Medical Students - News and Resources

In addition to our work with K-12 students, The Yellin Center has long worked with older students in college, graduate, and professional schools. One important piece of this work is the assessment and support we have offered to approximately 100 medical students, who are often sent to us by their academic dean when they encounter difficulties with school or licensing exams, or with their "rotations" in the clinical aspects of their training.

In fact, we are delighted to announce that we have just been awarded a grant (together with the nonprofit Center for Learning Differences) from the Sergei S. Zlinkoff Fund for Medical Research and Education that will allow us to quantify the impact of our work in the assessment and remediation of these students, with a view towards providing medical educators with guidance in helping these students to achieve success in their studies and careers.

As part of our work with medical students, the Resources section of our website has information on a number of tools and apps that can help medical students with the unique demands of their professional studies. As we noted in an earlier post, this section of our website isn't always easy to locate from our home page, so we are taking the opportunity to shine a light on this helpful information. 

photo credit: University of Exeter via flickrcc

Rethinking Medical Education: Ditching Two Plus Two

Most folks would agree that the goal of education is to prepare students to successfully navigate the world after they have left school. An ever-present conundrum, though, is that no one knows exactly what that world will look like. This is especially true today, when the world, and the skill set one needs to be successful in it, is changing faster and faster. How many of today's computer science majors took computer skills classes in elementary school? Most educators could never have predicted that learning to code would put students on the fast track to success in a field that will never, it seems, stop expanding.

To prepare their students to be more effective physicians in an uncertain future, some medical schools are veering away from tradition with experimental learning models. Most medical schools still follow a model developed in the early 1900s by Abraham Flexner, a prominent educator of the time. His "two plus two" system, still prevalent  in most medical schools in the United States today, dictated that students spend two years in the classroom learning basic science and memorizing facts, then two more years in hospitals using their new knowledge in a practical setting.

Critics argue that the two plus two system no longer works. For one thing, the number of facts students must learn is growing exponentially; according to Dr. John Henning Schumann, Chair of Internal Medicine at the University of Oklahoma – Tulsa, the entire body of medical knowledge doubles every three to four years. And facts that first- and second-year medical students fought to memorize during countless caffeine-fueled study sessions may be outdated and obsolete by the time they're working with patients a few years down the road.

Additionally, ties between public health policy and medical practice are growing more and more numerous. Medical students who learn to practice their craft only within the four walls of a clinic, some believe, are missing a huge part of the equation. Social determinants (lifestyle, housing, nutrition, etc.) play an enormous role in helping to diagnose and treat a patient. Proponents of the new medical educational model argue that medical students must learn about the health care system and all of its resources to be effective, and these lessons are missing from Flexner's model.

The University of Michigan and the University of California,San Francisco are two schools experimenting with new models of medical education. One big difference is the emphasis placed on collaboration. Students work together often, since the schools' administrations are betting that teamwork will be more and more important in the future practice of medicine. And instead of simply memorizing pages of information, instructors teach students to locate current information, synthesize the facts of each case with the latest research, and act on their conclusions to provide effective care.      

At the Yellin Center, where we have been working with medical students from New York University School of Medicine and other medical training programs for years, we know that some of the most successful doctors can pair their knowledge with problem-solving skills and creative critical thinking. They collaborate readily with other medical professionals and know how to communicate clearly with patients. We look forward to learning about the kind of doctors these new educational models produce!

Photo credit: Patrick via flickr cc

The New MCAT: What Future Doctors Need to Know

Medical training is filled with rites of passage. To become a physician, one must dissect cadavers, sit through endless lectures, and often incur substantial loans during medical school. Even after graduating, newly minted doctors need to survive on little sleep and money for years during residency. But the first challenge comes before medical school even begins: the Medical College Admission Test, or MCAT. And that rigorous test is about to get even more difficult. 

Observing that an older and more diverse population brings new challenges to the practice of medicine, the American Association of Medical Colleges (AAMC) has rolled out some major changes to the MCAT; they hope the new test's results will allow medical schools to better determine which candidates are ready to learn to be effective doctors in today's world. The revised test will be administered for the first time in April of 2015, affecting those who hope to begin medical school in fall of 2016.

