Before Starting Medical School: Create a Study Routine that Works for You

This blog is the second in a series on the soft skills that all premedical students should develop prior to starting medical school. 

Medical school admissions officers admit applicants who have demonstrated their ability to thrive in a challenging academic environment through competitive transcripts and test scores, meaningful experiences, and high-quality letters of recommendation.  Yet many first-year medical students find themselves shocked by the intensity of the curriculum. 

Dr. Aron Sousa, Senior Associate Dean of Academic Affairs at Michigan State University’s medical school, described this phenomenon in an email written to U.S. News and World Report.  "For the most part, the intellectual difficulty of the work is about the same as a meaningful upper-level college course, but there is so much studying and work that even very good students work long hours," he wrote. "Most medical schools expect their students to work 60-80 hours a week every week." 

David Delnegro, a fourth-year medical student at the University of South Florida, also via an email to U.S. News and World Report, echoed this sentiment. "The speed in which medical school material is delivered is breathtaking and will humble every incoming student, especially since little guidance is given on how to prioritize the mountain of material," he wrote.

We share this, not as a cause for alarm, but as a point for preparation. Incoming medical students often have a history of taking on academic challenges with relative ease, but many have not yet learned the study skills effective for an even more demanding environment.  

According to a Medscape article, Study Hacks for Medical School, written by Kolin Meehan, research shows that effective study habits can be distilled into three simple rules. “Accomplished students actively construct a study plan and configure the surroundings to maximize their chance of success. Whether using 3x5 flashcards or Quizlet, one highlighter or a rainbow of colors, effective study strategies share common features borne out in the literature: Fully remove all distractions, temporally disperse the material, and repeatedly test concepts. These three simple rules stand to beget untold benefits to students at every level,” Meehan wrote.

As the article’s title promises, Meehan also provides suggested “hacks” for meeting these three conditions: removing distractions, dispersing the material, and testing yourself. We’ve summarized them below. 

1. Mold your environment. Opt to go somewhere to study that is free of distractions. It should be away from others and quiet. Don’t just silence your phone, but keep it out of your sight. Meehan notes that research shows that even silenced and without notifications, keeping your phone within your field of vision creates a psychological distraction. You will waste energy trying to ignore it, so help yourself by keeping it put away.

2. Define your time. Meehan recommends that you use the “Pomodoro Technique.” This involves setting a timer for a set interval to work. For example, 25 minutes with no interruptions. Follow this with a five-minute break. Do this for about four iterations and then take a longer break, for about 30 minutes. Meehan explains why this strategy works. “Study sessions structured in this manner enable students to accomplish a day's work without perceiving the level of fatigue normally felt during long, uninterrupted study cycles. The short breaks punctuating the day are sufficient to initiate the consolidation process and enable longer study periods,” he wrote.

3. Slow and steady wins the race. While Meehan recommends the Pomodoro Technique for daily work, he emphasizes the need to study consistently throughout the full semester. Do. Not. Cram. Research shows that spaced repetition is necessary for long-term retention. “Study structures that incorporate spaced repetition vastly outperform single, large cramming sessions,” he wrote.

4. Test yourself. Use frequent self-assessments to ensure that you are recalling the information that you are attempting to learn. He notes that studies have shown the brain must be asked to recall the information to ensure retention. “Students face a very real ‘use it or lose it’ situation,” Meehan wrote.

5. Seriously, do not cram. Meehan again pointed to the superior results in studies of spaced learning combined with self-assessment and recall over passive review (or cramming). If you have been properly spacing your learning and testing yourself, the benefits of cramming are negligible. Save your time to enjoy a walk (or perhaps a quick rest!) before the exam. 

Try incorporating these three hacks into your day-to-day and let us know how they work for you. We think it will pay off.

Read the rest of the series: Learn How to Accept Critical Feedback Before Starting Medical School

Learn How to Accept Critical Feedback Before Starting Medical School

This blog is the first in a new series that we are publishing on the soft skills that all premedical students should develop prior to starting medical school. While your academic preparation has been underway for many years, we don’t want you to forget about those skills we believe will be vital to your success in medical school (and beyond).

Many pre-medical students have spent the majority of their lives receiving praise and playing starring roles both inside and outside of the classroom. Your commitment to success is part of why you made it into medical school, but it can also make the transition particularly tough. Medical school is not only a challenging academic environment, it is a time filled with new experiences and, accordingly, a lot of mistakes. You will get critical feedback in large doses. 

“My first piece of written feedback during my clinical year was ripe with criticism. I regrettably reacted to it by reading and re-reading it, allowing discouragement and imposter’s syndrome to slowly infiltrate my psyche. My voice began quivering during my presentations on rounds. My thoughts quickly became consumed with what every attending might be thinking of me at any given moment. It became harder to concentrate and learn. I stood in my own way, allowing my dependence on external validation to hamper my professional growth,” said Nabeel Salka, a third-year medical student at the University of Michigan, in a personal essay.  

In preparation for medical school, we want you to gain some comfort with the discomfort. We urge you to practice requesting and receiving negative feedback because feedback plays a critical role in performance and leadership effectiveness. Dr. Sheila Heen, a lecturer at Harvard Law School and author of Thanks for the Feedback: The Science and Art of Receiving Feedback Well, regularly references research that says those who regularly seek critical feedback report higher job satisfaction, adapt better into new roles, and receive higher performance reviews than those who do not seek out feedback. 

But it’s not always easy. Dr. Heen points out that feedback can cause various “trigger” responses, such as truth triggers, relationship triggers, and identity triggers that make it difficult to productively receive the provider’s message. 

