Learning in College vs Medical School

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The way information is taught in high school differs from college, which differs from medical school. Here’s what you need to know about how teaching and learning styles vary between each stage in your training to become a future doctor.

 

High School Teaching Methods

High school learning is terribly inefficient, and that’s by design. Grade school is largely a form of daycare for children and adolescents while parents are gone to work. From early in the morning until mid afternoon, you’re in school, and most of your time in school is spent in class being lectured to. Homework assignments often feel like busywork, rather than genuine efforts to teach you something valuable, and certain classes seem completely irrelevant altogether.

Your schedule and curriculum are both structured and regimented, leaving little room for electives or exploring your curiosity. Perhaps you have optionality with which physical education or PE class to take, or maybe some selection with the type of history class you enroll in. If you’re really lucky, perhaps you get the opportunity for an automotive workshopping class, which I wish I had a chance to do.

 

College Teaching Methods

College is your first foray into adulthood, and for the first time in your life independence is thrust upon you, both inside and outside of the classroom. Your learning will be more self-directed and independent compared to high school. Compared to high school, you’ll spend much less time in class, and there will be many more distractions tempting you away from your academics.

Of all the stages in training, college offers the most flexibility in what you actually study. The major you chose will dictate what range of courses you must take over your four years. You will still have general education requirements, or GE’s, but compared to high school you have much more flexibility with which courses you take and your day-to-day schedule. You can start early, late, and even have an extra day or two off per week.

When I first started college, I hated waking up early so much that I actually signed up for the engineering level calculus to fulfill my mathematics requirement rather than the math course designed for life science majors. The former was much more difficult than the latter, but my desire to sleep in was greater than the spread in difficulty.

On the premed track, however, there is less flexibility, particularly in the first two years. There are certain medical school prerequisite courses you must take, including biology, chemistry, physics, biochemistry, and so on. It’s only after fulfilling your prerequisite courses, in your latter two years of college, that you’ll be able to explore your curiosity and courses related to your chosen major.

In terms of the learning environment, it’s primarily large lecture halls with hundreds of students, at least at larger institutions. But if you attend a smaller liberal arts college, you won’t get lost in large auditoriums in the same way. Do note that several of your classes, such as English, will generally be more intimate classroom sessions of 20 or 30 students with active participation.

 

Medical School Teaching Methods

Medical school is the largest departure in learning style. Similar to high school, there is little flexibility in what you study, and you’re set on a mostly fixed curriculum and learning path. And similar to college, it’s heavily self-directed and independent learning, but to an even further extent.

In high school, you spend most of your time learning in the classroom, and a few hours here and there on your own. In university, it shifts towards fewer hours in the classroom and a larger proportion of work done on your own. Medical school magnifies this to the extreme, where the overwhelming majority of your learning and studying will be on your own, outside the classroom. This is in addition to 2-6 hours of classroom learning per day.

But it isn’t just a traditional large lecture hall classroom. Because medical school is focused on teaching you to become a competent and effective doctor, there are a variety of teaching modalities that come into play. Your first two years, termed the preclinical years, are primarily lecture-based. Your latter two years, or the clinical years, are focused on learning in the hospital or clinic. The learning styles in each stage are quite different.

 

Preclinical Years

Your preclinical years will be spent primarily in the auditorium and small group classroom sessions. You’ll also have various labs to teach anatomy, histology, pathology, and relevant skillsets for the hospital or clinic.

Historically, medical school was primarily classroom lecture-based. But in the last two decades, more and more medical schools are transitioning to interactive forms of teaching to improve medical students’ learning.

One of the most common forms is PBL, or problem-based learning. PBL, common in your preclinical years, is where you meet in small groups of 6-10 students twice per week. On the first day, you’ll be introduced to a case presentation. There’s a hypothetical patient presenting with a certain concern, and you’ll ask questions to work them up. There’s a physician facilitator in the room as well to make sure the group doesn’t get stuck or derailed. You’ll assign various tasks and responsibilities amongst yourselves, so that during the next session later that week, each student will teach the others what they’ve learned. One student may focus on the differential diagnosis, another on the disease pathophysiology, another discusses treatment, and so on.

Team-based learning, or TBL, is a hybrid between the classroom and small group learning. You’ll attend lecture in a large auditorium, but there will be several breaks throughout the lecture to work through problems with a few other students. This type of teaching style is less common at most medical schools.

