Bonnie Gregory, MD | Aaron Brandt, MD
March 22, 2023
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Okay, here’s the secret to crushing it in residency…wait for it…here it comes…THERE IS NO SECRET!!!
Each year, program directors and resident across the country ask the question of “how to study during residency,” just as the answer seems to become less straightforward. Traditional surgical education was primarily carried out through some combination of reading a selection of reference textbooks and papers and direct interaction between surgeon and trainee. Even today, most medical students and surgical trainees have been told to “look it up” or “read more,” but often it’s just not that simple. For one, the breadth of orthopaedic knowledge, research, and techniques continue to expand at an exponential rate. At the same time, duty hour limitations and pandemic/post-pandemic clinical training restrictions have impacted clinical exposure for many trainees. Truthfully though, learning a surgical specialty has never been straightforward. In the past, learners and educators alike could use the same standard approach to studying/teaching. For many this was successful, but likely for many more it was not. As we continue to understand various teaching and learning styles, surgical education needs to continue to evolve to best fit individual learners, while still ensuring a standard of knowledge prior to conclusion of training.
Thankfully, as the burden of what the study has increased, so has the volume of study resources at your disposal.
So how do you study? Clearly there is no one way for everyone, but here are some tips from our experiences and observations as a learners and educators.
Medical Students and Residents:
- Start somewhere.
Sounds simple, but this may be the most important tip of all. Starting can feel like the most challenging part of the study process. The volume of resources is growing; technology and innovation are expanding the types of learning tools, and the material we must absorb is growing and changing every day. This can be especially daunting if you are not one of those learners who can just sit down with a textbook and “learn.” There are a few ways to organize your studying depending on your preference that do allow you to just start:
- Grab a review textbook (think Orthopaedic Knowledge Update (OKU), etc) and literally start reading from page 1. Or instead read the chapters pertaining to the rotation you are on at the time
- Do questions (think Orthobullets or AAOS resident education center). Once again, either general question or those focused on your current rotation/education block
- Prefer to focus on your clinical work at hand? Read research articles/texts about your current clinical patients
- Use whatever other techniques you’ve found success with in the past! They are your “go-to” for a reason
Regardless of how you choose to learn while on rotation, just get started. And then keep going! Residency is truly a process. Work at it, but you also have to be able to give yourself a break or try new techniques if you are not seeing results. Not knowing something in a moment does not equate to being behind or inadequacy.
- Use your resources.
- Ask and share.
One of our most valuable resources is those who have done it before and whom you trust. Don’t spin your wheels or get caught in the rabbit hole when someone can point in a direction. You will run into the upper level or attending who is not helpful, but that’s okay. We give you permission to ask anyone training you about what they are teaching you. Don’t sweat if they hit you with a “look it up” or try to make you feel bad about something, just move on and know they probably aren’t going to be a trusted source of knowledge or support, so reach out to someone who is. Alternatively, you can always ask “Is there a book or paper you like best, or think is best?” While the way Dr. A did it is likely not the same as Dr. B, both have found their way through and can present options. Then it’s your choice where to lean.
- Prepare for cases.
One of the “musts” for any learner is being prepared for cases you will be in. First, this is part of being a good doctor and should be a priority. Of course, the fear of being pimped may be your only incentive. Still, most importantly, each case is an opportunity for real progress. If you prepare (look at the approach, review the pathology, study anatomy, read about the patient and actual workup, etc.), you will be more engaged in the surgery (and your attendings will notice). That preparation turns into an instant review opportunity. Even at your busiest time, pick one of those tasks at least and take advantage of each opportunity.
- To each their own.
You do you! Whatever floats your boat! Different strokes for different folks! No one way to…you get the idea! Don’t be frustrated with yourself if you are not the person who can just read and read to learn. If that form of information delivery isn’t best, try something else. Maybe you learn best from hearing or seeing information and can use the expanding virtual education platforms to watch surgical videos or conference presentations. Some people learn best from questions and reviewing the answers. Try doing questions sets and see if the information sticks better that way. All are worth a try. By the time you make it residency, you are to some degree a professional at learning. Sure, the environment will change drastically, and you will have to adapt, but it’s not the first time. Remember high school…I don’t. How about college? How did you study during college? This is where a lot of trial and error started, and we had more time to do it. Then medical school presented a new challenge. How did you adjust when you hit the wards for rotations? Starting residency does not mean you must abandon methods that got you to this point…so don’t!
Get to know yourself. Consider taking a learning style assessment such as the Kolb Learning Style Inventory or personality test to look at your style of learning and interaction. A test like this will not tell you how to study but can give some insight into where you may learn more effectively.
