Can you really make your brain BIGGER: Using cognitive science to increase your study efficiency and retention

Can you really make your brain BIGGER: Using cognitive science to increase your study efficiency and retention by Jason F. Hine, MD-Emergency Medicine SMHC

How are we as clinicians going to keep up with the ever-expanding fund of medical knowledge?

The rapid expanse of medical knowledge is a well-recognized reality creating a daunting circumstance for us as clinicians- trying to keep up with what we need to know.1 There are several strategies to help the practicing physician keep up. These include:

  1. “Peripheral brains” such as smartphone apps and pocket cards
  2. Secondary journals- which were discussed in our November Monthly Tips
  3. Efficient study techniques

Wouldn’t it be great if you could improve the efficiency with which you study and learn?

Enter cognitive science. While this is a vast field of research covering a range of topics, one area of study has been in the production and retention of memories.  A summation of this field’s findings can be found in the book Make It Stick: the Science of Successful Learning.2 Cognitive scientists Henry Roediger and Mark McDaniel teamed up with story teller Peter Brown to outline how we can improve our efficiency in learning and memory retention. In its simplified form, this involves four processes:

  • Retrieval Practice (R) – As a medical student you cannot spend 3 grueling hours on acid-base analysis, put the book down and expect to nail an ABG interpretation 4 months later. To solidify a memory into our long-term bank we must practice using it. Quite simply, this is the act of pulling information (a memory) from our memory back. This is retrieval practice.
  • Spacing (S) – The idea of spacing is linked to retrieval practice but gives greater detail about when we should be retrieving memories. It is fine to practice retrieving a memory 30 minutes after it is created (ie shortly after you read a new article), but it is more powerful and efficient in creating memory retention when some time has passed. Allowing for a bit of forgetting to occur and making the retrieval effortful leads to greater retention.
  • Interleaving (I) – Interestingly, cognitive science has found that when we mix our study of different subject matter we often gain a greater understanding of each. This is thought to be related to pattern recognition across topics, rule generation, and the linking of memories in our brains. By mixing our review of several articles, therefore, we can improve our retention of the take-home from each.
  • Generation (G) – The concept of generation is akin to an active rather than passive learner. It explains that in creating from our memory we again reinforce the content and improve retention. Activities such as recollective summaries or content application are much more retention-producing than passive actions such as rereading.

So, after reading an article use these steps to “Make it Stick”:

  1. Take a moment to write out the key points of the paper and how they may affect your practice (R, G).
  2. Create an alert 1 week later (via smartphone, calendar, post it notes, whichever structure works for you) to remind yourself to do a recollection exercise where you spend two minutes writing all you can remember on the article, then review and correct (R, S, G).
  3. Create a notecard with the article title on one side and short summation on the other (S, G).
  4. Whenever you sit to read a new article, review the notecard and simply speak aloud the major summative points (R, S, I, G). Once the article and its content become second nature, the notecard can be filed or discarded.

While more effortful than our inherent learning strategies, this method of study based on cognitive science is more time efficient. For most of us, our typical pattern involves reading an article, putting it down, forgetting it, and rereading it months to years later when we realize the content is lost. In the proposed study construct, after the first active reading session the subsequent retrieval activities are quite short, collectively require less time, and are higher yield for actually remembering the topic.

To learn more on the topic of memory retention, please read Make it Stick or use these links to my podcast website for my summary and interview with the author.

References:

  1. Densen P. Challenges and opportunities facing medical education. Trans Am Clin Climatol Assoc. 2011;122:48-58.
  2. Brown P, Roediger H, McDaniel M. Make It Stick : the Science of Successful Learning. Cambridge, Massachusetts :The Belknap Press of Harvard University Press, 2014.

November Faculty Development: Staying on Top of the Literature

Staying on Top of the Literature by Christopher Turner, MD Pediatric Surgery

When I was preparing for my pediatric surgery boards, I asked an emeritus professor for advice. He recommended what he had done for his boards: read every article ever published in the Journal of Pediatric Surgery. While this may have been feasible in 1979 with thirteen volumes, it was not feasible now with fifty-three. Not only have journals continued to churn out articles, they are doing it more quickly. The number of citations added to MEDLINE per year has almost tripled over the last twenty years from 322,825 in 1996 to 869,666 in 2016. Our ability to produce medical data as a community has exceeded our ability to consume it as individuals. I would like to offer you some strategies and resources to compete.

