Here we are, at the end of September, and for those in residency and fellowship, hopefully you're starting to get used to the lifestyle of the trainee. By now, the routine of waking up at all hours of the day and night, working on minimal sleep, cramming in study time, etc. should be second nature.
It was around this point during my first year of ophthalmology residency that I began to question the effectiveness of my learning/studying strategies. It seemed like my peers always had a better grasp on the obscure facts, picking up on subtle clinical findings, or be able to answer questions in lecture while I sat there clueless.
I'm sure there's some element of personality and self-confidence that comes into play, but I think that for most of us who are self-driven and high-achievers, 3 months seems to be the timeframe when we are most likely to experience some doubt about our process. I don't have any research to back up my claim, so this is strictly my opinion on the matter.
In any case, my aim with this article is to detail some specific tips that I wish I had learned while I was going through my training. While I agree that most (if not all) of these suggestions are pretty common-sense, it's still helpful to remind ourselves of these steps when we are working hard and don't see much progress. This article is going to be geared towards those who prefer having a structure outlined for them; for those who think their study system is sufficient, this may be an article worth skipping.
Tip #1: Plan your learning for the long-term.
You've probably noticed throughout this website that part of our philosophy is that the learning process, especially in medicine, requires some semblance of a logical structure. Through our many years of schooling and training, we have learned to assimilate large disparate quantities of information, regurgitating it on a test, then immediately dumping that information to prepare for the next quanta. This is a generally effective strategy for getting through school, especially when there is so much information to learn and when there is often a lot of memorization that is not directly applicable (for as many times as we memorize the Krebs cycle, how often do we actually recall the steps when we're in a patient's room?). However, residency learning is a completely different animal - theoretically your residency program is teaching you the skills and concepts necessary to be an excellent ophthalmologist, with an emphasis on practical knowledge.
That sounds great in theory, but what that means is that if you're like me and employed the "cram and forget" method to survive medical school, you have to form a completely new mindset for your future learning, so that you don't forget the things that matter. Continually remind yourself that you're now learning what you're actually going to be using for your career.
Tip #2: Use resources to form a framework for what you're learning.
It's helpful to have a structured approach to learning ophthalmology. There are a myriad of tools available to help. Residency itself is designed to provide a well-defined, goal-oriented program for learning ophthalmology. The many textbooks available to us (here are just some of them) are carefully edited and designed to help us organize and structure the knowledge we gain. Use them to construct a schema for remembering the detailed facts as well as the complex concepts.
Tip #3: There is no shortcut on study time - so be sure to budget out enough time each week to study.
There will always be the "next thing" that takes up study time - whether it's being on call, presenting a grand rounds case, preparing for surgery with an attending, or spending time with family and friends. Perhaps you are much more skilled or talented than I am at learning tons of ophthalmology concepts in 30 minutes or less, but I found that I needed to prioritize study as one of the many things in residency crucial to success.
My residency director and department chairman both advised us to try to study 2 hours per night during the week and at least 4 hours per day on the weekends (~18 hours/week). On face value, that sounds like a CRAZY amount of time to study. But if you consider how many pages you need to read per week in order to make it through the entire BCSC series in a year (if you're using the reading schedule as a guide), then you're averaging 18-25 pages per day. Of course, this amount of time is not a magical formula - it still matters how you spend that time - but it's a good reference point. If 2 hours per night still doesn't sound attainable, try slowly increasing the amount of time per session until you get there.
Another thing to keep in mind is that you can study in small chunks throughout the day and still end up with about 2 hours per day during the week. You can be reading while you eat, while you're on call and you're caught up on consults, or during those 15 minutes while you're waiting for your patient's pupils to dilate. Not everyone can orient their brain to switch gears that much, but that pace may be more doable than to try and bite off 2 straight hours at the end of a grueling day.
Of course, there will be days and weeks that are especially difficult to get sufficient time to study. Life happens. In residency, even little hassles like unexpectedly running out of milk can turn into a stressful time. However, if you commit to diligently putting in the time, this discipline will pay off tons for you (in the form of test scores and general knowledge) and for your patients.
Tip #4: Don't rush it!
I confess, I'm a fast reader...to a fault. I tend to skim what I read, and while I can usually recall tidbits, I will often miss important parts (or have trouble recalling them). My co-residents were not fast readers, so they were often envious of my speed-reading abilities. However, they would typically remember more details than I would, and though it might have been more stressful for them to read through our grueling reading schedule, they would often be able to demonstrate mastery of the subject much better than I.
