How to Succeed at Medical School - Dason Evans - E-Book

How to Succeed at Medical School E-Book

Dason Evans

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Beschreibung

Can you adapt to the wide variety of learning environments inmedicine? Can you show your best abilities in the exams at the same timeas learning to be a doctor? Can you balance your studies with an enjoyable sociallife? Can you develop your professionalism and manage your 'digitalfootprint'? How to Succeed at Medical School will help you learn thesevital skills, and much more. Written by experienced medical school teachers and packed full ofcase studies, illustrations, quotes from other students, tip boxes,exercises, portfolios and learning techniques to help youcommunicate, study and revise - it's an essentialresource to help you thrive at medical school. This thoroughly updated second edition includes new chapters onProfessionalism and Teaching, and provides invaluable insight intowhat to expect from the start of medical school right through tothe start of your medical career.

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Table of Contents

Cover

Dedication

Title Page

Copyright

About the authors

Foreword to the first edition

Introduction

Who is this book for?

What is this book for?

How will this book help you?

What is in it?

How to use this book

Summary

Chapter 1: What kind of learner are you?

Introduction

Aspects of learning

Learning styles

Summary

References and further reading

Questions and answers

Chapter 2: Learning knowledge

Introduction

How do I know what to learn?

The mind, memory and learning

Making notes

Learning environments

Application examples

Summary

References and further reading

Questions and answers

Chapter 3: Learning clinical skills

Introduction

How do I know what to learn?

Level of competence

Learning clinical skills

Frame of mind

Building a theoretical framework on how to perform a skill

Practise

Feedback

Learning in the clinical learning environment

Approach to patients

How to survive The Business Ward Round

Summary

References and further reading

Questions and answers

Chapter 4: Learning clinical communication skills

Introduction

Why learn clinical communication?

Assessing yourself and others

What are clinical communication skills?

Thinking about empathy

Thinking about diversity

Stereotyping

Summary

References and further reading

Questions and answers

Chapter 5: Working in a group

Introduction

Roles within a group

Group dynamic, group development

Other factors affecting learning in a group

Special cases

Summary

References and further reading

Questions and answers

Chapter 6: Developing your academic writing skills

Introduction

Plagiarism and referencing

Learning more

Summary

References and further reading

Questions and answers

Chapter 7: Portfolios and reflection

Introduction

What is a portfolio?

What is a portfolio useful for?

The basic structure of a portfolio

Special cases: e-portfolios

Making your portfolio work for you

Assessment of portfolios

Reflection

Reflection as a preparation

Solo or group reflection?

Summary

References and further reading

Questions and answers

Chapter 8: Life–work balance

Why is it important?

Time management

Seeking help

Relaxation tips from students

Summary

References and further reading

Questions and answers

Chapter 9: Revision

What is revision?

What kind of techniques?

Draw up a plan

Three student commentaries on revision

Organise your space

Revising knowledge

Revising clinical and communication skills

The connection between smell and memory

General hints and tips

What if I fail?

Summary

References and further reading

Questions and answers

Chapter 10: Exam technique: general rules

Introduction

Preparing for the exam

During the exam

After the exam

Messages from the other side

Chapter 11: Exam technique: specific examples

Introduction

Types of exams

Summary

Acknowledgements

Getting the best out of short answer questions

Getting the best out of the OSCE

OSCE technique

Suspension of disbelief

Getting the best out of workplace-based assessments (WPBA)

The viva

Summary

References and further reading

Questions and answers

Chapter 12: Teaching, mentoring and coaching: helping others to learn and develop

Introduction

An introduction on how to teach

Before teaching

After teaching

Motivation for teaching, curriculum considerations and unexpected outcomes

Mentoring and coaching

What is mentoring?

Finding the right mentor

Being a mentor and finding the right mentee

What to work on in a mentoring/coaching arrangement

Using a mentoring model

References and further reading

Questions and answers

Chapter 13: Professionalism: not as straightforward as you think

Introduction

What is professionalism?

Case studies

Professional boundaries and power imbalances

Assessment of professionalism at Medical School

Assessment of professionalism by the GMC

Acknowledgements

References and recommended reading

Questions and answers

Chapter 14: Thinking ahead: student-selected components, careers and electives

Careers in medicine

Student-selected components/modules

Electives

Summary

References and further reading

Questions and answers

Index

End User License Agreement

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Guide

Cover

Table of Contents

Foreword to the first edition

Introduction

Begin Reading

List of Illustrations

Chapter 1: What kind of learner are you?

Figure 1.1 Summary.

Chapter 2: Learning knowledge

Figure 2.1 Planning self-directed learning.

Figure 2.2 Finding the right depth to study can be difficult.

Figure 2.3 What is clubbing? Clubbing is a physical sign, a favourite of clinicians, where the bed of the nail is swollen, so that the finger nail or toe nail, rather than sliding downwards into the digit looks like it slopes in the opposite direction.

Figure 2.4 Key phrases.

Figure 2.5 A concept map.

Figure 2.6 MindMaps.

Chapter 3: Learning clinical skills

Figure 3.1 Different levels of proficiency are required for different skills.

Figure 3.2 The Evans–Brown model for learning clinical skills.

