“She Needs to Read More”: Helping Trainees Who Struggle with Medical Knowledge

Chapter

Abstract

Medical trainees must be able to master large volumes of knowledge quickly to be academically successful and competent to practice clinically. About a third of struggling medical learners have insufficient medical knowledge. In this chapter, through case examples and use of Bloom’s taxonomy as a theoretical framework, the author demonstrates how medical knowledge deficits can be distinguished from other types of academic difficulty. Once a medical knowledge deficit is identified, strategies to address this should be tailored to the etiology of the problem. In the experience of the author, who is the founding director of a comprehensive remediation program serving medical students and residents, the most common predominant underlying causes for a significant medical knowledge deficit in medical students are lack of committed study time, distraction, and anxiety and poor self-confidence. Questions to help the learner clarify the issues contributing to their insufficient working medical knowledge are offered. Specific remediation strategies are described in detail and illustrated with case examples. In addition, a list of study tips and test-taking strategies has been included to assist in remediation of these medical learners.

Keywords

Pancreatitis Flare Caffeine Thrombocytopenia Sine 

References

  1. 1.
    Olmesdahl PJ. The establishment of student needs: an important internal factor affecting course outcomes. Med Teach. 1999;21(2):174–9. doi: 10.1080/01421599979824.PubMedCrossRefGoogle Scholar
  2. 2.
    Hinman PG, Dottl S, Passon J. Academic development: a survey of academic difficulties experienced by medical students and support services provided. Teach Learn Med. 2009;21(3):254–60. doi: 10.1080/10401330903021041.PubMedCrossRefGoogle Scholar
  3. 3.
    Cleland J, Arnold R, Chesser A. Failing finals is often a surprise for the student but not the teacher: identifying difficulties and supporting students with academic difficulties. Med Teach. 2005;27(6):504–8. PMID: 16199356.PubMedCrossRefGoogle Scholar
  4. 4.
    Guerrasio J. Remediation program successes. Poster session presented at federation of states physician health programs, Fort Worth, TX; 2012.Google Scholar
  5. 5.
    Wiese JG. Strong as our weakest link. Presentation. San Francisco, CA: UCSF Grand Rounds; 2005.Google Scholar
  6. 6.
    Hoffman KI. The USMLE, the NBME subject examinations, and assessment of individual academic achievement. Acad Med. 1993;68(10):740–7. PMID: 8397598.PubMedCrossRefGoogle Scholar
  7. 7.
    Rohrer D, Pashler H. Recent research on human learning challenges conventional instructional strategies. Educ Res. 2010;39(5):406–12. doi: 10.3102/0013189X10374770.Google Scholar
  8. 8.
    Bloom BS, Engelhart MD, Furst EJ, Hill WH, Krathwohl DR. Taxonomy of educational objectives: the classification of educational goals/handbook I: cognitive domain. New York, NY: Longmans; 1956. p. 206.Google Scholar
  9. 9.
    Anderson LW, Sosniak LA, Bloom BS. National society for the study of education. Bloom’s taxonomy: a forty-year retrospective. Chicago, IL: National Society for the Study of Education (NSSE); 1994. p. 214.Google Scholar
  10. 10.
    Loyens SMM, Rikers RMJP, Schmidt HG. The impact of students’ conceptions of constructivist assumptions on academic achievement and drop-out. Stud High Educ. 2007;32(5):581–602.CrossRefGoogle Scholar
  11. 11.
    Sayer M, Chaput De Saintonge M, Evans D, Wood D. Support for students with academic difficulties. Med Educ. 2002;36(7):643–50. PMID: 12109986.PubMedCrossRefGoogle Scholar
  12. 12.
    Mattick K, Knight L. High-quality learning: harder to achieve than we think? Med Educ. 2007;41(7):638–44. PMID: 17614883.PubMedCrossRefGoogle Scholar