Changes to the Test

More Topics: In addition to content knowledge and critical thinking, areas tested by the old MCAT, the new one will feature questions about research design and graphical analysis/data interpretation. The lion's share of points will come from the verbal section and questions about biology, psychology, and biochemistry. Students should also be prepared to answer questions about organic chemistry, physics, and sociology, though there will be fewer of these. The AAMC says that the test will also draw clearer connections between scientific knowledge and its application to medicine.

More Time: The new test will take twice as long as the old MCAT. Standard administration will last a grueling 7.5 hours, including breaks. According to the AAMC, while there are more questions on the new MCAT, there will also be more time to answer each question.

More Prerequisites: Eight prerequisite courses prepared test-takers for the old MCAT. The new test covers more topics, and so the number of prerequisite courses jumps to eleven. Since course content varies by college, students should check to see how their school's science offerings line up with the AAMC's preparation recommendations.

New Scoring: Instead of being scored on a 1-45 scale, test takers can earn a maximum of 528 points on the new MCAT. Between 118 and 132 points are possible in each of the four sections.

General Study Tips

The new MCAT covers more material, meaning that cramming over the course of a few months is even less likely to be effective. The best way to study for cumulative exams like the MCAT is to take advantage of opportunities to learn throughout one's undergraduate career, even if the MCAT is still years away. College students should avoid last-minute study sessions to get through their midterms and finals in their science courses; taking the time to learn concepts deeply and thoroughly, through many shorter study sessions spread evenly over the semester, will result in more durable knowledge. Later, as they study for the MCAT, crammers will likely find themselves scrambling to relearn everything they forgot immediately after taking their college exams, even if their scores at the time were satisfactory. Hastily acquired knowledge does not last.

Would-be medical students should take as many practice MCATs as they can, as well. For more information on the benefits of practice tests versus traditional studying, see our previous post on current research about testing and memory.

Implications for Students with Disabilities

Certain types of reading difficulties, attention troubles, and sequencing issues will make the new MCAT even more challenging for some students. Students interested in medical school should compare their time and effort levels to those of their peers.College students who find it difficult to master the content of the science courses needed for medical school may want to explore whether they have subtle difficulties with some aspect of learning, such as an undiagnosed reading disorder or a problem with attention. An evaluation, such as those we provide here at the Yellin Center, may clarify these questions and will yield helpful strategies that students can use to improve their mastery of the course material. Even high performers may want to consider seeking out an assessment if they're putting in tremendous effort and unreasonably long hours. Those students who learn that they have weak pacing skills, for example,  may want to consider consulting an executive function coach to help them figure out how to get through each of the sections

Students with disabilities may benefit from accommodations, and the sooner such measures are in place, the better; examination boards are more likely to turn down requests for accommodations if the student cannot demonstrate a history of having such provisions in place. A high school student may be able to finish enough questions on a tough chemistry exam to earn a solid grade, but a particularly slow pace or waning attention is likely to impact her more as she enters college and medical school. 

Dr. Yellin Contributes to New Book on Medical Education

We are pleased to announce the publication this week of Remediation in Medical Education: A Mid-Course Correction, featuring a chapter by Dr. Paul Yellin on "Learning Differences and Medical Education."

As many of our readers are aware, Dr. Yellin works regularly with medical students and other young adults in professional and graduate schools, helping them to deal with newly discovered or long-standing academic challenges to their academic success. In his chapter, he describes the wide range of normal variation in how medical students learn, describing both "learning variations" and "learning disabilities." He discusses various aspects of learning, which he calls "constructs" -- memory, attention, language, temporal-sequential ordering, spatial ordering, and higher order cognition -- and how difficulties in any of these constructs can impact academic success in light of the demands of medical training. He goes on to discuss the legal implications of a disability of learning and to offer strategies and resources for both medical students who struggle and their instructors.

Remediation in Medical Education edited by Adina Kalet, MD, MPH and Calvin Chou, MD, PhD (Springer, 2014), covers a wide range of issues relating to medical education, from how medical schools can provide remediation for struggling students, to how cultural issues can impede effective communication, to medical students with underlying disorders, such as autism spectrum disorders, that affect their interpersonal interactions. Both editors have worked extensively in the field of medical education and effective communication between physicians and patients.

Memory Strategies: Use Music, Mnemonics, and YouTube to Improve Learning

A frequent issue mentioned by students who come to The Yellin Center for help with school is that they can’t remember information they studied when test time rolls around. They often suspect they have memory difficulties, but we frequently find that poor memory is not the problem. Even the strongest memories in the world can’t handle a limitless number of facts; these students are usually in need of better memory strategies. The more strategically they learn information, the easier it will be to “find” when taking exams.

