July 14, 2023
Mastering the Secrets of Study Productivity
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Imagine having the power to absorb new academic material effectively and with less effort. In this episode, you'll learn about techniques to help you do just that. Our guest, Lisa Hadfield-Law brings her 20 years of surgical education expertise to the table, sharing with our host Dr Gavin Nimon (Adelaide Orthopaedic Surgeon) her unique approach for breaking down complex subjects into seven manageable parts. Lisa's perspective is refreshingly attainable, emphasizing the importance of simplicity in learning and reminding us that we don't need to carry the burden of knowing it all.
We journey further into the realm of effective studying, as Lisa enlightens us on the crucial role sleep and repetition in our learning routines. Ever heard of the Pomodoro technique or considered the impact of music on your study sessions? Well, buckle up because those are just a couple of the intriguing strategies we discuss. Lisa generously shares her personal techniques for retaining information, including the creation of mini mind-maps and elaborate note-taking. To seal our conversation, we delve into the essence of learning for longevity rather than rapid knowledge consumption. This episode is designed to make your study time more productive, help you manage your learning projects better, and get that metaphorical 'axe' sharper than ever. Brace yourself for a wealth of practical insights!
Aussie Med Ed is sponsored by -HealthShare is a digital health company, that provides solutions for patients, General Practitioners and Specialists across Australia.
Aussie Med Ed is sponsored by Avant Medical Indemnity: They state that they offer holistic support to help the doctor practice safely and believe they have extensive cover that's continually evolving to meet your needs in the ever changing regulatory environment.
Transcript
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Whether your undertaking a course or degree, at some stage they may find themselves overwhelmed with the amount of knowledge they need to learn.
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Most of us have worked out what works for them, however you always wonder whether there is a better way.
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In today's episode of Aussie Med Ed, I interview a specialist in surgical education and ask her about what techniques she is aware of that can lead to more efficient use of a person's study time.
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G'day and welcome to Aussie Med Ed, the Australian medical education podcast.
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A program born during COVID times to emulate the general chit chat and banter around the hospital with the idea of educating the medical student and GP alike.
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I'm Gavin Nimon, an orthopaedic surgeon based in Adelaide, and it's my pleasure to bring Aussie Med Ed to you.
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And in this episode of Aussie Med Ed, we interview Lisa Hadfield-Law a surgical educationalist years of experience teaching surgeons in over 68 different countries.
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She's going to talk to us about the various techniques of studying and learning.
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And how she would approach the study of medicine in current day.
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I'd like to start by acknowledging the traditional owners of the land on which this podcast has been produced, the Kaurna people, and pay my respects to the elders both past, present and emerging.
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Well, it's my pleasure now to introduce Lisa Hadfield Lore.
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She's a specialist surgical educator and she works for the British Orthopaedic Association, as well as the Royal College of Surgeons of Edinburgh.
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With 20 years of experience, she knows how to study and learn and how to teach.
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She's going to talk to us about her approach.
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If she was learning a new course, how she would address the huge amount of information that you need to learn and what techniques she is aware of to study in an effective way.
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Welcome
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Lisa Hello, good morning.
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So, that's a really interesting question because, of course, the way I would approach things now, in my 60s, is very different from the way I approach things in my 20s or 30s.
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Partly because we didn't have access to the internet, and I can't believe...
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We managed anything, uh, before that time.
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So, with the benefit of hindsight, and understanding what I do now about how brains work, and how brains help us to learn, I would, number one, really get to grips with any curricula that was available to me.
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Now, when it comes to medical practice in the UK, there are very, very clearly laid down curricula.
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Because that's what's required by the General Medical Council.
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But all over the world, with all kinds of programs, there would usually be some kind of curriculum.
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A good idea of what people are expected to know, and a good idea how that would be assessed.
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So, That's where I would start really getting to grips with what is expected of me.
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And I've learned now not to arrogantly assume that I know better than somebody whose job it is to decide what I need to know as a general practitioner, as a physician, as a neurophysiologist, whatever it is.
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Somebody has taken some time and trouble to clearly define that to start with.
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So that's where I would start first off.