  13. 13.
    Hauer KE, Ciccone A, Henzel TR, Katsufrakis P, Miller SH, Norcross WA, Papadakis MA, Irby DM. Remediation of the deficiencies of physicians across the continuum from medical school to practice: a thematic review of the literature. Acad Med. 2009;84(12):1822–32. doi: 10.1097/ACM.0b013e3181bf3170.PubMedCrossRefGoogle Scholar
  14. 14.
    Gladwell M. Outliers: the story of success. New York, NY: Little, Brown and Company; 2008. p. 309.Google Scholar
  15. 15.
    Beier ME, Campbell M, Crook AE. Developing and demonstrating knowledge: ability and non-ability determinants of learning and performance. Intelligence. 2010;38(1):179–86. doi: 10.1016/j.intell.2009.09.007.CrossRefGoogle Scholar
  16. 16.
    Barrick MR, Mount MK. The big five personality dimensions and job performance: a meta-analysis. Pers Psychol. 1991;44(1):1–26. doi: 10.1111/j.1744-6570.1991.tb00688.x.CrossRefGoogle Scholar
  17. 17.
    Beier ME, Ackerman PL. Current events knowledge in adults: an investigation of age, intelligence, and nonability determinants. Psychol Aging. 2001;16(4):615–28. PMID: 11766916.PubMedCrossRefGoogle Scholar
  18. 18.
    Colquitt JA, LePine JA, Noe RA. Toward an integrative theory of training motivation: a meta-analytic path analysis of 20 years of research. J Appl Psychol. 2000;85(5):678–707. PMID: 11055143.PubMedCrossRefGoogle Scholar
  19. 19.
    Artino Jr AR, Dong T, DeZee KJ, Gilliland WR, Waechter DM, Cruess D, Durning SJ. Achievement goal structures and self-regulated learning: relationships and changes in medical school. Acad Med. 2012;87(10):1375–81. PMID: 22914521.PubMedCrossRefGoogle Scholar
  20. 20.
    Connelly J, Forsyth PB. The study skills guide: essential strategies for smart students. Philadelphia, PA: Kogan Page; 2010. p. 166.Google Scholar
  21. 21.
    Hosterman JA, Shannnon DP, Sondheimer HM. American association of American medical colleges. Medical students with disabilities: resources to enhance accessibility. Washington, DC: Association of American Medical Colleges; 2010. p. 104.Google Scholar
  22. 22.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV. 4th ed. Washington DC: American Psychiatric Association; 1994. p. 886.Google Scholar
  23. 23.
    Arnold LE. Sex differences in ADHD: conference summary. J Abnorm Child Psychol. 1996;24(5):555–69. PMID: 8956084.PubMedCrossRefGoogle Scholar
  24. 24.
    Gaub M, Carlson CL. Gender differences in ADHD: a meta-analysis and critical review. J Am Acad Child Adolesc Psychiatry. 1997;36(8):1036–45. PMID: 9256583.PubMedCrossRefGoogle Scholar
  25. 25.
    Vrugt A, Oort FJ. Metacognition, achievement goals, study strategies and academic achievement: pathways to achievement. Metacogn Learn. 2008;3(2):123–46. doi: 10.1007/s11409-008-9022-4.CrossRefGoogle Scholar
  26. 26.
    Cutts J, Campbell M, Gotlib L, Oman D, Oman R, Wallace JS. MCAT. New York, NY: Barron’s; 2011. p. 983.Google Scholar
  27. 27.
    Magliore K. Cracking the AP biology exam. 2011th ed. New York, NY: Random House, Inc.; 2010. p. 360.Google Scholar
  28. 28.
    Thalheimer W. The learning benefits of questions; 2003. http://www.learningadvantage.co.za/pdfs/questionmark/LearningBenefitsOfQuestions.pdf
  29. 29.
    Gibbs G, Simpson C. Conditions under which assessment supports student learning. Learn Teach High Educ. 2004;1:3–31.Google Scholar
  30. 30.
    Sivagnanam G, Sarawathi S, Rajasekaran A. Student-led objective tutorial (SLOT) in medical education. Med Educ Online. 2006;11(7):1–10. http://med-ed-online.net/index.php/meo/article/view/4610/4789 doi: 10.3402/meo.v11i.4610.
  31. 31.
