The study habits you set during your residency will be the foundation for the rest of your professional life. Even though that sounds really melodramatic, it’s not. If you don’t want to end up one of the “stupid” doctors, you’ll need to keep learning. Medicine changes so dramatically that it is critical to stay on top of things. Sounds easy, but it is amazing how few doctors develop a disciplined practice of being able to read and study.
Residency, despite what it may feel like some days, is the time that you are learning, and hopefully mastering, your specific profession. All residents have an annual examination called the “in-service training exam”. It’s a nice marker of how you are doing when compared to the other residents in your field, and it’s motivation to stay on top of the didactic part of your education. It is easy, like in medical school to try to “cram” for this test in a few weeks, but that’s really stupid. The test is supposed to motivate you to learn, not to cram. That being said, how you do on this exam is important, so you will want to review in the few weeks before the exam. Your in-service score is predictive of how well you will do on your board exam and may be considered by programs if you end up applying to subspecialty fellowships.
So, what is the best way to learn your field and, as a secondary benefit, do well on the in-service exam? How do you stay on top of the reading, and learn what you need to know? Just like exercise, it’s far more important to be consistent than intense. You can’t train for a marathon by running 15 miles once a month… and you can’t learn your field by “cramming” before the exams. One way to do this is to set up a “training” program for your reading:
Buy the textbook in your field. For many fields, there is more than one major textbook. If that’s the case, ask around to see which one is considered the “best” (it will be subjective, but you have to start somewhere!). If the textbook is on line at the medical school’s library you don’t have to actually buy the book, but you will miss out on the highlighting! If there is more than one good textbook, plan to read a different one next year.
Map out the year into 46 week “blocks” (3 off for vacation, 1 off for the winter holidays and 4 off to review for the inservice exam). Divide the textbook into 46 sections and assign the sections to the blocks. Since I’m a surgeon, I’ll use an example from one of our major textbooks:
- July 1: Chapter 1 – Systemic response to injury and metabolic support and Chapter 35 – Soft tissue Sarcomas
- July 8: Chapter 118 – Chest wall, lung, mediastinum and pleura
- July 15: Chapter 6 – Trauma
Most textbooks front load with the basic science chapters (which are a little dry compared to the clinical chapters). I don’t recommend you try to do the textbook in order or you will drown in the basic sciences (and forget why the field is fun!).
Make the textbook portable? If you are reading on line this may not apply. If not, print out the chapter you are studying for the week from the online source or make a copy of the chapter from the book. You may have to spend 5 or 10 minutes here or there getting through the chapter – being able to keep it folded up in your white coat pocket helps!
Read ahead and be flexible. If in the 2nd week of your study program you get a patient with breast cancer (for example), go ahead and read the chapter on breast. It will be much more meaningful if you are applying it to a specific patient which means you are much more likely to learn the information. Double up the chapters for that week if you can, swap if you can’t – but don’t lose track of the “training grid” (i.e. make sure you read enough to finish the textbook)
Use the SQ3R method when you are reading. This is a great technique for actually learning what you read, rather than having it go in one ear and out the other (so to speak).
- Survey – Look through the chapter at the section titles, graphs and tables.
- Question – Go through a second time (again pretty superficially) but this time create questions that are likely to be answered in the chapter and write them down (this part is actually important, so take the time to write them down!). For example, on a chapter about appendicitis, the questions would be something like: What causes appendicitis? What is the most accurate diagnostic test? Is there an advantage to laparoscopic over open appendectomy? Etc etc
- Read – Read with intention to answer the questions you generated and make notes for later review. Take the time to actually write the answers to the questions you generated.
- Review – Look over the notes you made and questions you answered. Force yourself to list the key concepts to tease them out of the details. Think about what questions you might ask on an exam on the topic. Most importantly – you should review the material the next day (<5 minutes), a few days after that, and then a month later. Set up a schedule and a method to make sure you keep track of this review. Of all the steps that lead to really learning the material, this is probably the most important!
- Recite – This is the one that seems stupid to most people, but it’s not. Based on what is known about learning, reciting the things you really want to remember (out loud, not in your head) every time you review the material really helps with retention. (Thank goodness for call rooms!)
Make notes so that you never have to go back to the book to review. Use whatever system works best for you. If you use the 3×5 card note system it will integrate with the other notes you are taking in the hospital.
