Five Resources to Make Learning Anatomy Easier

Studying for anatomy is one of the more time-consuming activities during medical school, and the sheer quantity of material makes it easy to get bogged down. The right tools can help a lot–here’s a collection of the web resources I’ve found most helpful thus far:

• GetBodySmart.com: this tutorial site shows you the origins and insertions of a muscle, then lets you add the surrounding structures one at a time to see how they fit together. Quizzes for each section, too!
• The Anatomy Lesson: this site has good self-teaching modules and a great collection of USMLE-style practice questions (static, unfortunately).
• U of Michigan’s Visible Human Browser: lets you drag the cross-section to the level you’re interested in. Based on the National Library of Medicine’s Visible Human data.
• Tufts’ Cross-Sectional Anatomy Home Page: Same data in a static format; includes identifications/self tests.
• Learn the Brachial Plexus in Five Minutes or Less: PDF of a slide show, teaching an easy schematic step by step.

Med School 2.0

I was talking to one of my school’s student representatives to the curriculum committee the other day, and it got me thinking about how medical education still follows a very traditional model, despite all of the advances in technology over the past 15 years (ie we still spend the bulk of our time listening to lectures and studying). My school isn’t stuck in the dark ages; among other things we have a nice (award-winning! or so they tell us) website that has forums, online quizzes, all our course materials, and the like. But medical school still follows the same pattern it has for a long time: 2 years of sitting in lecture, followed by 2 years of apprenticeship (followed by 3+ more years of apprenticeship–journeymanship?–during residency).

The clinical years are probably not amenable to radical alteration. But I think the preclinical years are ready for a transformation. People learn in different styles, but almost no one learns _best_ by sitting in lecture. Most med schools have a course in Problem-based Learning, or something like it, in which a small group of students discusses an actual case, doing outside research to fill in knowledge gaps. What about expanding PBL so that the cases incorporated most of the basic science curriculum? Lectures are already recorded and available for outside study, as are a variety of web-based tools and study guides. The issue would be ensuring thoroughness, but I think carefully designed modules could take care of that. (Olin College does something similar for engineering, and from what I’ve heard it’s been wildly successful.) Just one idea, and there are obviously a number of ways you could do this, but I think it’s time to shake things up!

5 Resolutions to Make for a Less Stressful Academic Life in 2010

Most New Year’s resolutions are as transient as the snow that’s blanketing Boston right now. They don’t have to be, though–the key is to decide on small, specific steps that lead to big payoffs when implemented consistently. Here are five changes I’m making this year to simplify my academic life and decrease stress.

1. Implement the 48-hour rule.
Basically, the goal here is to ensure my class notes are adequate as a study guide by the day after each lecture. In med school, the volume and pace of the material are just too high to catch up if you get behind even slightly. I take efficient class notes (Study Hacks-style), but the first month or two or school, I would end up with a stack of lecture notes that still needed to be processed the week before the exam. That meant I didn’t get to review some of the material thoroughly. I’ve blocked out an hour at the end of each day to get through that day’s notes and fill in any gaps.

2. Turn wireless off during lecture.
The hazards of taking notes on a laptop. It starts off with an innocent google query to define a new word, or a glance at our online schedule to see what’s next, but rapidly degenerates into checking RSS feeds. This is one of those Duh! resolutions, but here’s hoping to make it stick.

3. Draw things out.
One quirk of med school is that we have a huge number of different lecturers over the course of a given class. Sometimes these folks are experts in their field, but sometimes it has to do with professional politics–and they’re often not that good. Or even if they are, they frequently repeat material we’ve already seen. Instead of browsing the interwebs during such lectures (see 2. above), my plan for this semester is to use the time to sketch out concepts from other classes to check my recall.

4. Simplify the everyday.
Cooking, cleaning, filing my papers and notes…these are the things that pile up and encourage me to procrastinate before an exam. I already have a grocery checklist, and I’m in the process of putting together recipe cards with the lunches and dinners I regularly make, saving me from having to look up the recipes twice (once to write down the ingredients for my shopping list, and once when I prepare it). I’m hoping to get into a better routine for doing laundry and mending so it doesn’t pile up, too.

5. Recharge.
One of the perks of being a student in Boston is free admision to the Museum of Fine Arts, and it’s even kind of on my way home. So, my resolution here is to go for an hour after every exam, to have a breather and some built in time for reflection and regrouping.