Chapter 4: Learning clinical communication skills

Figure 4.1 Patient-centred clinical interview.

Figure 4.2 The Calgary Cambridge Guide: a guide to the medical interview.

Chapter 6: Developing your academic writing skills

Figure 6.1 Overview of essay writing.

Chapter 7: Portfolios and reflection

Figure 7.1 Structure of a portfolio.

Figure 7.2 The reflective cycle (Gibbs, 1988).

Chapter 8: Life–work balance

Figure 8.1 The stressed student demonstrates the fight/flight response.

Figure 8.2 The stress/anxiety cycle.

Chapter 11: Exam technique: specific examples

Figure 11.1 Process for answering extended matching questions.

Chapter 12: Teaching, mentoring and coaching: helping others to learn and develop

Figure 12.1 The teaching cycle.

Figure 12.2 A basic Lesson Plan.

List of Tables

Chapter 2: Learning knowledge

Table 2.1 Bloom's levels of knowledge

Chapter 3: Learning clinical skills

Table 3.1 Benner's model of levels of achievement.

Table 3.2 Potential learning opportunities.

Chapter 4: Learning clinical communication skills

Table 4.1 Model on information giving.

Chapter 5: Working in a group

Table 5.1 Advantages of working in a group.

Table 5.2 Disadvantages of working in a group.

Table 5.3 Belbin's model of team roles.

Table 5.4 Bruce Tuckman's four stages of team development.

Chapter 8: Life–work balance

Table 8.1 Activity sheet.

Table 8.2 Weekly timeTable planner.

Table 8.3 Physical changes taking place when stressed.

Table 8.4 The different physical responses of stress and relaxation.

Chapter 9: Revision

Table 9.1 A sample revision timeTable from a third-year student revising the heart.

Chapter 10: Exam technique: general rules

Table 10.1 Examples of students not reading the questions properly.

Table 10.2 Examples of highlighting key points in exam questions.

Chapter 11: Exam technique: specific examples

Table 11.1 Be clear on what is being asked of you.

Table 11.2 General rules of thumb for SJT.

Chapter 12: Teaching, mentoring and coaching: helping others to learn and develop

Table 12.1 Three educational philosophies.

Table 12.2 The continuum between learning and teaching.

Table 12.3 Gagnés' instruction events.

Table 12.4 A range of approaches to evaluating teaching.

Dedication

To Geert and Jerry, for their support and patience, without which this book would never have been written.

How to Succeed at Medical School

An essential guide to learning

 

SECOND EDITION

 

Dason Evans MBBS, MHPE, FHEASenior Lecturer in Medical EducationHead of Clinical SkillsBarts and the London School of Medicine and DentistryQueen Mary, University of London,London, UK

 

Jo Brown EdD, MSc, BSc (Hons), PgCAP, SFHEAReader in Medical EducationReader in Medical EducationAcademic Director of the Student ExperienceCentre for Clinical EducationSt George's, University of LondonLondon, UKxs

 

 

 

This edition first published 2015 © 2015, by John Wiley & Sons Ltd.

First edition © 2009 by Blackwell Publishing Ltd

BMJ Books is an imprint of BMJ Publishing Group Limited, used under licence by John Wiley & Sons.

Registered Office

John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK

Editorial Offices

350 Main Street, Malden, MA 02148-5020, USA

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For details of our global editorial offices, for customer services, and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell.

The right of Dason Evans and Jo Brown to be identified as the authors of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book.

Limit of Liability/Disclaimer of Warranty: While the publisher and author(s) have used their best efforts in preparing this book, they make no representations or warranties with respect to the accuracy or completeness of the contents of this book and specifically disclaim any implied warranties of merchantability or fitness for a particular purpose. It is sold on the understanding that the publisher is not engaged in rendering professional services and neither the publisher nor the author shall be liable for damages arising herefrom. If professional advice or other expert assistance is required, the services of a competent professional should be sought.

Library of Congress Cataloging-in-Publication Data

Evans, Dason, author.

How to succeed at medical school : an essential guide to learning / Dason Evans, Jo Brown. – Second edition.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-1-118-70341-0 (pbk.)

I. Brown, Jo, 1957-, author. II. Title.

[DNLM: 1. Education, Medical–methods. 2. Learning. W 18]

R737

610.71′1–dc23

2014049428

A catalogue record for this book is available from the British Library.

About the authors

Dason Evans and Jo Brown have worked together on and off since 2000, initially at Bart's and the London School of Medicine and Dentistry where they were awarded the Drapers Prize ‘in recognition of the exemplary practice and innovation for enhancing the quality of learning and teaching’, and subsequently at St George's, University of London, where they were appointed joint Chief Examiners for OSCEs. They have an international reputation for their work supporting students in academic difficulty and this expertise brings insights to this book, which will benefit all students. They are recognised for their student-centred approach to learning and their passionate advocacy for the need to empower students to make the best use of the learning opportunities open to them.

