THE STATMED
DOCTOR STUDY SKILLS
COURSE
Teaching Doctors a Better Way to Study
for Boards
Ryan Orwig, MS
The STATMed Learning Program
www.STATMedLearning.com
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CONTENT:
The STATMed Doctor Study Skills Course
Topic: Slides: Learning Foundations 3-20 STATMed Study System 21-22
Frameworking 23-68 Reading Phase: DR&M (Dynamic Reading & Marking)
69-86 Retrieval Practice 87-102
Homework Feedback: DR&M and Retrofitting 103-106 Advanced
Frameworking & Integrated STATMed Methods 107-125 Planning and
Management 127-162 Section 1: Making Your Study Plan 128-142
Section 2: The Academic Study Agenda 143-154
Section 3: The Study Manager 155-162
Concluding Thoughts 163-170
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Learning
Foundations
The STATMed Doctor Study Skills Course
Essential Learning Concepts for Boards
Study
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#1: STUDY SKILLS
THAT
NO LONGER WORK WELL ENOUGH
• Learners are often poor judges of what works and what does not when
studying
• Old skills that worked in other educational arenas might not work anymore • The
TRAP OF FAMILIARITY and the ILLUSION OF PRODUCTIVITY must be
identified and avoided
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#1: Top 5 Ineffective Boards
Study
Skills
1)
CRAMMING
• Many
bright learners excelled by
undergrad, grad school, or
school • Exploits SHORT
MEMORY (24-48 hours),
collapses due to time,
and density of material
cramming in
even med
TERM
but now
volume,
2)
PEERS
SPENDING MORE TIME THAN
• Given life
and work
there is no
time to
demands,
more “extra”
overcompensate • Must rely instead on being more EFFECTIVE and EFFICIENT
when studying
3) REREADING (and highlighting) MATERIAL or RECOPYING NOTES
• Passive, rote, and provides diminishing returns
• Blurs the line between familiarity and mastery
• Fails to promote random access or active retrieval
4) MAKING NOTECARDS
• Time-intensive, very passive, can devolve into recopying notes, possibly never revisited •
Fragments connections between details & big picture
5) RELIANCE ON “BIG PICTURE” OR OTHER TYPE OF OVERALL FAMILARITY •
Learning how to identify and master both big picture and the dizzying amount of details is a
critical skill set, but just knowing the big picture is not enough for boards mastery
• Familiarity alone can create an illusion of mastery and serve to frustrate you on text day
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#2: DISTRACTIONS:
COMPARTMENTALIZE OR
ELIMINATE
Distractions and interruptions derail study
sessions by causing inefficiency, corrupting
encoding, and complicating retrieval
#2: Compartmentalize or Eliminate
D
i
s
t
r
a
c
t
i
o
n
s
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PHONES
MULTITASKING
• The brain cannot multitask when encoding
information; multitasking destroys efficiency
while studying!
• Multitasking must be eliminated from
concentrated study sessions
• However, multitasking remains valuable when
not studying
TELEVISION
• No TV (or streaming!) during study
sessions
• Turn phones OFF during study block, ideally
out of sight
• Common Concern: “What if it is an
emergency?” Longest spell: 50 minutes •
Random interruptions corrupt encoding; this is
what phones do!
• Stay completely off apps as well during study
sessions
MUSIC
• Beware the lure of music
• Use white noise if silence is too much
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#3: OPTIMAL
STUDY
SESSION STRUCTURE
• Every STUDY HOUR should be framed and structured
• The 50/10 Rule is a simple model for structuring every study hour:
• 50 minutes of continuous, uninterrupted studying
• 10 minutes of a non-study break where you move around, multi-task, engage in
social media, talk with people, rest, exercise, etc.
• Use a TIMER to explicitly track study time and break time
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Optimal Study Session Structure:
What Happens Within a 50/10 Study Hour
During the 50 minutes of
Studying During the 10 minutes of Break
• Only study-based activities
belong in these 50 minutes •
Phones must be turned off •
Internet use must be selective
and related
to study
tasks
• No
multitasking
during
studying •
STATMed
skills will
dramatically
change what
can happen
during this
time
• Anything
you want
that is not
study
related
works
here, from resting, to addressing
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items on a
personal to do list,
to entertainment,
etc.
• This “reboots” the
learning circuit •
Multitasking is great
here: make phone
calls, indulge in
social media and
other media,
Internet, etc. •
Moving around or
engaging in
exercise is strongly
recommended
#3: Optimal Study Session Structure
Important
Concepts:
PRIMACY: We
remember more from the
beginning of a study
session
INTERMEDIATE:
Retention goes down in
the middle of a study
session
RECENCY: We
remember more from the end of a study
session
• Interruptions
& distractions disrupt learning and drag
retention down • Most people engage in random study
marathons, which are inefficient and fail to exploit
primacy and recency
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#3: Optimal Study Session
Structure:
Scheduling your Study Blocks
STUDY BLOCK ONE: 1:00 – 5:00 (four hours)
• Four hours is about as long as you can productively study
at one time
• Fourth hour might produce diminishing
returns, so spend time actively re-visiting
material if
possible
• Take a
one hour
break to
reset
STUDY
BLOCK
TWO:
5:00 –
7:00 (two
hours) •
This
illustrates
the
flexibility
of study
block
length
• All
blocks
utilize the
50/10
model
We do not schedule WHAT
we will study in a given
hour, just WHEN we will
study…and given your
lifestyle, even this type of
scheduling might be too
rigid, so we will explore
different scheduling,
planning, and tracking
models
Four
hours
Two
hours
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#4:
LEARNING &
MEMORY
CONCEPTS
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#4: LEARNING & MEMORY:
Types of Memory
Learning Foundations
Sequential Memory vs.
