Thursday, October 11, 2012

Time to Reassess your Study Habits? Nine Points to Consider.


      Are you beating yourself up after Block One? Saying, “should ‘a, could ‘a, would ‘a done better …BUTif only _________(fill in the blank)”. What is your excuse?
Maybe it is time to reassess your study habits?

1. Time: “But I don’t have enough time!” Take the test and see where your time really goes? How much time do you spend on your cell phone, texting, and checking your email? How motivated are you to study? “Deep motive correlated with time on assignments. Students who were less certain they wanted to work as a doctor undertook less study activity and spent less time with patients.” Yet, more time studying is not better if your problem is inefficient study habits! (Wilkinson, 2007) Which leads to the next issue …

2. Focusing: "But there is so much going on, I have trouble blocking out the distractions?" Use ear plugs, try the study carrels in the library, close out Facebook, turn off you cell phone, do what it takes! To quote KevinMD from his blog article “9 Essential Tips for new Medical Students” ~ “When you study, focus on studying.”

3. Location: Research shows that studying a certain piece of information repeatedly is good, but that studying it repeatedly in different surroundings is even better (Sasanow, 2010). So review that lecture power point in the LRC , then read it over again while studying in the library, then of course learn it during the lecture, then review it again at home. The research shows that if you learn something in multiple settings it will stick with you better as your mind is not connecting that piece of information with only one particular location or environment (Carey, 2010).

4. Multitasking: “But I went to all the lectures!” That is very good because research has shown those who attend live lectures score 3% higher than those who rely on even recorded lectures. (Wenger, 2012) BUT what were you doing during the lectures? Research shows that only 5% of people can multitask effectively (Weimer, 2012). Do you honestly believe you are in that 5%? Note the following quotes: “…students who did not text (during the lecture) scored significantly higher (on a post-lecture quiz) (Ellis, 2010).” “Students who tried to listen to the lecture while using … distractive windows (on their laptops ~ such as games, pictures, email, instant messaging, and web surfing) had significantly lower scores … (Kraushaar, 2010).” “The level of laptop use negatively correlated with how much attention students paid to lectures, the clarity of the lectures and how well they understood the lecture material (Fried, 2008).” “Their multitasking was significantly related to lower GPA … (Barak. 2012).”

5. Practice Review: “But I read the textbook!” But you didn’t really get it did you? While you were reading did you periodically stop and think about what you just learned? How did it relate to what you already know? Write down the key points and concepts you managed to extract from what you just read and then try to explain them, teach them, to yourself. Then go back and re-read the section again, refine your notes then meditate some more on the points. “…high-achievers spent significantly more hours/week on self-study (…and) scored higher on 3 factors which measured aspects of deliberate practice – planning, study style and motivation.” (Moulaert, 2004) The Moulaert study also showed that high achieving students owned more books and read more articles! So make good use of our library resources and our online medical literature databases.

6. Concept mapping: “But I memorized all the facts!” So after you have done your reading, got your notes, got your points, try ‘concept mapping’. In other words draw a diagram of what you just learned. Generally speaking, most educators are big on this as they believe “…having students draw detailed diagrams documenting what they are learning …forces students to make connections among facts.” However according to recent research you need to take this a step further…

7. Practice questions: “I am sure I got that now, I will remember that!” Now you need to test yourself so you are sure you own the material! Research reports that students who stop at point #5 can harbor “the illusion that they know the material better than they do” (Belluck, 2011). It also shows a further significant benefit to learning through testing, and the use of practice questions, even when students get the questions wrong. Note this reader’s comments: “During medical school we were also encouraged to "do questions" to prepare for both our institutional exams, as well as for the national licensing exams. In fact, there are large on-line 'question banks' and 'question books' that are available for purchase and everyone knows you need to do those to pass. The conventional wisdom is that if you do all the questions from the past 5 years of books, you'll pass the exam. I don't know why it works, but it does. These are NOT questions that you will see again on the exam so it's not a case of just memorizing the right answer.“ “While students have many different ways to study, which includes reading the text book, students can perform well on examinations using high yield review books and practice exam questions as resources. Students who used practice clinical vignette-type questions on average scored 5 points higher than the class average.” (Wenger, 2012) Have you started using Exam Master yet, or the many review books available to you in the library?

