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.

October Faculty Development: Strategies for Teaching Residents who Struggle with Time Management

Strategies for Teaching Residents who Struggle with Time Management by Carly McAteer, MD

Skill with time management and organization is essential for residents who are typically burdened with a large number of patient care, educational, and administrative tasks.  When a resident is struggling, it can be difficult to determine the particular cause.1  Residents who struggle with time management and organization present themselves by often being unprepared for deadlines, assignments, and patient rounds.  These residents can appear disorganized in appearance, shuffle through multiple documents while presenting at rounds, and often keep patients waiting while running behind.1  When it is determined that a resident is struggling with time management, some helpful strategies are:

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September Faculty Development: Measuring Competency as a Clinical Teacher

Measuring Competency as a Clinical Teacher By Elizabeth Herrle, MD

What does it mean to be competent?

  • Competence is a global assessment of an individual’s abilities as they relate to that individual’s current responsibilities. To be competent is “to possess all the required abilities in all domains in a defined context at a particular stage in clinical training”1.

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August Faculty Development: Teaching communication skills for difficult conversations

Teaching communication skills for difficult conversations-Annabelle Rae C. Norwood, MD MMP Geriatrics

As professionals working in the medical field, we are often tasked with difficult conversations of delivering bad news, disclosing medical error, or initiating advance care planning and end-of-life discussions with patients and their families. More often than not, skills needed to effectively communicate with patients about these difficult topics are not developed fully during medical training.  As such, the Accreditation Council for Graduate Medical Education now requires competency in communication skills for residents and fellows.1 There are different methods available in order to hone these skills.

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July Faculty Development: How to Excel as a Mentor, According to Mentees

How to Excel as a Mentor, According to Mentees

Kaylee Underkofler, MD/MPH Candidate, Maine Track ‘18

What does it take to become a great mentor? While many have pondered this immense question, Lee et al. and Cho et al. sought an answer from perhaps the most important judge of mentors: mentees.1,2 Their goal was to identify the characteristics and practices of exceptional mentors in the eyes of students. The five tips listed below are a unified summary of their results. It is proposed that these ideas could be used to self-assess mentoring abilities, to build faculty development programs, or to guide students and young faculty in the search for a mentor.2 While all the nuances that go into becoming a truly great mentor could not be captured here, this list does include what is most commonly cited as being appreciated by mentees and serves as a place to start for those looking to improve their mentoring abilities.

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June Faculty Development: Teaching Digital/E-Professionalism-Reflections for deepening understanding of professional identity on social media

Teaching Digital/E-Professionalism:  Reflections for deepening understanding of professional identity on social media

Nicholas Knowland, TUSM-Maine Track Program, M18

Ensuring the public trust in the medical profession is the reason for promoting professionalism as a key component of medical education. Therefore medical curricula place significant emphasis on the development of professional behaviors.

Digital professionalism, or e-professionalism, describes the increasing interaction of medical professionalism with the greater public through social media outlets. The terms are new but the reality that online images or postings can reflect on students or practitioners has been present for some time and is usually associated with negative connotations.  This has resulted in what some authors have described as a ‘hidden curriculum of digital unprofessionalism’ in which digital unprofessionalism is punished but rarely overtly taught. Despite the consequences that digital unprofessionalism lead to for a clinical student or clinician, the academic literature is increasingly focusing on the positive opportunities associated with professional physician social media use, such as using social media to actively share quality information.

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May Faculty Development: The Art of Retention

The Art of Retention

Karyn King TUSM-MMC, M18

It’s midnight the night before a final exam and you’re sitting in front of a pile of notes that you half-heartedly studied while watching the entire series of Friends (again) during the past four weeks of your histology course. Driven by caffeine and an ingrained fear of failure, you realize it’s time to cram every fact you can into your brain before your 8:00 am exam tomorrow morning. Flash forward to one week later when your test scores come out. You nervously open the grading portal, an 87! You think to yourself, “not bad, what was that exam on again?!”

Does this scenario sound at all familiar?

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April Faculty Development: Developing an Implicit Bias Curriculum: Six point Framework

Developing an Implicit Bias Curriculum: Six point Framework

John Gilboy, MS4 Tufts Maine Track.

Implicit bias has been shown to impact clinical decision-making and patient outcomes.1 In addition to clinical outcomes, bias among health care professionals has been linked to the gender gap within health care leadership and specialties. 2 While exploring health care disparities has been a focus in all levels of medical education, few educational interventions have adequately addressed recognition bias. Below is a six-point framework described by Sukhera et al to implement an implicit-bias-informed educational curriculum for health care provider.

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March Faculty Development: How To Teach Quiet Learners

How To Teach Quiet Learners

 Journal Club Entry by Anne Sprogell, TUSM-Maine Track Program, M18

In order to understand how to teach a quiet learner, it is first important to understand a quiet learner. Shy, quiet, or introverted learners are generally characterized by increased reflective thinking and reduced sociability. Their strengths can include the ability to focus, pay attention to details, take thorough notes, and listen to patients and team members. However, these students can struggle with certain aspects of medical school including group discussions with a larger number of students, forming relationships quickly with colleagues in the ever-changing teams of residents and attendings on inpatient services, and in rounds when ideas need to be offered quickly and assertively. Despite these challenges, there might be a few tips that teachers can use to allow their quiet students to shine. Read More…