- One size does not fit all.
Diversity is essential to progress and growth and goes beyond race and ethnicity. Diversity of thought, experience, and teaching and learning push us all to grow. As our learners’ profiles change, so must the learning environment itself. If you have been teaching the same way to every trainee who has sat in the lecture hall seats or entered your OR, it may be time for a change. If we treat and teach everyone the exact same way, there is no question that many of those individuals did not get effective instruction. Sure, the system works for some, but is it the best for every resident? Should we assume that a lower test score or “deficient” knowledge base is due to laziness or lack of ability? Or can we be open to other possibilities like differing learning styles or response to stress. We can be better teachers by identifying where a resident learns most effectively and efficiently.
One resident may be able to sit with a textbook night after night and score in the 99th percentile on the in-training exam or boards. Another may learn best from the hands-on aspects of the job and training. Both can end up the same end but not without recognition of the differences.
- Learn how to teach.
In a field like orthopaedic surgery, mentorship and apprentice-style teaching is, in theory, the ideal format for learning. This setting assumes two critical things: the learner can learn the material or skill, and the teacher can teach effectively. We are not all great teachers just because we graduate into the educator role. If you are the person who thinks I am a good teacher, chances are good you could use some education. As we learn our craft, we should also think about and develop our ability to teach. Every new trainee should be looked at with a new lens. While this doesn’t require a deep dive into educational theory, there is more to education than tradition or simply repeating what was done in the past.
So, we may not have all the secrets to studying in residency, but we have something that better, a path to start and more importantly keep going!!! As an intern, no one expects you to know all of orthopedic surgery, but they do expect you to be actively learning however and whenever you can. It’s easy to lose perspective when looking at the mountain of information to learn, but take a breath, start somewhere and know that it’s a five-year training program for a reason. All your work to get to this point cannot be forgotten. You will have to adapt and grow into residency, and no one person’s experience will be the same, but you can do it! It’s not just about residency at this point; it’s time to bring out the lifelong learner in you. As one mentor said, “Keep your foot on the gas!”
…and don’t worry, we won’t leave you hanging. Included is a sample document obtained from Dr. Olivia Rice who has compiled some of the resources that would be most useful. The list is not meant to be exhaustive or required but does provide some of the options to explore.
- Lensing G, Fortin T, McCandless M, et al. A Multi-Center Comparison of Orthopaedic Attending and Resident Learning Styles. J Surg Educ. 2022;79(4):957-963. doi:10.1016/j.jsurg.2022.02.005
- Margalit A, Mixa P; Day L, et al. Top Three Learning Platforms for Orthopaedic In-Training Knowledge Produce Different Results. JAAOS: Global Research and Reviews 5(8):e21.00148, August 2021. | DOI: 10.5435/JAAOSGlobal-D-21-00148
- Bostrom M, Lewis K, Berger G. The Role of Electronic Learning in Orthopaedic Graduate Medical Training: A Consensus From Leaders in Orthopaedic Training Programs. Journal of the American Academy of Orthopaedic Surgeons. 2021; 29 (8): 317-325. doi: 10.5435/JAAOS-D-20-00821.
- White EM, Esposito AC, Kurbatov V, et al. How I Learned is How I Teach – Perspectives on How Faculty Surgeons Approach Informed Consent Education. J Surg Educ. 2022;79(6):e181-e193. doi:10.1016/j.jsurg.2022.09.001
- Strauss EJ, Markus DH, Kingery MT, Zuckerman J, Egol KA. Orthopaedic Resident Burnout Is Associated with Poor In-Training Examination Performance. J Bone Joint Surg Am. 2019;101(19):e102. doi:10.2106/JBJS.18.00979
- Caulley L, Wadey V, Freeman R. Learning styles of first-year orthopedic surgical residents at 1 accredited institution. J Surg Educ. 2012;69(2):196-200. doi:10.1016/j.jsurg.2011.09.002
- Richard RD, Deegan BF, Klena JC. The learning styles of orthopedic residents, faculty, and applicants at an academic program. J Surg Educ. 2014;71(1):110-118. doi:10.1016/j.jsurg.2013.05.011
- Artino AR Jr, Konopasky A. The Practical Value of Educational Theory for Learning and Teaching in Graduate Medical Education. J Grad Med Educ. 2018;10(6):609-613. doi:10.4300/JGME-D-18-00825.1
DISCLOSURES: Dr. Gregory This individual reported nothing to disclose Dr. Brandt This individual reported nothing to disclose.
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