Teaching from textbooks

This Atlantic article isn’t a fan. I’m split on this. In general I think multidisciplinary learning centered around a topical theme engage students more than reading a textbook. The problem arises when there’s a certain body of knowledge that has to be mastered, for example to pass the USMLE. You just have to master a broad range of topics, and I think it can be hard to teach  that effectively without one. Plus, there’s something to be said for having a framework in which to put your existing knowledge. It’s easier to incorporate new facts when you have a skeleton on which to put them. Otherwise there’s a lot of randomness. The flip side of this is that when you have a survey that’s too broad, it also feels random–this was how I felt about introductory biology, for example: at one point you’re learning about organelles, then a neuron, then the heart’s chambers, and it doesn’t all feel like it ties together.

Evaluating job performance

The Atlantic takes on performance evaluations.

I’ve only had one “real” annual review–from before med school, when I worked for a consulting firm. There was a self-evaluation to fill out, and then I met with my boss, and he told me I was doing fine, which basically consisted of showing up on time and being enthusiastic. On the one hand, really, I was 23 and in an entry-level position. Still, it was not a terribly useful exercise except as a gateway to my 3% raise. Which is pretty much the vibe I get, from my husband and friends with corporate jobs, and from The Office.

In medical training, we instead get feedback. Both as a student and now in residency, we’re supposed to get some kind of feedback at the end of every rotation. This has also been somewhat hit or miss. For one thing, like the article suggests, people tend to think you’re doing a good job if they like you. This was most noticeable to me with certain male attendings who would banter about cars or what have you with my male counterparts, but it’s not a gender thing per say. Medicine tends to attract a lot of type A people who have strong interests and hobbies, and like to talk about them. I remember, for example, being stuck in a conversation between an attending and resident about Nantucket, and how things have changed over the years with all the new money buying up property. And let me just say that I had very little to add to that conversation.

Anyway feedback. So besides whether you bond with the person evaluating you, the other problem with medicine is most of how you spend your time is not observed. There is a move towards watching trainees interact with patients–some of my med school rotations had these index cards we had to get signed off, for example–and the good attendings and residents will let you do some of the talking. But for the most part, even as an intern, most of my H&Ps tend to be with me watching the resident do the interview, which I can guarantee doesn’t add much. So you get evaluated on what they can see–how you present a new patient, how you outline a plan, and, often, how you respond when pimped–which, for those of us who are less verbally agile spur of the moment, does not necessarily correspond to the extent of your medical knowledge.

Not that I’m complaining. I did well during my clinical rotations as a student, so I clearly wasn’t harmed by the whole thing. But neither have I felt like I’ve gotten much feedback that’s been helpful. What I’ve learned has mostly come from: i. from attendings who teach as they discuss the case; ii. from watching really good attendings and residents interact with patients; iii. from watching not very good attendings and residents interact with patients (ie what not to do); iv. from reading, conferences, and the like. Usually the constructive criticism I get falls under the category of “read more”, which is…not that helpful when you’re already tired and overworked. For one, frequently I got that feedback when I hadn’t encountered something yet in training–like starting my OBGYN rotation, when I was told that “I didn’t know as much as would be expected by this time in the year.” Contrast that to one helpful piece of advice as a student, when my resident told me to read the Step 1 and Step 2 review book topics that related to my patients.

What would be helpful? There are a lot of resources out there. Good feedback is frequent, immediately related to something that happened ie “teachable moments”, and gives suggestions for how to act differently next time. Basically, acting as a coach. Atul Gawande wrote a New Yorker article about getting someone to coach him once he’d finished training, as an attending. And that, in spades, is what feedback during medical training would ideally be. And, for that matter, for jobs in general.

How to decide what to study

So back to the issue of how I couldn’t talk about anything in French. That wasn’t really it. As it happened, I still remembered how to say all the words for extended family – stepmother and nephew and granddaughter. I also knew a lot of adjectives, especially for describing people, as well as classroom vocabulary – table, chair, pencil, chalk. Which would be useful, you know, if I found myself giving an autobiographical presentation to a classroom of French kids, but was less helpful in some other contexts. Contrast this with the Foreign Service Institute language courses, designed for adults who actually plan to be living or working abroad: the French course jumps right into dealing with real-life situations (Chapter 2 – At a hotel; Chapter 3 – At the train station).

It’s not that the vocabulary I learned was useless – obviously as a language beginner, any words are better than none. And I could see how it might be hard to interest 12-year-olds in making a hotel reservation. But I think it’s important to be thoughtful about why we are studying something, and what we hope to be able to do with the information we learn.

