Memorization vs. looking things up: what should we future docs focus on?

[achamess]

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The current threads about doctors becoming obsolete has got me thinking about what kind of knowledge/information is worth internalizing or committing to memory. Time is limited. So is brain space. Some things really are best left to look up on uptodate or a similar database. But other things should be in mind, always. What I want to know is, what are those things? In med school, we indiscriminately try to learn and memorize everything b/c boards or class exams require it. But we should exercise some judgment once we're past those hurdles. That's the stage I'm at now. I want to be really specific about the things for which I spend the time and effort committing to memory (w/ Anki of course🙂). I want the highest value information to be in mind, but then leave the other stuff to my 'peripheral brain'.

Here is a preliminary list to get us started.

Things to commit to memory:

1. Knowledge that must be used in acute settings where access to a computer is limited
- Ex. protocols trauma, 'codes', emergent situations, etc.

2. Exam techniques
- This is practical, skill stuff. You can't be reading Bates while working on a patient

3. Fundamental, conceptual knowledge that provides a framework for other learning
- This is more vague. I'd like some help fleshing this out. So for example, with respect to autoimmune disease, knowing that HLA-B%^*#(*995 is involved in disease X is not worth memorizing. But knowing that autoimmune disease has genetic inheritance often, and that certain classes of molecules are involved IS worth knowing.

4. Manual skills, i.e. procedures, surgical techniques, etc.


Things to leave to the peripheral brain

1. Detailed management stuff
- Sure, some basic idea of management of disease should be in mind, but protocols and standard of care is changing frequently. This is why we often check UpToDate before prescribing or determining a course of action. What are the most cutting edge regimens or interventions?

2. Clinical pharmacology - what drugs do we use for disease X? Some of that will undoubtedly be committed to memory, but I'd rather entrust the duty of prescribing the right med to smart applications that tell me what the latest and best drug is.

3. Rare disease diagnosis
- We don't really have a choice here. The zebras don't stay in our heads b/c we dont' see them enough. For things that fall outside the scope of the everyday, it is worth having clinical diagnosis support systems, like this that even diagnostic rockstars like this guy will refer to when uncertain.

That's what I got. What do you think?

PS. I don't want this thread to turn into a flame war about doctors not being needed anymore, or being replaced by computers and/or midlevels. I just want the collective opinion about what things we should spend our valuable, limited time and resources internalizing and what we shouldn't. Ok carry on 🙂

 

[evilbooyaa]

I think more than anything, physicians should be able to think through something so that they ASK the right questions when they go look something up.

A known unknown is something that can be easiliy looked up. An unknown unknown (something we don't know that we don't know) is much more problematic.

I think the other thing that is very important to know is when something doesn't seem right and you suspect a zebra. After all, with all the various presentations of so many diseases, it is very easy to not think about a zebra. As much as I hate to admit it (baesd on how much it annoyed me on my medicine rotation), keeping a broad differential for an unexpected condition is important.

All of this is for the people that actually diagnose conditions.

 

[Postictal Raiden]

The current threads about doctors becoming obsolete has got me thinking about what kind of knowledge/information is worth internalizing or committing to memory. Time is limited. So is brain space. Some things really are best left to look up on uptodate or a similar database. But other things should be in mind, always. What I want to know is, what are those things? In med school, we indiscriminately try to learn and memorize everything b/c boards or class exams require it. But we should exercise some judgment once we're past those hurdles. That's the stage I'm at now. I want to be really specific about the things for which I spend the time and effort committing to memory (w/ Anki of course🙂). I want the highest value information to be in mind, but then leave the other stuff to my 'peripheral brain'.

Here is a preliminary list to get us started.

Things to commit to memory:

1. Knowledge that must be used in acute settings where access to a computer is limited
- Ex. protocols trauma, 'codes', emergent situations, etc.

2. Exam techniques
- This is practical, skill stuff. You can't be reading Bates while working on a patient

3. Fundamental, conceptual knowledge that provides a framework for other learning
- This is more vague. I'd like some help fleshing this out. So for example, with respect to autoimmune disease, knowing that HLA-B%^*#(*995 is involved in disease X is not worth memorizing. But knowing that autoimmune disease has genetic inheritance often, and that certain classes of molecules are involved IS worth knowing.

4. Manual skills, i.e. procedures, surgical techniques, etc.


Things to leave to the peripheral brain

1. Detailed management stuff
- Sure, some basic idea of management of disease should be in mind, but protocols and standard of care is changing frequently. This is why we often check UpToDate before prescribing or determining a course of action. What are the most cutting edge regimens or interventions?