Dr Dason Evans is a Senior Lecturer in Medical Education and Head of Clinical Skills at Bart's and the London School of Medicine and Dentistry, Queen Mary, University of London. He is following a career in medical education and works clinically in sexual health. He has been working formally in medical education since 1999 and teaching and supporting students since 1995. Dr Evans has strong interests in clinical skills learning, teaching and assessment and learning within the clinical environment. Through his fellowship of the Higher Education Academy (HEA), and active contribution to the Association for the Study of Medical Education (ASME), the Association for Medical Education in Europe (AMEE) and external examining duties, he has a clear understanding of the current culture in health professional education. His research interests include clinical skills, preparation for practice, students in academic difficulty and education around sexual health. He has also co-authored a book on learning in the clinical environment and, with Jo Brown, a book chapter on academic support.

Dr Jo Brown is Reader in Medical Education and Head of Clinical Communication at St George's, University of London as well as being Academic Director of the Student Experience. She began her career in nursing and management and has been teaching since 1992. She has specialised in Clinical Communication since 1998 and her passion for the subject is infectious. In 2012, she won a prestigious National Teaching Fellowship award from the Higher Education Academy. She has a particular interest in providing academic support for students who struggle or fail while at medical school. She is a curriculum designer, examiner and an external examiner, and has spent 2 years visiting medical schools in The Netherlands and Canada to explore different conceptualisations of medical education. She is an experienced mentor of teachers in higher education and runs courses on teaching and learning techniques. She has developed and delivers postgraduate courses for senior doctors on the use of advanced clinical communication in everyday clinical practice. She is a member of the Association for the Study of Medical Education and is a Senior Fellow of the Higher Education Academy. Her research interests centre on the movement of learning from classroom to clinical environment and the challenges to learning in the clinical workplace.

Foreword to the first edition

Throughout the working career of a doctor, keeping up to date is a major factor in providing good care to patients. This book aims to help undergraduates learn some of the huge number of different skills required to distil new facts and new knowledge in order to keep ahead with their learning for the rest of their professional life. It is a most unusual book in that it is written to help students develop their own skills and awareness around learning. It does not contain factual knowledge but is about the skills required to cope with medical school. It covers aspects of learning such as cognitive skills, motivation, self-regulation of study skills and the actual ‘concept’ of learning rather than the content for knowledge. It helps aid students to learn effectively and efficiently and even tells you how you will know when you know enough!

It does this in sections about knowledge, learning clinical and communication skills, learning how to work in a small group and, lastly, it even gives helpful advice on ‘examination technique’! There are helpful suggestions about reflecting on the type of learner the student is and how to revise for examinations. Above all, it discusses the broader issues about ‘living’ and how to achieve a good life–work balance. It also helps with the aspirations of students and guides them to think about the future and the type of career they might like.

Although the authors say that they have written this book for students about to embark on a medical course and younger medical students, this book would also help those involved in ‘teaching’ health-care professionals. It certainly would have saved me a lot of time learning how to get through a medical course.

The authors both have a vast experience in this area and much of their book has been gleaned from first-hand experience. I certainly enjoyed reading it and would recommend it to all students and teachers.

Parveen KumarProfessor of Medicine and Education,Bart's and the London School of Medicine and Dentistry,Queen Mary College,University of London

Introduction

Who is this book for?

You may be reading this book because you are thinking of joining a medical course or because you are in the first few years of training. In this case, you will find this book particularly useful in helping you manage the transition to new ways of learning. Moreover, this book will be of interest to more senior students and may be of interest and relevance to students of other health professions and academics involved in their learning.

What is this book for?

Learning how to learn effectively and efficiently

During your years at medical school you will buy plenty of books. Almost all these books will cover what you need to know. This book is different, it concentrates on how to learn effectively and efficiently while at medical school and beyond. There is good evidence that helping students develop their awareness of how to learn and helping them develop a variety of learning techniques results in large improvements in performance.

Medical school is different

The learning environment at medical school is fundamentally different to secondary school or other university courses. You are expected to learn a huge amount of diverse information, ranging from Anatomy to Ethics, to become proficient in many new skills, ranging from taking blood to breaking bad news, and to be able to integrate skills with knowledge in order to work with a patient to make a diagnosis and management plan. You are expected to learn much of this without being specifically taught it. You are expected to be able to find out what you need to know and to learn it to an appropriate level, often with little support.

How will this book help you?

This book works on two levels. On the first level, it offers advice on how to learn most efficiently (study skills). This is divided up into four sections: Learning Knowledge, Learning Clinical and Communication Skills, Working in a Group and Exam Technique. On the second level, it aims to get you thinking about how you learn and when it might be best to use which study skills. This is embedded within these four sections and covered in more depth in four other sections: What Kind of Learner Are You?, Life-Work Balance, Revision and Thinking Ahead. By reading and working through this book you will gain not only a wider range of study skills, but also an awareness of when to use them in your learning.

What is in it?

An overview of the sections

The book starts with a chapter called What Kind of Learner are You?, which introduces a simple overview of learning style, helps you to think about what your preferred learning style is and how this might influence your learning. For example, you may be a perfectionist, wanting to understand the deepest nuances of everything that you learn—if this is the case, you may have trouble knowing at which point what you have learned is good enough and when to move on to the next thing to learn. By contrast, you might be a crammer, great at filling your head with facts for a few weeks before your exams, ready to forget shortly after—if this is the case, the volume of study may well overwhelm you, however good your short-term memory.