  1.      Primary Journal. Identify the primary journal for your specialty. Commit yourself to reviewing every issue.
    1. Make it a habit. Try to reserve time on your outlook calendar so it does not get skipped. Do it with a peer so you can hold each other accountable. Pair it with a treat (like a molasses cookie at Tandem!).
    2. If you like print, subscribe. If you like digital and free, consider Browzine (com). This is a service supported by our library that allows easy reading of most major journals on your tablet or phone. It also allows you to track individual journals and save articles.

2.     Secondary Journals. There are many services that curate the literature. Here are a few.

  1. Read (com/read-by-qxmd) or Case (https://www.casemedicalresearch.com) or Prime (www.unboundmedicine.com/products/prime). These apps send you the most popular articles in selected specialties. I have received a weekly email from Read since fellowship. It often shows me interesting articles that I would not have otherwise. Case allows you to listen to audio transcriptions of abstracts which might be useful for your commute.
  2. Journal Watch by the New England Journal of Medicine (org). A good option for medical specialties. It reviews 250 major journals and posts updates by email. The twelve specialties are cardiology, emergency medicine, gastroenterology, general medicine, HIV/AIDS, hospital medicine, infectious diseases, neurology, oncology, pediatrics, psychiatry, and women’s health.
  3. Patient Oriented Evidence that Matters (com). This sends email alerts with updates. I have not used it but it looks promising.
  4. Uptodate and Dynamed. Both of these review services also offer subscriptions to receive email alerts for “practice changing” updates. I have not used them either
  5. TDNet (com). This will send you the table of contents for the journals that you select. I find it clutters my inbox.
  1.      Deep Dive. Through myNCBI, it is possible to receive a regular email with all new publications from PubMed that match a particular search term. This can be overwhelming. It works well for very narrow topics and when you don’t want to miss a thing. Consider it for your research projects. Ask library staff to help you set it up.

I am sure many of you have your own habits and suggestions. Please send them to me if you are interested at cturner1@mmc.edu. I will try to post them here as comments.

I would like to thank Dina McKelvy and the library staff for their help compiling these resources and for their frequent kind assistance.

February Faculty Development: How to Get the Most Out of a Survey

How to Get the Most Out of a Survey
By: Kimberly Dao, Maine Track, M’18

‘‘Let’s just do a quick survey.’’
— Someone in everyone’s program

Surveys are an easily accessible and commonly used tool in many disciplines. However, the quality of responses and response rate can vary dramatically. Below are some basic tips to maximize your survey.

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August Faculty Development: Education Video Production: A How-To-Guide

Educational Video Production: A How-To Guide by: Alex Fiorentino, MD, Maine Track ’17

Learners of many types are increasingly utilizing online educational videos, and medical learning is no exception to this trend.  As an example, the massive open online course platform Khan Academy has generated a video series geared toward helping nursing students prepare for the NCLEX-RN licensing exam.  At the time of this writing, the platform’s overview of nephron function has been viewed more than 1.6 million times1.

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June Faculty Development: Use of Social Media as a Supplement to Medical Education Curricula

Use of Social Media as a Supplement to Medical Education Curricula by Nate Rogers, MD, Maine track ‘16

Though the majority of medical education literature has studied social media and issues of professionalism in relation to its use, medical professionals are beginning to recognize its potential as a powerful educational tool. Twitter and Facebook represent two of the largest and most widely studied social media platforms in medical education, with healthcare professionals finding creative uses of the apps to enhance learning.

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December Faculty Development: Tips for Effective Presentation Slides

Why effective presentation slides matter

Presentation software like Microsoft PowerPoint, Apple Keynote, and Prezi are ubiquitous in medical education and the business of healthcare. When used appropriately in a direct presentation format, these tools let educators display visual aids, emphasize key points, and interact with learners to promote their understanding.

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