How Can I Remember All That I've Learned in Preclinical Classes?

Alex Millman, MD

Disclosures

December 15, 2010

Question

Do you have any tips for remembering all the stuff I learned in the first 2 years, and for integrating it into clinical practice?

Response from Alex Millman, MD
Resident Physician, University of California, San Francisco

Trying to remember the material learned during the preclinical years of medical school is a perennial challenge for physicians in training. The quantity of information is daunting, and it can certainly feel as though your brain is overflowing with facts that are difficult to relate to clinical practice. If you find yourself in this situation, remember these 2 important points: (1) everyone in medicine has confronted this issue at some point in his or her career; and (2) you know more than you think you do.

The transition from the preclinical to the clinical years presents a new set of challenges for all medical students. Not only are you confronted with the complexities of functioning on a team, navigating long hours, and caring for patients, you also are learning new aspects of clinical medicine while simultaneously trying to preserve your "book knowledge." How does one do this effectively?

The first 2 years of medical school provide a foundation -- a starting place from which clinical knowledge will grow. Although it may be difficult to find time to review old material during clerkships, clinical practice provides an important tool for learning: the patient.

Learning from the context of patient care is truly the most effective way for reviewing topics and expanding your knowledge base. I find it easiest to remember things when related to an experience with a patient. Caring for patients provides necessary opportunities for experiential learning by actually demonstrating the pathophysiology learned during the preclinical years.

For example, I have read about the different physical exam maneuvers that accentuate the murmur of aortic stenosis compared with that of outflow tract obstruction. However, it was not until I treated a patient with aortic stenosis that I was able to truly commit the difference to memory. Moreover, caring for patients motivates you to read more about their diseases and treatments. Associating one's learning with an actual patient provides a considerably stronger framework for remembering facts than simply sitting down and reading about random topics for 2 hours.

Medical student presentations can also serve as excellent mechanisms for reviewing preclinical material and for expanding your knowledge base. As a medical student on a clinical team, you will likely be expected to make at least 1 presentation on a particular disease topic during the course of your rotation. This gives you a chance to become a "mini-expert" on a topic while reviewing material you might have forgotten.

For example, if you have a patient with a type of renal tubular acidosis (RTA), it would behoove you to refresh yourself on the mechanisms behind different types of RTAs. Discussing the pathophysiology behind the disease and pairing it with additional information about diagnosis and therapeutics will help you review and expand your knowledge base simultaneously. In fact, these types of topic reviews also allow you to educate other members of the medical team (so be sure to listen to others' presentations as well). Remember, medical students are closest to the basic science years. Other members of the team appreciate a chance to refresh their own knowledge as well.

Although it may seem daunting to remember and apply knowledge from the first 2 years of medical school to the clinical arena, there are methods for effectively doing so. By continuously revisiting old topics in the context of patient care, you will be able to review your basic science foundation while concurrently learning more about clinical medicine. Although clinical practices are consistently in flux, developing the skills to build upon your understanding of the basic mechanisms of disease is essential to becoming a successful physician.

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