AbalaTips 101: Studying for 3rd yr Clinical Subject: --> ACTIVE LEARNING

 Good day mga kaAbalaTips mga dokie, its nice to be back blogging again now let us tackle on how to do active learning in some of the subjects which will apply what we had learned in our basic subjects, these are called clinical subjects, 

Disclaimer: This AbalaTip is not intended to invalidate or to mention that your learning method is wrong, but rather this is a guide and to emphasize the advantages of active learning in medical school

Lets get another active learning meaning

ACTIVE LEARNING- according to the definition by Professor T. Kirkland of University of Washington, "Active learning is an instructional approach in which students actively participate in the learning process, as opposed to sitting quietly and listening. Active learning builds on constructivist learning theory, which posits that people learn by by connecting new ideas and experiences to what they already know"

Lets us recall the Modified NTL Institute Pyramid for Active Learning

**Take note in this picture the higher the percent, the higher number of information is learned and stored in your long term memory

The goal for this blog is for teaching the medical students the methods on how to retain at least 50% to 90% of information that they have learned in the medical school especially the CLINICAL SUBJECTS now let us define it;

CLINICAL SUBJECTS meaning that it will now discuss each of the diseases entity and apply treatment both medical or non-medical or preventive aspect onto it 

Now let us go with AbalaTips 101: Approach to Clinical Subjects which will include the following 

Lets Divide it into 2 parts

I. Clinical subjects with Basics Introduction

II. Clinical Subjects purely Clinical subjects

I. Clinical Subjects with Basic Introduction

**Internal Medicine (and Physical Examination)

**Surgery

**Pediatrics

**OB-GYNE

**Neurology (Basics pertaining to Neuroanatomy and Neurophysiology)

Psychiatry

**-These subjects when taught in higher levels it becomes purely Clinical Subjects thus falling into Category II also

II. Clinical Subjects purely Clinical subjects

Dermatology

ENT

Ophthalmology

In some schools it can include the following which both falls into two categories

Emergency Medicine

Rehabilitation Medicine 

Toxicology

NOW LET US DISCUSS THE GENERAL ACTIVE LEARNING APPROACHES or STRATEGIES for these subjects

I. Clinical Subject with Basic Introduction

- that way that we did that is very effective is to understand the concepts, how to understand the concepts by ANALYZING and UNDERSTANDING, to simplify the concept let us recall of PPCMD2's "Horizontal-Vertical Learning with Clinical Correlations" 

PPCMD2 states that in his blog or article about "Way of Studying for Medicine and its Board Exam as an Average Student" these subjects are correlated to each other thus treating the Medical Course as one whole subjects apply what you had learned do not chunk them since it may cause your retention to be jumbled, for longer term memory, lets apply active learning onto it

The goal here is to correctly apply the active learning strategy at the same time applying these concepts

According to the university of Melbourne and modified these are the things that we can do for active learning

• Use memorization strategies- examples are MNEMONICS that you can see in First Aid USMLE review materials or in the medtwitter 
• Change the format of information- example a long paragraph in Harrison or Nelson or Katzung , or Harper turn them into diagrams, bullets, or tables 
• Write and Draw frequently- make summaries, glossary or picture taking (for example summary of your Physiology, or Draw for example what you had learned in Legal Medicine)
• Work with Friends (especially who like to be in groups)
• Add missing links or information gaps such as write on piece of paper memorize, then after memorized remove the papers (in my interpretation and experience, this is where PPC's "Vertical-Horizontal Learning with Clinical Correlations" comes into play pls click here for the link to the blog [credits and with Permission from PPCMD2])
• Practice Labeling, Diagrams- usually done in SGDs Case discussions, Laboratories, Practicals) [you can use the blog about visualizing your lessons in this blog here)
• Test your understanding- via Pre/Post test - without notes, this will help you learn your weaknesses, also for us medical students we may also practice to correlate, simplify, and use our mother tongue as if talking to a patient
• Create an Immersion Environment- such as flashcards, anki decks, sticky notes or Manila paper all over the room

Now you may ask, why is it that those bulleted statements above are repetitive? because they are the core of the discussion, that is active learning. 