Simultaneous Memory
SEQUENTIAL MEMORY: Based on rote
memory, which hampers easy access EX:
How does “The Pledge of Allegiance” end?
• You likely have to go from the beginning all
the way through to find the end
SIMULTANEOUS MEMORY: Allows for random
access, which is what we need to be able to do
on test day
• EX: (SPOILERS!) How does the movie
Raiders of the Lost Ark (or any movie you
actually know well) end?
• You can jump to the end randomly with little
effort
SHORT TERM MEMORY (STM): Typically
lasts 24-48 hours, then it is jettisoned if not
revisited;
LONG TERM MEMORY (LTM): When
information stored in STM is revisited over
time, it is transferred to LTM, where material
will stay indefinitely; then, the issue is one of
RETRIEVAL
To offset memory limitations, we need: • Use
study methods that bridge from STM to LTM
• Use study methods that emphasize
practicing retrieval of information
Raiders of the Lost Ark, Paramount Pictures
Short Term Memory vs.
Long Term Memory
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#4: LEARNING & MEMORY:
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Learning Foundations
Massed vs. Distributed
Learning
INFERIOR (BUT COMMON): SUPERIOR
(CHALLENGING):
• Massed Learning: When learning is concentrated over
fewer, longer sessions, over a short period of time
• Distributed Learning: When learning is broken into
numerous short sessions over a longer period of time
• Blocked Practice: Mastering one topic in isolation before
moving onto the next topic of study: AAA, BBB, CCC
• Interleaved Practice: Alternating between topics en
route to mastery, instead of mastering topic “a” before
moving on topic “b”, etc.: ABC, ABC, ABC
Massed & Blocked Interleaved
Massed &
Blocked Distributed & Interleaved
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#4: LEARNING & MEMORY: The Curve of Forgetting
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Initial
TIME � (DAYS)
• Illustrates why CRAMMING
worked for short-term
learning
• We offset this phenomenon by
engaging the
Curve of Learning
3rd
using a variety of
STATMed methods for
tactical revisitations that
will be distributed over
time and interleaved with
other subjects
• While you can never
2nd
Learning Foundations
Experience 1st Revisitation
perfectly offset the Curve of
Forgetting, we
can be
better
about
Revisitation
Revisitation
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#4: LEARNING & MEMORY:
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Learning Foundations
Review vs.
Retrieval Practice
om
REVIEW: Any time
students re-experience
the material they have
already studied when it is
in front of them
• It
is passive, inefficient, and
gives students a false sense of
mastery • Does little to actively
build memory or retrieval
pathways
• How most learners spend their time
RETRIEVAL PRACTICE: Any time
students force
themselves to try and recall
the material they have already studied
• Requires
the student to try to access information already studied
• Can
also be called SELF-TESTING
• Does not feel good, so students are less inclined to engage in these
modes
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#4: LEARNING & MEMORY:
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Learning Foundations
Other Relevant Learning
Concepts
om
A. Executive Functioning: Organizing tasks and materials
• Serves as
the ”command
center” for all
cognitive skills
• Works like
an “executive assistant” or
manager” – this is where you
workflows, prioritize,
self-monitor, regulate
& focus, and build
understandings of dense
and concepts
“project
create
organize,
emotions
conceptual
lectures
B.
Linear versus
Nonlinear Learning:
• Linear
reading/learning:
reading mode, where
a first-second-third
progression, which
overall learning
learning: Not intuitive but
unlock better learning using
STATMed skills • Linear is like a
Default
we read in
limits our
• Non-linear
will
specific
will only be
linear is like
passes at various speeds or altitudes
SNOWPLOW: Only get one pass,
as good as that single pass • Nona HELICOPTER: Can make various
C. The Role of Effort: Time spent studying should feel effortful; STATMed skills will
help actualize the right type of effort our learners should be
exerting
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#5: PROPER
STATMED
BOARDS PREP MINDSET
STATMed Dual-Track Boards
Prep Mindset
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Wrong Way to Consider Prep
,,,,,,,,,
STATMed Way to Consider Prep
Studying For Boards:
Boards Prep:
Mixed View
Two Tracks
Reading review books and review
materials
Watching review
lectures
Re-watching
review lectures
Reviewing
(reading over) stuff
I have already
learned
Taking copious
notes
Making combined
notes with the goal
of review Quizzing
myself
Doing practice
questions
Reading practice
question
explanations
Doing practice
tests
,,,,,,,,,,
Reviewing test
results
STUDYING:
• STATMed
methods organize,
enrich, and fortify
knowledge
• Study materials
come from review
program/source of
choice • Any study
act NOT involving
practice
questions
• Should spend majority of time here
starting out
emphasize mixed questions simulating
test environment • Emphasis on test• Any use of practice
taking process if relevant
questions: untimed/tutor, timed, practice • Includes learning from knowledge and
tests, etc. • Eventually should
test-taking insights
PRACTICE QUESTIONS:
• Lumps all aspects of boards prep under
one umbrella, which is too broad • Makes
dividing tasks and planning even more
problematic
• Breaks boards prep into two categories: 1)
Studying and 2) Practice Questions
• Planning should reflect these two parallel
aspects of preparation
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LEARNING FOUNDATIONS:
Summary
• Reflect on these foundational concepts throughout the class and
beyond to establish a stronger base for your own learning moving
forward
• As you develop your own perspective on new learning foundations,
emphasize making things external and explicit (as opposed to
internal and implicit) to improve performance
• The definition of studying includes robust study tools and
methods as well as management and organizational strategies
• By the end of the course, you will acquire these tools, understand
how and why they work, and put them all together into a
comprehensive system tailored for your needs
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STUDY
SYSTEM CORE STUDY
METHODS
1
Lecture*
Framework
2
3
DR&M
4
Retrieval
Practice
Lecture is omitted when not relevant
• FRAMEWORKING: Explicitly find the structure of your study material first and fast •
LECTURE*: If you have corresponding lecture material, watch the material, linking it to the
framework
• DR&M (Dynamic Reading & Marking): Read and mark the material emphasizing structure
and easy self-testing
• RETRIEVAL PRACTICE: The act of forcing recall (self-testing) as opposed to passive review •
PLANNING and MANAGEMENT: Create an explicit system to optimize study and maximize
efficiency
*NOTE: Many doctors reviewing for boards will not use a lecture-based system, which is fine!