The chapter on Learning Knowledge covers how to make the most of lectures, including taking lecture notes; what sort of books to use and how to learn from them, through effective note taking, reviewing your learning and testing yourself, how to sift out the rubbish from the Internet and search effectively using IT, making the most of the library and how to find appropriate review articles from journals that give the most up to date view.

In the chapters on Learning Clinical Skills and Clinical Communication Skills, we offer guidance on how to be self-directed in learning these skills, how to make the most out of simulation and how to capitalise on the richness that learning with patients offers. We specifically cover the clinical learning environment, as many students find the clinical setting (hospital wards, general practice) a very different and unstructured environment to learn in, we discuss how to get the most from your clinical tutors and where some of the hidden learning opportunities are. The ward round as a learning opportunity gets a special mention. With respect to clinical communication skills, we present an evidence-based approach and advice on learning both in simulation and in the clinical environment: learning both by doing and also by watching others. New in the second edition, we highlight the role of empathy and the ways in which diversity affects our practice and include a new section on how to give information effectively. We discuss the essential nature of feedback, both how to give effective feedback and also how to receive it, and how to act on it. Finally, we cover the patient presentation, a common cause of anxiety among both medical students and their supervisors. Throughout both chapters, we make no apologies for repeatedly stressing the primacy of patient care.

Much of the learning in medical schools in the United Kingdom is through Working in a Group. Working and learning in a group is inescapable in medicine and this section starts with a discussion on the pros and cons of group work and how to get the best from it. It specifically discusses Problem-Based Learning (PBL) and its variants, informal learning groups and how to make interprofessional learning work.

Students at medical school often struggle with developing an Academic Writing style, referencing appropriately and concepts of plagiarism. We give an introduction to these areas in a dedicated chapter, which we hope will start you off with safe foundations.

Portfolios and Reflection are inescapable in undergraduate and postgraduate medical education, and the chapter on the subject provides a pragmatic overview on what portfolios are, how to make them work for you and demystifies some of the concepts of reflection.

For the rest of your life, there will be too much to do at work and too much to do at home. Balancing social and professional lives forms a recurring theme in research about stress in doctors. The chapter on Life–Work Balance provides some guidance into how to manage both a healthy social life and a healthy study life and, most importantly, will help you get into good habits right at the start of your professional career. Both time management and stress management are covered here.

The chapter on Revision builds on and summarises the principles from the previous ones, discussing how to manage the learning environment, prioritising, planning and timetabling and managing stress. This chapter, above all others, offers wholesome, sensible advice on how to manage the limited time running up to exams.

The chapters on Exam Technique cover generic advice about how to approach exams, lists the different kinds of assessments that you might face at medical school and then offers specific advice on how to make the most from each of these. It includes how to do your best in multiple-choice, extended matching question exams, data interpretation questions and how to survive the OSCE or clinical skills exam. We discuss coping mechanisms that do not work, alongside those that do and advice on how to manage exam stress. New in this edition is specific advice on the latest trend in assessment—the dreaded ‘Situational Judgement Test’ (SJT)—which should help you prepare effectively and recognise what the questions are actually looking for.

Increasingly, medical students are involved in formal and informal teaching of others. The new chapter on Teaching, Mentoring and Coaching helps guide you through this, linking clearly from the chapters on how students learn, in order to explain how you can help others learn.

In this second edition, we provide a new chapter on Professionalism. Professionalism is the very foundation of medical practice and this is mirrored throughout this book. Professionalism is not separate, but integrated within each chapter. Whether it be learning effectively, encouraging life-long learning, concepts of referencing and plagiarism or a strong emphasis on learning in order to provide excellent care for patients, rather than to pass exams, you will find little in this book that will not count towards your developing professionalism. What this chapter specifically covers is how to learn professionalism, how it is assessed and some of the dilemmas around professionalism, particularly the quagmire that is digital professionalism. We hope that this chapter will help you to review and actively manage your ‘digital footprint’. In addition, it may stimulate you to become involved with this emerging, rapidly changing field.

Finally, the chapter on Thinking Ahead: Selected Study Components, Careers and Electives offers some thoughts about longer term planning of learning—including which optional components of your course to choose, which electives to go on and some discussion on how to check out which career in medicine might be right for you.

How to use this book

This book has been written to provide a whole view, but each chapter has been designed to stand alone, with considerable cross referencing. Whether you prefer to start at the beginning and read start to finish or dip in and out, both approaches will work. We highly recommend that you read with some rough paper handy and actively engage with the few exercises that you will find in most chapters—it will be easy to skip them, but your understanding and learning will not be as deep if you do. Teaching on learning styles (what kind of learner are you) and on life–work balance is often unappealing. We have worked hard to make these chapters relevant, interesting and practical; they are fundamental and we would strongly encourage you to give them a go.

Summary

This book will not teach you what you need to know to be a doctor. However, by using this book actively you will learn how to study more effectively and efficiently at medical school, how to balance studying with an enjoyable social life and how to show your best abilities in the exams. In other words, this book will show you not only how to survive but also how to thrive at medical school and how to enjoy learning for the rest of your life.

Chapter 1What kind of learner are you?

