Learning medicine

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Paulina Horwat
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Rapid progress in medicine, high standards for medical students, and social pressure to accomplish well are a burden to young medicine adepts. Often they seek help to enhance their performance and meet the university's requirements. How to study in medical school and balance every aspect of life? We can distinguish techniques and habits supported by the evidence and beneficial in the studying process.

Introduction

Gaining knowledge, understanding concepts, and continuous improvement are inseparable parts of the medical student and physician life. Although junior medical students face many difficulties and hardships during initial training, this is only the beginning of the lifelong learning path. The everlasting need for enhancing qualifications imposes the obligation not to desist in acquiring information. However, the amount of material expected to be learned by medical students is overwhelming; young adepts experience feelings of loss and meaningless, leading to unexpectedly early burnout [1]. Here the question arises of how this problem can be managed. How to study in medical school to build healthy habits, form long-lasting engagement in medicine, and effectively prepare for examinations?

Dunlosky study strategies

In 2013 Dunlosky and his colleagues [2] published a paper discussing the most effective learning techniques. They chose ten strategies based on the literature review and student opinions, elaborative interrogation, self-explanation, summarization, highlighting, keyword mnemonic, imagery for text, rereading, practice testing, distributed practice, and interleaved practice. The analysis was performed taking into consideration additional variables, including the type of material studied, learning conditions, student characteristics, and criterion tasks, which means how the student’s improvement will be evaluated. Techniques were segregated into low, moderate, and high utility. The low or moderate utility did not indicate that strategy cannot be used. It underlined the method's limitations and that it may be employed for specific, shorter parts of the material.
The best results were obtained from practice testing and distributed practice. Practice testing showed promising results in many previous studies [3,4], confirming that applying knowledge boosts our learning outcomes. The hypothesis suggests that practice testing produces direct and mediated effects [5], where direct ones describe the change in the learning by pure test taking and mediated how test taking influences further learning process. Secondly, distributed practice shows the benefits of spreading studying over time. The technique enhances long-lasting learning outcomes.
Mild-utility strategies include elaborative interrogation, self-explanation, and interleaved practice. However, it is worth mentioning that these techniques lack enough scientific evidence for their effectiveness for strictly educational purposes. They require further research.
Summarization, highlighting, the keyword mnemonic, imagery use of text learning, and rereading presented the lowes utility. The main issue was their limitations to precise tasks and lack of amplifying students’ achievements.
Dunlosky methods are used to evaluate students’ performance and learning difficulties in medical school. Lately, an online survey considering studying techniques was undertaken at Charité Medicine University in Berlin [6]. Results showed that 60% of respondents used low-utility techniques. Nevertheless, also 62% used high-utility ones, with a majority usage of practice testing.  Furthermore, comparing junior and senior students, there was a statistically significant decrease in the use of low-utility techniques as the students progressed in their studies. It indicates that medical students adjust to the greater spam of knowledge, which is required, shifting on their own to the more productive studying techniques. How beneficial it would be for younger students to get to know how to learn at the beginning of the academic path. The learning method also predicted the level of difficulty student faces. It comes as no surprise that those who used low utility techniques encountered more difficulties compared to moderate utility ones.
In 2011 at the Witten/Herdecke University, a seven-week learning workshop [7] was introduced. Its goal was to acquaint students with a holistic approach to learning, find inner motivation, enhance self-regulation, and present valuable techniques. The wholesome idea was composed of physical, physiological, psychological, and mental parts. It underlies how the well-being of the students is necessary to make a habit of lifelong learning. Additionally, it enabled students to reflect on their previous learning behavior. Thorough consideration helped to find the supreme method for each individual.

Do medical students study all the time?

The standard approach is that medical students must devote their whole lives to obtain a favorable outcome. Whereas for some, it seems to be an effortless task, others struggle through all years of medical school. However, academic success also depends on independent factors, such as the learning environment, financial and social support.
One of the research papers about medical students' habits provided a hand of information on what the majority of students with As’ did [8]. They attended classes more frequently than others, which turned out to be more beneficial than watching online lectures. Besides, re-watching the lecture multiple times before examination showed no superiority over watching a lesson once and engaging actively in the material (making notes). Additionally, it may be helpful to review the lecture on the same day when it took place.
Half of the high-grade students studied between 6-8 hours per day. Learning more than 8 hours per day did not follow tremendous academic success. Furthermore, the most favorable amount of outside resources used during studying varies around 1-2 platforms or websites. Interestingly, watching additional lectures on the given topics did not reveal added benefits.

Do doctors and medical students memorize everything?

One would have thought that learning by heart is the most advantageous way of succeeding. However, medicine is a vast field focusing on people and requires more than basic knowledge from a practitioner. In order to help patients, physicians need to consider the human aspect and individual situations and use the brain plasticity and capacity to merge separate details into unity. Lately, medical universities have focused on adjusting curriculums for integrated and interdisciplinary learning processes [9]. Since preclinical classes, students are encouraged to apply gained knowledge in problem-solving and clinical cases. Knowledge can be divided into conceptual and procedural. Conceptual knowledge corresponds to facts and information acquired from textbooks, whereas procedural knowledge uses these facts and is responsible for clinical problem solving [10].
Interestingly, preclinical studying may be beneficial for clinical carriers only until a certain point. If students want to become better at patient treatment, they need as much as possible of the clinical clerkship experience. Constant studying may not be as beneficial as we think, and empirical learning is an inherent part of becoming a well-trained doctor.

Kolb’s learning cycle

Kolb’s cycle is the procedure of learning which includes concrete experience, reflective observation, abstract conceptualization, and active experimentation [11]. It assumes that we change after undergoing an action. Later, it reflects on how we acquire and use knowledge. The cycle starts with concrete experience when we physically perform an activity. Based on this, we can think about our deeds and proceed to the reflective observation stage. When we notice errors or opportunities to enhance performance, we think abstractly and pass to the next phase. Implementing amendments means we actively experiment and close the cycle by carrying out the previous action slightly differently [12]. Experience-based learning was established as beneficial already in 1992 [13] and is broadly used in physician training. A good example is working with a standardized patient in a simulation condition. Attendants who undergo such training perform significantly better during practice exams like OSCE (Objective Structured Clinical Examination) [11].

Motivation and goals influence our way of learning

We can feature four types of learning. The deep one focuses on understanding an issue, and the surface one is based primarily on memorizing [14]. It is known that surface learning and defective time management lead to inferior academic performance. Other types of learning include monitoring and strategic method. The monitoring process is connected to deep understanding and has additional metacognitive aspects, which cooperate in problem-solving. On the other hand, a strategic approach is based on efficient time organization and concentration on the studied topic. The way how we learn depends on us; hence motivation, personal characteristics, and growth has a considerable influence on performance. It has been shown that students with high inner motivation seek an opportunity for self-improvement in the learning process and can maintain better academic outcomes [15]. Additionally, this kind of student experiencing burnout is rarer than those with no precise goal. The quality of life and personal growth also enhance chances for better performance. Besides, in order to manage academic exhaustion, emphasis should be placed on the community and developing relationships [16].

Conclusion

Medical studies are demanding and require absorbing massive amounts of textbook material. Because of this, medical schools should consider how they can help their students and update curriculums to meet the standards of modern, evidence-based medicine and practice. Using well-studied learning techniques supports attendants and guarantees better performance in upcoming examinations. Goal-oriented learning with the intention of self-development decreases the risk of students’ hardships and burnout, enabling them to implement the idea of lifelong learning.

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