Testing is particularly difficult for medical or law students, or even high school students in chemistry or history classes, because there is so much material to remember. We often recommend that students use mnemonics to help them recall lists of facts. For example, to remember the taxonomy for biology, if students can remember the sentence “King Philip Cuts Open Five Green Snakes,” they’ll have access to the first letter of each of the taxonomic levels in order (Kingdom, Phylum, Class, Order, Family, Genus, Species).

Another way to recall information is to turn it into song lyrics to go with a catchy tune. We think this is a great idea, and we’re not the only ones. A recent news story tells of a young British doctor doing just that to help the staff at his hospital remember to use the asthma treatment guidelines when treating wheezing patients. When traditional reminders weren't working, Dr. Tapas Mukherjee made a YouTube video  in which he sang his new asthma-related lyrics to the tune of Deep Blue Something’s “Breakfast at Tiffany’s” and crossed his fingers. Within two months, doctors at his hospital reported that they all knew the guidelines. More importantly, they performed much better on measures that tested their knowledge of specifics. For his efforts, Dr. Mukherjee won the British Thoracic Society Innovation in Education Award in 2012 and the National Health Service Expo/Network Casebook II Innovation Award this year.

There are plenty of other great examples of students using song to help get troublesome facts to stick. One is a video made by Canadian medical students. (Those unfamiliar with second-degree AV block, a disorder that causes irregular heartbeat, may find it a little tough to follow but will still get the idea). Another winner is “This is Why We Clot,” described on the page as “Drug Life’s hot new single about the use of anticoagulants.” To see a model of how this tactic could work with younger children, watch the silly “Place Value Song” from Teacher Tipster  below to see how Mr. Smith uses a song to help his youngsters learn how to grasp the concept of tens and ones.



The most memorable study song, of course, is the one a student invents himself. So next time your student has to learn a list of prepositions, recall a series of events, or perform a multi-step procedure, help him turn the information into a song. Teachers can try this out in the classroom by putting students in groups; finished songs can be recorded and played or performed live for the class. Turn studying into a rockin’ good time!

Changes in Medical Education

Two recent articles in The New York Times focus on how medical education is changing. Both reflect the trend away from the traditional path of four years of hard science courses in college, followed by four years of medical school, where coursework continues to focus strictly on science based topics.

One move away from this is the growth in post-baccalaureate pre-med programs, where college graduates who have not taken the necessary science courses, or who are out in the working world but want to switch to a career in medicine, can prepare for medical school. According to the Times article, more than 15% of new medical students have gained admission after completing such programs and there are now 135 post-baccalaureate programs listed with the Association of American Medical Colleges (AAMC). These students may have studied poetry, history, or psychology in college and may have had work experience as teachers, artists, or marketers. They can bring a very different perspective to their medical education and their interactions with their patients.

Another trend involves changes to the medical school curriculum itself, towards what the Times piece calls "heart and soul and social science." The AAMC is making substantial changes to the Medical College Admission Test (MCAT) in an effort to look for strengths in areas other than just science, with the goal of admitting individuals to medical school who bring a broader skill set -- including the ability to connect to their patients, not just to analyze test results. Beginning in 2015, the MCAT will include sections on "Psychological, Social and Biological Foundations of Behavior" which are designed, according to the MCAT website, to recognize "the importance of socio-cultural and behavioral determinants of health and health outcomes." In addition, another new section called "Critical Analysis and Reasoning Skills" is intended to help identify applicants from diverse backgrounds. Students entering college this coming fall will be the first group to take the new MCAT when it is put in place in 2015.

Dr. Yellin's work as a consultant to the Office of Student Affairs at New York University School of Medicine and his extensive experience performing evaluations of medical students lead him to observe that whatever changes may occur to medical school admissions and curriculum, the academic demands of medical school will continue to be an issue for future physicians."Like other strong learners," he notes, "medical students will not get very far in their studies or careers without an understanding of how they actually learn and without developing a repertoire of strategies. Often, learning strategies that have worked for them in other environments don't work for them in the demanding setting of medical school. They need to develop new strategies for the extraordinary demands of the medical curriculum and that requires them to understand how they learn, since even very successful students will have stronger and weaker areas in their academic skills."