Eventually I figured out a strategy for reading the material that worked best for me, that suited my reading impatience while still focusing on committing the bulk of the information to memory. For those who are slower readers (and there is certainly nothing wrong with this), be sure to pace yourself so that at the very least you can make it through the week's reading once. If you're like me and tend to skim, allow yourself time to read through the material multiple times during the week.
My reading schedule typically started on Friday night (a bit different how I structured the schedule on this site). I tried to average about 2 hours per night during the week (which sometimes meant late nights), and about 4-6 hours per day on the weekends. My first goal would be to completely finish the reading section for the week by the end of the weekend, which would usually be pretty attainable in about 12-14 hours. This allowed me to get a "big picture" read of the section.
From Monday through Wednesday, I would re-read the material but focus on both memorizing details (which for me takes a ton of repetition), and solidifying conceptual ideas. On Thursdays, my fellow residents and I would meet up and quiz each other about the week's reading, as a way to make sure we really knew the information as well as to clarify any questions or difficult concepts. I would usually take Thursday nights off, and begin again on Friday.
With this schedule, I typically took Thursday, Saturday, and Sunday nights off (though on some more ambitious weekends I would study all day Saturday). It helped that my wife was going through nursing school at the time and would be studying her own material, but as tough as that pace was, I definitely feel like my grasp on the whole of ophthalmology is stronger because of that discipline.
Now, I have several friends who did not have to spend nearly as much time studying. And perhaps you are one of those very gifted people who has the eidetic memory necessary to efficiently assimilate the volumes of information we need to know. But if you're like me, take heart to know that you can achieve that same level of knowledge and understanding - it just might take some more work.
I know this point got a bit off topic, but it goes back to the idea that once you have a study schedule figured out that works for you, trust your system and don't try to rush the end-result. If you don't understand or remember it the first time through, read it again until it makes sense. Remember, everyone who has made it to ophthalmology residency should have what it takes to succeed. Keep at it!
Tips #5 & 6: Learn actively...and review!
I decided to bundle these two tips together because they really go hand-in-hand. Active learning is really just a fancy term for keeping your brain engaged with the material to maximize comprehension and retention. There are, of course, many ways to do this, and depending on your learning style and preference, how you actively learn will probably look different than someone else.
For those who want some more practical suggestions on how to actively learn, here are a few ways that may or may not work for you:
- Highlight/underline: One of my co-residents studied best with a highlighter. As he would read, he would highlight specific parts of the text that were important for him to review, and he would change the color of the highlighter every year. Another one of my co-residents preferred the underline method, underlining key terms and concepts. This is a great way to make sure you read every single word and pause on concepts if you're having a hard time understanding it. It's also a great resource for review, as your eyes will instinctively drift to the highlighted passages. The important thing is to remain consistent in your system (perhaps you want to use one color for terms, one color for concepts, one color for numbers to memorize, etc.) so that you don't confuse yourself later.
Take notes: I wrote down notes in the margins of my textbooks, which were often a summary or even word-for-word from the text. Because I found that I had a hard time recalling sentences but could remember short bullet-points better, this allowed me to quickly glance at the margins and recall the important parts of each section.
- Outline: While this can be a bit more tedious, this method is often considered a very helpful way to solidly grasp difficult concepts. In fact, an ophthalmologist serving on the educational committee at the American Academy of Ophthalmology once told me that outlining the BCSC texts was an assignment for those residents struggling with comprehension. I personally did this (and outlined all but the Clinical Optics text of the BCSC), and while it was definitely a time-consuming challenge, I now have a very helpful and handy resource to reference when I review. In fact, that set of outlines is partially the impetus for this site - while I don't intend to release my residency outlines as it is currently formatted (too much similarity to the BCSC), I do hope to slowly accumulate all of that collected information onto this site, and perhaps release a heavily-modified version of those outlines in the future.
- Review: As important as it is to learn the material well the first time around, it's equally (or perhaps more) important to review what you've learned so that you don't forget the details, and so that you can demonstrate to yourself that you know the conceptual material well. This can be achieved by many different ways - there are several books and websites that are dedicated to providing quiz questions that help you review (and we will be working to provide some of those quizzes as well). You may also want to get together with your residents each week and quiz each other like my co-residents and I did. If there is a big enough response from this audience, we may be able to open up an online community that facilitates that same level of real-time quizzing with contests and such (that's one of our hopes anyways).
Do you have any other tips for learning ophthalmology? What strategies have worked for you? Leave a comment!