“Lifelong learning” is a phrase that gets tossed around a lot in our profession. It takes about a quarter of one’s life spent churning out above-average performances in a formalized education system just to get to medical school. After that, you might spend upwards of a decade completing your education and training as a physician, and once you do become a fully licensed physician, you just have more responsibilities to balance with your learning. Somewhere in there, you also have to learn how to teach (which, by the way, is an entire discipline of its own). No one is exaggerating when they speak of lifelong learning in medicine. The learning really never stops.
But how often in this life of learning do you pause to evaluate whether you are learning as effectively as possible? Most people probably pay closer attention to the gas mileage of their cars. By the time you get to medical school, whatever approach to learning you had before that point was probably working pretty well for you. But if you happen to be like me, that approach probably shouldn’t have worked as well as it did, and it doesn’t work in medical school.
The beginning of medical school was a big checkpoint for me in my development as a lifelong learner. I failed my first Foundations of Medicine exam, and for a little while afterwards, I experienced exactly the kind of crisis that fills the anxiety dreams of self-doubting medical students everywhere. I thought I had finally found the limit of my ability to learn, and it fell short of what I was going to need in medical school. Does this sound like an existential crisis? It was, and it couldn’t have happened at a better time.
I studied political science and German in college, and then spent seven years working in outdoor education and leadership before I decided to enroll in a post-baccalaureate program and prepare for medical school. The prerequisites for med school were very different from the courses I took in college. I felt academically out-of-shape much of the time, and my lifelong fear of math terrorized me throughout physics and general chemistry. But I hacked my way through those courses, just as I had done with every other academic challenge in life: by relying on stamina and hard work. These were the mainstays of my “learning style,” and they worked.
It took me a long time to realize this, but throughout my life, I have always spent an inordinate amount of time on school work. Assignments that should have taken an hour to complete took me more like two or three hours. The eventual results of my work were good, and my parents and teachers saw me as a hard worker, which is an admirable trait, so I just went along with it. But there are a limited number of hours in a day, and in medical school, I could fill every single waking hour with the kind of studying I was doing before, and it still would not be enough (not to mention the unsustainability of trading all forms of self-care for study). Medical school was one of the first challenges I had ever encountered that could not be overcome simply by working harder.
This revelation was frightening, but with the benefit of hindsight, I can now say that it was also incredibly liberating. It forced me to go back to the drawing board again and again to try different methods. I poured effort into trying new routines, reading about evidence-based learning methods, and evaluating the benefits and burdens of everything I tried. This was scary because it required a modest investment of extra time and energy to try new techniques, and both of these resources are in finite supply in med school. Some methods failed miserably, and just when I had figured out what worked for me in one course, that course ended and the next one required something completely different.
However, the rewards from that initial investment (of a lot of courage and a little extra time) were the best part of my first year. I’m not talking about improved exam scores. They did get better, and that was momentarily gratifying, but it was not nearly as exciting as the lifelong reward of learning how to learn. Before medical school, I was afraid that my brain might be too old for the challenge. But after a year of this, my brain feels more plastic than ever. It does feel tired sometimes, and often filled to capacity, but it’s “the good kind of sore” that you feel after a work-out.
Without the pressure of that first eye-opening Foundations exam, I might not have questioned my existing learning habits. I would have continued to rely on them indefinitely. I will probably never settle on the perfect recipe for my learning because the lessons are always changing, but I am no longer afraid of reaching a limit in my ability to learn. Taking a close look at my own learning experience has given me the tools to expand my capabilities, and that feels like a super-power.
