With the start of the new school year, 25,000 incoming medical students in the United States—and hundreds of thousands of students around the world—are wondering how best to study so they can succeed in classes, on board exams, and in the clinic. Fortunately, decades worth of neuroscience research has given us an entire toolkit of techniques, many of which you probably have not heard of before. Both of us have devoted much of our careers before and during medical school to assimilating and testing these cognitive techniques; the result of these efforts is our learning platform, Osmosis. Here we will highlight five of the most effective, neuroscience-backed study techniques that we've incorporated into Osmosis that every clinical student should know and how you can apply them. Technique 1: Test-Enhanced Learning Having taken dozens of high-stakes summative tests, ranging from class finals to the MCAT, SAT, and ACT, you've probably come to associate tests with the end of a learning experience rather than as part of it. Fortunately, over the past decade, researchers have been chipping away at this dogma; now, educators are beginning to view low-stakes formative tests as integral parts of the learning process. Testing has been shown to more effectively improve knowledge retention compared with less active forms of studying, such as rereading information or rewatching lectures. Thus, it is important to find opportunities to quiz yourself with flashcards and questions, ideally on a daily or weekly basis, to ensure that you're truly internalizing the material. In a New York Times commentary titled "How Tests Make Us Smarter," Professor Henry L. Roediger of the Washington University in St Louis further describes how active retrieval of information through testing strengthens the underlying knowledge. Equally important, however, is when you take these tests, which brings us to the next technique. Technique 2: Spaced Repetition First described in the 1880s by German psychologist Hermann Ebbinghaus, spaced repetition is hardly a novel technique. However, it's only now becoming widely adopted by students and teachers. The key concept is that spacing your studying and self-testing over time as opposed to massing, also known as "cramming," will flatten your forgetting curve and help you retain information longer. The reason cramming persists as a popular behavior is that it is often more effective in the short term. Pulling an all-nighter can certainly help you pass tomorrow's exam, but 1 month later, you will have forgotten much of that information. Given that learning medicine is more akin to an ultramarathon as opposed to a sprint, it would behoove you to space out your study sessions. There are many tools that can schedule these sessions for you, including Anki and Osmosis. It's important to note that spaced repetition does not just help with knowledge retention—it also helps with skill development, as this study on learning surgical procedures demonstrated. All this being said, recognizing potential issues with spaced repetition is also important. Given how dynamic medicine is (eg, guideline changes, pharmaceutical discoveries), you actually do not want to remember what you learn in school forever. That’s why you should use a spaced repetition system that updates you on these changes (something we’ve pioneered at Osmosis). Technique 3: Interleaved Practice Let's say that you want to learn concepts A, B, and C. The traditional model of education has you master each in turn through massed practice: AAABBBCCC. Interleaving mixes this up, for example: ABCBCABAC. Similar to spaced repetition, interleaving may not be as effective in the short term but is more effective in the long term. This is because massing often becomes a passive process, where your brain goes into cruise control and you default to mechanically applying knowledge; interleaving forces you to think through each concept every time and helps you figure out how they overlap and differ. Thus, for example, when you learn about the various diuretics, do not practice all the thiazides followed by all the loops; instead, interleave them. These first three techniques all fall under what UCLA psychology researcher Robert Bjork and his colleagues call "desirable difficulties." These are counterintuitive strategies that lead to reductions in short-term performance but improvements in long-term performance. Technique 4: Memory Associations Have you ever had difficulty recalling someone's name even though you remembered a seemingly obscure fact, such as where that person is from? This can in part be explained by the Baker-baker paradox, which essentially describes why it is easier to remember what someone does (baker) than what their name is (Baker). The name is simply a string of letters, whereas the profession is an evocative concept that helps you quickly form associations, such as your favorite baked good or the bakery near where you live. The more associations you can form to something you're trying to learn, the more likely you are to remember it in the future because there are more paths you can take to retrieve it. These associations can range from visually compelling images or "memory palaces," which is the basis for the education company Picmonic (which found up to a 331% improvement in memory 1 month after learning disease topics), to actual patient cases, which can be accessed through such tools as ReelDx Education and Celebrity Diagnosis. We recommend combining two or more of these tools to ensure that you're forming strong associations to the thousands of otherwise seemingly discrete facts that you encounter during your medical training. Technique 5: Fogg Behavior Model Now that you know a few techniques that are proven to help you learn more efficiently and remember longer, how do you actually make a habit of them? This is where the Fogg behavior model can transform your life (and help you counsel your future patients better). Stanford behavioral scientist BJ Fogg reduces behavior change to three variables: motivation, ability, and trigger. If you think about any behavior—exercising, quitting smoking, or studying using the techniques described above—you need a certain level of motivation and ability, followed by a trigger, to implement the behavior. For example, say you want to study new material and review past concepts on a daily basis. Your motivation is a desire to do well on class and board exams and, more important, when you see patients. You can increase your motivation through engaging such practices as gamification and social accountability (eg, study groups). You can increase your ability by using such tools as mobile apps that make this material readily accessible wherever you are. Finally, you can trigger the behavior through reminder emails, text messages, and push notifications. On this last point, the key is not to burn out on the triggers so that they do not have an effect in the future. One unique way to decrease the chance of this happening is by making each trigger relevant by syncing it to your individual curriculum and schedule—so you get, for example, practice questions on gram-positive bacteria when you're actually learning about them as opposed to randomly. We've previously written in the Annals of Internal Medicine about how we've implemented this using an intelligent recommendation systemic, similar to what Amazon and Netflix use. Bringing It All Together Now that you know about these effective strategies, how do you make sure you actually apply them? Fortunately, the behavior change model above can help you implement these and other behaviors in your life. We also recommend checking out the many educational tools that enable you to use one or more of these techniques, so that you are more efficient with your limited time. Source
