How I Learn More Efficiently Than Everyone At Medical School
How do I process new information, encode it into my memory and then ensure that I understand it and can apply it in as little time as possible while staying focused?
One of the things I always found crazy at medical school was that some people would spend hours and hours reading over lectures or spend days in the library on topics that I'd get through in less than 30-minutes. Now I get it, it's easy to feel like you are being productive and learning by sitting down in front of your books for 12-hours straight but what if I told you there was a way to study more effectively in less time and still have room for things that help you to consolidate what you've learned like going to the gym or getting enough sleep and also fit in all the things you want to get done other than studying?
When I studied for my surgical exams around my day job as a surgeon and running a seven-figure business on the side I had to be efficient with my time and so I needed a different approach to processing and remembering content I was seeing for the first time. The method that I used is based on learning psychology research and is evidence-based and I'm surprised that more people don't use the same techniques and still default to sitting at their desk till they fall asleep.
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Start From The End And Build Context
So the first way that I save loads of time and stay efficient when learning is to completely switch up how I approach processing new information when I'm encountering it for the first time. While most people will start on the first page of their textbooks, online lectures or video courses and grind through till the end I'm starting from the end and working backwards to help build context. Why is learning new content in it's intended order so inefficient? Well the first time we encounter anything new our brains actually aren't actually that good at immediately processing and understanding the new information. If you don't have any existing, related knowledge it's difficult for our brains to understand how the information is relevant and link it to existing memories. Think of your brain like a computer; if you save a new file but don't have any similar files or a folder structure you're probably just going to save that new file to your desktop or anywhere and then it can be hard to remember the name of the file and actually find it quickly when you need it and maybe if your desktop or downloads folder gets messy and takes up loads of space you just move everything to the recycle bin to make some space, we've all done it and your brain is the same. This is why it can feel confusing to read a new concept or topic for the very first time, you don't necessarily have sufficient context to help your brains identify that it is relevant, link it to existing memories and move it to your long-term memory as you develop understanding.
This process of getting information into our brains is called encoding, which is the input of information into the memory system. Once we receive sensory information from the environment, our brains label or code it. We organize the information with other similar information and connect new concepts to existing concepts. Encoding information occurs before the storage stage and so organizing what you are learning is really important.
Remember our brains filter information, deciding what is important enough to ‘save’ from our sensory memory to our short-term memory, and ultimately into our long-term memory. In terms of efficiency if you're reading through new concepts in your textbook or listening to a video about something new you'll probably end up wasting time going back over that new content by either re-reading or re-watching it to try and memorize it or build deeper understanding. So it always made sense to me to build structure around a new topic first and go gradually deeper and deeper to build understanding quickly starting with understanding the simplest, basic principles first before diving into the more specific information.
For example if I'm learning about the neuromuscular junction I don't just read through and try and memorize that acetylcholine is broken down in the neuromuscular junction and recycled by acetylecholinesterase, that's much deeper more specific knowledge. Instead I'll start by first building a scaffolding of knowledge around the new topic. I'll look at the key learning outcomes and will jump to the end of the book chapter or lecture and just quickly get a top-level overview of why this is important to help build relevance and give my brain that folder system. I'll then start with something more basic like understanding what the neuromuscular junction is and why it's important and testing myself on this before moving to more advanced concepts. I'm spending time helping my brain organize new information and link it to topics that I already know.
Stage 1: Skim Reading
In practical terms I'll skim through and quickly figure out how the new material is organized focusing on headings, diagrams and key learning outcomes without worrying too much at this stage about testing myself.
Stage 2: Concepts
I'll then go through and focus on what the key concepts actually are and how well I know them. I'm not worried about the details here but I'm looking at diagrams, tables and explanations and seeing whether my brain perceives them as hard or easy on first pass. During this stage I'll be writing active recall questions rather than just passively reading so I'm staying productive and actively learning. I don't get hung up on new concepts that I don't know and I'm not wasting time going over and over tougher concepts and facts like 99% of people sat in the library. I tackle the hard concepts in stage 3.
Stage 3: Focus on the harder topics
Stages one and 2 will have built relevance and highlighted the new information your brain perceived as hard. Stage 3 is really about breaking down the harder information you skipped and coming back to it to ensure understanding and help your brain to encode it. Because you've now already built relevance and identified related concepts in stages 1 and 2 you've given your brain a nice framework to then better understand the concepts you originally felt were harder. This will make absorbing and encoding the new information so much easier. At this stage I'll also read around the topic to help further build relevance and use evidence-based techniques like active recall and the Feynman method to ensure that I can explain harder concepts and test myself by applying the knowledge.
You can think of this process like peeling back an onion like Shrek says. You're focusing on the structure and easy concepts first to build context and then you're going deeper to learn new or more complex topics rather than just reading through in the suggested order as this is a lot less efficient. To get a bit deeper into this let's next look at why spending ages in the library or sat at your desk learning overloads your brain and how I keep my cognitive load focused to get quality work done in less time.
Easing Your Cognitive Load
Cognitive Load Theory emphasises the limited capacity of working memory, as opposed to the near-unlimited capacity of long-term memory. It states that processing too much information at once can lead to a cognitive overload in working memory. This overload can slow down and hinder the learning process as it has a negative impact on the transfer of information from working memory to long-term memory.
