{"id":578,"date":"2011-09-08T12:24:15","date_gmt":"2011-09-08T16:24:15","guid":{"rendered":"http:\/\/blogstemp2.wpengine.com\/?p=578"},"modified":"2011-09-08T12:24:15","modified_gmt":"2011-09-08T16:24:15","slug":"finding-the-learning-sweet-spot","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/09\/finding-the-learning-sweet-spot\/","title":{"rendered":"Finding the Learning Sweet Spot"},"content":{"rendered":"

\"Dr.<\/a>Dr. Bergman Lewis is a senior resident in Pediatrics at Seattle Children’s Hospital. By way of introduction, I am finishing my pediatric residency at Seattle Children\u2019s Hospital, have enjoyed being a resident editor of Journal Watch Pediatrics and Adolescent Medicine<\/em> for the past 3 years, and will write as an interim blogger for the next month or so. Greg left big shoes to fill but I\u2019ll do my best to pave the way for the next resident blogger.<\/p><\/blockquote>\n

I am in the agitating phase of studying for a test \u2014 I am loosely aware of what looms ahead but have not strategically plunged into studying. The General Pediatrics Boards are about 5 weeks away. Similar to my view of all standardized tests, I\u2019ve dreaded this test since the first time I heard about it. I have been trying \u2014 with varying levels of success \u2014 to adapt the \u201cright\u201d attitude: Focus more on learning material that I think a \u201cgood pediatrician\u201d should know and less on being bitter about how much it costs. (The worst part about failing is that I\u2019d have to pay again next year!)\u00a0<\/p>\n

On a good day, the prospect of studying for boards serves as an appropriate wrap-up to 4 years of medical school and 3 years of residency. On a bad day, it\u2019s another painful hoop to jump through. But the test must be taken, so I\u2019ve sucked it up and bought a book. I ended up buying First Aid for the Pediatric Boards, <\/a>which was a steal at $53 compared with Laughing Your Way to Passing\u00a0 the Pediatric Boards <\/a>($97!). Maybe I\u2019m wrong, but I do not anticipate laughing will be an integral part of my studying.\u00a0<\/div>\n

\"\"<\/a><\/p>\n

Given my imminent trip back to the books, I have been reflecting on how learning happens in medical school and residency. Before I entered medical school, I was involved in launching a middle school where I taught sixth grade for 2 years. At the Seattle Girls\u2019 School, we taught an integrated curriculum. For example, the first trimester\u2019s theme was inventions, and core subjects like reading and math were taught under this umbrella theme. We explained to parents that by mirroring how we learn naturally, neural connections are made, and students stay passionate about learning.\u00a0<\/p>\n

When I entered medical school, I experienced an environment that was quite far from facilitating natural learning. In fact, the first year of medical school took the most natural \u201cintegrated curriculum,\u201d \u2014 the human body \u2014 and artificially broke it down into histology, pathology, anatomy, and biochemistry. Without a strong science background or honed study skills, I struggled and barely eked by in my classes. It was not until clinical clerkships that I started to believe I might<\/em> be smart enough to be a doctor. As I began caring for patients, the connections I couldn\u2019t make from a PowerPoint presentation began to appear. I often wish I could go back to the first 2 years of medical school now that I have a scaffolding of patient encounters on which to hang my knowledge.\u00a0<\/p>\n

\"\"<\/a><\/p>\n

Learning in residency looks different than it did in medical school. For those like me who learn from hands-on patient interactions, there is endless material, but little time to process it. Although it may feel more comfortable to learn from a prepared noon conference lecture, do you learn more from the patient care call that causes you to leave the lecture? The answer to where this sweet spot of learning and hands-on experience lies is a moving target, and different for all of us.\u00a0<\/p>\n

The intensity at which our highest quality of learning occurs is another variable. Some of us may absorb information best when presenting a patient on rounds, voicing a plan despite being less experienced than anyone in the audience. For others, being in the hot seat short circuits all neural connections. During residency, I experienced some of my best learning when I was post-call on rounds but had gotten at least 30 minutes of sleep (this has interesting implications for new work hour restrictions that may take people off post-call rounds).\u00a0<\/p>\n

The fact is, we all learn differently and most of us spend much time worrying about if we are learning enough<\/em>. If only we\u2019d give ourselves a collective break. We are all naturally curious people who want to be the best doctors we can be. We cannot help but learn. We should<\/em> have a bit more faith in the process and trust that when we\u2019re spit out the other end of residency, we will have acquired enough knowledge to be good doctors.\u00a0<\/p>\n

Of course, our formal training represents the tip of the iceberg of what we will eventually learn. It does seem like developing good learning habits from the get-go is important. For this reason, in residency we should be paying as much attention to how we learn as what we learn. For what it\u2019s worth, here\u2019s some advice for learning that I wish I\u2019d been given:\u00a0<\/p>\n