*
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STUDY
SYSTEM CORE STUDY
METHODS
Practice
OR
1
Lecture
Framework
2
2
DR&M
4
3
Retrieval
Practice
1
DR&M
Framework
Retrieval
3
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Frameworking
• The act of extracting the organizational superstructure from a learning event (lecture
materials, textbook, review book, etc.) before engaging in that learning event • The first
step in the STATMed Study Process
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FRAMEWORKING UNIT 1
• How to use Frameworking to find the organizational structure or
“big picture” of every learning event before engaging in that event
• For boards study, a “leaning event” is likely a chapter/section of a
review book/textbook OR some sort of PowerPoint-based
review unit that may or may not have a corresponding lecture
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Defining
Frameworking:
• Done before reading or watching lecture, this is an advanced, tactical
form of what some people call “previewing” or “pre-reading”
• Must be done fast (10 minutes per hour of lecture) in a non-linear manner •
Time limits become flexible when applied to textbooks and review books • Does not
involve traditional reading or learning, just extraction of structure
• Each non-linear pass extracts a specific level of hierarchical information •
Each pass should be made in completion before moving to the next
“deeper” level
• Only contains categories and labels, never “details” or “answers” • Must
be written out in the form of a visual schematic on a single page •
Creates a bird’s eye view of the structure of the learning event, a crucial
perspective often obscured when studying dense medical information •
Becomes a concrete first step when studying or re-studying for boards
that can be used throughout the study process
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Frameworking: The
Process
• Start by FLOATING: Skimming through the material from beginning to end, going
back and forth, looking for organizational patterns and trying to determine the top
most layer of information, surveying the layout and design
o Do not start writing out your framework while floating
o You might mark up the master document to identify or “tag” layers
• FIRST PASS: Write down the top-most layer, leaving white space to fill in
deeper layers
• MORE PASSES (2nd, 3rd, 4th, etc.): Fill in each layer with a different color,
going end to end before digging down to next layer
• Change color between PASSES: Each pass should be a different color • Only
write in categorical labels, never the details/answers • Can lay out framework
three ways: outline, cascade, or web • Depending on time and density of text,
you might not get through all layers
Sample Lecture: Frameworking 27
Note: Mock Lecture created from Wikipedia and other cited sources. Do not use to learn content information
STATMedlearning.com Frameworking 28
Start: FLOATING
Regardless of the format your FRAMEWORK will take (outline,
cascade, or web), always start by FLOATING through the selected
content
• FLOATING is a variety of quick back-and-forth, end-to-end passes,
quickly surveying the overall learning event looking at:
• The scope, density, design, and style of the material
• Whether finding hierarchy will be easy, hard, or somewhere in-between • Possibly
consider layout you will use (outline, cascade, or web)
• Identifying the top-most/primary “layer” of information
• Should take less than a minute with well-designed and delineated
notes
• Could take several minutes with dense or poorly designed notes
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EXAMPLE: Floating
• Start
on page one and do not address
OBJECTIVES now
• Assess
layout/structure: I see two
blocky paragraphs, wonder if this is
just
introductory stuff…
• Then I see ROMAN NUMERAL I:
Triploid Syndrome….
• …which makes me wonder “Is this rest
of this lecture set up using Roman
numerals/classic outline formatting?”
• This is how you look for structure
• Since
I am FLOATING
NONLINEARLY, I
read NOTHING else on this page and
only look for the next equal
layer:
• In
this case, that would be
Roman
Numeral II, which is not on this page
so I jump to the next page….
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EXAMPLE: Floating – Pages 2
&3
On page 2, the first thing I see is more
outline-style markers under Roman numeral
I, so I still suspect the lecture has a classic
outline-type structure
• I am not “reading,”
just looking for
structure, which
means, looking for
Roman numeral
II …
• … which I find
midway through
page 2 with: II:
Aneuploidy …
• …and I then I fly
through the rest of
page 2 and all of
page 3 because
there is no Roman
numeral III there,
either
This illustrates
non-linear
reading
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Frameworking
EXAMPLE: Floating – Pages 4
&5
• Page
4 is a
continuation of
section II …
•…
I conclude this
because there is
no
Roman numeral
III on this page
•I
find Roman
numeral III at
the
top of page 5
• As
I scan page 5,
I
don’t see Roman
numeral IV, so I
keep moving…
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Frameworking 32
EXAMPLE:
Floating – Page 6
• The top part of page 6
seems like a direct
continuation of section III
from page 5
• Note: I do not know if I am right
or wrong yet… frameworking is
all about creating a hypothesis
of
the structure, and I’ll
refine and
correct and deepen
this sense of
structure as I move
forward with
the learning
process…
• Midway through the
page, I
see Roman numeral IV
• Then, at the bottom of
the
page, I find Roman
numeral
V
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Frameworking 33
EXAMPLE: Floating – Pages 7-
8
• Page
a
continuation of
Section
V:
Microdeletion
from previous
page
•I
am not sure what
is going on at the
7 is
bottom of page 7
onto page 8 with
“chromosome
analysis”
• Is
this just part of
Section V, or is a
sixth section?
