Innovation Lecture

Drinking from a Fire Hydrant: Musings on Active Learning in Medical School

Almost everyone has seen a doctor at some point in their lives. Yet, for most, what actually goes on in medical school remains a mystery. Chances are that if you’re reading this, you have experienced the delightful experience that is medical school. Sleeping in late, eating well, and relaxing with friends and family on the weekend are just a few of the joys that we medical students get to experience. Just kidding. Medical school, as most of us know, is beyond challenging. At my school, faculty members fondly liken the medical school experience to drinking from a fire hydrant. As medical students, our pre-clinical days are comprised of hours and hours of lectures and power points. Then, when class is all over, we get to top off the day with several additional hours of studying. It’s challenging, it’s overwhelming, and at times, it seems downright impossible.

Part of what makes medical school such a unique challenge is the fact that medicine is a tactile discipline and yet, pre-clinical education is traditionally taught in a classroom setting. In response to this dichotomy, the University of Vermont’s Larner College of Medicine recently made headlines by announcing that it would become the first public American medical school to completely eliminate lectures from its curriculum, joining private Case Western Reserve University School of Medicine in Ohio ( This change, which is expected to be fully implemented by the year 2019, comes in response to concern that the traditional lecture format does not promote knowledge retention and instead relies on “passive” learning where the learner is not actively engaged in their education. To draw an analogy, passive learning is like being fed while active learning requires learners to pick up the fork to feed themselves.

Although the University of Vermont and Case Western Reserve University seem to be the only two institutions whose medical schools have committed to becoming completely lecture-free, it’s interesting to realize that other schools have moved towards a more active learning format as well. In my school, the College of Osteopathic Medicine of the Pacific (COMP) , students pick their own small groups. These small student-led groups meet several times a month and work together to complete assignments and discuss scenarios that are based upon real clinical scenarios. Northwestern University’s Feinberg School of Medicine is one of several schools that employs a problem based learning curriculum, and in 2015, Harvard Medical School also restructured their curriculum to become more problem-based. Ultimately, medical school curriculums exist on a spectrum from passive to active curriculum styles and the continuum seems to be shifting to favor active learning styles at many medical institutions.

Moving away from a traditional lecture setting certainly presents its own unique challenges that affect learning. The non-lecture curriculum requires more self-reliance on the part of the students, who must teach themselves new material. The small groups used at COMP, for example, are completely student-led. A faculty member may pop in for a few minutes to make sure that the group is running smoothly, but often these faculty members are not experts in the subject matter at hand and are present to deal more with administrative issues than to teach content.  It also means that students are required to participate in groups, whereas many schools may have optional attendance for lectures. Perhaps the biggest challenge of the active learning curriculum, however, is the necessity for different personalities to work together to achieve a common goal. The traditional classroom setting involves one teacher who employs a specific style to reach multiple students. In the active learning curriculum, small groups are often used, in which each member has a different personality. Students in these groups must work together, sometimes despite personality differences, to master the curriculum and achieve common goals. Although the group setting closely resembles the team-based approach taken in most healthcare settings, it can undoubtedly be frustrating, especially for someone like myself who tends to be more introverted and likes to study on his/her own. In my personal experience, the members of my small group were incredibly supportive and had a variety of strengths, yet there were many days when I couldn’t wait to return to the comfort of my own room to be able to really learn the material myself. Sometimes trying to learn unfamiliar concepts with others was a distraction, and despite the best of intentions, small group was like the blind leading the blind when we were all confused on certain concepts. There were some times that the small group felt comforting, like someone holding my hand, and other times when it felt too overwhelming, like someone pressing my face up against that proverbial fire hydrant. Ultimately, I felt like the combination of both lectures and small groups was actually more dynamic than relying solely on one or the other. While the University of Vermont and Case Western Reserve University have both made the bold move to abstain from lectures altogether, they join the company of many medical schools, both allopathic and osteopathic, that have recognized the importance of active learning for the medical school curriculum. Let me know what alternatives your medical school offers to traditional lecture-style learning!


Study Tools and Tricks to Doing Your Best in Medical School

Congratulations, you have made it into medical school! Now what? Where do you begin with all the resources designed to help you do your best in medical school? Not to worry, for no matter what type of curriculum your medical school may use, the fundamental resources that most medical students use remain the same. The following is a concise list of the best study tools to help you do well in your course work, as well as to best prepare you for your future board exams.