--Truth triggers: When we question the veracity of the feedback. We may feel misunderstood, wronged, or indignant, and we are more likely to reject the feedback or go on the defensive.

--Relationship triggers: When the person providing the feedback colors how we receive it. We may feel targeted or bullied. 

--Identity triggers: When feedback hits at how we see ourselves. We may feel shaken, confused, and particularly sensitive. 

So, once you identify your triggers, what’s the next step? Tasha Eurich, organizational psychologist and executive coach, provides guidelines for overcoming the initial emotional reaction, and accepting critical feedback for the useful tool that it is. 

--Don’t rush it. Negative feedback is inherently uncomfortable and emotional. Sit with the discomfort, feel the emotions, and don’t feel compelled to respond to feedback immediately. While researching for her book, Insight, Eurich interviewed a group of people who dramatically improved in self-awareness. Within this group, two clear patterns emerged: First, she found that they made a habit of seeking out critical feedback (although many agreed it was “unpleasant”). Second, after receiving feedback, they took their time, days or even weeks, to respond. During this reflection period, some worked to transform their view of the feedback from an emotional reaction (e.g, “upsetting”) to a rational one (e.g, “helpful and productive data”). Others used “self-affirmation” techniques such as considering their many good qualities (“I am a committed medical student.'') to contextualize the feedback into a broader picture, thus making it feel less threatening.  

--Gather more data. Request additional data points via feedback from others to understand the situation more completely. Is this feedback relevant to many interactions or is it an outlier? Find out if others agree and what additional context they can provide. In addition to providing a more complete picture and reducing personal blind spots, the additional data can help inform an improvement strategy. 

--Don’t choose isolation. There is a real tendency for people to cut off relationships with those who provide negative feedback, to their own detriment. Eurich references research by Marshall Goldsmith and Howard Morgan, who tracked 11,000 leaders within a leadership development program; the contingent who received critical feedback and continued to engage with their coworkers made dramatic behavioral improvements, while those who didn’t were much less likely to see improvement. Maintaining relationships with those who provide difficult feedback drives better progression over time. 

Within medicine, particularly in the clinical setting, there are additional barriers to feedback beyond our own emotional responses. An article in the NEJM Resident 360 identifies the following: not enough time, conflicting priorities, lack of physical/private space to provide feedback, power differentials (particularly for upward feedback), lack of (enough) observations, and a lack of a growth mindset (receiver). Understanding these barriers can help you to create structures to overcome them, such as seeking out feedback on a routine basis, learning to identify feedback in whatever form it may come, gaining comfort in hearing feedback publicly, and accepting that some feedback may not be valid due to a lack of observations. 

Nabeel Salka ended his personal essay by describing the power he felt when he learned to accept negative feedback for what it is, a growth opportunity rather than an indictment of his abilities as a physician. He wrote, “Nearly a year after receiving my first piece of written feedback, I read it again. This time I didn’t feel hurt or ashamed. In fact, I felt like I understood the actual content of the criticism for the first time. Rather than concerning myself with the grade and how much the resident disapproved of my performance, I learned that I could be more organized when presenting.” 

Starting medical school with an ability to see criticism as a learning moment, and nothing more, will allow you to enjoy and take advantage of challenging opportunities in this unique period of your life.

New Attorneys Lack Leadership and Client Interaction Skills

Law students name communication as the top soft skill required for lawyers. Practicing lawyers are more likely to say that it’s judgment. Bloomberg Law’s Law School Preparedness Survey provides insight into how law school prepares new attorneys for legal careers from the perspective of practicing attorneys, law students, faculty, and law librarians. And, on this particular point, attorney and student views were not quite aligned. After communications, students named research and self-management as the top soft skills, while attorneys placed communication and self-management after judgment.

Veteran attorneys were also asked to rate new attorneys’ soft skills on a scale from very weak to very strong. Not surprisingly, attorneys ranked new arrivals highest on email skills with 77 percent of attorneys reporting the skill slightly strong, strong or very strong. Attorneys ranked critical thinking (68 percent), organization skills (62 percent), and verbal communication (62 percent) next highest among the soft skills. On the other end of the spectrum, leadership skills and client interactions garnered the highest percentages of very weak, weak, or slightly weak ratings, at 65 and 64 percent respectively. Networking, decision-making, and judgment fared only slightly better with over 50 percent of attorneys rating new attorneys weak in these skills. Notably, the practicing attorneys’ ratings did not overlap significantly with the views of faculty, who generally rated new attorneys’ soft skills more positively, with the exception of client interactions and email.    

The survey also asked respondents where they thought the skills should be taught: in undergraduate courses, in law school, or on the job. There was consensus across all groups— attorneys, law students, faculty, and law librarians—that writing and research skills should be obtained prior to starting work and that management skills should be taught on the job. Across the groups, a majority felt that research and writing skills should be taught in law school. As for soft skills, there was a lack of agreement across groups. Law students and law librarians believe soft skills belong in the undergraduate curriculum at 46 and 47 percent, respectively. Attorneys were most likely to say that soft skills should be acquired on the job (43 percent), and 47 percent of faculty thought soft skills should be taught in law school. 

Finally, veteran attorneys were asked what skills they wish new attorneys had prior to practicing, and what skills they wish they had been taught prior to starting work. For new arrivals, the vast majority named client communications and interactions (80 percent), and professional writing (79 percent). Similarly, attorneys said that they wished they had learned client interactions (55 percent), conflict management (42 percent), leadership skills (33 percent), and professional communications (31 percent) prior to starting their careers.

Find the full survey results here.