{"id":1174,"date":"2014-04-05T13:38:02","date_gmt":"2014-04-05T17:38:02","guid":{"rendered":"http:\/\/blogstemp2.wpengine.com\/?p=1174"},"modified":"2015-06-04T14:24:31","modified_gmt":"2015-06-04T18:24:31","slug":"learning-to-unlearn","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2014\/04\/learning-to-unlearn\/","title":{"rendered":"Learning to Unlearn and Other Advanced Skills"},"content":{"rendered":"

In my transition from pure learner (i.e., the med student role<\/i>) to teacher-learner (i.e., the attending<\/i>), I’ve actually found myself focusing more on the learner than the teacher part of my dual existence. \u00a0Strong learning seems to be requisite to strong teaching, and I am realizing that succeeding on the next level requires some extra meta-cognition, that is,\u00a0learning to learn in new ways.<\/p>\n

Learning to Unlearn <\/b><\/p>\n

In med school, learners amass an incredible amount of new information and \"\"master a completely new language. Suffice it to say that \u201cdrinking from the firehose\u201d probably understates the reality of undergraduate medical education.<\/p>\n

Our schools inculcate lots of so-called \u201cfacts\u201d into our students\u2019 fresh minds, and said students suck up these facts like infinitely absorptive sponges. Sure, students often purge the data after cramming for tests, but they inevitably reclaim much of this knowledge over the next several years. And thus, students graduate medical school with their minds encumbered by extraordinary amounts of information to apply to patient care.<\/p>\n

This approach unfortunately is faulty in two respects: Memory is imperfect, and facts are not immune to mutability. I have been caught on rounds reciting \u201cfacts I learned in medical school\u201d only to have my team discover that almost no reputable sources can corroborate my claims \u2014 or even worse, that a reputable source completely refutes them. I cannot always pin down the etiology of my\u00a0misinformation. I usually blame time\u2019s effect on the faulty memory compartment. More importantly, I make a mental note to condemn that parcel of my brain and\u00a0vacate it\u00a0for future use.<\/p>\n

My advice: <\/i>Actively seek out the misinformation in your brain, and purge it. Identify what you thought you’ve learned but isn’t true.<\/p>\n

<\/b>Learning to Get Answers Without the Certainty of an Answer Key<\/b><\/p>\n

As learners progress through their undergraduate and graduate training, they move from the black-and-white world of correct answers to a landscape of gray zones devoid of an answer key. Students often live and die by \u201cwhat\u2019s going to be on the test.\u201d\u00a0Even residents living in the oft-ambiguous world of clinical medicine have some anchor of certainty: the attending\u2019s final word. No matter what shade of correct or incorrect a clinical decision is, the resident can often fall back on what the attending will want.<\/p>\n

When there is no longer a judge of correctness\u00a0\u2014 be it the professor, the course director, or the attending \u2013 it can be quite unnerving. In this situation, the teacher-learn should remember that \u201cfacts\u201d you\u2019ve learned are never truths. They are half-truths with varying degrees of evidence that can be variably applied to actual clinical scenarios.<\/p>\n

My advice: <\/i>When faced with situations where a correct answer cannot be known, gather all the information you can to make an informed decision. Remember that the teacher-learner becomes a de facto<\/i> answer key, but be ready to adjust the grading rubric too.<\/p>\n

Learning to Learn Critically<\/b><\/p>\n

The learner role affords a certain luxury to students and residents: leaving all the critical thinking to the experts. For example, when you rotate on your cardiology rotation, you must recite gospel verses like, \u201cGive an ACE inhibitor and \u03b2-blocker for everyone with\u00a0reduced ejection fraction.\u201d But what about that latest study on angiotensin\u00a0receptor neprilysin inhibitors<\/a>? Well, you get to leave the interpretation and its application to real-life settings to the renowned cardiology attending.<\/p>\n

I am not saying that residents aren\u2019t expect to think<\/em> critically. But they often don\u2019t have the time to\u00a0learn\u00a0<\/em>critically: to\u00a0analyze the latest developments and consider how to integrate the evidence into practice. Instead, students and residents defer or default to the experts (and integrate this information as \u201cfacts\u201d into their brain; see sections above).<\/p>\n

Now imagine what happens when\u00a0no expert is present. The teacher-learner needs to be prepared to face situations in which he or she might be the one distilling very complicated data into spoon-fed \u201cpearls.\u201d The teacher-learner also needs to decide how much stock to put into his or her\u00a0own truths.<\/p>\n

My advice: <\/i>Imagine how you would apply newly acquired knowledge to your patients before actually doing so. Someday you will not have an expert to lead the way, and you never know when your trainees might look to you for guidance.<\/p>\n

Follow Dr. Paul Bergl on Twitter @PaulBerglMD<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

In my transition from pure learner (i.e., the med student role) to teacher-learner (i.e., the attending), I’ve actually found myself focusing more on the learner than the teacher part of my dual existence. \u00a0Strong learning seems to be requisite to strong teaching, and I am realizing that succeeding on the next level requires some extra […]<\/p>\n","protected":false},"author":25,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[26,33,37,40],"class_list":["post-1174","post","type-post","status-publish","format-standard","hentry","category-about-residency","tag-evidence-based-medicine","tag-reflections","tag-resident-experience","tag-student-experience"],"yoast_head":"\nLearning to Unlearn and Other Advanced Skills - Insights on Residency Training<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2014\/04\/learning-to-unlearn\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Learning to Unlearn and Other Advanced Skills\" \/>\n<meta property=\"og:description\" content=\"In my transition from pure learner (i.e., the med student role) to teacher-learner (i.e., the attending), I’ve actually found myself focusing more on the learner than the teacher part of my dual existence. \u00a0Strong learning seems to be requisite to strong teaching, and I am realizing that succeeding on the next level requires some extra […]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2014\/04\/learning-to-unlearn\/\" \/>\n<meta property=\"og:site_name\" content=\"Insights on Residency Training\" \/>\n<meta property=\"article:published_time\" content=\"2014-04-05T17:38:02+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2015-06-04T18:24:31+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/blogs.nejm.org\/general-medicine\/wp-content\/uploads\/sites\/4\/2014\/04\/73bf30f2-7bbd-4711-ab34-601d1d78e655.jpg\" \/>\n<meta name=\"author\" content=\"Paul Bergl, M.D.\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Paul Bergl, M.D.\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2014\/04\/learning-to-unlearn\/\",\"url\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2014\/04\/learning-to-unlearn\/\",\"name\":\"Learning to Unlearn and Other Advanced Skills - Insights on Residency Training\",\"isPartOf\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#website\"},\"datePublished\":\"2014-04-05T17:38:02+00:00\",\"dateModified\":\"2015-06-04T18:24:31+00:00\",\"author\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#\/schema\/person\/051113720e4c7729846a840eb088f8cc\"},\"breadcrumb\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2014\/04\/learning-to-unlearn\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2014\/04\/learning-to-unlearn\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2014\/04\/learning-to-unlearn\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/blogs.nejm.org\/general-medicine\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Learning to Unlearn and Other Advanced Skills\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#website\",\"url\":\"https:\/\/blogs.nejm.org\/general-medicine\/\",\"name\":\"Insights on Residency Training\",\"description\":\"Observation of residents across diverse medical specialties\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/blogs.nejm.org\/general-medicine\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#\/schema\/person\/051113720e4c7729846a840eb088f8cc\",\"name\":\"Paul Bergl, M.D.\",\"description\":\"Paul has spent all his life in the Upper Midwest. 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