• NOTE:
This sort of
thing may happen,
so we have
to be
prepared to
be
confused and
make judgment
calls about structure
FLOATING through well-organized
notes like these might take 15-30
seconds, while floating through
denser, less organized notes can take
several minutes
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Choosing
Framework Format
• After FLOATING, you must decide on the format you will use to
write out the framework: OUTLINE, CASCADE, or WEB
• Any format is viable, but you are encouraged to experiment with
all formats
• You might be more passive in your most comfortable state; if the
process becomes mindless or rote, you must change your
approach by using a different framework format
• Many expert students end up preferring the style they liked least
initially: WEBS
STATMedlearning.com Frameworking 35
FORMAT EXAMPLE:
OUTLINE
st
EX: OUTLINE—1
Pass
STATMedlearning.com Frameworking 36
• While
FLOATING through the
document
(approximately 25 seconds), he
chooses to do an outline
• Upon completing his floating, he has
“eyeballed” the material and
decides on
a two-column OUTLINE
• Categories I and II take up four of the
eight pages of the lecture, so giving
them
half of the framework page makes
sense
• The rest of the material will go in
column
two, with category III getting the most
“real estate” because it spans the
most
pages
• Your
ultimate goal is to get the
whole
lecture on a single page; this might
take
some trial and error as you develop
this
skill
st
EX: OUTLINE—1
Pass
STATMedlearning.com Frameworking 37
• Flips
back through the material, pulling out
the top-most layer identified while
floating
& writing it onto the page
• Each layer should be a different color to
help emphasize hierarchy – so this entire
layer is RED, for instance
• Structurally, he identifies the Roman
numeral sections I – V, underlining them
with a solid line
• He also decides to add two other MAIN
CATEGORIES: “Intro” and
“Chromosome Analysis,” but
underlines
them with a dotted line to indicate he
“made
up” these categories—if these turn out to
be wrong, he can correct this during or
after
lecture or reading
• Note the varying amount of space left
between the main “shelves”—this is bc
some sections (II and II) are longer than
others (IV)
• Definitely feel free to abbreviate!
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nd
EX: OUTLINE—2
Pass
• On 2nd pass, again flipping beginning-to-end
through the material, identifies & writes in the
NEXT layer of information, changing pen color
once more
• Does not fall into the trap of reading to learn—only
“reads” to find structure
• Continues to leave space for another pass when
needed (see: subcategories under Aneuploidy)
• Never writes in the DETAILS; uses numbered
place holders instead (See: Triploid Syndrome –
Signs and Symptoms)
• Writing in details/ “answers” would overload and
effectively destroy the framework
Just write “7”
to represent the
7 signs and
symptoms
indicated by
the bullets
STATMedlearning.com Frameworking 39
rd
OUTLINE—3 Pass
EX:
• If time allows, makes another pass, filling in the
next layer of information, again in a new color
• Avoids writing out details—focus instead on
working toward placeholders for terminal details
“Epidemiology” and “Genetics” do not
get numbered
prompts bc it would require too
much reading
1
2
3
4
5
”Signs and symptoms” gets labeled with a “5”
simply because it is listed as 5 bullets
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FORMAT
EXAMPLE:
CASCADE
• Cascades start at the top and flow downward
• Can use word boxes or other shapes, may or may not use lines
• This style looks somewhat like a CONCEPT MAP, but the CASCADE
FRAMEWORK is created PRIOR to any “concrete” studying and it DOES
NOT CONTAIN ANY DETAILS, just PLACEHOLDERS
• The following example uses the same lecture and picks up at the first
pass after floating:
st
EX: CASCADE—1
Pass
STATMedlearning.com Frameworking 41
• Decides
on CASCADE
during or immediately
after FLOATING
• Must choose a portrait
or
landscape layout (he
goes with landscape for
this one)
• When planning layout,
think about your page
as
limited real estate—ID
the middle of the page
and use page or slide
count to determine the
“middle” concept
• The “middle concept” in
this lecture is III Sex
Chromosome Aneuploidy
(starts on page FIVE of
EIGHT)
st
EX: CASCADE—1
Pass
STATMedlearning.com Frameworking 42
• Writes
in the top-layer of
information ACROSS
THE TOP of the page
page) its own category
Note: Does not give “Chromosome Analysis”
(entire last page) its own category…these are
common decisions you are forced to make
when frameworking
• Gives
“Intro” section (about ¼ of the first
STATMedlearning.com Frameworking 43
Pass
nd
EX: CASCADE—2
• Going into 2nd Pass,
change PEN COLOR
• Fill in next level, making
sure to use the vertical
depth of the page
• Notice how this student
puts
“Chromosome
Analysis”
under “Microdeletion
Syndrome” (guessing,
incorrectly, that this
belongs
“under” this section
instead
of being its own section)
• This is a natural part of
frameworking and will be
resolved in lecture or when reading
or while reading, which will augment learning regardless
NOTE: Uses RED STAR with QUESTION MARK to
note that he is not sure if this is where “chromosome of outcome!
