Medicine From The Trenches

Experiences from undergradute, graduate school, medical school, residency and beyond.

Strategies for Conceptual Learning (undergraduate and professional school)

Many students enter healthcare with the idea that they will “memorize” their way to academic excellence. This strategy is useful for short-term memory of things such as pharmacology formulas that one can write down quickly in the exam margin until needed or a pneumonic such as “Mrs. Ass” for remembering whether a heart murmur is systolic or diastolic. Yes, rote memorization can get to a certain level but strong academic performance and life-long learning requires mastery of conceptual learning.Conceptual learning involves linking of information and building upon a knowledge base. When I entered medical school, my school’s curriculum was “classic” in that first year we learned “what was there”; second year we learned “what can go wrong” and third year we learned how to fix things that go wrong. (Fourth year was refinement of first, second and third year). First year set the concepts and basis for our mastery but we had to build upon those concepts and integrate learning from second, third and fourth year in order to have the tools to become competent and knowledgeable physicians.

Conceptual learning starts with a very strong undergraduate experience. I use the word, “experience” because one should acquire the tools to master conceptual learning as an undergraduate. Sure there are plenty of people who will say that they “party all of the time” and then “cram” right before the test so that the material is “fresh” in their minds. My suspicions, borne out by some of those people’s test scores, especially on exams of applied knowledge, supports that they don’t know and can’t remember concepts. In short, they crash and burn- usually stating “I can’t do standardized tests”.

The experience of concept mastery can start with that first pre-med course where one utilizes the syllabus to identify concepts for mastery. Your textbook can also provide valuable information as to conceptual mastery. Many textbooks will summarize concepts at the beginning of a chapter or at the end of a chapter. This doesn’t mean that one sits and memorizes the concepts as a list but it does mean that one utilizes the list of concepts as a “check off” in terms of mastery of a chapter or mastery of material for an exam. Sure, you can “cram” in information for undergraduate work but once one enters medical (or physician assistant) school, the volume of material tends to favor conceptual learning as opposed to rote memorization. For example, you may be studying the treatment of viral illness in particular course block. You have to understand the concepts of viral structure, viral pathogenesis, immunological barriers and cellular reception/structure. After one couples that information with viral transmission and resistance characteristics (host & viral), one gets a pretty good idea of how viral diseases are diagnosed and treated. One also gets the concept that antibiotics are useless against viral illness. As you are standing at the bedside of a patient who is suffering from a viral illness such as influenza, you understand the characteristics of the symptoms reported and the signs that you are observing. You add those to your clinical experiences in terms of a differential diagnosis and treatment plan which is your key to efficiently treating your patient.

In short, if any of the conceptual knowledge is missing, you will not become an efficient clinician and you will find yourself constantly “behind” in terms of “shoring up” your knowledge gaps. This is the main reason that many people become “overwhelmed” quickly by the volume of material that must be assimilated in a short period of time. For example, about the second week of the first year of medical school, I start to see some of the more obsessive/compulsive students begin to “unravel”. Later on, often after the first exam block, I see some of the more “laid-back” individuals start to up their “game” and make adjustments to their learning strategies.

The people who have the shortest conceptual learning adjustment periods are the folks who have been conceptual learners as undergraduates. They are usually the most disciplined students and they are generally the students who seek assistance when needed and they tend to have less “emotion” when it comes to the materials that they need to learn. In essence, they are just building upon a foundation rather than trying to memorize a stack of words and phrases. No matter how a concept is tested, they are ready for the challenge. No matter how complicated the patient disease presentation, they systematically take that presentation apart and develop strategies for patient care.

I recall my experience with Organic Chemistry, one of my least-favorite courses as an undergraduate chemistry major. My passion lie in analytical and physical chemistry rather than carbon chemistry but my goal was to become an excellent chemist. My career plans were not medical school but graduate study in Analytical Chemistry. Since organic chemistry was far from the math-based chemistry disciplines that I loved, I approached this course from a purely conceptual (and practical level). In short, I probably spent more time organizing this course for my learning style than my other chemistry courses but I had the assistance of excellent professors, whose office hours I frequented, and I sought their experience and assistance with my organization of this coursework. To do otherwise in any discipline or course as an undergraduate took away from the knowledge base and experience that I knew that I would need as a professional chemist. In the end, Organic Chemistry was one of my strongest course performances even though I didn’t plan on becoming an organic chemist. (I ended up in graduate school studying Biochemistry and Molecular Biology).

As a physician, I am required to participate in continuing medical education (CME) for the maintenance of my license and for the maintenance of certification in terms of my medical specialty. It would be difficult to participate in my CME/MOC activities if I didn’t have a strong conceptual basis for this coursework. Most of my CME/MOC activities involve week-long conferences with testing at the end in order to receive my certificates. If I did not have the knowledge base, I would not be able to add the new knowledge and assimilate it quickly. Many of my CME/MOC activities center around evidence based medicine which means that I have to know how to keep up with scientific/medical literature and either incorporate into my practice or reject what I am reading or studying. As an academic physician, I am charged with keeping my scientific knowledge up to date and accurate in both my research/teaching and my practice. This takes a strong conceptual basis for efficiency and accuracy.

As an example, new pharmaceuticals are entering practice weekly and one has to make decisions as to whether one will prescribe a newer pharmaceutical versus a pharmaceutical treatment that has been present for years. Drug company representatives will furnish practitioners with plenty of literature – supporting their new and most likely expensive pharmaceutical but one has to have the knowledge base or ability to quickly acquire the knowledge to fully evaluate drug company claims. We have seen plenty of examples where the newest drug is not always the best drug for treating certain disease entities.

Finally, how does one become a conceptual learner? The steps are generally:

· Look at your course syllabus for the course content and objectives. A well-designed syllabus should give you plenty of ideas as to how the information for the upcoming course will be organized and tested.

· Look at your textbook and determine how the textbook will supplement and reinforce the concepts of the course.

· Look at how the material will be tested. Will there be examinations (essay, multiple choice or oral)? Will there be performance criteria for mastery? How does any laboratory exercises and material fit into the grading/testing of the material?

· Take emotions and “what grade you have to have” out of the learning process. If you master the concepts, the grade will take care of itself. If you focus on what score you have to have on any particular exam, you will generally come up short. It’s a waste of time trying to figure out how to “beat the curve” rather than focusing on what you need to learn and how to get it mastered.


26 April, 2013 Posted by | academics, difficulty in medical school, physican assistant, study skills, success in medical school | 3 Comments