Medical Education: How do you take notes?

Over the past year I have interviewed well more than 100 clinicians and educators to better understand how they learn, and how they employ what I have come to call the four natural learning actions. These structured conversations have been enlightening – and if you are interested in participating in the process, just let me know. Over the next few months I will be blogging about these finding, submitting a few manuscripts for publication, and extending the research. In the meantime I thought I would begin to share a few of the more interesting ‘learning architectures’ that I discovered.

Case #1: “I’ve used the same notebook for my two big annual meetings since around 1994…”

One clinician told the story of the one notebook that he has used for nearly 20 years. For 350 days a year this notebook sits in plain sight in his office bookcase. Twice each year he takes this book – including every note that he has jotted down from the two major medical meetings he attends each year – and packs it in his brief case as he prepares to travel to the upcoming meeting. Two meetings times 19 years equals 38 separate learning experiences. As he boards the plane to the next meeting he will use the time to flip through the pages of past meeting notes. He mentioned that this is always a time of both shame and learning – shame in that he had forgotten most of what he wrote down at the last meeting and learning because this exercise prepared him to be a better learner at the next meeting.

Over the course of the meeting he would take notes from the sessions he attended, from the hallway conversations he had, and even from the chance meetings he might experience on the exhibit hall floor. Each night he would try to revisit what he captured that day. And over the three or four days of the meeting he would take anywhere from 4-10 pages of notes. On the flight home he would flip back through his notes and even flip (once again) through the notes of prior meetings so that he could identify any actionable items – these became his “to do list”…though he readily admitted that he rarely acted on these items. Once back in his office the book would be replaced on the bookshelf.

As he described it, “Simply looking at the spine of the book a few times each month served in some small way as a trigger to think about the meeting, and think about the notes I took…I just never figured out a better system to ensure I took action on what I knew was important…”

Case #2: “I use the back of my business cards to jot down anything (and everything) I think is important from my annual meetings…”

One educator suggested that he too was struggling with his note taking and reminder system – he went so far as to ask me not to judge him on the system that he had used for the past decade.

While packing for a major medical meeting he would bring up to 50 business cards. Though some of these cards would be shared with folks he met at the meeting, the primary purpose of this stack of cards was for note taking. With each conversation or learning moment that he accumulated over three or four days at the meeting he would also accumulate a set of cards with notes. Over the course of the day each business card with a note on the back would go into his front left chest pocket. Each night these cards would become ‘flash cards’ allowing him to review what he had learned that day before being stacked neatly on the hotel room night stand. Before the return flight home he would collect the week’s worth of cards so he could continue to flip through these cards and would even begin to organize and prioritize the cards before putting a colored rubber-band around the deck. Upon returning to the office he would try to find time to review the cards once more, but more often than not the banded stack was immediately deposited in the bottom right drawer of his desk.

As he described it, “I know what is in that desk drawer – stacks and stacks of banded business cards. Each stack represents a major meeting I attended. And at least once a week I bang my shin on that drawer! The black and blue marks on my shin serve as a reminder of just how bad my note taking system really is!”

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These are just two of the the stories I have been told over the past year – there are dozens just as eccentric, just as frustrating, and just as painful. To be clear, I would never judge a clinician or educator for the jerry-rigged system they have tried to engineer for themselves. The reality is so little effort has been devoted to building better structure for note taking and reminders, that we are each left largely to our own devices…and each tend to do what we have always done!

Over the coming weeks as I share more stories about note taking, reminder systems, search models, and social learning skills I hope you will see that these systems are rarely ever refined or evolved. Yet it is these very systems that support the four natural learning actions which are requisite in each and every medical education program and model we employ.

If you have similar stories to share, please do. And, perhaps together we can help learners and educators alike realize that a well-structured learning architecture is critical to driving change in our lifelong learning models.

All the best,

Brian