Here’s to a new decade! Cheers!

Reads this week

• DIY data analysis
• Evidence-based pathways for common conditions from UK’s NHS.
• NCAA DI football teams can be successful AND have academic standards: TMQ; how Cal does it.
• Psyblog: Seminarians’ “good Samaritan” tendencies depended more on whether they were in a hurry than their personality type.

Are adolescents different?

NYT has an interview with Laurence Steinberg on whether neuroscience should have a say in whether adolescents can be sentenced to life without the possibility of parole. The issue here is not just that teenagers are more likely to be rehabilitated than adult offenders–it’s that their prefrontal cortex is very much still developing, making them less good at impulse control. It’s an important point, and one that sometimes get overlooked–adolescents are not yet developmentally adults (obviously, or the age of majority would be lower). The problem I see with this logic is that if this is true for teenagers, it should also be true for adults with demonstrable deficits in this area, like someone with a frontal lobe injury that results in erratic behavior. But making law more individualized based on such a factor seems to open up a whole array of slippery slope concerns. I don’t know–what do you think?

Data-driven decision making!

Seth Godin on what to do when the data contradicts your hunch.

Easy hack to increase your learning efficiency

The thing that every doctor I meet tells me about the first two years of medical school is that it’s like learning a foreign language: there’s so much material that it’s impossible to retain it all. Instead, the goal is to immerse yourself in it so that you gradually start to retain factoids that you can connect into the bigger picture. Classes are taught this way, too; despite the frequency with which “integrated curriculum” is thrown around, we still get the histology of the kidney in one class, and then the physiology in another lecture weeks later. Professors reference material they assume their colleagues have already covered, so if you missed a concept the first time around, you’ll pick it up the next time you see it.

Well. Having spent some time in a non-English-speaking country, I think the immersion approach is bogus for both language-learning AND med school. They both involve way too much material to take a passive approach to learning. Immigrants can live for years in a country without mastering the language. I learned early on that if I ran into a word and just looked it up, three days later I would have zero recollection of the meaning. I would remember encountering the word, and the process of taking out the dictionary–but the definition would escape me. To be able to retain anything, I needed to add the word to my vocabulary-study notebook.

As it turns out, it’s not just me. Kids showed better retention to a word pair test by guessing an answer, then checking it, then by having the full allotted time to study the pair. The problem is that in med school, the volume of information is too great to keep up with this way.

My approach: the Jabberwocky method. My grandfather taught me how to memorize poetry effectively when I was about 9 years old in this way:

• Read the poem.
• Read the poem with a few key words deleted.
• Fill them in.
• Check your work.
• Repeat with more words deleted, until you have the entire poem memorized.

It seems like it should take longer than just repeating the poem to yourself until it sticks. But although it takes a couple minutes to set up, learning the poem comes painlessly, and it’s effective: I can still rattle off Jabberwocky 15+ years later.

How does this translate to language learning, or medical school? For the former, I recommend learning whole dialogues or paragraphs of prose text on the topic you’d like to be able to converse about. (Side note: I have a set of language tapes that work this way, and they are fantastic for retaining weird vocabulary.) For med school, I have been compiling my notes in nested bullets. Microsoft Word’s notebook feature makes it easy to collapse a section, so I can learn the top level of bullets, then the next, and so on. It’s been effective so far–and this way I don’t feel like I’m getting dunked by a tidal wave of material.

Instinct, time pressure, and the 1-minute eye exam

In my last post I talked about quarterback decisions: those moments when a situation presents itself and a decision has to be made on the spot, no time for weighing of options or due diligence or development of logic models. I argued that consistently making good decisions in these moments is the result of an instinct developed from practice, hours of repetition that help us sense the best path to take even when we can’t consciously articulate a reason why. I think it’s hard to argue that reliable instincts are invaluable, and that developing them takes time and more time.

And yet…isn’t there a shortcut? What do you do when faced with a situation which you encounter only rarely, but in which time is nevertheless essential? How can you develop good instincts when it’s not possible to have endless re-dos? Flight simulators, or their equivalent, are one option: this is the logic of the fire drill. But they can’t fully simulate pressure under fire, because we consciously know this is a test. There are statistics out there about how poorly CPR-trained bystanders do at following the guidelines: it’s not that they’re too complicated, or even that they’ve forgotten what to do–the rescuers are just too slow to get adequate oxygen saturation. That’s why the first step is to call for help: professional rescuers are much more successful, because they do it all the time. They’ve practiced, so to speak, in high pressure environments.

