COMMENTARY

Is 'High-Yield ' Learning Making Future Docs Less Prepared?

Kyle Slinn, RN, MEd; Reviewed by: Rishi Desai, MD, MPH

Disclosures

March 18, 2019

The term "high-yield" has become a popular catchphrase in the medical school community. Students use it regularly in online forums as they seek out study aids, and medical school test-prep resources have been using it in their marketing for some time. Even Osmosis's own marketing team convinced me to include it in the title of our new Osmosis High-Yield Pathology Notes. However, as both a healthcare professional and a patient, I have concerns. I worry that the term "high-yield" has become synonymous with simply passing a specific test and that it could have negative outcomes on clinical practice in the long term.

Generally, "high-yield" refers to the most important information in a given topic. "What high-yield books are there on the cardiovascular system?" may be a question you see on Reddit or the Student Doctor Network, two large online communities for medical students. The student is asking for a concise resource that covers only the information he or she needs to know.

One problem with traditional textbooks is that they typically cover far more information than the student will need to learn. Consider a typical pathology textbook. The book provides a lengthy description on topics covering all 4 years of medical school, as well as content for residents and practicing physicians, rather than what a student needs for a specific course or single lecture on cardiac pathology.

For students, this means that they have to sift through pages and pages of material that they don't immediately need to know, to find the bits of information that they do need to know. This is time-consuming, mentally taxing, and stressful. Imagine doing this for each class. In my experience, most students feel overwhelmed by the volume of material they're expected to read and resort to a game of guessing which section of a chapter is important on a given day. Now tack on the stress of time spent managing clinical rotations, extracurriculars, or any number of nonacademic responsibilities that demand student attention. Needless to say, students need something beyond their textbooks.

In response to this need, numerous medical education companies and services have arisen, including Osmosis. Medical education companies help alleviate student anxiety about what they need to know at a given time. This is the context in which the term "high-yield" has become so popular.

As a patient, it alarms me to think that my future clinician may only know a few bullet points about my disease.

As most students are well aware, far more applicants apply to residency programs than spots are available; thus, administrators now use top exam scores to help narrow the pool of applicants. For medical students, exams have become a high-stakes game to compete for the highest score. Every student is doing everything they can to succeed with little margin for error. This has resulted in a subtle shift in how "high-yield" is being used.

Some medical education companies have catered to students by substantially narrowing the scope of what is considered high-yield to include only a subset of the material found on a specific high-stakes exam, like the United States Medical Licensing Examination (USMLE). That may amount to a single bullet point of information. That's the slippery slope of "high-yield": Less information that covers only what is relevant to an examination is considered more valuable to a student.

As a patient, it alarms me to think that my future clinician may only know a few bullet points about my disease. Imagine a civil engineer who only knows a few bullet points about concrete, or an accountant only knowing a few bullet points about taxes. This sort of reductionist approach can lead to major blind spots and diagnostic biases. The steady pressure and focus on high-stakes exams keeps students asking, "What is on this test so I can pass it?" instead of "What do I need to know to be a good clinician?"

The good news is that we can reclaim the phrase "high-yield" if we focus on creating the best possible learning experience. We can help students by being as efficient with their time as possible. The educational content we make needs to be clear, concise, and organized in a logical sense, so that students don't waste time trying to figure out what we're trying to say. We can help students organize all of the material they need to study into bite-sized goals so they don't feel overwhelmed, and help them keep on track with their classes. We can help students remember content they've already learned by regularly quizzing them in a no-stakes, pressure-free way. We can help bridge the gaps between theoretical content and the application of that content to clinical practice. With these changes, we can shift student focus from passing a test to lifelong learning, creating the sort of clinicians we all need and want.

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