analysis” fits in the hierarchy; will resolve this in lecture
STATMedlearning.com Frameworking 44
rd
EX: CASCADE—3
Pass
• Goes
through the lecture
from beginning to end
yet
again, filling in the next
layer of structural
information, using a
new
color
• Although
you can use
lines and boxes to
connect your
framework,
you can also, like this
model, rely primarily on
placement/juxtaposition of
concepts
This framework format helps us
easily see where the bulk/depth
of the lecture can be found
STATMedlearning.com Frameworking 45
FORMAT
EXAMPLE:
WEB
• Webs start in the middle and radiate outward
• Some use lines to connect, others let the positioning of the text
delineate connections
• Again, while it might look like a CONCEPT MAP, it is not because it is
made prior to lecture/reading, and it does not contain details
• It is easy to mix aspects of CASCADES and WEB
• The WEB example picks up after floating:
STATMedlearning.com Frameworking 46
st
EX: 1 Pass Web
• WEBS let you
maximize the page
• Color and shape help
make layers “pop” out
• This example connects
with arrowed lines (not
required)
STATMedlearning.com Frameworking 47
EX: 2
nd
Pass Web
• Framework
created
using mapping
software
• Be
cautious of
conflicting learning
curves: Only use
software if you know
how to use it
• Learn
how to
framework by hand
first, then learn the
software
• Leaves
Pass
space for 3rd
STATMedlearning.com Frameworking 48
EX: 3rd Pass Web
• 3rd Pass uses
cascade/outline drop
downs instead of circular
webs—this works well for
many learners
• She should use more
NUMBERS for place
holding details
• Can always add
numbers/layers later
(during lecture or reading)
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SUMMARY:
Frameworking Process
Used to find organization/structure first before addressing details by following basic
rules
• Always use a timer: 10 minutes (7-15 minutes max) per hour of lecture • Some
handouts span more than a single hour; some lectures might be 1.5 hours or two hours or might
contain several lectures in one packet
• TIP: Write down how long each Framework took in the corner or on the back to track progress in
skill acquisition
• FRAMEWORKING
• Do
is NON-LINEAR, which can be counter-intuitive
not get slowed down by trying to READ & LEARN
• WRITE
DOWN the framework in a systematic, single-page schematic
• Use a DIFFERENT COLOR on each pass to emphasize layers
• Frameworking
digitally on a laptop or tablet is viable as long as you do not lose
foundational development learning software/apps/hardware
• Must
self-reflect on process to get better as you develop this skill, which will require
trial and error
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FRAMEWORKING UNIT 2
Top 10 Insights & Guidelines for
Frameworking
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Frameworking 51
1.
Read for
Structure,
Not
for
“Learning”
THE KEY FACTOR TO CONSIDER: Why are you
reading when building FRAMEWORK?
• GOOD: If you are “scanning” to determine where things fit and how
they relate
• BAD: If you are reading to study, learn, memorize, etc.
GOAL WHEN READING: Discover structure, organization,
hierarchy, categories, labels, etc.
• This might mean scanning single words or phrases
• At other times, this might mean you have to read certain phrases,
sentences, groups of sentences, objectives, etc.
STATMedlearning.com Frameworking 52
• TERMINAL
DETAILS: Means
“details” or “answers”
2. Numerate Details
• Do
not write the TERMINAL
DETAILS into your framework •
Instead, put NUMBERS in their
place
• Example ONE: Flawed because
writes in terminal details
(answers) in green
• Example TWO: Great example
of numerating details that can be
used to prompt recall; answers/
details are in the source material
• What is the recurrence risk of
triploidy?
• What are the four clinical
EX 1:
EX 2:
features of triploidy?
25+ words/numbers in
STATMedlearning.com
3. Mark Text to Find
Structure
extraneous terminal
details
Condensed to two numbers
• You SHOULD NOT mark text to “learn” while
frameworking
• You SHOULD mark text during frameworking
to clarify and help extract structure
• Structural marking
Factors
may involve colorcoding layers,
adding “speculative
labels,” or adding
outline-style Roman
numerals, numbers,
or letters to identify
hierarchy
• If structure cannot
be identified and
extracted during
frameworking, just
wait and find it later
D. Micro
E. PE
F. Testing
12
Frameworking 53
A. Causes B. Definition C. Risk
345
Adds
layered
numbers
to bullets
Speculative
Labels
Adds
1
23
1
2
Frameworking 54
4. Base Layout on Content Needs
While FLOATING, think about best use of your space
each of the four equal space on the page •
Does not factor in volume of each of the FOUR
groups, leading to bad use of space
GOOD LAYOUT:
• Moves main idea upwards, leaving more
space at the bottom
• Puts 1, 2, and 4 up top, and gives 3 more
than half the page below
BAD LAYOUT:
• Identified title: “Single Gene Classic
Mendel” and puts in dead center
• Identifies FOUR main topics, blindly gives
STATMedlearning.com Frameworking 55
5. Limit FRAMEWORKS to
One Page
Page 1 Page 2
Bad Example:
• Flawed Rationale:
Makes a framework
that can later be
used
as “master notes
page” after lecture,
so
spreads it over 2
pages to allow for
future notes
• Problem: Can’t “see”
framework when
spread over multiple
pages
• Problem: Filling the
framework with
notes/details/answers
while studying
“washes out” structure • Problem: Devolves back into Do not: Write in terminal details, answers, or notes
Do: Plan on writing on the framework during and after
low-yield,
lecture to make corrections, elaborations, or more layers
labor-intensive writing out most of lecture
NOTE: We’ll address dense boards materials later!
• Problem: Cannot use framework to self-test
Do not: Leave space for answer-based notes
Do: Leave space for more layers of framework
STATMedlearning.com Frameworking 56
6. Develop Symbol
System for Graphics
GRAPHIC
CHART
FIGURE
PICTURE
• Create
your own symbol-based
shorthand to speed up process
• Especially useful when embedding shorthand symbol for a graphic, picture, chart, etc. directly
into the framework where it fits
• Never worry about learning/understanding this info during frameworking
7. “What happens
when I cannot figure out where
STATMedlearning.com
Frameworking
57
something fits?”