Photo: Alex Proimos/Flickr Creative Commons

"Flagging" on Law School Admission Tests

In a recent blog, we wrote about a report from the Government Accountability Office that looked at how testing companies were complying with the provisions of the Americans with Disabilities Act (ADA). At that time, we noted that the one testing organization that did not participate in the interviews or provide written information for the report was the Law School Admissions Council (LSAC), which administers the LSAT, the test which accredited law schools use in their admissions process.

Now, the American Bar Association (ABA), with almost 400,000 members, has called for the LSAC to change its policies on dealing with individuals with disabilities and to bring its test into line with such other high stakes tests as the SAT, ACT, and GRE. What makes this American Bar Association resolution so important is that it comes from the organization that accredits law schools and that requires law schools to use an admissions test. Although the ABA does not control the LSAT, it tacitly endorses its use. Pressure for change from the ABA may prove the best hope for change in how the LSAT functions and may move the LSAC to comply with the ABA resolution that the LSAC ensure that, "the reporting of test scores is consistent for all applicants and does not differentiate on the basis that an applicant received an accommodation for a disability."

The ADA requires that all testing organizations provide individuals with documented disabilities with accommodations such as extended time, extra breaks, or auxiliary aids, which aids should "best ensure" that the test reflects the test taker's abilities and not his or her disabilities. But most of the high stakes testing organizations go further and report the scores of individuals taking their test with accommodations in the same manner as those who take it without accommodations; they do not "flag" a score as having been earned through "non-standard administration." That was not always the case, and only happened after settlement of a federal lawsuit in 2000 and subsequent action by testing companies. The SATs continued to flag scores for students who received test accommodations until 2003.

What has the American Bar Association and others concerned is that the LSAT -- along with the MCAT, the Medical College Admissions Test -- continues to flag scores of students who take their tests with accommodations, in contrast to every other major high stakes test. The LSAC has stated that they continue to flag because, "it would be misleading to report scores earned with additional test time without some indication of the non standard administration." They further note, that "scores earned with additional time are not comparable to standard scores," even though the other testing organizations have concluded that this is not the case with their tests.

As might be expected, there have been lawsuits against the LSAC and even agreements with the Justice Department, but no case has resulted in changes to the flagging policy. We hope that this welcome action by the American Bar Association will be key to changing the flagging policy for the LSAT.

Photo used under Creative Commons

New Federal Report on Testing Accommodations

A review of the role of federal agencies in enforcing compliance with the Americans with Disabilities Act (ADA) by private testing agencies was recently released by the U.S. Government Accountability Office. We think the report provides a good overview of the subject of testing accommodations and makes interesting reading for those with an interest in this subject.

The review was prompted by concerns that organizations that administer such high stakes tests as the SAT, ACT, GRE, MCAT, and certification exams such as USMLE and MPRE operate without sufficient oversight by federal agencies charged with making sure they comply with the ADA. The testing organizations are required by the ADA to provide reasonable accommodations -- modifications such as extended time, use of special technologies, or special testing locations -- to enable students with documented disabilties to have full access to their tests. 

The GAO interviewed or obtained written information from most testing organizations except the Law School Admission Council (which administers the LSAT), which refused to cooperate. We don’t know why they declined to participate, but we are disappointed that they were not willing to discuss their approach to disability accommodations. The GAO also interviewed officials from a representative array of colleges and high schools, and reviewed complaints to the Departments of Justice, Education, and Health and Human Services, all of which (but primarily Justice) have some oversight of this issue.

The report noted that about two percent of the students taking high stakes examinations last year did so with testing accommodations -- some 179,000 of the 7.7 million individuals who took such tests. Of this number, about one-half were students with learning disabilities and one-quarter were students with ADD or ADHD. By far, the most frequently requested and granted accommodation was 50 percent extended time to take the exam.

The report concludes that the Department of Justice needs to take steps to better analyze the data it has available on complaints, to reach out to testing agencies, and to coordinate with other agencies such as the Departments of Education and Health and Human Services. In a statement included in the report, the Justice Department agreed with these recommendations and laid out steps they will be taking to implement such improvements.

A Dose of Their Own Medicine

A recent settlement announced by the U.S. Department of Justice with the US Board of Medical Examiners highlights some of the issues faced by students taking standardized tests, such as the SAT, the ACT, or the US Medical Licensing Examination (USMLE).

All of these high stakes exams are governed by the requirements of the Americans with Disabilities Act (ADA) which requires that private entities such as the College Board or the National Board of Medical Examiners must offer their exams in an accessible place and manner to individuals with disabilities.

