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March 20, 2006

Further Thinking about Medical Education

So, in my last post, I wrote gobs about what to do for each class. This will be more about how to plan and carry out the plan on a day to day basis. There's two schedules that you have to mesh: the class-centric schedule and the your-time-centric schedule. This is how I think of it: you've got a morning, afternoon and evening in each day. Some of those are weekday periods, some are weekend periods, some are at the beginning, some are in the middle, and some are just before the test. Within these blocks of time you have to take care of yourself (laundry, fitness, the bills, family, leisure, etc), class, and studying. Even though the topic of class is presumably the same as the topic of study time, it is inherently different in that you can't control it.

Let me take a moment about this 'fog of confusion' graph. What kind of goofball crap is that, Niels? Sounds like something out of a get-rich-quick-scheme book. Well, it's based on Clauswitz's fog of war. During war, and especially during an engagment, no one knows everything that's going on or everything that will happen. Uncertainty about the future is one thing, knowing that you don't know what you will soon need to know is something different. In war this is exemplified by time delays: a forward commander calls in an airstrike which is delivered on target, but the enemy got away under cover of darkness and no one knows it, and this will effect the projected number of bullets that need to be delivered through the supply chain, but the quartermaster already dispatched the projected number of bullets needed. Now resources have to be diverted to provide the bullets, the bullets are promised but redirected again in response to an even greater emergency so when contact with the enemy is made again, the promised bullets aren't on hand, grenades are used, which weren't budgeted for, and quickly no one really feels like they know what is going on.

Similarly, in learning, you're responsible for budgeting your time to learn the things you need to know, but sometimes it's not obvious what is going to require more time to learn. Worse, sometimes you underestimate the time required and spend it on something else, like writing a blog entry called "Further Thinking about Medical Education" and start falling behind, even though YOU THINK YOU'RE AHEAD OF THE GAME. Oh, Niels, this is simply poor planning on your part. I'm not talking about me. No one knows what the future holds, and when time is a scarce resource that must be allocated among competing interests, errors of allocation are bound to occur. The trick is to reduce them by as much as possible. And this why bosses are always 'looking for visibility' on something. They're trying to pull up and away enough to see the bigger picture, see where the resource could be best allocated. This is what schedules, budgets, and other planning documents are for. There are no consequences for violating what was written in the plan, per se. The planning documents are thought exercises to figure out how to allocate resources in response to various branches and sequels leading away from the current decision point. Planning documents are drawn up when things are safe and happy, with the expectation that when the time to make a decision comes, there will not be enough time then to work out the various planning alternatives.

If you want the luxury of considering alternatives, branches and sequels, you will have had to work them out in the plan ahead of time. A plan is not I will do A, B, and C. A plan is part descriptive and part proscriptive. Descriptive planning is budgetting: you assume you will earn so much money this year. Based on that, you allocate the fixed requirements, like rent, then set caps various other categories, like dining out, and minimums on others, like savings.Descriptive planning doesn't normally lead to back-up plans. Emergency plans are typically more proscriptive. If the mayor of New Orleans advises everyone to evacuate the city, then we will always, always, go to my parents house. Proscriptive plans are where you start getting into back-up plans: if my parents are out of town, we will visit some relatives in Tennessee.

Anyway, so how does this all relate to planning for the next block in medical school? Have a generic template plan, and fill it in each time as you go. I recommend the above as a good, generic form to customize during the first weekend before the beginning of a block. During that first weekend, you'll see it calls for a preview. As I've said before, produce something. So previewing doesn't just mean flipping through the book, it means laying out before you, within eyespan, what you need to do. In addition to my schedule, I also prepare these two column preview sheets, one sheet per class (don't worry, I'm taking more than two classes). The are the lectures, numbered, with the reading assignments in the margins. Every time I write a flashcard for that lecture, I will note the class, the block, lecture number, and page number in the lower left corner of the question side; if a figure needs to be referenced, I'll note it on the answer side. For example, the lower left corner of a block three physiology notecard from today lecture reads "P3-37-L22" P = physiology, 3 = block three, 37 = 37th lecture, L = Levitzky's textbook, 22 is the page number.

So how do these allow me to allocate time to favor the branches and sequels I prefer? Remember those three uses of time? Yourself, class, and studying? Well, what if my daughter falls out of a car, bounces her face off the curb, as happened earlier this year? Of course I'm going to go home if something like that happens, but for me, that means driving two hours each way, and probably staying the night. I'll need to leave the recording equipment at the apartment in Houston, and, while I'm in the car, I need to call someone to record the lectures. Using that time in the car and planning to spend some of my time later listening to the lectures I miss. Which lectures will I miss? How do I best decide when to go back? There will surely be earlier and later alternatives. If I'm missing five lectures the next day, as I would see on my schedule (not shown - I use Palm Desktop), maybe I'll try to get back earlier, even wake up the next morning at 4 am to get back. And when I review for the test, the absence of notecards for, say lecture 41, will remind me that I didn't go tot that lecture, so I need to allocate some time to go over that material in more detail.

Posted by Niels Olson at March 20, 2006 5:40 PM

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