EXAMPLE:
More likely to happen with boards
review program PowerPoints than
review books:
• If
you do not know how something relates or
fits, use a SYMBOL to “tag” it and/or a place
on the page to write it in…then, in lecture
and/or reading, seek out the answer and fix
the framework accordingly
• This
brings INQUIRY into your study
session, which is one of the most powerful
ways to augment learning
• In this syphilis lecture, due
to some confusion in the
way the PowerPoint is
written, he is not sure if
“syphilis alopecia” is a type
of syphilis or a symptom of
secondary syphilis
• He guesses it is a type but
marks it with a RED
STAR
& UNDERLINES IT to
alert
him that this is a point of
confusion
• He will resolve/correct
this
in or after lecture
STATMedlearning.com
Frameworking 58
8. Finding SUMMARY
& “HINGE” Slides
• SUMMARY slides: Recaps of preceding slides
require non-linear reading to unlock; find and
exploit these whenever possible via non-linear
skimming when frameworking
•
A
B
C
D
E
Reading backwards from this SUMMARY
SLIDE unlocks section of the lecture
“HINGE” slides: Serve as “preview” slides in
many PP lectures, coming BEFORE sections or
BETWEEN topics; can be in the form of bullets,
tables, or other repeated labels
Sample from middle of a lecture
A
EA
B
C
D
E
BC
D
STATMedlearning.com Frameworking 59
1
2
3
1
•
12
233
8. HINGE SLIDE:
Example
Reading the bulleted list at the bottom of the “Aneuploidy” slide
(then skimming ahead) reveals the structure of this upcoming
section • This is a HINGE SLIDE because it comes BEFORE
the section • The trick is learning when to “read” and when not
to
• We cannot read the dense Aneuploidy paragraph at the top
of the slide—it is too dense to quickly extract info from
• But we can skim over the bulleted list and ideally see key
labels that we recognize, then skim forward a handful of slides
to see if there is a “hit” on any of these terms (in other words,
do they show up?) • This is a critical frameworking skill,
especially with PowerPoints
9. Do Not
Rearrange the Material When
STATMedlearning.com Frameworking 60
FRAMEWORKING GOAL:
1. To extract the skeletal framework that the expert teaching the course/writing the book used 2.
Then, to use this framework to augment your ability to interface with this source material
Do not rearrange it to suit your liking while frameworking:
• To do so means you are reading too much
• Might expose you to some misconceptions you have
• If you must, you can rearrange it later in the study sequence, but not now
Good “arrangement” decision: You can choose between a web, outline, cascade, or some
combination of these formats to lay out your framework
Bad rearrangement decision: You cannot decide that, even though the review program expert
created 6 main categories for her lecture on Chromosome Abnormalities, you would rather
combine them into 5 main categories, fusing III. Aneuploidy and IV. Sex Chromosome Aneuploidy
into one main category ANEUPLOIDY category
STATMedlearning.com Frameworking 61
10. When is the
Framework
Finished?
1. TIME LIMIT
review
will
the
EXPIRES when
doing timed
framework (10 min
per hour lecture);
this may not apply
to dense
texts, which we
cover later in
course
2. THE BIG
PICTURE/FRAMEWORK is complete: If you feel like
the framework is complete and you have time
remaining, you are done
3. READY TO READ and/or WRITE OUT TERMINAL
DETAILS: When you feel this, you are done building
your framework
Summary
Frameworking Unit 2: Top 10
STATMedlearning.com Frameworking 62
Insights & Guidelines
• Frameworking has a limited scope—the preparation to learn—but plays a
vital role in redesigning the learning process because it emphasizes where
learning must start: with organization
• Reduces the impact of attention problems, executive function issues, or
struggles with managing volume of detail because you build the big picture
before delving into details
• Provides a structure to identify and eliminate knowledge gaps •
Methodology is essential, as is practice
• Frameworking works with any text-based learning activity, but different
constructs—traditional word-based notes, PowerPoints, textbooks, etc.—
require their own modifications
• We will directly apply this to boards review materials later in the course •
Frameworks will also be repurposed into powerful self-testing tools
STATMedlearning.com Frameworking 63
FRAMEWORKING UNIT 3
Using Frameworks During Lecture,
After Lecture, and Without Lecture
STATMedlearning.com Frameworking 64
Using the Framework
in Lecture
How Learners Might Use Their
Frameworks in Lecture
• Student A: Uses frameworking to get familiar with
topic initially, then uses it during lecture to follow
along, start making connections, and get back on
track when they inevitably get lost due to
distractions
• Student B: Since they have already studied this
many times, use it to fill in gaps and possibly self
test or predict what is coming up, demanding a
higher level of activity and engagement
• Is the item being discussed a main idea, a
• Student C: Uses framework to get a CRUDE
sub-topic, a sub-sub-topic?
