family and friends can be hard — but it’s absolutely necessary if you’re going to find time to study. My husband is working on his dissertation and is one of the most disciplined people I know; he has set times for studying that revolve around times we have child care. I will be using my off-day (every Friday) for dedicated study time, learning efficiently while our son is in pre-kindergarten and nightly when he goes to sleep. Nightly, I will spend an hour doing content-specific Prep and Med Study practice questions online and using Laughing Your Way to the Pediatric Boards to study specific topics such as cardiology and nephrology. During my longer study sessions on Fridays or weekends, I will do timed practice tests of 60 randomized questions in an hour to simulate question blocks.
As Louis Pasteur said, “chance favors the prepared mind.” Whatever works best for you, get it done. And if you haven’t figured out how yet, ask someone with some experience. For me, that involves having a central patient-specific issue to guide content related studying, learning with methods that work best for me, having a team-approach to studying, asking others for what I need, and setting aside time to study.
What does learning efficiently mean for you? Have any of these methods worked for your learning style?
Jalan Washington Burton, MD, MPH, is a pediatrician at Children’s National Health Systems in Washington, DC.
This post is part of the “Lifelong Learning” series. Posts on this topic include:
A Mid-Career Perspective on Lifelong Learning in Medicine, by John Mandrola, MD
Keeping Up with Core Medical Knowledge, by Natalie Levy, MD
Keep Learning Even When You’re Not Studying for the Boards, by Sara Cohen, MD
I Studied for the Internal Medicine Boards on the StairMaster, by Monique Tello, MD