Best study tools:

  1. First Aid for USMLE Step 1. This book provides a generalized overview of the concepts taught in each of your courses. It is worth annotating as you go through the curriculum in your first and second years because the book is a compilation of key concepts tested by “the boards”. The boards, aka the Step 1 exam, is a key exam that you will take at the end of your second year of medical school, and the score you receive will help determine where you are matched for residencies. Needless to say, the boards are VERY important. Keep in mind that First Aid is only a simplified version of most of what you need to know for the boards, so annotating from lecture material is a must. Otherwise, you will likely not receive the board score you want. It is also worth noting that each year a new version is released, so aim to get the most recent one. The 2016 version is available here on Amazon for $45.
  2. First Aid Organ Systems. This book goes into greater detail than the First Aid for USMLE Step 1 book and is excellent for organ systems based curriculums. Though many USMLE blog forums have pointed out that there are more mistakes in this book than the USMLE First Aid book, the book is revised each year and any spelling and/or grammatical mistakes noted are made available online. Despite this, I’ve personally used and annotated the book, and it has greatly helped me in my organ systems courses. I will be using this, alongside First Aid for USMLE Step 1, as my step 1 study guides. The newest version is available in a two pack (one is organ systems and the other is basic sciences) on Amazon for $124.50.
  3. Pathoma. This book is gold for pathology. Every medical student should have a copy. It hits the high yield points for both in-class exams and for the boards, has videos available for more in-depth explanations, and is sectioned by different organ system pathologies. It also provides histological pictures and explanations as well, and is easy to read. Annotating lecture notes in Pathoma with also help you in preparing for the boards. A free trial version is available online. Full access, along with a hard copy, is available on the same website for $84.95.
  4. Goljan Rapid Review Pathology. This is another popular pathology book. It goes into much more detail than Pathoma, but it can be cumbersome to read. Most medical students prefer Pathoma along with lecture annotation, but if you prefer a more detail-intensive textbook, this is the one for you. The newest edition can be found on Amazon for $45. A newer edition (5th edition) is set to come out sometime soon this year, so keep a look out if you choose this text.
  5. Firecracker: While textbooks are great for learning, self-testing is equally, if not more, important. Firecracker is a USMLE Step 1 prep question bank that helps quiz you on material you learn throughout your course work. Starting from day 1, if you use one of the first aid books listed above in conjunction with your lectures, and begin quizzing yourself on the material with a question bank like Firecracker, you will be very prepared for your course exams and for your board exams. Firecracker is a tool that is best used throughout the school year to reinforce what you are learning in lecture. Firecracker is available for a free trial and for various prices for different lengths of time.
  6. USMLE Rx. This is another excellent online question bank that is designed to help prepare you for your board exams, and it is integrated with the first aid book. This question bank can also be used throughout the year to reinforce what you learn in lecture and has more questions overall than Firecracker, but it is also more expensive than Firecracker.  You can try a trial version online.
  7. First Aid USMLE Q&A Book: This book is like the aforementioned question banks but in book format. It provides questions, along with answer explanations in the back. One of the advantages of having a hard copy Q&A book is the ability to easily annotate and review notes; while you still have a note taking option in firecracker and USMLE Rx, it is more difficult to track. Nevertheless, the online question banks are easier to mark and review difficult concepts than the book. You can buy it on Amazon for $36.

Other resources:

  1. Planner: Organization is KEY in medical school. If you find yourself lacking time to study, get a planner and start writing down your hourly/daily goals. It will help a lot, especially as exam time rolls around.
  2. Academic Success Advisor: Every medical school has one, and they may be called something different, but the function is the same – to help you find the best study strategies and tools that work for you. Make an appointment (soon after you begin classes) with your school’s academic success advisor and ask for tips and pointers on possible study strategies. Also, if you have questions about resources, advisors are the “go-to” people.
  3. Medical school textbooks: If your school does not include textbooks in their tuition fees, but you are still “required” to buy them, attempt to find free versions online first. Often, review books alongside lectures will give you the information you need. However, if the information still feels insufficient, old editions of the required textbook are a cheaper alternative to the required, new ones, and will give you all of the content you need. (For cardiology, I highly recommend Lilly’s Pathophysiology of Heart Disease. Well-written and easy to read.)
  4. Notecards: I started my first year with notecards/flashcards but realized soon that I was taking more time to make them than I was using them to study. However, many of my classmates swear by note cards and it works well for them. I still use flashcards for memorizing drugs or for difficult-to-remember concepts, but otherwise I have stopped using them. As I said, do not be afraid to try out new strategies when studying – you are still developing the study habits that will work best for you in the future.
  5. Whiteboard: Repetition is key for memorization. Drawing out mechanisms of action, or making charts and diagrams repeatedly on a white board can really help the facts stick. I’d highly recommend investing in one.
  6. OneNote: Most new computers come with the OneNote software and it is a great tool for organizing your notes online and retrieving them easily months later. I personally like to print out and write handwritten notes (I’m old-fashioned) but I used OneNote in the beginning and really liked it. Plus, if your laptop were to suddenly stop working, OneNote backs up all your information so you can retrieve it from the application on another computer.