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Okay,
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basically you'd look at the curriculum or the syllabus and try and analyse it.
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Would you make notes of it and try and work out what were the important aspects and what were the less important ones?
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How would you come to terms with what are the important aspects to do in that scenario?
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So, I would chunk things up and I would really try to boil whatever the subject is down to seven points.
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So, seven simple chunks and use that as a sort of framework for then going after what I need.
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So, say I was needing to learn about...
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the reason somebody would turn up to an outpatients clinic with a set of symptoms.
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I would start with that in the middle, the group of patients or the topic I'm looking at, and then I would look for seven areas.
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That I would need to then flesh out to really understand a subject.
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That's where I'd start if it were completely new to me.
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Now, if the topic wasn't completely new and I knew a bit about it, then again, I would take the topic, write it in the, in the middle of a, a piece of paper, and then I would try and put everything I know down.
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about that particular topic before I start anything.
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So, just get everything down and start to look for some links and then either go online and look at videos or journals or books to work out which bits were right.
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And which bits weren't, where the holes are in my knowledge and then how I might go about filling those.
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That's sometimes called the Feynman technique and that's really useful if you know a little bit about something, which a lot of the topics that your listeners will be addressing will
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know a little bit about.
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Excellent.
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I certainly know that when I was looking at trying to study, I would try and keep it simple and try not to expand it too much.
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There's a tendency to try and read as much as you possibly can about a certain subject and then get bogged down by the little nitpicks of knowledge about that.
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What is your approach?
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Do you think it's important to try and remember everything or try and get the basics first up?
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Well, that's a little bit like trying to drink out of a fire hose.
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And we can sometimes be seduced, and I certainly have been seduced, into sitting down with a book or some stuff and then ploughing my way through it.
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Reading it, highlighting, underlining, and then feeling very proud of myself at the end of a very long session because I've done a lot of work.
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But that is really just reading, trying to remember, and then trying to regurgitate.
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And what most of your listeners are wanting to do is to learn stuff that is going to last, and learn stuff that is going to last to get through exams.
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but also to be accessible in real life practice with patients.
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We don't need to know everything anymore.
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You, people are not walking around with a great big formulary in their pocket anymore.
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Stuff is accessible, but we need to know where to access it, how to access it, and what we're looking for.
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So, Making structures, filing systems if you like, about what we need to know, how we access it, to then use that to make decisions and to recognise patterns.
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That's what we're after.
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We're not needing to remember and regurgitate stuff anymore.
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That happened quite a lot with my generation and I have loads of stuff in my head.
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That is no use to man the beast.
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So I can draw out the carpal bones beautifully for you But I wouldn't be able to recognize those on an x ray and that so therefore that's that's not really any use to anybody Certainly not me
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So really keeping it simple and trying to know approach to where to go for to expand your knowledge when you need to is The way to go almost like A lot of the open book exams that some of the courses offer as well, where it's not about actually remembering the individual information, it's actually about an approach to actually addressing the answers.
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Exactly right.
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And that's why these sort of, these filing systems in your mind are so very important.
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And that's why I start with topic 7 issues, major points around that topic and then fleshing those out.
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Another really important thing for clinicians to remember is If we go back to that carpal bones example, the reason that isn't any use to me is it's not linked to anything.
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The way clinicians hold things in their head and make them accessible is around what educators sometimes call illness scripts, and what you and your listeners would call patient scenarios.
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So, in our minds, we will have a whole load of patients we've heard about or experienced and stuck to those patients will be lots of theories, lots of differential diagnoses, lots of investigations, that kind of thing.
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So, if I give you an example, I've been out of clinical practice for 20 years now.
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But having come across an accident the summer before last, as I was running towards the person lying in the middle of the road who'd been hit by a lorry, I, I wasn't thinking, ooh, what are the list of things it could possibly be?
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As I was running towards her, There were all kinds of patients I've looked after in the past that we've talked about, I've read about in journals, I've heard about on ATLS programs, and looking for matches.
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What, how was she moving?
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What was she sounding like?
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What did the environment look like?
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And it was all like a really quick match with lots of pictures and images in my mind.