There will be other small group forms sprinkled throughout medical school. At my medical school, we had a practice of medicine, or POM course, that was a continuous thread over all 4 years. It covered the ethical side of practicing medicine, communication skills, and the different types of health insurance models around the world and so on.

I’m a huge proponent in the value of a proper medical school anatomy experience, even more so if you’re considering something surgical for residency. In the traditional medical school anatomy experience, you’ll have between 4 and 6 students assigned to a cadaver, and you’ll spend most of your first year dissecting and learning about all the organ systems. You’ll get your hands dirty, literally, and this is one of the best ways to have a true and deep understanding of human anatomy. There’s also a prosection, meaning a cadaver that’s simultaneously being dissected in stages by the instructors for students to view as a reference. After all, sometimes there are anomalies in anatomy, or perhaps your anatomy team inadvertently caused damage to certain structures on your own cadaver. Doing your own dissection in combination with viewing the prosection allows you to get the best of both worlds.

Some medical schools forgo a traditional anatomy experience in favor of only prosections. At these programs, you don’t do any dissections yourselves, and simply view the cadaver that is prepared by the instructors. As a senior medical student, you may get the opportunity to become an anatomy instructor, and I’m very glad I did. It’s rewarding to teach first year medical students, and also a great way to reinforce key anatomy prior to starting a surgical residency.

There are also small group lab sessions for histology and pathology, whereby you’re observing slides through a microscope of various healthy and diseased tissues throughout the body. If you’re color blind, like I am, then this will likely be one of your least favorite classes.

Medical school isn’t just about learning information but also learning various skills. On my first day of medical school orientation, we learned how to draw blood on each other, which also served as an awesome ice breaker. In both your preclinical years, you’ll spend considerable time in small group workshops learning various clinical skills. This includes everything from the basics of how to use a stethoscope to learning physical exam skills or more nuanced techniques like performing a lumbar puncture to test cerebrospinal fluid. For most of the physical exams, you’ll practice on each other, but for the male and female genital physical exams, you’ll have a standardized patient. As you progress to your clinical years, you’ll focus on more advanced techniques, such as the laparoscopic surgical techniques.

To learn how to be most effective in patient interaction, you’ll do practice or group OSCE’s, or Objective Structured Clinical Examinations, whereby you simulate a patient encounter with a standardized patient. It’s completely normal to feel nerves in your first several GOSCE’s, as you’re being watched through cameras by an attending physician and some classmates, all of whom will give you feedback. Over time and with practice, this will become second nature and any anxieties will vanish.

 

Clinical Years

During your clinical years, you’ll be primarily self-directed and spending most of your time in the hospital, clinic, or operating room. Learning is less structured and is primarily downstream of what patients you have on your service. You’ll occasionally be asked to prepare presentations for the attending and residents based on patient pathologies. For example, if a patient on your internal medicine service has kidney pathology, you may be asked to prepare a simple 5 or 10 minute presentation on the types of nephrotic syndrome, a form of kidney disorder.

It’s common to still attend small group sessions once per week, but these are a relatively minor part in your learning. Based on your rotation, you may have skill workshops. For example, while on your surgery rotation, you’ll have some workshops focused on various surgical techniques, including suturing and knot tying. But if you’ve been following either this or my personal channel, then you know I strongly advise students to be practicing these techniques on their own before they get to their surgery rotations. Other examples include learning how to intubate a patient, place a central line, or perform a thoracentesis or paracentesis.

In your fourth and final year of medical school, you’ll attend sub-internships, or audition rotations, whereby your expectations and level of responsibility are elevated. I explain these further in another article but with regards to learning style, it’s quite similar to your third year core clinical rotations. You may be asked to present something more substantial, and rather than just your attending and a couple residents, it may be at grand rounds in front of a few dozen attendings and residents. The pressure is on but you’ll be able to handle it.

Despite the variety of different learning formats, it’s interesting that medical schools don’t place a heavy emphasis on learning how to learn. That’s the main reason I created this channel – to help you understand how to study better. And this becomes even more important since the overwhelming majority of your medical school learning will be self-directed, outside of the classroom. To be the most successful, you need to be focusing on active learning methods, leveraging the times in the day when you are mentally fresh, and strategic with all aspects of your study environment, including whether you study by yourself or with friends.

If you’d like to learn more about how to study better, check out my study strategies article. 

 

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