Alexander is an MD-PhD student at Duke University School of Medicine. He is currently in his 5th year. Peter Wei (Duke Med Class of 2014) is in his first year of residency in radiology. They have worked together on the book Learning Medicine: An Evidence-Based Guide, which talks about various learning techniques that can be leveraged to improve the process of learning. We are excited to be featuring them on our series today!
How did you first become interested in medicine? @Alexander, what compelled you to pursue an MD-PHD? @Peter, how did you become interested in Radiology?
Peter: I became interested in radiology because it is one of the most innovation-focused fields of medicine. Only a few decades ago, the field was essentially limited to X-rays and ultrasound. Nowadays, we have access to all sorts of additional techniques including CTs, MRIs, PET scans, and various nuclear medicine protocols, that can give us an enormous amount of information about a patient’s disease. As someone who was always interested in innovation within medicine, this history and the culture of innovation it fostered was a major draw.
Alex: I became interested in medicine while in high school. I had taken an interest in my health and athletic performance, and that was a kind of gateway into wanting to learn more about how the human body works and why it sometimes doesn’t (in the case of disease). I’d also always enjoyed my science classes the most growing up, and so medicine seemed like the best kind of applied science, with a love for people and a fascination with science intersecting. When I was in college, I got a taste of basic research, working in several labs, and I really enjoyed the process – asking questions, doing experiments, sharing the results with others. I saw myself being able to do research for a long time. Like many undergrads, I didn’t know all my options, and I thought (incorrectly) that there was a dichotomy between doing bench research and medicine, and that I had to pick one or the other. But then I found out that MD-PhD was actually a thing, where I could pursue both research and medicine, and do so in a way that the two enhanced and informed each other. And from that point, I pursued the career path that I’m on now. I think it was the right choice for me.
What advice would you give incoming medical school students on the transition to medical school and succeeding in medical school?
Peter: Learn to prioritize and to let some things go. A lot of students come in from college accustomed to getting high grades and understanding everything in class. In medical school, things are different. Not only do classes move a lot faster, but the expectation is that you are responsible for filtering and deciding what is important to learn. A lot of students who are not used to this new mindset end up overwhelmed trying to memorize everything from the growth media used to culture different bacteria to the research interests of some particular lecturer. It’s important to learn how to focus on the important stuff, and we devote a great deal of the book to helping students learn what is essential and what can be safely forgotten.
Alex: Take the time to develop key habits and practices that will enhance not just your medical pursuits, but also all areas of your life. Sleep well. Eat well. Exercise regularly. Develop a system for managing tasks and projects that works for you. Investigate effective learning strategies and tools that you can apply to your medical studies, rather than just relying on what worked in college. The volume and pace of learning in medical school is a different level than undergrad.
What advice would you give current undergraduates as they go through the process of applying to medical school?
Peter: For college students, I would say that once they’ve taken the med school prerequisite courses, they should explore as broadly as possible. There’s a whole world of knowledge out there, and I definitely got the most value out of courses such as economics that were well outside the standard premed curriculum. Once you enter medical school it will be much more difficult to explore outside of medicine, so make the most of it.
Alex: Seek guidance from people you trust, rather than trying to do everything alone. Pre-med advisors at colleges are usually quite helpful. If there are some upperclassmen you know who have been successful, offer to take them out to lunch or coffee and pick their brain.
With regard to selecting schools to apply to, heed the usual advice, but also take into consideration factors that aren’t just academic, such as location, cost of living, proximity to friends and family. These things matter as much as the scholastic features of the school. Despite what you might have heard, there is time for life outside of studying in med school. So you want to be ensuring that you can enjoy that time when you have it.
What compelled the two of you to write the book Learning Medicine: An Evidence Based Guide?
Peter: The learning method we set out in Learning Medicine was something that we cobbled together and perfected during our years at Duke. It ended up becoming pretty popular there, with each class teaching the class below them how to get the most out of spaced repetition and other tactics. We were pretty pleased with how much value people were getting from it, but we wanted to spread this knowledge to other medical schools as well – hence, Learning Medicine.
Alex: As they say, necessity is the mother of invention.
Duke Med is a condensed curriculum, giving just one year to the preclinical material. So the pace and volume of learning was even greater than most students encounter at schools with traditional curricula. We both recognized early on that the methods we used in undergrad were not going to suffice for the challenges of med school. Many of our classmates felt the same, but they seemed to want to take the brute force approach, resigning to just work harder and longer. That didn’t sit right with either of us, so we sought out tools and methods that would allow us to learn more and better without having to just do more of the same.