8. Test Taking Strategies: Learn key test-taking strategies and the anatomy of multiple choice exams, by attending the study skills lecture to be given by Sue Simon, in the UMHS Auditorium on Wednesday, October 24, 2012 at 12:30 pm . Also take note of these “Tips for Success: Mastering Multiple-Choice Tests”.

9. Manage Stress: “But I am feeling so tired!” Research demonstrates that “stress symptoms, such as fatigue, sleeping problems, anxiety, irritability and depression, were common (during undergraduate medical training).” Some other common symptoms of stress to watch out for are abdominal pain, nervousness, headache, dizziness, and pain in the neck, shoulders, or lower back. (Niemi, 2006) Learning to manage your stress early on will prevent more serious problems later, such as possible burnout. “Burnout is a psychological syndrome of emotional exhaustion, depersonalization, and impaired personal accomplishment induced by repeated workplace stressors. Current research suggests that physician burnout may have its origins in medical school.” (Mazurkiewicz, 2012) Don’t hold back from availing yourself of our campus counseling service for any extra support you may need to help get your stress level under control!

I hope you have been able to take something away from your read of these 9 points ~ and ‘all the best’ for an improved block 2 and your continued success at UMHS-St. Kitts! To quote Dean Camacho’s motto, Never give up, never give up!”

Ann Celestine
Library Director

References:

Barak, L. (2012). Multitasking in the university classroom. International Journal for the Scholarship of Teaching and Learning, 6 (2) http://academics.georgiasouthern.edu/ijsotl/v6n2.html.

Belluck, Pam. (2011). To really learn, quit studying and take a test. The New York Times- Science, January 20, 2011. http://www.nytimes.com/2011/01/21/science/21memory.html

Carey, B. (2010). Forget what you know about good study habits. The New York Times – Health – Mind Column, September 6, 2010. http://www.nytimes.com/2010/09/07/health/views/07mind.html?pagewanted=all

Ellis, Y., Daniels, W. and Jauregui, A. (2010). The effect of multitasking on the grade performance of business students. Research in Higher Education Journal, 8 http://www.aabri.com/manuscripts/10498.pdf

Fried, C. B. (2008). In-class laptop use and its effects on student learning. Computers and Education, 50 (3), 906-914.

Karpicke, J.D., Blunt, J.R. (2011). Retrieval practice produces more learning than elaborative studying with concept mapping. Science, 11 February 2011: 331 (6018), 772-775.Published online 20 January 2011 [DOI:10.1126/science.1199327].

Kraushaar, J. M. and Novak, D. C. (2010). Examining the affects of student multitasking with laptops during lecture. Journal of Information Systems Education, 21 (2), 241-251.

Niemi, P.,Vainiomäki, P. (2006). Medical students' distress--quality, continuity and gender differences during a six-year medical programme. Medical Teacher, 28(2), 136-141.

Mazurkiewicz, R., Korenstein, D., Fallar, R., & Ripp, J. (2012). The prevalence and correlations of medical student burnout in the pre-clinical years: a cross-sectional study. Psychology, Health & Medicine, 17(2), 188-195.

Moulaert, V., Verwijnen, M. M., Rikers, R., & Scherpbier, A. A. (2004). The effects of deliberate practice in undergraduate medical education. Medical Education, 38(10), 1044-1052. doi:10.1111/j.1365-2929.2004.01954.x

Pugsley, L. (2009). Study effectively. Education for Primary Care, 20(3), 195-197.

