Friday, 18 November 2016

How do I study for this?

Studying in my final year of medicine, there is one question I get asked by the years below me all the time. "how do you study for this? what should I study from, the books, pubmed or the internet?"
Compared to twenty-thirty years ago and with the boom of the internet we have a huge amount of resources at our disposal. And its this huge variety in educational resources makes this question an increasingly common one. Here is my answer:

Disclaimer: First of all, everyone has their own best method, some people learn best from videos, others from quizzes and case studies, this is an important disclaimer when considering study methods.

What is there?:
  • Fundamental textbooks
  • Wikipedia
  • Pubmed
  • Uptodate
  • Lectures and lecture notes
  • Clinical case and question books/sites
  • Revision books
  • Senior and classmate notes
  • Group sessions
  • Youtube
  • The ward
  • medical blogs
  • FOAMed/MEDed and twitter
(SKIP TO SUMMARY/ANSWER AT THE END IF YOU LIKE)


Textbooks:
The bread and butter of medical study. Often huge, boring and full of what some may consider unnecessary detail. Older doctors will swear by them and the younger doctors may completely avoid them. Use your textbooks as reference! No one has time to read the entire Goodman and Gilmans pharmacology or Kandels textbook of neuroscience. Textbooks are becoming increasingly thicker and thicker and the level of information can terrify first and second year students. When it comes to the fundamentals however, use them! but look for concise or targeted student versions:
Anatomy - Greys anatomy for students
Physiology- Berne and levys physiology
Pharmacology- Rang and Dales
These kind of books for the basic sciences are a must read in their entirety, try and find a smaller concise version for each core subject afterwards. Its in the clinical subjects where you should only use textbooks for reference, Harrison Cecils etc.

Read them, make brief notes, highlight important concepts, bookmark pages, the fundamental textbooks need to look like they have survived a train-wreck after the first couple years of medicine.
moving to the clinical years is where things get tricky...


Wikipedia:
Whenever you google a clinical condition the first post is most likely to be wikipedia post. Hugely informative and structured perfectly with sections for diagnosis, presentation, prognosis and related diseases etc. Take it with a grain of salt. Wikipedia is created by hardworking freelance contributors, many the posts are accurate and uptodate but you never know, they may not be! Until wikipedia has more efficient controls in place, its best used as a quick refresher and definition search tool 

Pubmed:
The centre of all that is EBM (eveidence based medicine), you can effectively answer any clinical question here for free. however, its hard work! often you have to search  hundreds of articles, and even if you find a nice review, it will probably contain many pages of information that you just arn't ready for yet as a medical student. which brings me to Uptodate

UptoDate:
Requiring a login or at least a registered institution, its not free! However this is the best place hands down to answer any clinical question you may have. The information is reviewed regularly and all the relevant clinical information that is interspersed through articles on pubmed is concentrated here. Again there is the issue of perhaps being a little too advanced for the average medical student. Best used a reference to clinical questions especially patient and disease management questions. 

Lectures:
Tedious, time consuming and highly dependant on the skill of the lecturer. We have all sat through a lecture so boring that you struggle to keep your eyes open, it can be a waste of time. On the contrary we have all been to that amazing lecture that kept us on the edge of our seat and full of curiosity at the end. Sometimes I feel I learn more from certain lectures than I ever could in a day reading through the relevant textbook. As much as we moan and and groan about them, lectures are important! attend them, drink coffee, and make notes! lectures will form the backbone of your study and are an important place to cement the core concepts you will need to study in revision. The medical exams are often about what you were lectured on remember.

Clincal cases and question books/sites:
Use these after you have studied, prior to exams. The best way to really test if you really know a subject is to test yourself. Often through testing yourself you find the holes in your knowledge base. it really works! Clinical case books are excellent, a little tedious but are probably the best way to test yourself in a way that will prove to be useful when you start work as a doctor (that special way of thinking when you approach a patient). Multiple choice question books and similar quiz books have now been surpassed by websites with endless question banks. The BMJ on examination site (which I use regularly) is just fantastic. One of my colleagues swears by the Firecracker app, where he answers about 50 quick questions a day on the metro/underground on the way and back from university. Unfortunately there is a catch, these questions banks can be incredibly expensive, so maybe its best to use these resources only before the big exams such as finals or end of phases.