• Are there other equal tier topics coming up? •
SENSE of structure for dense/”poorly designed”
lecture; then, takes this crude hypothesis of
structure into lecture, and sharpens, refines, and
fills it in during lecture. After lecture, she is
definitely better off and has a strong sense of
structure and relationships between concepts
Not getting overwhelmed by details even in
lecture; encoding details will come later • Not
taking copious stenographer-style notes
• Looking for “holes” in knowledge or
flagging known areas of weakness
• KEY: Get it done first and fast, then use if
as the spine of your entire study process
during lecture, reading, and self-testing
Goals of The Framework in
Lecture
• See where a given concept fits in the
framework of what is being discussed
• Predict/anticipate what is coming next •
Make conceptual connections
• Be aware of hierarchy:
STATMedlearning.com Frameworking 65
Using the
FRAMEWORK in LECTURE
During Lecture:
• LECTURE
NOTES/PPs are
in front of you
(printed or
digital) while
watching lecture,
getting most of
your attention
• FRAMEWORK
is
off to the side,
like a road map,
used to predict,
reference,
orient, & make
corrections
Framework is
off to the side,
which you
check
frequently yet
lecture, probably
on-demand (but
would work
LIVE)
Focus
on lecture notes,
taking minimal
notes
briefly
Watch
• Rely on making connections, following along & predicting rather than taking tons of notes • If
you get lost, use framework to get back on track
• If your framework is wrong or unclear, fix it
• If you noted questions on your framework, listen for the “answers,” making annotations to the
framework when needed
STATMedlearning.com 66
How Much Should
FRAMEWORKING and Watching
LECTURE Provide?
BEFORE LECTURE:
• The framework is the “closet” and its corresponding labels are the shelves, NOT the items that go on the
shelves of the closet … in other words, not the specific details
• While this information is limited, it is the right information to identify first—this is true for first-time
learners and re-studying boards doctors
DURING LECTURE:
• Here you solidify, correct, or add “shelves” and maybe start placing details or seeing relationships •
You are not really learning all these details yet, but by the end of lecture, you are primed to start
encoding details within the framework (and you might have already started this)
• NOTE: If the lecture was poorly designed or otherwise especially challenging, your FRAMEWORK might be
crude, superficial, messy, or otherwise incomplete; treat it as a hypothesis that will be resolved during and
after lecture. This will result in better engagement, retention, and understanding because frameworking
is an ongoing process…
AFTER LECTURE:
• You might still have 75-90% of the work to do, but since you have emphasized organization in your first
two experiences, studying after lecture will be improved, especially with new STATMed methods
• If the framework was crude or otherwise flawed, continue to sharpen it during and after lecture
STATMedlearning.com Frameworking 67
Using Framework while
Reading/Studying
FRAMEWORK
should be:
• Out and visible, but off to the
side, while studying and
reading material after lecture
• Used in much the same way it
was during lecture, with the
student constantly yet briefly
checking or “pinging” the
framework to connect the
details with the big picture,
letting you see the “big picture”
from a bird’s eye view
• Use framework to orient
yourself, see where you have
been and where you are
see patterns, annotate to
make a better framework,
self-test off of the document,
etc.
going,
• This will all make more
sense once we add more
STATMed Skills…
Framework:
Checked briefly on and off
during reading/study
Lecture Notes:
Lecture
This is what you
Notes
are focusing on
STATMedlearning.com Frameworking 68
Frameworking:
Summary & Assignment
• Frameworking should be done before any study-based reading or learning event •
Frameworking only provides a limited amount of information, but it is the RIGHT information
to start with
• Complex learning must emphasize organization, and frameworking will help students unlock
this critical aspect of learning, which is often lost when studying for boards
• After establishing foundational skills with FRAMEWORKING, you can start to modify the
skills to fit your preferences & the needs of your materials
• The role of the framework will expand during the Reading (DR&M) and Retrieval Practice
phases
ASSIGNMENT: Complete the FRAMEWORKS assigned by your STATMed specialist. These
are not boards-specific, but by completing them to the best of your ability you will gain the
foundation needed to apply this skill to broader, denser boards-related materials • Expect to
struggle
• Experiment with various formats (outline, cascade, web, combinations)
• Try to be time-sensitive (set your timer), but you can use a little extra time if needed to work
out some kinks—write down how much time you spend per framework
• Complete all frameworks to the best of your ability—do not expect them all to be “correct,”
but bring them all to completion
69
DR&M
Dynamic Reading & Marking
DR&M 70
Dynamic Reading & Marking:
DR&M
OR
• The phase where you actually READ the material
• Ideally only read it once
• Mark the material while reading in a strategic manner to augment
interaction, engagement, and retention
• Marking should facilitate retrieval practice
DR&M 71
DR&M: The Basics
• Dynamic Reading & Marking (DR&M) will be largely linear •
Some of the reading can be non-linear, which can be achieved by
periodically:
• “POPPING
UP” to check where you are in the big picture by checking your
framework
•
how
fits
•
sure
•
and
allowed
phase •
should
Asking
and
connections
“SCOUTING
AHEAD” to see
what you are
currently reading
with upcoming info
“TRACKING BACK” to make
you understand context
Minimal
underlining
highlighting is
during this
Reading
involve:
questions,
identifying
structure,
summarizing
information,
making
• You should NOT be trying to MEMORIZE EVERY DETAIL right now
• Mark the material to make self-testing more viable in
the future • Use the DR&M strategies presented in the
following slides
DR&M 72
MARK TO
EMPHASIZE FRAMEWORK
Label the Framework: Letters, Number, and Color DR&M 73
A. Def
A.
B.
B.
1
C.
1
2
3
I
2
II
abcde
Horns C.
1
234
Grey matter
space
space 2
space
III
A.
• Labeling and color-coding can easily
indicate hierarchy
Loc.
B.