Overall the best thing that I may suggest, is apply what you had learned from previous year or same topic from different subject and correlate it together in addition do active learning

Let me compare the strategies that a Filipino Medical Student scenario which may encompass 

Criteria	PASSIVE LEARNING	ACTIVE LEARNING
Textbook	The medical student will highlight the textbook after class and try to recall the information from the lecturer	The medical student will summarize on his or her own way and will make use of labels, diagrams or/and bulleted forms of what is written on the textbook after class then will translate into simple way or mother tongue based on understanding
Transes	The medical student will highlight whatever is written on the transcript starting from the class and again  recall whatever is highlighted	The medical student will create a concept map of the topics on the transcript + addition by the lecturer, or the student will create a transcript on his or her own
SGDs or Ward Discussions	The medical student after researching the case of the patient, will copy his/her report as it is on the textbook and will report to group as it is	The medical student thru art can make a simpler concept of what is written in the textbook and convert it into more understandable diagrams or explain well the picture based on his her understanding
Sample Exams	The medical student may read a sample exam that already has rationalization to it and will remember the correct answer	The medical student will read a blank sample exam and will rationalize on his on her own, or preferably use it as pre and post test to gain a better understanding of the topi

Based on the table it can be implied that the Active Learning is student  centered which increases memory retention since it is the medical student that is doing most of the learnings with the help of the professors, mentors, and friends 

II. Purely Clinical Subjects 

This subjects are purely clinical which only focus on specific diseases entity unlike the basics which may be applied on other topics, this topics may have the following general format can be seen in all discussions 

• Normal Anatomy and Physiology (and Biochemistry)
• Epidemiology 
• Clinical Manifestations
• Pathology
• Diagnosis
• Differential Diagnosis
• Treatment (Pharmacologic, Surgical, Non-pharmacological)
• Complications
• Prevention

this topics are focus on a specific diseases entity but let us find the way on how to approach this topics 

The way that we can do is to bullet the MOST IMPORTANT FACTS in the following

Normal Anatomy and Physiology

- bullet may not be applicable here, but take note of the numbers, if you have an atlas like Netter then you can read the textbook again WITH ATLAS and 

- for Physiology, correlate, simplify and mother tongue and reverse it when you are reading Pathophysiology

Epidemiology

- Common age distribution

- Most common sex affected (predilection)

- Distribution (monomodal, bimodal, trimodal etc)

- Age affected

- If genetic, most common mutation involved

Pathophysiology

- usually this is analytical, reverse physiology and still do correlate, simplify, and mother tongue (if youre wondering in mother tongue it means explaining it in Tagalog as if you are talking to a real patient)

- if discussing metabolic diseases related in Pediatrics I will advise to reread the specific reaction or pathway in Biochemistry that makes the manifestation to show to the child

**Preferrably convert this to flowcharts or diagrams

Clinical Manifestations

- days when the sign will present

- signs of the patient

- for symptoms most commonly observed to patients

- direction (in cases of rashes)

- period of communicability

- characteristic sign of the diseases (for Dermatology Ophthalmology, an atlas will be preferrable and for Neurology, go back to your basics in Neuroanatomy and Neurophysiology, also try to buy a copy of Netter Concise Neurology since it is an atlas showing signs and symptoms in neurology)

- Scoring system used (or DSM Criteria in Psychiatry)

Pathology

- characteristic microscopic or gross morphology (for correlation you may review your Robbins)

- (For infectious diseases portion) review the characteristic appearance of the micro-organsims or if you have time the test or appearance on gram stain, test it will be positive etc.

      - If parasite borne, learn also about the parasite recall parasitology, learn about the lifecycle of the parasite

Diagnosis

- Most common or specific Physical Examination findings and special test on the patient

- Most common laboratory request and its requested

- Radiographic findings

Treatment

- Most commonly used treatment modality

- Other modalities and if it can have benefit or harm 

Complications

- most common complications; sign, symptoms, diagnosis and treatment 

Prevention

- Non-pharmacologic 

- Vaccines if applicable

Usually done in bullet form and with pictures from atlas to make active learning