Learning Process

Four variables in the learning process:

	Study skills are basically the cognitive activities and processes that a learner uses to encode, store, and retrieve information. These have been referred to by some authors as "learner activities or tactics", and form the first variable in the learning process.
	A second variable relates to the enduring characteristics of the learner that affect the encoding, storage, and retrieval of information. For example, some students can read and comprehend more rapidly than other students. Other students may be able to listen to a tape or live lecture and comprehend more rapidly than when they read narrative text.
	The third variable is the type and structure of the material to be learned. The most effective study skill to encode, store and retrieve information on the anatomy of the heart would be different from the skill needed to learn the seven diagnostic characteristics of a microorganism, or from the skill needed to learn how to conduct a history and physical.
	The fourth variable is the type of assessment used to evaluate learning. For example, a particular study skill may be more effective in preparing for an essay examination than it would be for a multiple choice examination.

These four variables are interactive whenever a student attempts to learn, and what works for one student may not be optimal for others.

The curriculums of most medical schools provide a wide range of learning experiences and objectives that range from formal lectures, small group tutorials, problem-based learning, laboratory exercises, demonstrations, reading assignments, one-on-one with a faculty member, bedside teaching in an inpatient environment, ambulatory medicine experiences, etc.

The single biggest limitation that many medical students impose upon themselves is the application of a very narrow range of study skills/learning tactics to this wide range of learning opportunities.

This means that students who wish to obtain optimal learning should first learn to formulate a plan for dealing with each new learning experience.

Learning how to plan a strategy to learn, then, becomes part of the repertoire of a medical student that wishes to gain the most from each learning experience. Learning to plan to learn also applies to the self-directed life long learning necessary to maintain competency across the span of a medical practice.

Keep in mind, however, that the planning should not take so long so as to seriously erode the time available for actual learning.

Steps in the "Planning to Learn" process:

	Analyzing a learning situation: Two analyses are given below under common learning experiences at Kansas University School of Medicine.
	Deciding on a course of action: Keep in mind that change is sometimes uncomfortable, but essential to obtain optimal results.
	Implementing the plan: Get in the groove quickly for each learning experience.
	Monitoring success: There are many ways of doing this. Some examples would be to: Go over old exams without having the correct answers marked. Form a study group to share concepts, answer questions, check understanding etc. Practice skills (except invasive skills) on a friend. Share your understanding of a patients condition or a disease process with your clinical team. Check knowledge base by answering questions from USMLE Step 2 review books.
	Modifying the plan as necessary: You are your own personal "learning scientist". If the reaction yield is low, make changes designed to increase learning. If you need assistance check SOS Connections for a qualified academic counselor.

Seven principles that facilitate learning:

	Utilize active study skills/learning activities: "Act" on the material to be learned.
	Construct clear learning objectives: If your teachers do not do this, write a set of questions designed to gather essential information about the subject material.
	Maintain a high level of motivation: There will be ups and downs. Learn effective stress management techniques.
	Manage learning over time: Sir William Osler lectured medical students on time management back in 1892.
	Link new knowledge to prior knowledge: Develop a method that reviews and reinforces previously studied material while initially exploring new material.
	Look for relationships (within the subject matter that is): Although any supportive relationship will work in medical school, the relationships we have in mind involve the subject material of medicine.
	Utilize evaluations to correct misconceptions

An analysis of common learning experiences at Kansas University School of Medicine

Lecture--Syllabus--Textbook--Small Group Tutorial: This is the most common type of formal learning experience in the first two years at KUSM. This type of learning experience is a teacher-centered approach where students are told what is important to learn by an instructor who is an expert in the field. The instructor develops a set of "learning objectives" around which the lectures, the accompanying syllabus, reading assignments, and small group activities are organized. Attendance is usually required at the small group tutorials, but otherwise attendance is optional. Evaluation is via multiple choice questions generated to evaluate mastery of the learning objectives. Small group tutorials are held at least one time per week with a group of 8-10 medical students meeting with one member of the faculty. These experiences may be either teacher centered (teacher chooses the topics under discussion), or student centered where students have an opportunity to work on concepts that are problematic to the group. Quizzes and participation scores may be given and count toward the final grade. Final examinations are comprehensive.

Lecture--Morning Report or Grand rounds--Noon Conferences--Afternoon Professor's Rounds--Evening Call. This would be a general description of a day in one of the basic clerkships taught during the third year of medical school. One month of each clerkship is spent at the Medical Center, and the second month at a hospital affiliated with the Medical School. Medical students are expected to be at the hospital seven days per week except for days officially designated as recess or unless the student has been specifically excused by the attending physician. Each clerkship will provide a syllabus that provides the student with:

Required conferences and lectures are conducted that cover some of the objectives. Patients are scheduled, but are not necessarily seen by each student on service. Thus students must be self-directed to meet the objectives not covered by conferences, lectures and patient contacts. Each student is continuously evaluated on a day-to-day basis by faculty and house staff. A mid-clerkship formative evaluation with feedback on perceived deficiencies is conducted. Final grades are generated from a combination of clinical performance, scores on in- house examinations, which may be multiple choice, oral, or case history exams, and scores on discipline-specific National Board of Medical Examiners Shelf Examinations. In addition, there is a "hidden curriculum" in each clerkship. The hidden curriculum involves the use of interpersonal skills and judgement in working with other health care professionals, learning to work as a member of a team, ordering laboratory studies and retrieving results, giving oral presentations, talking with family members, writing notes, developing values on ethical issues, and many other things that make life on the wards easier to manage

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