Spacing, part 3

Still more. Highlights:

• “The optimal spacing gap depends on when the information will be tested in the future. For participants who completed the final test 7 days after their final study session, the optimal spacing gap was 1 day. However, for participants who waited 35 days before taking the final test, the optimal spacing gap was 11 days. For those who completed the final test after 70 days, the best spacing gap was 21 days. In general, the optimal spacing gap equaled 10 – 20 % of the test delay. In other words, the longer the test delay, the longer the optimal spacing gap.”
• Not great evidence for expanding (increasing intervals between reviews) vs fixed schedules
• For teachers, one suggestion: the dreaded cumulative test, since it forces students to go back over the old material

More on spaced repetition

I’m not the only one who thinks it’s underutilized! (Gated, unfortunately)

…the spacing effect would seem to have considerable potential for improving classroom learning. However, there is little evidence that this potential has been realized. Neither American classrooms nor American textbooks appear to implement spaced reviews in any systematic way…Nor is there much evidence that the next generation of educators is being better informed. In a recent sampling of practitioner-oriented textbooks suitable for use in teacher education programs, I found either little or no mention of the practical benefits of the spacing effect, and in some cases the spacing effect was confused with other phenomena…One well-known educator, in fact, advised against spaced practice at least in the early stages of learning…

 

 

Back to school

…so I’ve been on a little blog hiatus over the summer. I used my time off after graduation to do some traveling and work on personal projects, and then starting intern year became this all-consuming effort just to keep my head above water. I’m still swimming, though, so it’s time once again to pick up the…keyboard.

One of the projects I was working on was improving my French. I grew up in Canada, so French was the second language to learn by default, and I feel like I’ve been learning it, badly, my whole life – I spent a couple years in elementary school in an immersion program, and then after my family moved to the States I kept taking it, in high school and then in college. But despite having things like AP tests and a minor in the language, I’ve always felt, well, bashful about it. Because I’ve never had to use it much, and so I feel very awkward and self-conscious with it.

I don’t think this is too atypical for American language students, although I may be especially bad. One of the things I realized when I started to study – using Memrise, among other tools – is that I had no vocabulary. The structure of the language, the grammar, is all still in there somewhere, although I’m a bit rusty with the subjunctive. But the words! 3000 words to understand enough of a text that we can effectively get the rest by context. My active vocabulary, when I started, was maybe 1/10th of that. (Admittedly, not having thought much in French for several years.) I can read quite a bit more fluently than that would suggest, and write quite adequately with access to a dictionary. But I had endless words that I kind of recognized, but couldn’t produce an exact translation, or translate from the English. Maybe not easy words, but not exactly uncommon ones – I knew how to say fish, but not tuna or clams, let alone the menu’s description of the dish. I basically had the vocabulary of a 2-year-old. No wonder I was always embarrassed about not being able to speak the language.

And then I started to think, why is that? Of all the years of school-based language learning, no one ever emphasized the importance of just learning vocabulary. I should have known, myself: when I rebelled and decided to study abroad in Italy instead of any of the many francophone countries, thereby introducing another romance language with which to confuse myself, I realized very early that any word I learned, no matter how seemingly “obscure” to a non-native speaker, would come up again. Words like poodle, festival, parking ticket. In fact, you can get by pretty well with some basic grammar – the present tense, a past tense and whatever you call the future tense where I’m going to do XYZ. But vocab is hard to fake.

That would be more understandable if it had to be painful, slow rote learning. But via memrise, I learned about spaced repetition: basically, as you learn a word, you review it less and less often, so that you can keep reviewing a lot of material efficiently. AND. It’s been known about for decades. It’s easier with technology – with memrise, or with software like Anki, but it’s definitely not necessary – you can have a system for organizing your flashcards. Why didn’t I know about this? In all of my many years of school, I don’t remember this ever coming up. And when I think about how much more I would have gotten out of French had I been spending 5-10 minutes a day reviewing vocab, well, it’s not a happy thought.

Better late than never, though, I guess. Anyway, all this is to say that I’ve been thinking a lot this summer about how we learn – languages, medicine, history, and I’ll be blogging through it. Bear with me.

Knowing what you don’t know

Via Slate:

I have fond recollections of Peet’s from back when I lived in Massachusetts and their brand also seems to be strong on the west coast.

As a California to East Coast transplant, this pains me a little: how can anyone not know that Peet’s is a Berkeley institution? But it’s a perfect illustration that sometimes we can’t see our own knowledge gaps. The information may be one click away, but finding it requires awareness of our own blinders.