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So we know that that's how people hold stuff.
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In their long-term memory that will then be accessible when we need it in practice, in outpatients, in the ed, in general practice rooms.
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And that really
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reinforces the whole approach of actually the more you see, the more it makes it easier to learn things.
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Exposing the students to the clinics and the theaters helps them remember information.
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Yeah, so what, what happens is we've got in our long term memory all these illness scripts, all this stuff that's connected together amazingly, and when we are seeing something in theatre or in clinic or on ward rounds, The relevant stuff is pulled back into our working memory, and new things added to it, things changed, and then put back.
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So it's that retrieval and putting back that is crucial in practice, but also what is required when you are revising.
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So, really good revision is about retrieving stuff back into our working memory, adding new stuff, changing and putting it back.
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It's that ability to pull out what's in our long term memory.
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And so, Really good revision shouldn't feel comfortable because it needs to be about sort of half forgetting stuff and bringing it back out and it's not comfy.
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If you're sitting revising, reading things and underlining and feeling very proud of yourself, if it's feeling lovely and comfy, it's, it's probably not working.
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Certainly,
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I know the Feynman technique involves this as actually questioning what you're reading and simplifying it to help you remember things.
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Yeah, absolutely.
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So if you're learning about something, reading about something, or you're in a lecture, or you're listening to a podcast like this, being able to listen, then stop, look away.
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Um, try to explain what you've heard in your own words is a fantastic way of revising.
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And another technique is something called the Leitner system.
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And I thought this was really excellent.
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So essentially, you have either physical boxes, five Physical boxes or online boxes.
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And so, as you're practicing that retrieval of concepts, information, combinations of information, as you're practicing retrieval, once you, you have your five boxes, one of them you review daily.
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Another, the next one, number two, every other day.
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The next one, number three, every four days.
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The next one, number four, every nine days.
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And the final one, the fifth box, is every two weeks.
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So every time you manage to retrieve or explain or you're confident that you know something, you move that topic, that bit, up a box.
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Yes, that system is certainly a good way of providing repetition and also questioning as well at the same time.
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Yeah, it's that retrieval.
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It's that retrieval.
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It's a little bit like treading a pathway into your long term memory and treading it back again.
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The more you tread it, the more you'll be able to find it when you really need it.
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What about the technique or concern that you often get of actually trying to buy more and more information or look for more information?
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That golden...
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book that will help you remember everything perfectly.
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Is that a good technique or is it better to stick with one text or one or one or two texts that help you learn things and focus on that, which covers most of what you need to know?
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It's so interesting, isn't it?
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Because my sister and I always laugh about that.
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When we want to learn something, we buy the most expensive book we can find and then assume that that's going to do it.
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Of course, if it's left on your desk and just looking at you, it acts actually a little bit like a guilt bomb, because of course it doesn't work.
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Also, because of my generation, we, we loved books because that's all, all we had.
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But of course now, Things date so quickly.
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And if you think about how long it takes to turn a book around and the process of publishing it, by the time it comes onto the market, often it's already out of date.
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So I tend not to use Many books now.
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And I will use journals, I will use podcasts like this, and I will use sources from the internet.
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But again, it's difficult, isn't it?
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Because there's so much stuff, how do we know it's reliable?
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Well, that, I think, again, uh, uh, being an older learner now, and, and I have got some areas of expertise.
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I'm able to be a bit more discerning and work out what are, what's, what are reliable sources and what kind of information I can trust and what I can't.
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But if we go back, Gavin, to the curriculum, oftentimes with a lot of our curricula, there are recommended resources.
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And again, go, go back to, who are you working with?
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who is an expert and who can recommend some really useful resources.
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That's what I do now.
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If I'm new to something, if there's an area that I'm really not confident that I understand the landscape, I will find somebody who does, who understands the landscape and also my needs in terms of being a learner.
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Once you've got this information, what's the approach to actually trying to retain it?
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We know we talked about the repetitive nature and the questioning nature.
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What about actually the actual process of actually sitting down and studying?
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You know, there's a tendency to have the music in the background or do it in front of a TV or do it when you're rushing late at night.