2. Clinical pharmacology - what drugs do we use for disease X? Some of that will undoubtedly be committed to memory, but I'd rather entrust the duty of prescribing the right med to smart applications that tell me what the latest and best drug is.

3. Rare disease diagnosis
- We don't really have a choice here. The zebras don't stay in our heads b/c we dont' see them enough. For things that fall outside the scope of the everyday, it is worth having clinical diagnosis support systems, like this that even diagnostic rockstars like this guy will refer to when uncertain.

That's what I got. What do you think?

PS. I don't want this thread to turn into a flame war about doctors not being needed anymore, or being replaced by computers and/or midlevels. I just want the collective opinion about what things we should spend our valuable, limited time and resources internalizing and what we shouldn't. Ok carry on 🙂

I agree with you.

I think medical education must undergo a major shift to keep up with the evolution in technology, economics, and politics. Instead of all the time and efforts spent on memorizing data that can be easily looked up on internet, medical curricula should focus on how to prepare students to handle the leadership and the business aspects of medicine.

I remember once reading an article about Albert Einstein and came across a little story that I found interesting. One of Einstein's colleagues asked him for his telephone number, so Einstein reached for the directory to look it up. His colleague asked him surprisingly why doesn't he know his own phone number. Einstein replied that why should he memorize something that can be easily looked up?

 

[todds]

Things to leave to the peripheral brain

1. Detailed management stuff
- Sure, some basic idea of management of disease should be in mind, but protocols and standard of care is changing frequently. This is why we often check UpToDate before prescribing or determining a course of action. What are the most cutting edge regimens or interventions?

2. Clinical pharmacology - what drugs do we use for disease X? Some of that will undoubtedly be committed to memory, but I'd rather entrust the duty of prescribing the right med to smart applications that tell me what the latest and best drug is.

3. Rare disease diagnosis
- We don't really have a choice here. The zebras don't stay in our heads b/c we dont' see them enough. For things that fall outside the scope of the everyday, it is worth having clinical diagnosis support systems, like this that even diagnostic rockstars like this guy will refer to when uncertain.

I highly disagre with you on many of these points:

1. You must understand what everything does so you can use the principles and apply it to YOUR patient. These are not protocols, rather guidelines. Guidelines are guides, and the principle behind the guides should be understood and applied, otherwise noone is actually getting good care, they're just getting random care of the averages.

2. You don't realize how grey this is. What smart application can sift through volumes of arguments and discussions that span years in the literature. Again see #1. You must be able to understand what the best drug would be for YOUR patient, living infront of you. This is not to be taken lightly at all.

3. Zebras is based on clinical suspicion generated and being through in your history. You must understand when not to fit a square in a round hole. Not everyone remembers the zebras, but you need a good idea of what it is so that when you do read up about it later you arent completely lost.

 

[achamess]

I highly disagre with you on many of these points:

1. You must understand what everything does so you can use the principles and apply it to YOUR patient. These are not protocols, rather guidelines. Guidelines are guides, and the principle behind the guides should be understood and applied, otherwise noone is actually getting good care, they're just getting random care of the averages.

2. You don't realize how grey this is. What smart application can sift through volumes of arguments and discussions that span years in the literature. Again see #1. You must be able to understand what the best drug would be for YOUR patient, living infront of you. This is not to be taken lightly at all.

3. Zebras is based on clinical suspicion generated and being through in your history. You must understand when not to fit a square in a round hole. Not everyone remembers the zebras, but you need a good idea of what it is so that when you do read up about it later you arent completely lost.

Thanks for your thoughts. So in your opinion, what kind of information would you leave to be looked up?

 

[urbanclassic]

I think more than anything, physicians should be able to think through something so that they ASK the right questions when they go look something up.

A known unknown is something that can be easiliy looked up. An unknown unknown (something we don't know that we don't know) is much more problematic.

I think the other thing that is very important to know is when something doesn't seem right and you suspect a zebra. After all, with all the various presentations of so many diseases, it is very easy to not think about a zebra. As much as I hate to admit it (baesd on how much it annoyed me on my medicine rotation), keeping a broad differential for an unexpected condition is important.

All of this is for the people that actually diagnose conditions.

I agree with you. It's extremely time consuming and frustrating to look up something when you don't know the subject very well. And a lot of time times, looking up something may cause you to remember something you could not immediately recall of straight memory.