Overview

This chapter forms a foundation for the rest of this book. It will help you become aware of your learning preferences and the factors that tend to affect your learning. This awareness itself will be useful to you, both with respect to planning your learning and with respect to highlighting which chapters of the book you are likely to find particularly important. We have tried to give a brief overview of the most important factors and have tried to encourage you to make some judgements. You might want to revisit this chapter when you have finished the book to see if your impressions have changed.

Introduction

This chapter might be quite tough to work through. It asks you to take time away from reading to think about the things that affect your learning. The temptation will be just to read on; however, you will benefit considerably from having a few sheets of paper handy and trying to answer each question. Concentrate on each brief exercise and answer it as best you can, it will make the information sink in much better. At the end of the chapter, we have put a summary diagram, which we hope will highlight where you have assessed your strengths and weaknesses.

We will cover the following aspects of learning:

cognitive aspects (how

deep

is your learning?)

motivation (what

drives

you to learn?)

self-regulation of study skills (are you

aware

of how you learn?)

how do you know when you know enough?

conception of learning (what you think learning is for?)

learning in groups (love it or hate it)

mood and learning (a help or a hindrance)

VARK (your preferences in using your senses in learning).

You may want to have a brief break after each section, as there is quite a bit to think about.

Aspects of learning

You may have already completed learning style inventories or psychometric tests to try and define what sort of learner you are. There are all sorts of different learning styles and each tends to look at slightly different aspects of learning. The authors of the learning styles inventories claim that greatness can be reached by understanding how you think and learn, using their learning style inventory of course. Our aim is more modest—we hope that by thinking about how you learn, you will become aware of what aspects of learning you will find easier and where the challenges might lie ahead for you.

Filling in a learning style questionnaire was fantastic, it helped me realise the kind of learner I am and build on my natural style.

Jo, first-year graduate entry student.

Cognitive aspects

This refers to the way that you go about building new information into memories—how much do you skim over the surface or how much do you struggle to really understand? How well can you remember something that you have learned? For how long?

EXERCISE

Think about a topic that you learnt really well. How ‘deep’ was your learning? How much did you think about how your new learning linked in to what you knew already? Did you learn to understand or did you learn to memorise? Which do you find easier?

Make a judgement call, on the line below. Where would you put yourself?

If you have a preference for memorisation (the left-hand end of the line), then you will do very well with some things—drug names, anatomy, tests that ask you to regurgitate facts—but you are likely to struggle more on those tasks that require a deep understanding or application of the facts; unfortunately, a good amount of research indicates that students scoring towards the right tend to do better at medical school. You might think about some strategies to encourage you to shift more to the right, and in Chapter 2 (Learning Knowledge), we will go through some of these. If you tend to memorise as many facts as possible shortly before exams, forgetting them shortly after and have an easy time the rest of the year, then you will run into trouble with the volume of work in medicine and will need to start working regularly; this might be a challenge for you.

We give more tips on encouraging deep learning in Chapter 2, and advice on timetabling and regular study in Chapter 8.

Motivation

What makes you learn? Do you learn for interest, or perhaps to pass exam or even to please others? Some medical students learn best because they are fascinated by the science of medicine, others learn best when they can see the practical application of their learning and a few learn best when someone is standing over them pressurising them.

EXERCISE

Spend a minute thinking about what motivates your learning. You might want to spend some time talking with your friends about this, be honest with yourself. As you come to a decision, think about how you might make use of this insight.

I am most motivated to learn by:

If you find the

science fascinating

, spend a couple of hours each week in the library looking at the journals—

Nature

, The

Lancet

. When learning about diabetes, you will want to read about insulin receptors, about the pathology, about the underlying mechanisms by which diabetes causes increased cardiovascular risk, in addition to the core areas that you

need

to learn. The commonest pitfall if you are this kind of learner is that you might have some trouble with knowing when to stop reading and when enough is enough—you cannot have a PhD level of knowledge on everything in medicine; we discuss tactics to manage this in

Chapter 2

.

If it is patients and the

practical application of knowledge

that does it for you, you might find some of the bookwork in medicine rather dull and difficult to digest. Spend time thinking about practical applications. If you are learning about dry biochemical pathways, read also about clinical presentations of patients with problems in those pathways. You can look for case studies or even patient videos online that are relevant to your learning. You will want to buy some clinical textbooks early, so that you can read around clinical features of diseases. When learning about the pathology of the cervix, have a read about cervical smears, about the diagnosis and treatment of cervical cancer, think about how what you are learning will affect the care you give to patients. You might ask a friendly gynaecologist if you can sit in on their colposcopy clinic. See as many patients as possible and read about the conditions that you have seen—you will remember information much more clearly if you can link it in your memory to a patient you have seen.

Many students are most highly

motivated by exams

. If this is you, then look up the exam structure early in the year—look at the objectives, plan how you will cover them. Use past questions to structure your learning and to test yourself, write your own, learn in a group and write tests for each other. The revision section of this book will appeal to you (

Chapter 9

) and also some of the study strategies in

Chapter 2

.

Does

‘knowing that you’ve done a good job'

motivate you to learn more? For many of us, praise and reward are important. If it is a major driver for you, you might want to be pragmatic in some of your learning. If you are sitting in an asthma clinic next Thursday, then learn about the management of asthma before then. You will feel like you understand what is going on, you will ask sensible questions and the clinician in clinic is likely to be impressed—this will motivate you to study more. This simple technique works exceptionally well!