Senior and classmates notes:
Forget it, the source isnt always reliable and most of the learning is in producing the notes yourself. One of my colleagues makes a killing selling his anatomy notes to first years, perhaps a good buisness solution, dont fall for it. On the plus side, notes may be targeted to an exam well and help when you have missed lectures. My advice, avoid if possible.

Group sessions:
Moving a bit away from the topic of resources, group studying is a real preference for some people. I think I will address the debate 'group vs solo studying' in another post. It depends a lot of the group itself and the study method, tackling clinical cases together is a good method.

Youtube:
What a resource, there are hundreds of videos on youtube and many of them are fantastic. I mentioned in a previous post Paul Bolin lectures and how they are brilliant for students preparing for the USMLE. Youtube is probably the best place for people interested in surgery and procedural medicine. Intubation, inserting catheters, chest drains and surgical approaches its all there (although can take some searching to find decent videos and in the correct language). Its incredibly difficult to learn a procedure from reading a book or passage, they are best learnt visually in a step by step matter, or better yet on the ward!!

The ward:
A must for all students. Spending time on the wards presents potential learning opportunities in areas which are favoured by in examinations, particularly practical assessments. Remember that medical school is a precursor for life as a doctor and thus, adequate exposure is necessary to assimilate the abilities expected of new doctor when they start. Although tempting to spend less time on the wards, especially near exams, try not to skip these session. Take a pen and note pad, note down everything you learn or new drug/disease/concept you hear. Try and take at least one history every time you are on the ward.

Medical blogs (like me :)):
There are some incredible medical blogs out there, life in the fast lane and emergency anatomy to name a couple that I usually use. It can be difficult to keep track of the variety in posts and to stay on track when studying a particular subject. You have to be careful with the accuracy of the information and sometimes it best to use the references in the post and read the original material before even reading the main post. I kind of feel that blogs are actually best for gaining an insight into the world of medicine, for opinions on the latest research and methods and for all that humanitarian stuff that forms much more of medicine than most of us are aware about. Patient care and professionalism are fundamental to a great doctor, it can be hard to find a good understanding about some of these issues from textbooks, blogs are invaluable! (not many textbooks will have a part about how to study like this will they ha).

Twitter:
There is an amazing movement happening in medical education at the moment, the hashtag or FOAMed movement. Hashtags like #FOAMed and #MEDed are attached to various things from the internet (videos, blogs, websites) to form this huge collection of medical education resources. More specific hashtags can be used to focus on the subject at hand #FOAMcc for crtical care for example or even summarize the findings from important conferences like #AHA16. Its a wonderful movement and its keeping medicine uptodate almost instantaneously and completely for free. Watch this space!

Ok I have rambled on a bit now and my lunch break is ending. Here is my best answer to the question above:

Attend lectures, make notes and read through them briefly that same day. Use the lectures to form a kind of back bone of core topics. Use the text book to cover these core topics by subject. And use the entire textbooks when addressing core fundamentals like anatomy and physiology. 
When you start clinical modules, use smaller review books with a more concise approach (I'm thinking Kumar and clarks vs Harrisons for example or Surgical talks vs Sabistons surgery). Whenever you have a clinical question use Uptodate and Pubmed. If you feel you need to understand something better use the fundamental textbooks. Try and explore the topics with twitter and blogs. When you are close to exams use clinical case books and online question banks, referring to the textbooks when you find a hole in your knowledge. 

NOTEs:
_The Eisenhower box to time management, works for studying too:
Remember you don't have to study everything in order, spaced repetition is the better way of learning in the long term.

Any questions feel free to comment and Ill get back to you, gotta runn..

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