It’s situations like these that call for good rules of thumb: tests or guidelines that remove ambiguity when we don’t have time to process it. Brain Blogger has an article about how doctors spend too much time diagnosing stroke patients who present with dizziness, because the differential diagnosis is unclear and resolving that ambiguity through MRIs takes time. A 1-minute bedside eye exam was shown to be more accurate than the MRIs–and had the additional benefit of being quick, allowing patients to get treatment faster, reducing the risk of brain damage.

There are countless areas in medicine that rely on these quick, empirical tests: the Apgar score for neonates is another example. These tests aren’t fancy, but they help doctors to quickly assess and respond to a situation when time is of the essence.

What Mars and Venus can teach us about better decision making

DoubleX has a nice interview with Lise Elliot about her new book about sex differences and the brain. Her main point isn’t radical: whatever differences do exist are minor, but they tend to snowball based on our tendency to build on what’s already there. For example, given the choice between playing with blocks and drawing, kids who are spatially oriented will gravitate towards the blocks, thereby reinforcing that ability.

This makes a lot of sense to me, not because I think differences don’t exist–on the contrary, I think that differences in the prevalence of autism-spectrum disorders among males, eg, suggest that there really are neurobiological differences between the genders–but because I distrust the tendency to fixate on supposedly rigid differences, ignoring both individual variation and more importantly, that most of the differences are in abilities that are improvable. For example, I was good at problem solving in things like physics all through school. I doubt I was a statistical outlier–rather, it was my dad’s years of answering my questions, taking me to the science museum, and helping me with my math homework that gave me the confidence to not panic when faced with tricky problems but to work through them. I’ve experienced something similar recently in my martial arts classes–movements that a year ago seemed impossible become conceivable and eventually easy. I’m definitely not gifted in this area–it’s the sheer repetition that bludgeons it into my unwilling muscles.

In his book, How We Decide, Jonah Lehrer talks about how the decisions we make in many situations are essentially unconscious: a quarterback scanning a field for an open receiver, eg. Situations like these are basically pattern recognition, formed from years of experiencing similar situations. In the same way, chess grandmasters use a different part of their brain than amateurs when they play, relying on learned solutions to problems instead of figuring them out for the first time. What does this mean for our everyday decision making? I would argue that more of our decisions are analogous to a quarterback in a football game than we would guess. Aristotle’s maxim that excellence is not an act but a habit holds true. To consistently make good decisions in a given area, we need to develop an instinct for the situation, achieved at least in part through repetition–the flight simulator approach. What would this consist of? Maybe just taking some time to brainstorm and assess the “what-ifs” in this realm would prepare us for when it counts.

How do rewards change our behavior?

PsyBlog has a nice article about how incentives can actually decrease our desire to do an activity we enjoy: kids who liked to draw drew less when promised a reward for participating, and what they did create was less good than the control group. It makes sense, in a sideways sort of way–introducing a reward into a situation you already enjoy replaces intrinsic motivation with an external, and less satisfying, incentive. It reminds me of the bit in Nudge where the authors describe an Israeli daycare that decided to start fining parents small amounts if they were late picking up their kids. The situation is reversed–that experiment made an internal negative seem like less of a transgression–but it’s the same principle.

This seems a simple, albeit cautionary, concept: don’t make it a chore to do what you love. But what about situations in which our motivations are ambiguous? Example: I take a martial arts class that meets at 6pm. I love this class–as soon as we’re done with warm-ups and actually training. I almost always go home in a happy, endorphin-induced haze. And yet it’s still a battle at the end of the day to force myself to go to class when my lazy limbic system wants nothing more than to lie on the couch. I’ve discovered that promising myself that I can read or watch TV all evening greatly increases the odds that I make it to class.

It may be that rewards are more effective when our decision to do or not do an activity is coupled to one of two possible outcomes. In this case:
Martial arts class = guilt-free vegging out time
No martial arts class = expectation to do work at home = tedium and/or guilt

Because in this model there is both a carrot and stick, it could be either or both factors that help improve motivation. Of course, this only works if you follow through with your mental bargaining…