There are a few students who thrive on

external pressure

. They love teachers who intimidate students, whereas most of their peers tend to hide in threatening environments, they thrive in them. If this is you, then you might want to try and create situations that will drive you to learn. Agree deadlines with tutors or your peers, agree to teach students in your year or the year below; encourage them to try and catch you out, so that you know that you will have to learn your topic well.

Of course, you will not fit singly into any one of these five vignettes, but you will know which ones apply most to you. You are also likely to find that different topics might have different motivations for you. Clearly, there will not be a single strategy that applies to you. You cannot only read about the conditions that you have seen patients with or you will never learn about the rare ones. Similarly, if you are 100% examination focused, you might miss out on the things that are important but not examined. However, knowing and manipulating what motivates you in order to maximise your study is a key skill. It might even be worth pinning a note up on the wall above your desk, reminding you of what motivates you.

Self-regulation of study skills

Students who are aware of how they are learning (this is called metacognition) tend to perform much better than those who do not. This book is largely about helping you develop effective study skills and an awareness of when and how to use which ones. How aware of your learning are you? How consciously do you make choices in how you learn? Did you use different methods to learn different topics at school? If not, why not? The more you can learn to think about how you are learning, the more you will develop as an effective learner.

EXERCISE

Think about the following tasks. Spend 2 minutes on each task thinking about how you would go about it. Time yourself; it will be time well spent.

You have a list of complications of diabetes to learn.

You have to memorise a list of drug names for treating high blood pressure; the names all sound rather foreign to you.

You have to learn the surface markings of the various lobes of the lungs so that you know which one is where when you are examining a patient.

You have to learn how to take blood.

How easy was it to plan how you would go about each task? Was your plan for each task different or the same? Did you have several options for each task or just one? The more options and the more active your decisions, the easier you will find learning. If you tended to think of just one method of learning (‘I would just keep repeating it until I remembered’ or ‘I would just learn it’), then you are likely to benefit from spending extra time on Chapter 2 and it might be worthwhile finding out if there are some study skills workshops run by your university. Improving in your study skills is an investment that will really pay off.

Learning how to learn was the most important thing I got from medical school, unfortunately I didn't realise this until the second year!

Rebecca, finalist.

How do you know that you know enough?

The A-level syllabus that you studied was well defined, in terms of both breadth of topics and depth that you need to go to in each topic. This is not so true at medical school and, as we have already mentioned, knowing when to stop can be a challenge. Some students are excellent at monitoring their progress and use the sort of tricks that we discuss in the chapter on learning knowledge (Chapter 2), but others either tend to learn far too much (and run out of time) or learn far too little.

EXERCISE

Think for a minute how you know when you have learnt enough on a topic. What evidence do you use that you know something?

This evidence that you rely on to know that you know enough on a topic may be objective, subjective or ‘non-evidence’. Objective measures might include testing yourself from a book of past questions, or writing questions before you start learning from the course objectives and seeing if you can answer them when you think that you have finished learning; perhaps you try and explain it to someone else and see if you can answer all their questions. More subjective evidence will include others telling you that you are knowledgeable or perhaps you make a judgement that you can now understand something that previously you found rather complex, perhaps you look at the learning objectives and make a judgement on whether you have covered them. Non-evidence tends to be pretty useless, it includes judgements such as judging the number of hours that you have looked at a page, or how many books you have on the subject or how tidy your notes look as some ‘guesstimate’ of how much you have learnt.

You are likely to use a blend of these three approaches, and students who tend to cross-reference objective and subjective measures are likely to have a far more accurate idea of where they are up to in their learning. Students who use non-evidence tend to be rather surprised when they fail exams—‘but I spent hours looking at the books’ or ‘but my notes are always so perfect’.

Conception of learning

What is learning for? What is learning about? Do you see learning as a passive increase in knowledge or perhaps as memorisation of facts; perhaps you see learning as a way of gaining information that you can apply in practice or perhaps you learn in order to try and make sense of the world around you. Students who tend to try and make personal meaning out of what they learn seem to be more motivated and achieve deeper learning.

You might have left secondary school thinking that learning was about getting facts into your head. If so, you should be aware of the transition in higher education, where you will be expected to question, debate and weigh up different, conflicting evidence in order to try and make some sort of sense of the information in front of you and how it relates to the world around you. You can speed that transition by questioning yourself: asking ‘What if…?’ or ‘Why…?’ and ‘What use is this information?’.

As an example, when you are learning about diabetes, you might ask yourself ‘what if diabetes was not a disease that either you had or you did not have, but a continuum between normal blood sugar and damagingly high blood sugar?’ Perhaps you will ask ‘why is the threshold for diagnosing diabetes a fasting sugar of 7.0 mmol/L and not 7.4 mmol/L?’ If you have a very concrete idea of facts, valid questions like these might be uncomfortable. It is better to have this discomfort and learn to manage it early on, rather than later in your career. You might have to trust us on this one!