There are other systems to make notes that work, too – so find the one that works best for you and then use it! Some people type their final review notes in Word, Evernote or OneNote so they can search their notes. Another unique way to make notes that are easier to remember is to use Mindmapping . Mindmeister and Xmind are on line for making these kind of notes, if this is what works best for you.
Organize your system for review. Your goal should be to read something every day and to complete the week’s reading every week. In addition, you need to have a rotating system of review to make sure you look at your notes a day or two after you make them, a week later and a month later (at a minimum). The more you review the more you retain, so build in as much review as you can.
Great article. I appreciate you mentioning different note services. I’ve never heard of those before…
I’m starting my 4th year now, and I just finished Step 2 CS & CK. I’m trying to stay in study mode (mostly for radiology… which I hope to pursue), and it’s really difficult without a test looming ahead. I agree that consistency not intensity is what works in the end. Good reminder!
Fantastic article. This is really a good article. It gives us a proper insight to utilise time in a best possible way. Thanks a million !!!
Thank you! I’m open to any new ideas or suggestions, too!
I am a brand new intern and I found your article really helpful! I hope to be able to apply it throughout this year … The reading is truly formidable!
great article.i just started my surgical residency n im planing to study something everyday n this article gave me a very good idea of how o can accomplish that.thanks.
Thanks for the helpful advice! How would you further incorporate other resources such as medical blogs, landmark publications, and monthly journals etc in your study plan..?
The basics (textbooks, assigned readings, lecture notes) are more than enough during the basic sciences. Once you get to the clinics, reviewing the literature for patients in your care becomes more and more important.
Thank you for such a great article. I would be interested to hear your suggestions on the currently available surgical textbooks for a general surgery resident. I’m now doing a two-year research fellowship and plan on continuing my reading plan. Depending on who you ask, some suggest Schwartz, Sabiston, Greenfield, or ACS Surgery. I think most people generally suggest Cameron as the standard for senior-level residents. What are your thoughts on books for junior and senior level surgical residents (and for someone in between, like me, who is going back to residency in two years as a PGY 3)?
Cameron really helps to prepare for the boards, but at your level, I’d stay with the more classic textbooks (they are all good!). Even better, if you have access to it, is the SCORE curriculum: http://www.surgicalcore.org/public/aboutscore
Hi Dr. Brandt,
Thank you for giving us such amazing advice. I guess everyone has a different learning style, but I am also a note taker who has the issue of writing too much and never seeing anything through. How much detail do you include when you note take? I tried your method of using card, but ended up making 4 cards after reading one chapter for the condition…. I obviously do have an issue of keeping things succinct…. I would really appreciate your advice!
4 cards for a chapter isn’t bad! When I used this technique as a resident, I routinely had 6-8 cards for every Grand Rounds and/or chapter. Try hard to use bullet points and link the key points to memorable examples.
what a wonderful article. it is really good article, and most importantly it works for me. i’m applying all what you suggested in the article and it is perfectly ok……….it is like magic to me, because i’ve tried so many methods but all sucks but this article is fantastic…..i just wanna say a simple thank you sir, because i know i can’t thank you enough.
Whenever, I read your blogs; I always get the feeling of interacting with a fellow resident or a student. Your compassionate nature reflects upon in every topic you happen to deal with. Not a hint of ego or pride. You still have a child inside you, that helps you solve everyday problems with ingenuity, which one loses, as one climbs the administrative/professional ladder, more so being a surgeon. I feel totally blessed to have a teacher of your calibre amongst us. MAY GOD BLESS YOU, guiding you through your every endeavour.
Thank you so much for such a great & helpful article. I am an orthopedic resident and due to the significant variety of cases in my field I found it very difficult to make a study plan. On one hand if I want to assign myself to a specific chapter in a certain period of timeI will loose my opportunity to match my clinical experience and my readings to have better understanding of the cases on the other hand if I want to follow my daily cases I can never come up with a proper reading of the chapters and can’t have a good perspective of the field. May I have your advice please.
The key is to do both – read about each patient but make sure you cover a major textbook in a year. Make a list of the chapter/sections in your book and how many you have to read to cover them in a year. When you see a patient with a specific problem, read about it, make your notes (this is key!) and check that topic off your list. Here’s another posts to add some details. I’m becoming a big fan of EverNote for taking and keeping these kinds of notes. Good luck!
Pingback: Studying for the In-Training Exam | wellnessrounds