    Pashler H, Bain PM, Bottge BA, Graesser A, Koedinger K, McDaniel M, Metcalfe J. Organizing instruction and study to improve student learning (NCER 2007-2004). Washington, DC: National Center for Education Research, Institute of Education Sciences, US Department of Education; 2007. http://ies.ed.gov/ncee/wwc/pdf/practiceguides/20072004.pdf
  32. 32.
    Larsen DP, Butler AC, Roediger 3rd HL. Test-enhanced learning in medical education. Med Educ. 2008;42(10):959–66. doi: 10.1111/j.1365-2923.2008.03124.x.PubMedCrossRefGoogle Scholar
  33. 33.
    Marcell M. Effectiveness of regular online quizzing in increasing class participation and preparation. Int J Scholarsh Teach Learn. 2008;2(1):1–9.Google Scholar
  34. 34.
    Guerrasio J. Remediation of the Struggling Medical Learner. Irwin, PA: Association for Hospital Medical Education; 2013.Google Scholar
  35. 35.
    Kelly DP, Levine MD. A neurodevelopmental approach to differences in learning. In: Fine AH, Kotkin R, editors. Therapist’s guide to learning and attention disorders. San Diego, CA: Elsevier Science; 2003. p. 87–108.CrossRefGoogle Scholar
  36. 36.
    Ackerman PL, Heggestad ED. Intelligence, personality and intelligence: evidence for overlapping traits. Psychol Bull. 1997;121(2):219–45. PMID: 9100487.PubMedCrossRefGoogle Scholar
  37. 37.
    Hembree R. Correlates, causes, effects, and treatment of test anxiety. Rev Educ Res. 1988;58(1):47–77.CrossRefGoogle Scholar
  38. 38.
    Eysenck HJ, Eysenck MK. Personality and individual differences: a natural science approach. New York, NY: Plenum; 1985. p. 424.CrossRefGoogle Scholar
  39. 39.
    Covington MV, Omelich CL. “I knew it was cold before the exam”: a test of the anxiety blockage hypothesis. J Educ Psychol. 1987;79(4):393–400. doi: 10.1037/0022-0663.79.4.393.CrossRefGoogle Scholar
  40. 40.
    Zeidner M. Test anxiety: the state of the art. New York, NY: Plenum; 1998. p. 440.Google Scholar
  41. 41.
    Elliott R. Tests, abilities, race and conflict. Intelligence. 1988;12(4):333–50.CrossRefGoogle Scholar
  42. 42.
    Stankov L, Crawford JD. Self-confidence and performance on tests of cognitive abilities. Intelligence. 1997;25(2):93–109.CrossRefGoogle Scholar
  43. 43.
    Fenollar P, Roman S, Cuestas PJ. University students’ academic performance: an integrative conceptual framework and empirical analysis. Br J Educ Psychol. 2007;77(Pt 4):873–91. PMID: 17535509.PubMedCrossRefGoogle Scholar
  44. 44.
    Mayer RE. Cognitive theory of multimedia learning. In: Mayer RE, editor. The Cambridge handbook of multimedia learning. New York, NY: Cambridge University Press; 2005. p. 31–48.CrossRefGoogle Scholar
  45. 45.
    Winston KA, Van der Vleuten CP, Scherpbier AJ. An investigation into the design and effectiveness of a mandatory cognitive skills programme for at-risk medical students. Med Teach. 2010;32(3):236–43. doi: 10.3109/01421590903197035.PubMedCrossRefGoogle Scholar
  46. 46.
    American Academy of Child and Adolescent Psychiatry. Children with learning disabilities. Facts for Families. 2011;16:2. http://www.aacap.org/AACAP/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Children_With_Learning_Disabilities_16.aspx
  47. 47.
    Flavell JH. Metacognition and cognitive monitoring: a new area of cognitive-developmental inquiry. Am Psychol. 1979;34(10):906–11.CrossRefGoogle Scholar
  48. 48.
    Mevarech ZR, Amrany C. Immediate and delayed effects of metacognitive instruction on regulation of cognition and mathematics achievement. Metacogn Learn. 2008;3(2):147–57. doi: 10.1007/s11409-008-9023-3.CrossRefGoogle Scholar
  49. 49.
    Saks NS, Karl S. Academic support services in U.S. and Canadian medical schools. Med Educ Online. 2004;9(6):1–8. doi: 10.3402/meo.v9i.4348.Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.University of Colorado School of MedicineAuroraUSA

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