Learning in groups

Collaborative learning has its pros and cons. Some students feel that they can only really learn through discussion and debate with others and they tend to struggle to find people with whom you can discuss everything that you have learnt. If this is you, you will benefit from reading the chapters on study skills (Chapter 2) and revision (Chapter 9). In contrast, some students find that they hate to study with others. These students tend to struggle to know whether they are learning to the right depth and they really struggle with clinical and communication skills learning, as feedback from peers and peer practice is crucial. If you fit into this group, the chapters on clinical and communication skills learning (Chapters 3 and 4) and working in a group (Chapter 5) will be particularly relevant to you.

Mood

Mood affects learning. Have you ever been so angry or frustrated that you were unable to study? Or so passionate about a subject that everything you read seemed to make sense? ‘Feeling’ can be intimately involved with ‘thinking’?

EXERCISE

Mark on the line where you imagine you lie between the two extremes.

Are there things that particularly swing you one way or another along this line? Some people find certain triggers throw them into emotional responses; guilt, for example, drives some to study but handicaps others. How about anxiety? Do you spend too much time worrying about the things you have not done rather than getting on and doing them?

What if you are on the other end of the scale, emotion never affects your thinking and learning, would you be missing out on the passion, the buzz of knowing that you are ‘on a roll’? How will you develop empathy if you cannot see how emotion affects people's decisions (logically, surely everyone should agree to take part in medical research)? What about teamwork skills—how will you relate to others if you cannot see the emotional contexts in which they exist?

Think about where you are on the line and consider at what point on that line you might be more productive. Spend some time considering how you can actively manage the triggers and swings to be a little more productive a little more of the time. We have worked with many students and the simplest strategies are usually the best—a young woman whose studying used to be distracted by regular family crises moved out of home. When phone calls replaced knocks on her bedroom door, she discovered that she could switch off her phone while she was studying and she could study with a clear head.

Sometimes emotion clouds all your thoughts, and that is a time to get help. Indeed, everyone will struggle with the way that they are feeling and the way that affects their work at one time or another in their careers. In Chapter 8, we talk about avenues to ensure that you gain support when you need it.

VARK: using your senses

Think about incense. What comes immediately to mind? For some people they will see something relating to incense—perhaps the smoke curling up from a burning pot. Others will hear something—perhaps the ringing noise that an incense burner in church makes when it is swung or the word incense being said. Others might see the word as it is written, perhaps think about the different meanings of the word: ‘pieces of fragrant substance’ or ‘to infuriate’. Finally, you might think about the movements that you would make to light or to swing the incense around.

It seems that some people have a visual preference, others an auditory or aural preference. Some prefer to read or write things to learn them and others have a strong kinaesthetic preference—that is physically to do things. The VARK learning style has come up for criticism, but it has some uses. Look at the following descriptions and think of how much they each apply to you.

Visual people will like to use colour and shapes, and they draw flow charts and like to have everything in sight in front of them. They like books that are visually appealing, with small blocks of text, plenty of tables and diagrams. They might find learning visual topics like anatomy much easier than memorising lists of words.

Aural people like to listen, they think that lectures are better than books and like it when someone explains things to them in words or they explain to others. They remember the anecdotes from the lecture, or what that patient said and sometimes they forget to write things down as they are too busy listening. They are not fond of books and tend to read books by forming the words in their heads. Sometimes their lips move when they are reading.

Those with a read/write preference tend to like books and texts and lists. They might copy out chunks of text from the book to form their notes, which are often quite lengthy and quite dry. They are good at spelling and can remember lists of words. They might look at a foreign word and work out what it means from similar words that they know.

Kinaesthetic learners like to learn by doing. They like practical applications—‘this goes there’. Real-life examples are great and learning by trial and error really consolidates their learning. Abstract things are more difficult for them and they strive to think of applications for what they are learning.

EXERCISE

For each of these preferences, rate whether you think that you are strong (you often think and learn in this way), average (you sometimes think and learn in this way) or weak (you rarely think or learn in this way)

Weak

Average

Strong

Visual learning

Aural/auditory learning

Read/write learning

Kinaesthetic learning

Most people have a preference: some have strong preferences, others have a more even spread.

Think about your preferences, your strengths. This will give some indication of the sorts of tasks and subjects that you will find easiest. Think about how you can capitalise on your strengths:

If you are a visual person, are you making best use of colour and pictures? Would you be better making your notes on a pad of A3 rather than A4 so that you can see more in one glance? Do you take one of those 4- or 10-colour pens into lectures with you? If not, why not? Do you try and convert difficult concepts into flow charts or cartoons? You will like the section on concept mapping in

Chapter 2

.

If you are an auditory person, then do you make the best use of lectures, sitting near the front, away from distractions? Have you tried using tapes or reading your notes out loud? Do you ever put difficult facts to music to help you remember? You will find teaching and explaining to others really useful. How about starting a study group or a debating society?

If you like the written word, you can write brief descriptions of diagrams or flow charts. You can change the words that your notes are written in, choosing your own words, so that you are sure that you are processing the information. You can write down patient stories, make lists and write essays. You might well like studying in libraries. Perhaps you could start an online group with others from your medical school or other medical schools where you explain things to each other on a message board or wiki.

If you have a kinaesthetic approach, you will want to find practical applications for what you are learning. Get out there and do things—if you have seen a patient with a diabetic foot ulcer you will find it much easier to read about it. Apply what you have learned whenever you can, search for relevance. Use your imagination and imagine things happening when you read about them.