Sasanow, A. (2010). Varying study locations could improve content retention, psychologists say. The Tufts Daily, October 7, 2010. http://www.tuftsdaily.com/features/varying-study-locations-could-improve-content-retention-psychologists-say-1.2358170

Weimer, M. (2012). Students think they can multitask. Here’s proof they can’t. The Teaching Professor Blog, Faculty Focus, September 20, 2012, http://www.facultyfocus.com/articles/teaching-professor-blog/multitasking-confronting-students-with-the-facts/

Wenger, S.L., Hobbs, G.R., [et al]. (2012). Medical students study habits: Practice questions help exam scores. Journal of the International Association of Medical Science Educators, No. 4, n.d. Retrieved from the association’s website. http://www.iamse.org/artman/publish/printer_500.shtml .

Wilkinson, T. J., Wells, J., & Bushnell, J. A. (2007). Medical student characteristics associated with time in study: Is spending more time always a good thing?. Medical Teacher, 29(2/3), 106-110. doi:10.1080/01421590601175317

Labels: , , , , , ,

Wednesday, May 23, 2012

Facing the Challenge of Teaching Evidence-Based Medicine to Medical Students

I would encourage you all to read this article!

George P., Reis S., Nothnagle M., (2012). Using a Learning Coach to Teach Residents Evidence-based Medicine. Family Medicine, 44(5), 351-355. http://www.stfm.org/fmhub/fm2012/May/Paul351.pdf
This study demonstrates how important the acquisition of ‘information mastery skills’ are to physician success in practicing evidence-based medicine! It shows what one university medical school did to try to improve these skills in their students, targeting their second year family medicine residents. [Alpert Medical School, Brown University, Family Medicine Residency Program and the Department of Family Medicine, Memorial Hospital of Rhode Island]
The article quotes the current ACGME accreditation competency:  
“The ACGME requires that residents demonstrate competency in information mastery or the ability to 'locate, appraise, and assimilate evidence from scientific studies'.“ 

Reiterated in the ACGMEs Next Accreditation System (NAS) ‘General Milestones’*:
(adopting July 2013)
Level 2: (residents) “Formulates a searchable question from a clinical question (e.g., using PICO format).”
Level 3: (residents) “Applies a set of critical appraisal criteria to different types of research, including synopses of original research findings, systemic reviews and meta-analyses, and clinical-practice guidelines.” “Critically evaluates information from others.”
Level 4: (graduating resident) “Demonstrates a clinical practice that incorporates principles and basic practices of evidence-based practice and information mastery.”

Overall, I agree with the approaches taken by the developers of the course, the one-on-one coaching model coupled with being a structured component of the curriculum, and would encourage the adoption of a similar type of program at UMHS. Post intervention assessment of the resident’s EBM knowledge showed a notable increase of 31.8% , along with improved attitudes toward EBM and its increased use in the clinical setting. However there is still room for improvement as the average score on the posttest was still only 58%!
 A few areas I suggest warrant further consideration or emphasis when undertaking such a program :

  • stressing the quality and value of subscription clinical point-of-care databases, full-text journal databases, and other library resources.
  • the integral involvement of the medical librarians in the program (course development, delivery, and evaluation).
  • incorporating the ‘6S’ model ** for accessing pre-appraised evidence and providing directional steps to the search process.
  • augmenting the course with training in current methods for staying up-to-date while navigating the flood of medical information, such as RSS alerting.
  • recognizing that information resources are dynamic and will continue to challenge the information searcher’s flexibility and adaptability. Thus, it is important that the program emphasize teaching the concepts of information searching rather than focusing on the idiosyncrasies of any individual resource, or promoting dependency on any one database.
  • working toward seamless integration of relevant evidence-based clinical information into the individual patient’s electronic medical record (a CDSS or Computerized Decision Support System).
Evidence-based practice isn’t just about finding an answer to your clinical question, it is finding the current best answer based on the peer-reviewed medical evidence, for the care of your particular patient.
I invite your comments ….

