Style of Learning Shapes Performance

The courses in medical school can be approached in two different ways. The ideal approach is the pyramid method: the student masters the basic concepts in the early courses to build the foundation layer and then adds concepts from subsequent courses to build more layers. This approach makes it easier to learn advanced topics because the student remembers the underlying fundamentals. This approach also improves the higher levels of learning: application, analysis, synthesis, and evaluation.

Unfortunately, only a minority of medical students use that approach. The alternate approach is memorize and forget. [...] This approach addresses only the lowest level of learning: knowledge.

In later years, the medical students who used the memorize and forget approach never master the concepts underlying all of medicine. Instead of understanding diseases and integrating that knowledge with information on the various ways patients present when sick, they memorize the commonest patterns of diseases. When a pattern memorizer encounters a patient that doesn't fit the pattern, the patient is in trouble. The physician will shoe-horn the patient into a wrong pattern or request many diagnostic tests or consults or refer the patient to another physician (who may be equally clueless). The lack of thorough understanding of health and disease underlies the mediocre performance of many physicians.

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