Think also about your weaknesses and how you can address them. There are two main approaches here. First you can try and redesign the task to play to your preferences. If you have to memorise a list of drug names and you are terrible at ‘read/write’ but strong on auditory memory, make up a song or a poem and sing it out loud. If you have a preference for visual things, turn the words into pictures: the drug zopiclone might become a number of identical (clones) Z-shaped floppy aliens (zoppy), all sleepy in bed (zopiclone is a sleeping pill).

The second way that you might address your weaknesses is to train yourself to be stronger in these areas. Timetable extra time for the tasks that you might find challenging, and ask your peers what tricks they use. You can find others with similar preferences to you (the incense exercise is a good one, although lots of people say ‘the smell’, which does not fit well into VARK, but is discussed more in Chapter 9) and find out how they learn. If, as a group, you all hate learning vocabulary then at least you can empathise when you are testing each other on drug names—you will most likely learn at a similar rate.

You can find out more about VARK at www.vark-learn.com or by typing VARK into your favourite Internet search engine. There is not a huge amount of evidence for VARK over any of the other dimensions of learning listed above but, like the others, it is useful to help you think about where your strengths and weaknesses lie, how you can capitalise on your strengths and actively manage your weaknesses.

Learning styles

As we mentioned at the start of this chapter, different learning style inventories tend to measure different combinations of the aspects of learning that we have listed. If your medical school has a progressive curriculum, you might well fill out a questionnaire on your learning style and even get some numbers or a graph that will summarise your preferences. We would recommend that you look through this chapter a couple of times and actually do the exercises and answer the questions. Write some notes on where you identify your strengths and weaknesses, triggers that upset your learning and tips that maximise your learning.

Summary

This chapter has asked you to make multiple judgements about factors that affect your learning, which is not something you might have done before. Your judgements might not have been terribly accurate and we would recommend that you revisit this chapter again when you have read the remainder of the book and had a chance to think in more depth about what factors affect your learning.

The multiple aspects within this chapter have made it rather complex. You might find Figure 1.1 useful in summarising the chapter—you can mark on each axis where you think your strengths are (perhaps you decide 10 relates to “strength” or “no problem”).

Figure 1.1 Summary.

References and further reading

Coffield, F. (2004a).

Learning Styles and Pedagogy in Post-16 Learning: A Systematic and Critical Review

. London, Learning and Skills Research Centre.

Coffield, F. (2004b).

Should We be Using Learning Styles?: What Research has to Say to Practice

. London, Learning and Skills Research Centre.

Questions and answers

Q: I have done an online test for VARK and my kinaesthetic score is low—will I have trouble learning clinical skills?

A: The predictive validity of these different tests is not great. Some studies have suggested that students with either deep (learn to remember and understand) or pragmatic (learn to pass exams effectively) learning styles do better in medical school exams than those with superficial styles (cram facts for the exams, skim over the top), but this really is not rocket science to understand. The usefulness in these inventories is that they encourage you to think about your preferences and the way that you tend to learn—do you think that this judgement is true for you? If you tend to avoid practising when learning a skill, how are you going to make sure that you practise your clinical skills a great deal when you are learning them? See Chapter 3 for an in-depth description of effective clinical skills learning.

Q: My medical school not only makes me do learning style inventories, but also inventories on how I work in a team—it drives me mad!

A: There are inventories for almost everything you can imagine, as a significant proportion of the world is made up of people who like to measure things, everything; in fact they even make up new things in order to measure them. As you might guess from this chapter, our emphasis is less on formal, accurate, statistically significant measurement, but much more on using these tools pragmatically in order to develop your self-awareness. We know that students who develop self-awareness with respect to learning outperform their peers, so see what you can take out from the exercises. Perhaps you want to find Professor Coffield's papers (Which critiques, and criticises, learning styles inventories in depth) and engage in a discussion with your course convenor.

Chapter 2Learning knowledge

Overview

This chapter introduces some of the key issues and strategies for learning knowledge. We discuss the different types of knowledge and tips for improving your learning based on what we know about how memory works. Finally, we discuss different learning environments and how to make best use of them.

Introduction

There is one thing that we can be pretty sure about—that you are intelligent. You did well at school (you might even have been near the top of the class) and some of you will have relied on a good memory, but not a great deal of study, to pass your exams. Unfortunately, medical school is not like secondary school, college or sixth form. The curriculum is not as clearly set as for A-levels, and it has a tendency to change a little while you are still trying to follow it. The volume of work is huge, too big for even the best minds to hold without effort and too much information to cram into your head the week before the exam. The source of knowledge might be different too: you might have been told what to learn at school—learn the classes and do the set homework and you will do well at most secondary schools. In medicine, you will not get taught everything that you need to know, and yet you will still be expected to learn it—to work out what you need to learn, to work out ways of learning it, to work out ways of knowing when you have learnt it and to get on and learn it.

This drastic change of emphasis comes as a culture shock to many. This chapter highlights some of the issues with learning in medical school and looks to established theories from educational psychology and established study skills techniques to make your learning as efficient and effective as possible.

There are some key messages running through this chapter, which might be worth highlighting here.

The purpose of learning is to be able to recall and apply information; therefore, it makes sense to learn it in a way that will make recall and application easier.