Ann Celestine,
Library Director
http://lib.umhs-sk.net/

*Nasca, T. J., Brigham, T., Philibert, I., & Flynn, T. C. (2012). The Next GME Accreditation System — Rationale and Benefits. New England Journal Of Medicine, 366(11), 1051-1056. doi:10.1056/NEJMsr1200117.
**DiCenso, A., Bayley, L., & Haynes, R. (2009). Accessing pre-appraised evidence: fine-tuning the 5S model into a 6S model. Evidence Based Nursing, 12(4), 99-101. doi:10.1136/ebn.12.4.99-b

Labels: , , , , , ,

Thursday, April 19, 2012

AAMC reports 20% of Medical Students are Mistreated

One of this months top stories from the AMA MedEd Update News was about the mistreatment of medical students and the move to more accurately gather information on the prevelance of this problem in order to raise awarness and to better address the issue.
"...the Association of American Medical Colleges (AAMC) has made significant changes to its annual questionnaire of graduating medical students to improve collection of data on medical student mistreatment."
In the current 2012 survey, questions regarding mistreatment will be more visible.
"Current data from previous questionnaires show that approximately one in five medical students report that they have experienced mistreatment. Data from the 2012 questionnaire, which is currently in the field, will be available for release by the fall."

Labels: , , , , , ,

Wednesday, January 11, 2012

What it means to care for your patient!

Third year UMHS-SK medical student, Kristin Riggs, puts a little heart back into the practice of medicine. "For Jose" is a moving, personal narrative published this month in "Family Medicine" Journal ~ [Vol.44,No.1 Jan 2012] . Ms. Riggs will no doubt have many more similar patient encounters as she embarks on her chosen career as a family physician, but this one with Jose, she has generously shared with all of us.
"In just a split second, his eyes told me more than any doctor or procedure had told me that day; he was scared, he was alone, and there was nothing he could do about it."
Thanks Kristin for holding Jose's hand!
Please take a few minutes to read this precious experience! Click on the link to the TOC's for the latest issue [January 2012], and scroll down to the article.

Labels: , , ,

Wednesday, August 17, 2011

Physician Supply & Demand Projections

Some interesting statistical projections for the next ten years came out during a recent panel discussion held at the annual conference in Chicago of the Association of Staff Physician Recruiters. Here are a few highlights:
"By 2020, there is expected to be a shortage of 91,500 physicians — 45,400 primary care and 46,100 subspecialists — in the United States..."
"By 2019, the number of physicians reaching retirement age is expected to more than double, compared to 2009."
"Medical school enrollment is projected to increase 40 percent by 2015, compared to 2002, according to AAMC data. More medical schools are expected to open across the country, and growth in non-U.S. based medical schools enrolling U.S. students (such as Caribbean-based institutions) also influence this increase."
"...the number of residency and fellowship slots actually grew nearly 18 percent between 2000 and 2009..."
Read the full news report from the Becker Hospital Review by clicking on the post title.

Labels: , , ,

Friday, September 17, 2010

Can Burnout be Blamed for Unprofessionalism Among Medical Students?

JAMA this week released the findings of a study which looked at the toll burnout is taking among medical students.
The article is titled the "Relationship Between Burnout and Professional Conduct and Attitudes Among US Medical Students".
Hypothesis: "...professional conduct, attitudes regarding appropriate relations with industry, and attitudes regarding physicians' responsibility to society are influenced more by medical students' degree of professional distress than personal distress."
Conclusion: "Burnout was associated with self-reported unprofessional conduct and less altruistic professional values among medical students at 7 US schools."
To read more click on the title to take you to JAMA's website.
JAMA. 2010;304(11):1173-1180. doi:10.1001/jama.2010.1318

Labels: , , , , , ,

Thursday, September 11, 2008

Critical shortage of internal medicine MDs foreseen

WASHINGTON (Reuters) - "Only 23 percent of U.S. medical students plan to practice internal medicine and just 2 percent intend to become general practitioners, leading to a possible healthcare crisis, researchers reported on Tuesday."
Click on the link to Reuters to read full article...

Labels: , , ,