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What are the best approaches to try and retain this information?
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Okay, so the really, there are some important principles here.
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We've said that retrieval practice is crucial.
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That's what learning stuff is about.
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Treading the pathway into your long term memory, retrieving, half forgetting and retrieving again.
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is something very important about spaced out practice of that retrieval.
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So that, if we go back to the Leitner system of daily, every other four days, nine days, that spaced practice of retrieving stuff and not cramming is really important.
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My generation loved a good cram.
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They loved the good squeezing a load of stuff in the night before.
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We understand much more though now about the role of sleep.
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Sleep when it comes to learning it, it's a little bit like when you go to sleep.
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Your, your mind is, is all tied it up and, and it's like sorting out the hard drive of your mind and duplications wiped out connections that you weren't aware of.
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Start it, it, it binds and it strengthens and it reinforces the connections.
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So not enough sleep is an absolute disaster.
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So my generation who would sleep for two or three hours, That was a real mistake because it's not enough time to solidify knowing all that stuff.
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So, sleep is crucial.
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There's an interesting thing here.
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There's something about learning something just before you go to sleep.
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That is very powerful.
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So, I, for a long time, thought relax back, do something different.
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No, it looks like having a good review of some important stuff just before you go to bed might really work well.
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So, space learning, getting enough sleep, time.
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Now, probably no more than 90 minutes before you stop.
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and do something else.
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So you're not crowding that pathway into your long term memory and back out again.
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So 90 minutes.
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One technique, the Pomodoro technique, and it's only called that because the person who invented it had got one of those plastic tomato cooking timers and would set it to 25 minutes.
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No phones, no distractions, no TV, nothing.
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No music, just really hyper focused for 25 minutes, and then go and do something completely different and active for 5 minutes.
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Then back for 25 minutes, really hyper focused, do do do do do, and then go away for another 5 minutes, um, and do something completely different.
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That's called the Pomodoro Technique, and that has got some really, really good results.
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The distractions thing is an interesting one.
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So clearly, you've reduced as many distractions as you possibly can.
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So you go somewhere where there isn't going to be loads of stuff going on all around you that will distract you.
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Get your phone out of the way.
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Because actually nobody can multitask no matter what they say.
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The music thing is interesting because lots of people really enjoy music and really like it and want to have it in the background.
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But the bottom line is, we know it is distracting, no matter what kind of music it is, whether it's...
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Classical, whether it's rock.
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You may like it, and as long as you're doing something where you're on automatic pilot, you're fine.
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But if you're trying to learn something, it will get in the way.
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We know it dilutes the content.
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The distractions
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point is a really important thing.
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I recall while studying, the number of times I actually thought of jobs that I suddenly would want to do.
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Where normally I would never wanna do them was really quite annoying to yourself.
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And I would find by having a break and getting those little jobs outta the way would actually take that off those off of your mind.
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And so you get back on with the study.
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Yeah, that's, that is a good way.
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And then you feel as though you've got to the end of the day really productive.
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Yeah.
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For a long time I've actually noticed the benefits of studying the night before or actually reading what I've already read during the day, the last minute, just before I go to sleep to help consolidate my knowledge.
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And I still use that technique while operating.
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If I have a difficult operation coming up, I'll be reading through those notes in advance, looking at the patient's notes and looking at my resources, just before I go to sleep.
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And I'll wake up feeling like I've done the operation three times in my head.
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When I go into surgery, I feel so much more confident in doing that.
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Oh, that's really, that's really interesting.
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And I wonder, Gavin, whether when it comes to doing your complex or high performance surgeries, It might be worth you thinking about doing some cognitive simulation, which is not just sort of thinking about it and thinking about the steps, it's recreating using all your senses.
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the night before and going through the operation as though you are doing it in your mind's eye.
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There's some amazing results from that as well.
00:21:17.355 --> 00:21:35.194
So that's, that's worth thinking about when you're doing something practical, whether it's a very complex procedure that you're doing or for our medical students or GPs, some of the practical procedures that are just new and difficult.
