Posts tagged learning

πάθει μάθος

From the Agamemnon of Aeschylus (written c. 458 BCE)

Pathei Mathos can be translated as learning from adversary, or wisdom arises from (personal) suffering, or personal experience is the genesis of true learning.

Understood in its original context, Aeschylus expresses that wisdom arising from personal experience is more valuable than what any impersonal words, faith, or doctrine can impart to us. 

Why You Are Still Alive - The Immune System Explained by Kurzgesagt.

Four Stages of Competence

In the 1970s, Noel Burch described four stages of learning any new skill and it could be summarized as follows:

  • Unconscious incompetence, where one does not recognize a deficit;
  • Conscious incompetence, where one does recognize a deficit and how to improve their skill;
  • Conscious competence, where one is competent but requires concentration to perform the skill, and;
  • Unconscious competence: where the skill has become second nature.

Everyone strives for unconscious competence. The mastery of a skill has become so complete that you can do it effortlessly. The scariest state to be in is the first stage. “You do not know what you do not know.” That can be a terrible position to be in, especially when a patient’s life is on the line.

That is why receiving feedback is so important. That is why we train for so many years, under the watchful eye of so many experts to be a master of the craft. Sometimes, in order to make that transition to the next step of our competency, it requires someone else to point out where we need help.

There is no possibility for teaching without learning. As well as there is no possibility of learning without teaching.
Paulo Freire

Jeopardy / Millionaire

If you find yourself wanting to do a group study session but want to bring some excitement and competition to the table, why not set up a game night for your friends?

For academic medical students, try a hand at adapting Jeopardy. It takes some time to build up enough cards and factoids to make a late night session worthwhile. Do it in teams or fly solo. Can you answer fast enough?

For clinical medical students, adapt a game of Who Wants To Be A Millionaire? Put yourself in the hot seat in the audience of your friends and try to rank up in a certain topic. Find help with the 50/50 option, poll your audience, or call a friend (e.g. a dermatology resident for a skin lesion question). Rewards can range from free meals to switching prized call shifts to just good old fashion prestige. 

Have you ever played a study game? Share your ideas below.

Phases of the Bipolar Spectrum.
Our mood is always in a constant state of flux. In patients with bipolar disorder, the mood can swing quite dramatically into the highs and lows. They can be pleasantly but intensely perked up one visit or severely and suicidally depressed the next.
This diagram, adapted from the citation above, hopes to illustrate this.

Phases of the Bipolar Spectrum.

Our mood is always in a constant state of flux. In patients with bipolar disorder, the mood can swing quite dramatically into the highs and lows. They can be pleasantly but intensely perked up one visit or severely and suicidally depressed the next.

This diagram, adapted from the citation above, hopes to illustrate this.

Neil deGrasse Tyson speaks about learning mathematics from the Great Debate: the Storytelling of Science.

I watched this last night and I think it is advice that applies to many of the readers who have asked through the years what to do about their struggles with math, chemistry, physics etc. Certainly, I feel that it applies to those who question if medicine is too hard for their passion to stay alive.

With practice, you can become better at your craft, no matter what discipline you pursue. It takes time, it takes work, and it takes practice. But you do eventually get there.

Watch the full Q & A session linked above for other responses by Dr. Lawrence Krauss and Bill Nye to this question.

