As we reach the end of the year, for many of us it is simply the time to move on to the next year. However, for our second-year podiatry students it is time to worry about the first board exam. For those of you out of school, I will ask you to recall those oh-so-fun times studying for the board exam. You will recall that the board exam was the second hurdle in your education (the first was getting through the first two years of school and doing as well academically as possible). Clearly, this creates a significant area of stress and anxiety for students. It behooves each of our students, then, to begin studying for the board exam as early as possible. As a result, I find it important to spend some extra time to talk about studying. Now, for those of you who have been around for a while, you might feel this is not a particularly important topic to discuss. However, as lifelong learners we can all understand the importance of learning how to learn. To that end, this is the first of a three-part series about learning how to learn. In today’s editorial, we will discuss two fundamental principles that underlie how we learn and remember things. In the next two editorials we will cover study errors and then a model for correct studying that leads to long term memory retention and recall.

Before we get started, I would like to frame this discussion by asking this question: How much formal education did you receive as a student about how to learn and study? If you are anything like me or most of the educators I have spoken with throughout the country, you probably have not received much formal education in how to learn or metacognition. Whether it is high school, college, or advanced training such as medical school, it is assumed we simply know how to study properly. In many cases, we get by and receive good grades through a lot of hard work and our own intelligence. In high school and college this may have been possible, but upon entering medical school and receiving a mountain of information commonly described as drinking water from a fire hose, muscling through one's education oftentimes leads to failure.

As a professor at a podiatric medical college, I have seen this same problem occur time and again, and the common theme for almost all of the students that have academic trouble (minus things like family emergencies and unavoidable personal tragedies) is that they are simply studying the wrong way. What are they doing wrong? For that answer we'll have to wait until next week. I have to add some suspense to this topic!

So, there is a proper way to study, and there is moderately strong research supporting the best methods to study. I will state at the outset that, unfortunately, most of that research is on K-12 and college level learners. There needs to be a significant increase in the amount of research on this topic as it pertains to medical students. The other caveat that I will mention at the outset, is that much of the medical student-level research comes from the UK and Europe, and their medical education system is significantly different from the United States. Perhaps the largest difference is that those medical students do their training at the college level rather than receiving a college degree and then going on to medical school. As such, there will always be some problem generalizing the outcomes of this research to our students in the United States.

How Memory Works

The current prevailing model¹ of how we bring information in, process, store, and retrieve it is shown in Figure 1. It is broken into three primary processes: encoding, storage, and retrieval. We first sense some stimulus – be it visual, auditory, tactile, or other. This information must enter short term memory. This is a very fast process, and we lose a lot of information. This is necessary to prevent overload. Once in short term memory the information can only remain for around 30 seconds unless we rehearse the information repeatedly. Think of trying to remember a phone number someone just relayed to you. Moving that information from short to long-term memory, then, requires encoding, which processes information, creating neurological connections. This information is stored and later retrieved back into short-term memory when needed.

Spoiler alert: studying the “right way” requires an efficient use of this system. As we’ll see later, methods that focus on improving encoding and retrieval practice are keys to creating long-term durable knowledge. As it turns out, studying correctly is also much more time efficient, which is what allows the most successful medical students to swallow the water coming from that firehose.

You Can’t Help But Forget!

Way back in 1913 Hermann Ebbinghaus wrote about memory and the natural process of forgetting². As shown in Figure 2, we forget a significant portion of what we learn very quickly (up to an astounding 42% of lost information after 20 minutes). As time passes, we continue to forget. We’ll learn in this series that this important forgetting curve can be leveraged through effective study techniques to actually help us retain more information over the long term.

Using these two models as a foundation we’ll see that we can use these memory and forgetting concepts to understand why certain other strategies, so popular with many a stumbling student, will let us down and then to create successful study strategies to learn.

Best wishes.

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]

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