An article in Wired magazine opened my eyes to the power of spaced repetition and then I stumbled upon the flashcard program Anki which is a powerful way to employ SR. I started to use Anki aggressively, benefitting from it immediately. I started to write about my experiences on my personal blog, DrWillBe and some of my posts picked up traction with other med students. From those posts, I got a lot of email from people wanting more specific guidance on how to take advantage of SR in med school. Realizing the unmet need, Peter and I set out to write a book on using SR for learning medicine.
The original intent was to be a kind of quick, practical guide on using Anki, but as we were writing, we realized that our book would have more impact and help students more if we addressed more than just one method. So, we shifted gears and went deeper into the science of learning, with the aim of identifying the best, most effective methods that educational research supports, and to take those insights and make them practical and actionable for the busy med student. As you can imagine, this was a challenging task, and it took us a while to do our research and learn about what was known about learning. In the end, we developed a comprehensive methodology learning medicine, that uses not just spaced repetition, but also other evidence-backed methods such as test-enhanced learning, interleaved practice, and deliberate practice. These are some of the key techniques that learning science has described, as you at Osmosis well know, since you’ve incoporated these things into your system as well. We’ve employed our system in our own learning at Duke Med to very good effect.
Where do you see yourself in 10 years?
Peter: In addition to being a practicing physician, I hope to work with researchers and companies to help bring the next generation of imaging technology into clinical practice.
Alex: Well, hopefully by that point, I’ll actually be a real adult and no longer be a professional student. 🙂
I’d like to be a physician-scientist, with an active research program as well as clinical practice. I hope to be a pain medicine specialist, focusing my research and clinical efforts on understanding and treating chronic pain, which is a huge problem in the US and globally.
What would you personally like to see changed with how medical education is currently run today?
Peter: I’d like more critical thinking about what is truly essential to teach in medical school. Again and again on the wards, we hear residents and attendings say that they remember learning the stuff we were learning in medical school, but it had no relevance in their practice and so they naturally quickly forgot it. But the board exams contain some information that’s of purely academic interest (quick: what chromosomal translocation is typical of CML?). And medical schools – and our book – necessarily accommodate that fact. We don’t expect that every fact in medical school be relevant to every resident; after all, different specialties require different knowledge. But paying more attention to ensuring that the medical curriculum is focused on topics of clinical relevance will really help students study effectively and become better clinicians.
Alex: Well, for one, I’d like to see more integration of the evidence-based techniques that we highlight in our book and that you at Osmosis employ. Many medical schools still structure their curricula around the binge-purge cycle, where students go to lectures, they cram some material, then take a test, and move on the next thing. That gives the impression of learning, but with respect to building long-term, durable knowledge, it leaves much to be desired.
Do you have any final thoughts regarding the medical profession as a whole?
Peter: In the last chapter of our book we talk about what skills it will take to become an effective 21st century doctor. And one point that we emphasize is that it’s really no longer enough for physicians to focus on only learning medicine. With a changing business landscape and the kind of innovations that widespread computing have made possible, physicians need to be willing to be proactive in shaping the future of how medicine is practiced. We wrote Learning Medicine in part to teach students how to efficiently learn the knowledge they need to do good clinical work. But we also wrote it in the hope that this efficiency would allow them the opportunity to look beyond being diagnostic machines and becoming the leaders that can improve the way medicine works.
Alex: I think the role of the physician in the next few years is going to change dramatically, with diagnosis and management being increasingly outsourced to smart machines. That’s the bread and butter of the physicians now, with our medical education being predominantly focused on docs being dispensers of biomedical knowledge. That’s a losing battle in my mind. Dr. Watson will ultimately be a much better diagnostician than even Dr. House can be. So where does that leave physicians?
My prediction is that all this advancing technology will work to humanize medicine again. And so, the physician of the 21st century should be adept at those skills and roles that are uniquely human, such as interpersonal communication, leadership and management, ethics and decision-making, behavior modification, and the like. These are not topics that get much time or attention in our current medical education system. So in a way, we’re setting ourselves up to be obsolete by focusing so much on recognizing Orphan Annie nuclei versus learning how to help patients quit smoking or how to have an end-of-life discussion. Don’t get me wrong. I love Step 1 factoids as much as the next guy. I was the one secretly doing Anki cards in that Clinical Skills course while my preceptor was talking about motivational interviewing. So I don’t say these things gleefully. I just think it’s the reality of where medicine is going, and so I’m increasingly focusing on bringing the same rigor and effort to learning the ‘soft skills’ as I once did to learning about t9;22 chromosomal translocations. I’d advise my fellow med students to consider doing the same. Biomedical knowledge is still important, but it should be balanced with an equal focus on doing what only humans can do.