00:21:36.069 --> 00:21:39.430
While you're, you're learning how to make them, just part of
00:21:41.259 --> 00:21:47.109
what you think it explains to the listener how you might use this technique for practicing, say, the shoulder examination?
00:21:47.509 --> 00:21:52.089
Could they use this technique going to an OSCE, they might get a shoulder examination as a case?
00:21:52.398 --> 00:21:54.588
They could use cognitive simulation as a way of...
00:21:54.888 --> 00:21:57.559
Being aware of it prior, in the weeks leading up to it.
00:21:57.888 --> 00:22:00.439
How would you do that if you were going to that sort of approach?
00:22:00.989 --> 00:22:04.589
So the trick here is it's multisensory.
00:22:04.594 --> 00:22:07.019
So it's using all your centers.
00:22:07.289 --> 00:22:12.029
You are going into a patient in your mind's eye.
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You are seeing, you are hearing, you are feeling what, what you're feeling at the end of.
00:22:19.579 --> 00:22:24.159
fingers and also where you're standing in relation to the patient.
00:22:24.169 --> 00:22:33.808
Sometimes even smelling familiar scents in the, for example, the outpatients department or in your GP surgery room.
00:22:34.119 --> 00:22:40.079
It is recreating it and going through it as though you're actually doing it.
00:22:40.500 --> 00:22:48.875
And the, the results from that Significantly impact what happens when you go into a real patient.
00:22:49.105 --> 00:22:54.515
It's as, as you said, Gavin, it's as though you've done it before, because you have.
00:22:54.884 --> 00:22:56.234
It's just in your mind.
00:22:57.375 --> 00:22:57.974
Exactly.
00:22:57.974 --> 00:23:01.045
I think it's a great way of actually practicing this technique.
00:23:01.233 --> 00:23:03.999
Being prepared mentally is a key.
00:23:09.559 --> 00:23:12.420
I'd like to let you know that Aussie Med Ed is supported by Healthshare.
00:23:12.769 --> 00:23:18.028
Healthshare is a digital health company that provides solutions for patients, GPs and specialists across Australia.
00:23:18.480 --> 00:23:32.339
Two of Healthshare's core products are Better Consult, a pre consultation questionnaire that allows GPs to know a patient's agenda before the consult begins, with the aim to reduce admin and free up time during a consult, and Healthshare's Specialist Referral Directory.
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A specialist and allied health directory integrate into GP practice management software, helping GPs find the right specialist.
00:23:39.575 --> 00:23:41.305
You can find out more from healthshare.
00:23:41.355 --> 00:23:41.634
com.
00:23:41.644 --> 00:23:41.654
au
00:23:50.075 --> 00:24:00.164
I mean, the bottom line is when it comes to not just knowing stuff, but doing things, again, it is deliberate practice that is the key here.
00:24:00.164 --> 00:24:02.263
It's not just doing something a lot of times.
00:24:02.555 --> 00:24:10.625
It's doing it with real purpose, really thinking about what you're doing, really pushing right to the edge of your comfort zone.
00:24:10.825 --> 00:24:12.734
So again, practice.
00:24:13.388 --> 00:24:20.099
It's not just feeling lovely and having a great time, that's just doing something without any purpose.
00:24:20.099 --> 00:24:21.519
And that does feel very nice.
00:24:21.819 --> 00:24:24.759
Really good practice is hard work.
00:24:25.519 --> 00:24:28.329
What other things do you need to take into account when you're trying to study?
00:24:28.669 --> 00:24:34.148
We've talked about obviously getting a good night's sleep and studying at the end of the day as well to help consolidate your knowledge.
00:24:34.555 --> 00:24:42.035
But what about the use of caffeine and coffee to help you remember things, or also sugary drinks to help keep you motivated and fired up?
00:24:42.115 --> 00:24:45.025
Do those things actually help you, or are they actually more of a hindrance?
00:24:45.703 --> 00:24:45.723
So
00:24:45.724 --> 00:24:46.375
interesting.
00:24:46.464 --> 00:24:52.084
The latest feeling is that looking at really healthy, nutritious...
00:24:52.244 --> 00:24:58.454
Snacks is much better than those sugar spikes and the caffeine spikes.
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