Integrating Powerful Strategies for Learning into Graduate Medical Education

Graduate Medical Education (GME) is more commonly referred to as “residency” and “fellowship”. The length depends on the speciality you pursue with it ranging from 3 to 9  years of training. Moving through your training, your level of responsibility, autonomy, and independence increases each year with the goal for you to practice independently within your specialty. 

Your experience as a resident is significantly different than undergraduate medical education. Typically, residents will engage in at most 80 hours a week with some days being shorter and others being longer. Your days are fairly long with seeing patients, receiving supervision, grand rounds, notes, reports, and didactics. All of this is layered on top of finding time to study for In-Training Exams and Boards. So your strategy for learning has to adapt.

Learning efficiently means learning the way you learn best.

Key Principles to Practice During Residency

In order to develop the learning strategy that works best for you, we recommend incorporating these principles of learning.

1. Create a Study Plan

Having a study plan helps learners remain focused, organized and create a sense of accountability. Additionally, it increases productivity, assists with time management, reduces stress, and contributes to better performance. A study plan is more than a timetable, but a document that defines a methodology to prepare, plan, and tackle the content being studied. 

2. Pace Yourself

Spaced Repetition is spreading out your review to maximize long term retention. The ideal is 1 day, 7 days, 16 days, and 35 days or 1 day, 1 week, 2 weeks, 1 month. You can use this pattern as you plan your timetable. One practical way to do this is select one day per week to be a review day. On the review day, no new information is introduced, just a review of previously learned topics.

Numerous studies stressed the importance of practice. In a recent 2013 study, students took practice tests over several weeks. On the final test, they scored more than a full letter grade better, on average, than did students who studied the way they normally had.

3. Be efficient with content. 

It is easy to get complacent and do study activities for the sake of “studying”. However, with the limited time available for study during GME, it is critical to focus on weak areas. You can identify these areas through the use of questions or as you encounter topics during your training. ONce an area is identified, use resources that have worked for you in the past. This might be focused questions on the topic in learning mode, it might be a video, or it might be a textbook.

4. Be efficient with time. 

As stated before, hours in GRE are long. If you were accustomed to having long blocks of time to study, that is probably no longer a reality. It is important to use the pockets of time that you do have. This is where the study plan is key. It should include two ongoing lists: one with topics that require a focused study time and one with topics to look up and review quickly. Having a list of quick topics will allow you to use pockets of time effectively. Often, we get that 20 minute break and by the time we figure out what we need to do, most of the time is gone. Keeping the ongoing list will allow you to check items off efficiently. Then when you do get that study day, you have a list of topics you need to tackle also.

5. Test, Test, Test. 

It can not be emphasized enough just how important using questions is in your preparation. This active study method is not oln effective in helping you learn information, it additionally helps you identify those weak areas, those areas that need additional focus.

Questions are also an important tool in review (recall the theory of spaced repetition). Using questions you had previously missed is an excellent way to review information. Using missed questions is an efficient way to incorporate the “ideal” spaced repetition pattern (1 day, 1 week, 2 weeks, 1 month).

Always have a set of questions to do on your phone. If you are caught in traffic or a long line, maybe you can work through one question! This way you are always prepared to use an unexpected block of time.

6. Revisit Study Strategies. 

Study strategies that have worked for you in UME, still have a place in GME. If there are facts (drug names, genetic markers, etc.) that you cannot recall, flashcards may be the answer (trusty paper version or electronic versions, both work.). One benefit of electronic flashcards is that the principles of spaced repetition are built in. Mnemonics (word and visual) can definitely help you recall information more easily. While there are commercial products that provide many different types of mnemonics, making up your own can be quite effective.

Self care is important

It goes without saying that if you are sleep deprived, your memory and learning capacity are impaired. It is important to balance the need to study with caring for your physical and mental health. Maintaining your health and wellbeing and a positive mindset will pay off dividends in the long run.

This is not an all or nothing endeavor. 

Anything you do is better than nothing. Don’t discount how much the little things you do on a daily basis add up. Don’t beat yourself up for not getting it all done. Congratulate yourself on what you did accomplish. This is where having a checklist of tasks or topics might be more helpful than a daily schedule. We often equate a study plan with a day by day, hour by hour schedule. However, for some people, having a list of tasks for a week is much more manageable. This way, if there is a day when everything planned just falls apart,you don’t feel like all is lost because one planned day is undone. The goals are weekly, so there is time to still meet your benchmarks.

You have been successful thus far and that success will continue. Continuing to use the learning principles that work for you and constantly evaluating your progress will be important as you move through GME.