Before going out and buying all of these books and purchasing subscriptions to the online question banks, do a little research this summer and decide which ones are the best fit for you. One of the things to keep in mind is that not only do you want to find good study resources to do well in your coursework, but also those that will best prepare you for your upcoming board exams. Doing well in your courses will set the ground work for being prepared for your Step 1 board exam. The best combination of resources is one general review book, one pathology book, and one question bank.

When you get closer to preparing for your board exam, you will be using the notes from your general review and pathology books, in conjunction with more intensive question banks such as UWorld. It is best not to overwhelm yourself with resources in the beginning, and it is OK to experiment with techniques and resources that work best for you. Of course I have not listed all the possible resources, as there are far too many. However, the ones listed here will provide a solid start to your academic success.

Featured image:
Contemplate by Walt Stoneburner

Humour Lifestyle

Study Strategies: The Good, The Bad, and The Ugly

The Tortoise
The tortoise is in it for the long haul. He studies for a fixed amount of time, every day. He has a routine. He never has to worry about cramming or catching up, because he’s always on top of things. The med school years for him are simple years; he studies and refrains from indulgence. Indulgence is too time consuming, and throws him off his rhythm. “If I party on Friday night,” he says, “then how will I get up at 6:30 to study on Saturday?”

The Hare
The hare is usually a social butterfly. So much energy, and so productive . . . in spurts. But the hare also enjoys taking time for herself. She takes evenings or maybe even whole days off studying. If she didn’t do this, she would fall victim to the dreaded burnout. At least that’s what she tells herself. Although she is often behind, her ability to catch up is second to none. Many of us have probably heard the adage that it’s impossible to cram in medical school. Well, not for the hare. Cramming for the hare just starts a few days earlier than it did in college. It really is impossible to cram for a neuro test the day before the test, but it is possible to pull 3 consecutive 20-hour cram days and still do well. As for long-term retention, who knows? Only boards will tell.

The Moocher
The moocher is lazy. He keeps to himself most weeks. He does not make study guides or contribute to anyone else’s learning. If at all possible, he will not show up to lecture. When a test is not looming, he can be found in his underwear at home, drinking beer and cruising the interwebs. Then, when a test looms near, he breaks free from his filthy cocoon of lethargy and can be seen on campus and social media snatching up all the condensed study guides everyone else in the class has made in the previous weeks. The moocher usually does okay on the tests, but one wonders how he will perform during rotations and residency when he does not have such helpful resources on hand.

The Memorizer
The memorizer is the queen of facts. Her ability to absorb large tables of seemingly random bits of information is unparalleled. While some may struggle to recall even the names of different medications, the memorizer will calmly recite all of the generic drug names, all of the brand names, how to spell them, how each of them is metabolized, their side effects, and which are contraindicated under what circumstances. She can do this after only going over the material once. Her classmates are in awe of her. Truly she is blessed.

The Reader
The reader… reads! Truly he is a rarity in our times. While he abhors the brute memorization of random facts, he loves to read textbooks. Bringing together a large body of knowledge into a logical system is what the reader enjoys most. He is a systematic learner who loves finding out how the little details fit into the bigger picture. The reader also must have strong shoulders, for textbooks are not known for being lightweight.

The High Yielder
The high yielder is focused first and foremost on the next exam. Perhaps it is a flaw, or maybe just an efficient allocation of her resources, but the only thing she cares about is information likely to be on the next test. She might be heard on campus saying something resembling the following: “Did the professor say that’s going to be on the test? No? Then I’m punting it. I’ll learn it later for boards if I have to.”

The Recluse
The recluse is only seen on mandatory days. Nobody really knows what he does. The only thing known for certain is that he does not go to class or social events. He doesn’t have a Facebook, and certainly shuns the company of others when he is forced to be on campus. The recluse may either be an actual loner, who would much rather be alone than in a group, or he may just be an older, married father of 3 who spends his time with family and studying at home. Either way, whenever he shows up, everybody turns and whispers to each other “Who IS that? Is he in our class?”

The Deity
The deity is revered by all. She is at the top of the class. Her study methods are mysterious. She somehow gets top scores on tests, actively participates in multiple clubs, is on student government, volunteers regularly at free clinics, and conducts research. She has a strong presence at social events and on social media. All of the students and professors adore her. Many have tried to discover her secret, but it remains a mystery. The current hypothesis is that she only sleeps 3 hours per night.

Featured image:
Studying in Starbucks by Nicola Sapiens De Mitri