18 December 2011

How we learn

I worry somewhat that learning for learning's sake can be a liability in medical school. Perhaps out of necessity, my class devotes the bulk of its energy to excelling on exams. Sometimes this drive to perform runs counter to learning: one of the most effective study tools is to obtain old copies of quizzes and exams. One can do quite well by memorizing the answers to questions that historically appear on exams, even without understanding quite what they mean. Another winning strategy is to come up with mnemonics particular to the examination ("The four arteries we were supposed to remember begin with the letters MIDS").

It makes sense why some classmates would opt to limit their studying to what will be assessed on exams and boards. Many have girlfriends, boyfriends, spouses, and children that (deservedly) compete for their energy and time. Getting top marks in courses yields academic distinction and hefty scholarships. Even our class's lingo revolves around the test: topics likely to appear on an exam are termed "high-yield." Wasting classmates' time with "low-yield" topics is a cardinal sin. Few students read the assigned textbooks, because the exam material derives from the bolded bullet points in our lectures' PowerPoint slides. We were told ahead of time exactly which physical examination methods we needed to know on the final exam; others were summarily ignored.

Even the boards that we take second year (the standardized examination that all allopathic medical students take, and that plays heavily into residency placements) promote shortcuts. If a question begins: "A 19-year old female sex worker comes into your clinic," I instantly know that the answer they will want me to put is a type of STI. Real life is not so simple. Clinical decisions do not involve choosing the best answer of the five choices proferred.

The fundamental question is: should we consider medical school an educational experience in its own right? Or should we treat it as a stepping-stone to our desired residency and career? I fear that learning to the test prevents us from becoming that breed of excellent physician that inspired me to enter the profession.