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.