I remember when we first worked together at the beginning of the year. You were so shy and so nervous. Yet, look at you now: you look and sound confident - and rightly so. Your histories and physicals are impeccable and you are formulating sound management plans on your own. I could not be any happier with your progress this year. Just stellar work today.
One of my internal medicine preceptors and role models comments on my development this year.
More than a year ago, I took my first steps into clinical training by starting my summer medicine rotation. It had begun a new chapter in my development and left a profound impression on me. It was during that brief one-month window that I first started to hone my skills out in the field under the tutelage of not only my preceptors but also the residents.
Now, I find myself on the opposite end of that spectrum; I had an opportunity to meet an up-and-coming third year medical student, a graduated second year clerk in his summer medicine rotation. For a morning, I was tasked to work alongside him and offer some support as I helped him with his patients. 
When we are in the thick of things, it is easy to lose perspective of how far we have come. With only a year separating us, it was surprising to me how far I had grown.
The man was bright and had a very academic mannerism of speaking, the hallmark of two years of lectures. Despite a formidable understanding of theory, there lacked experience and comfort with the practicalities of medicine. This was the great divide between us. I could see his unease at handling a presentation, at coming up with an approach and a differential. It was the same unease I had felt so many months ago, and one that I still feel often, albeit not as often or as strongly as I had before. 
But still, what a difference a year has made! Being able to see him, to work with him, and help him in this moment of his journey enabled me to appreciate and to put my own learning in perspective: there has been progress; there will be progress.

More than a year ago, I took my first steps into clinical training by starting my summer medicine rotation. It had begun a new chapter in my development and left a profound impression on me. It was during that brief one-month window that I first started to hone my skills out in the field under the tutelage of not only my preceptors but also the residents.

Now, I find myself on the opposite end of that spectrum; I had an opportunity to meet an up-and-coming third year medical student, a graduated second year clerk in his summer medicine rotation. For a morning, I was tasked to work alongside him and offer some support as I helped him with his patients. 

When we are in the thick of things, it is easy to lose perspective of how far we have come. With only a year separating us, it was surprising to me how far I had grown.

The man was bright and had a very academic mannerism of speaking, the hallmark of two years of lectures. Despite a formidable understanding of theory, there lacked experience and comfort with the practicalities of medicine. This was the great divide between us. I could see his unease at handling a presentation, at coming up with an approach and a differential. It was the same unease I had felt so many months ago, and one that I still feel often, albeit not as often or as strongly as I had before. 

But still, what a difference a year has made! Being able to see him, to work with him, and help him in this moment of his journey enabled me to appreciate and to put my own learning in perspective: there has been progress; there will be progress.

A Rookie Cut

Over the past year, I have noticed a young man attending the barbershop I frequent. A tall and well-dressed adolescent who bared some resemblance to my barber, he initially started off with the scut work: sweeping the floor, greeting the customers, and watching. Always watching intently as my barber trimmed my hair.

Slowly, over time, he had begun to learn the tools of the trade - the different scissors and the brushes; the straight razor and the strop - and began to practice on the dummy heads.

Today, I went to the barbershop to find him cutting what must be his first set of heads full of hair. All the while, he was receiving pointers and tips from my barber, his father.

His eyes were focused, his body was tense, as he trimmed the weight from the man’s temple. Snip. Snip. As the locks fell to the floor, he re-examined his work. Was it too little? Was it too much?

“Remember to angle your brush up. It’ll give you more room to work with,” his father would say, and he would oblige and try again, with more angling of his left wrist. In the end, the older man seemed satisfied with the young man’s work. A sizeable tip came the trainee’s way, to which he hurriedly returned to the man.

“The cut is free. I’m still practicing.”

“You’re always going to be practicing. Besides, you’ve earned it. Keep the change.” The customer gathered himself and took his cane as he thanked the barber in training yet again. The young man was pleased.

“Next?” Of all the people waiting in the barbershop, no one took a second glance.

“Does your son know what he’s doing? I mean it’s a rookie cut,” came one snappy customer. No one moved. They wanted the expert, the experienced barber, the man who knew every bump under every patch of hair on their heads. They wanted his father. The brilliance of the man’s eyes that a moment ago seemed so alive, dulled. He put down the gown and reached for the broom.

“Sure, I’ll go,” I said, taking up his offer. He gave me a smile and motioned me to the chair. “Have a seat.”

I understood his plight. We were all in the same boat together. As learners, we depend on the good will of the people we see for us to gain experience, to be better, to become professionals. The process must start somewhere. It was time I returned this favour to another student.

“Caesar trim. Sides short. Front long,” his father called out.

“Hey.”

“Hello.”

“Thanks for giving me the opportunity.”

“No problem. We all have to start somewhere.”