The theory isn’t just about helping students to remember more – occupying our cognitive resources with irrelevant or excessive information can lead to inefficient learning. Avoiding cognitive overload means undertaking a more focused and concise approach to learning. So if you are reading through a book chapter that is pretty wordy or watching a video from someone who isn't that great at explaining things in simple terms chances are you're going to get overloaded with information that isn't critically relevant to what you are learning. Remember books, lectures and videos are all created by people just like you and me and they can easily wander off topic and bring in their own experiences that mean what they are teaching isn't actually that concise. And learning psychologists have even given this a name; The Redundancy Effect. When a learners’ working memory becomes clogged up by unnecessary information, they may remember the irrelevant information and forget what they actually need to know. So if you're sat in the library right now reading through a 45 slide presentation or listening to someone go wildly off topic try and question what is relevant to your own learning needs against your curriculum and exams.
When I approach learning new information I'm obsessed with staying efficient and aim to cut out anything irrelevant and focus on the topics that are high-yield or that I'm worst at and then simplify this information and link it to things I already know.
Now to help understand how I reduce my cognitive load when learning in a bit more detail let's look a little more at the science. Cognitive Load Theory was published by John Sweller in the journal Cognitive Science in 1988 and the concept of cognitive load was further broken down into three types of cognitive load:
- Intrinsic
- Extraneous and
- Germane
Intrinsic cognitive load is simply the complexity or difficulty of the new information that you're learning and to reduce this I'll try and simplify information and find easy to understand explanations or go through pre-made worked examples that break down complex topics.
Extraneous cognitive load refers to how the topic is presented to learners and is basically what we have just talked about getting overloaded with unnecessary information. For example if you're given loads of text to describe what a square is it's probably not as effective as just showing you an image of a square. If you are having to jump between different mediums like text, images and videos to actually understand a topic this is called the Split Attention Effect and it causes you to lose focus. Research shows that students who learnt in a split-source format achieved lower learning outcomes than their peers who learnt in an integrated format. This is why I'll usually spend time researching the best learning resources and skimming through new content to pull out the most important points first to ensure relevance.
Finally Germane cognitive load is the processing, construction and automation of schemas. It was first described by Sweller in 1998, almost a decade on from his original work on cognitive load. In simple terms germane cognitive load is all about linking new content to our existing knowledge and organising it appropriately. A schema simply means something that organizes categories of information and the relationships among them and this really links back to building context and ordering your knowledge.
So now I've organised my knowledge and provided context and I've reduced my cognitive load to stay efficient let's look at how I'll use active recall as I go along to ensure what I've encoded is being stored in my long-term memory.
Self-testing With Active Recall
Karpicke, et al. (2009) believe that students get "illusions of competence" from rereading their notes and textbook which is why people find it so tricky to adopt active recall as they are convinced rereading works despite the evidence and people just spend ages in the library reading over their notes. One reason for this illusion is that the text contains all the information, so it is easy to glance over it and feel as if you know it well, when that is not the case at all,.
For me testing myself and trying to recall information as I go through on the first pass of learning new content hugely helps my understanding and speed of learning. So as I skim over the new information and go deeper and deeper into the more difficult topics I'll be constantly testing myself and creating active recall questions. One of the simplest ways to do this is to just cover the section of the text-book or slides that you are learning and test yourself to remember the key facts. I'll usually ask myself things like "can I explain what I've just read" or "can I re-draw that diagram" for each short section of new knowledge encountered. If I can't I'll go back and remind myself and then try again before moving on. This is really important as if you can't recall the information you simply haven't learned it effectively and for me testing myself has been the single most impactful thing I've changed up in how I learn and it's helped me to retain information for longer. So why are some folks still in the library for 14-hours? Well it's much easier and comfortable to passively read from a book and feel productive whereas building context and testing yourself are more effort initially but in the long run it's so much more effective and most importantly it's way more efficient.
The other way I'll use active recall is by jumping in to question banks and past papers early and trying to get through as many questions as possible to test my knowledge and learn along the way. This is much more efficient than just testing yourself towards the end of your study period. Jumping into questions that require you to apply knowledge and then figuring out how to do it is much faster than simply reading an entire book and then practising testing yourself and like using worked examples this helps to reduce your cognitive load and focuses your brain on the key information needed to solve a problem.
Study Without Distractions
Getting distracted and procrastinating is a sure fire way to prolong learning. So the other way that I learn more efficiently than others is that I'll set myself up to really focus on what I'm learning and I'll work for 3-4 hour intervals when I know I am sharp and can get work done. Over the years I've built up a habit and a routine to ensure I can learn without distractions. I will make sure that I timeblock out learning sessions in advance and for me I'll usually get up and go straight to my desk which I've prepped the night before and get down to studying. I'll have some lo-fi music on or if I'm away from my desk I'll use my noise cancelling headphones and I'll set myself a target for the day that is achievable.
The other really important thing I do here is to not overwork myself. As we know both sleep and exercise massively help us to consolidate what we learn and so I'll make a conscious effort to take breaks which helps me to stay focused when I come back to what I'm learning. Equally if I do get distracted or maybe I'm a little bit tired I don't beat myself up about it and I'll make sure I take an extended break before coming back to studying. Lots of people feel guilty about taking breaks or doing things other than learning and this can lead to anxiety and stress which is a bit of a vicious cycle as if you're a little bit anxious or feel you have work hanging over you you're going to be distracted and less focused. So stick with the process, don't spend hours and hours in the library and make a conscious effort to build context, focus on relevant information, test yourself as you go along and avoid distractions and burnout and that's pretty much what made me way more efficient at learning than everyone else at my medical school.