Studying during residency

Here are some questions I received a long time ago about studying during residency:

1. Do you have any thoughts on studying to become a better doctor?
2. What and how do you study when not preparing for some fun standardized test?

The easy answer for the latter is that in our modern system of medical education and board certification, you’re always preparing for a fun standardized test.

But I think the real answer to both of these questions to make it about your patients as much as possible.

Approach

You should always consider a broad differential and use real patients as opportunities to consider and learn about alternative diagnoses. If you have the motivation, consider further broadening your differential or treatment considerations unnecessarily just to have a relevant excuse to learn more about given topics. Think “I know it’s not disease X, but what if it was?”

Grounding as much learning as you can with patient care will give you the broad foundation you need in your field to build on when new things come along. But on top of that, linking up the information you learn from resources and articles with real live patient memories gives that information more staying power and helps you fight against the forgetting curve.

In medical school, you are hyper-directed in the content you must master, though in many cases toward low-yield material and wasted energy. In residency, you have more leeway toward becoming an expert in things that will directly impact your practice.

Content

I think for many residents it’s generally difficult to “study” in the medical school sense of systematically sitting down with a book or resource without a test looming in the near future. You’ll have the in-service, which you can use as motivation for dedicated review and MCQ fun, but preparing for your patients/daily activities is something you can do continually and, when done aggressively, can cover a large fraction of the relevant material. You may find relevant book chapters helpful on occasion, but squeezing in UptoDate articles and occasionally reading their references, the infrequent Google Scholar/PubMed search, and reading up on the next day’s procedures/surgeries (or the equivalent for your field), are going to work well in general.

I do think that Anki style flashcards and question banks are still good tools. If you have rotations that contain relatively well-defined material, these may even be straightforward to consider and implement on a schedule. In radiology, for example, it’s pretty easy to (at least plan) to read a book on chest radiography and do the chest RadPrimer MCQs on a dedicated chest rotation.

You may need to give yourself a long-term curriculum to work through, whether that’s guided by a commercial question bank or just following the table of contents of a gold standard textbook.

The Crux

The real limitation here is time and energy. Residency is busy. Call shifts can be brutal, and by the time you recover, you’re on call again. You may have a spouse who needs support and children who deserve a parent. And people keep trying to dump boring research projects on you. Sometimes, something’s gotta give.

But what I would say is that you’ll be more able to learn efficiently if your outside-work-life is harmonious enough that you can be fully present for your daily work. That part is almost non-negotiable. So before you guilt yourself for not studying enough at home, make sure you’re doing the things that you need to in order to recharge your battery to be a thoughtful physician for your patients. The trite lines with all the burnout talk out there is that you need exercise, eat healthily, and spend time nurturing your meaningful relationships. And you know what? That’s probably a good start.

Most of the things that really have an impact will come up as you engage actively with patient care, but some of the other BS will only come when its time to review for that next standardized high-stakes exam.

Ultimately, you caring about your patients as individual human beings and paying attention are the two most important things you can do to provide good care and to learn.