1
• Can happen during FRAMEWORKING or
might require closer reading during DR&M
• Part of your job during DR&M is to
continue to identify and extract
framework
Aneuploidy
Aneuploidy
DR&M 74
FrameworkFinding: Finalize
Labels
• If you did not find headings/sub
headings to add as “speculative
labels” during frameworking, find
and add them now
• Two HINGE SLIDES (circled)
reveal the hidden structure of
sections of this dense PowerPoint lecture
1
2
3
Aneuploidy
Sex Chromosome
Aneuploidy
• Find and label/structure during frameworking, lecture, DR&M, or even later
• In this example, the student adds
Sex Chromosome Aneuploidy
Comp/contrast
numbers, color, and
Chromosome
missing sub headings Aneuploidy”)
(”Aneuploidy” and “Sex
Sex Chromosome Aneuploidy
DR&M 75
MCLs: Finding and Labeling Missing Categorical Layers (MCLs)
DEF
Cause
Transm
Results:
Epidem
Dx
Neurocysticerosis Dx
Prevention
Tx
ABL use:
Helps…
Surg:
SURG CI:
� Finalized label!
• MCLs
are hidden categories implied by the text • When material is too dense to allow you to find
further layers during frameworking, dedicate time during DR&M to identify and label these
missing categorical layers
• By finding and writing the MCLs into the margins, you are engaging in a higher form of
transaction and analysis, finding hidden structure, and setting yourself up for self-testing
EXAMPLE: Dense packet with random list of bullets • Frameworking did not allow her to find missing
categorical layers because they are buried in the bulleted text
• During DR&M, she takes the time to find and label the MCLs (see: far left side of example)
• This improves understanding, interaction, and retention, and makes retrieval practice more viable • She
could then write these newly-discovered categories into her pre-existing framework (Def, cause, transm,
epidem, dx, etc.): this is called retrofitting the framework
DR&M 76
Retrofit the Framework: Example 1
Shallow initial framework:
Source material too dense
for more
Detailed retrofitted framework:
MCLs identified and filled into
framework during DR&M
• Source
material too dense to allow for detailed frameworking leads to a very shallow initial framework • A
shallow framework is still valuable since it gives the student an explicit understanding of scope and structure •
She then fills in the framework during DR&M, adding the MCLs she finds in the reading to the FW • This is called
RETROFITTING the FRAMEWORK; it is the most important part of her learning since it demands
hyper-awareness and engagement while studying, and it builds 1) storage “shelves” and 2) prompts that can be
used for retrieval practice (the main goal of her studying)
DR&M 77
Retrofit the Framework: Example 1 (cont.)
SWINE DYSENTERY (SD)
1) Caused by a spirochaetal bacterium called Brachyspira
via the fecal oral
A. Caus. Agent B. MOA hyodysenteriae,
route, leading to invasion of the colon
crypts, then to goblet and epithelial
(3) C. Peak Age
cell colonization. The disease is
common in pigs from 25 to 165 lbs,
1
and peak ages are six to 1223
week old pigs, but can
affect any
D. Infl. Resp (4)
E. Sx (5)
2) Inflammatory response goes
from tissue loss, mast cell 3
12
diarrhea (i.e. dysentery).
degranulation, and failure to
reabsorb Na and Cl. This 4
generates strong β hemolysis on
blood agar under anaerobic
incubation conditions, causing a
severe inflammation of the large
12
intestine with a bloody mucous
3) The first signs are partial
anorexia, passage of soft 3
feces, and possibly fever. The
course is variable. 4
Mucoid diarrhea with flecks of
blood and mucus develops
progresses to a watery
mucohemorrhagic 5
diarrhea. Then feces are brown
and contain flecks of
A. Caus. Agent
B. MOA (3) C. Peak age D. Inflam.
Resp (4)
F. Dx (3)
12
E. Sx (5)
fibrin and
debris.
the
enteritis, and heavy
bacteria 1
5) Differential diagnoses include
G. DDx (4)
4) Diagnosis comes from clinical
picture and serological 3
and biochemical confirmation of
intestinal spirochetosis,
F. Dx (3) G. DDx (4)
H. Tx (5)
234
salmonellosis, proliferative
• During DR&M, focus on finding and labeling
whipworm infections
1
H. Tx (5)
MCLs in text, then retrofitting them
(writing them back into) the original
carbadox, lincomycin, tylosin,and tiamulin are framework
Bacitracin,
6) Water medication is preferred at first.
2345
commonly used.
• MCLs are always prompts, never Original source
“answers,” setting up
self-testing : Too dense to extract structure during frameworking, so DR&M
phase focuses on ID’ing and extracting MCLs
MARK
WITHIN THE TEXT
DR&M 78
DR&M 79
Numerating Items:
Example 1
• Numerate lists of items within the text:
bullets, sentences, details, etc.
• Write the total number of items in the
heading, the margin, white space, etc.
• This activity tells you how many items
must be learned, connects to
framework, organizes information, and
facilitates retrieval practice
EXAMPLE:
• This makes returning to self-test from the slide very easy
• Can self-test from the top: “What are the four causes of acute mediastinitis?” • Can
self-test inward from more specific elements: “What are the eight procedures for
esophageal perforation?”
• Use a notecard or your hand to cover the answers while you work inward when self-testing
During DR&M, she:
• Identifies the
Numerating Items:
Example 2
MCLs (Epidem, S/Sx, RF, Dx,
etc.)
• Writes MCLs in the margins
with
1
DR&M 80AKA
231
Can lead to (3):
2
numbers
• Numbers the items within the text itself
• Adds highlights to make finding
Epi (2)
3 4. 5. 6
RF (3)
1
2 3
Dx
-can be
answers
easier/faster
performed (6)
1
23456
S/Sx (6)
12
• Experiments with color-coding
• Goal is to read & mark fairly quickly, then “memorize” via self-testing
(using MCL and numbers), not slow reading or re-reading
• Can retrofit these MCLs into FRAMEWORK as well during DR&M