The regulations to the ADA explain that modifications to such exam can include things like extended time or the manner in which the exam is given. The regulations also give examples of what they call "auxiliary aids and services" such as Brailled or large print questions and answer sheets, or transcribers for individuals with manual impairments.

In the recent settlement, Frederick Romberg, a medical student, was denied test accommodations for the first part of his medical licensing examination (called Step 1) on the basis of dyslexia, a learning disability. The denial was based on the test organization's finding that Romberg failed to demonstrate that he was disabled within the meaning of the ADA, which requires that an individual be "substantially limited in a major life activity". Although this dispute was resolved by settlement, it is clear from its terms that the Justice Department did not accept the NBME position on how to determine whether a person is entitled to accommodations. In addition to the requirements that this settlement imposes on the NBME, other private testing organizations -- the College Board (SAT) and the ACT folks included -- can consider themselves reminded about what they need to do when faced with an application for disability accommodations.

The agreed-to terms of the settlement in the Romberg case include:

• The Board must limit its request for documentation to what is reasonable to demonstrate a disability
• Documentation should be focused on whether and how the applicant's ability to take the exam under standard conditions is impacted
• The Board must carefully consider the recommendation of qualified professionals who have observed the applicant in a clinical setting
• The Board needs to consider whether applicant's ability to read (since this was a dyslexia case) is restricted compared to the ability of most people
• Where, as here, an individual did not have his learning disability diagnosed until later in life, the Board must consider reasonably supported explanations, academic records, and other evidence about the applicant's reading ability
• Considerable weight must be given to past accommodations, such as in an IEP or 504 Plan

As for Mr. Romberg -- he was given a separate testing area and double the standard testing time for the first two parts of his medical licensing exam. In addition to providing the basis for the Justice Department to remind testing organizations of their responsibilities, we suspect this settlement will result in Mr. Romberg changing his title to Dr. Romberg within the next few years.

Conference on Dyslexia and Related Learning Issues

Next Monday and Tuesday, March 14th and 15th, the 38th Annual Conference of the New York Branch of the International Dyslexia Association will take place in New York City. This conference always attracts a large number of educators, parents, and clinicians and offers sessions to appeal to a wide variety of interests.

This year's program includes a session on Monday by Dr. Paul Yellin, who will be speaking on "Learning Differences in High Achieving Students." This session will focus on Dr. Yellin's experiences working with medical students, college students, and young adults with a variety of learning differences. He will examine case studies which illustrate critical features of learning differences and their impact on academic success and work productivity, and discuss an interdisciplinary approach to assessment, diagnosis and treatment.

On Tuesday, Susan Yellin, Esq., Yellin Center Director of Advocacy and Transition Services will be joined by Christina Bertsch, as they discuss "Life After High School: Keys to College Success" and other issues raised by their book, Life After High School: A Guide for Students with Disabilities and Their Families."


Also on Tuesday, Jo Anne Simon, Esq. will be discussing high stakes standardized tests, such as the SAT, and issues about eligibility for accommodations under the latest revision of the Americans with Disabilities Act.

These are only a few of the 60 plus sessions this conference will offer. If you have some time on Monday or Tuesday (one day registration is available) you might want to join us there!

Learning Strategies for High Achieving Students

The Master Scholars Career Advising Program at the New York University School of Medicine and Dr. Lynn Buckvar-Keltz, the school's Associate Dean for Academic Affairs, hosted the annual presentation of Dr. Paul Yellin to the medical school student body last evening. Dr. Yellin's presentation, Strategies for Success in Medical School: The Impact of Normal Variations in Learning Profiles on Academic Performance in Medical Students, is part of his ongoing work with the the Dean of Academic Affairs and with individual medical students from NYU and other medical schools. Dr. Yellin also works with physicians who have completed medical school as well as young professionals in law and other fields.

Why would these students or recent graduates in highly demanding fields, who have been able to be admitted to competitive training programs, need the services of a physician who focuses his work on learning and school success? And why would a large number of first year students at the NYU Medical School take time away from their studies or leisure to attend Dr. Yellin's talk last night?

The answer, according to Dr. Yellin, is that it is not unusual for anyone to hit "bumps in the road" when entering a new phase of one's education or career. Some academically successful students first have difficulty late in their academic careers, when they find that the strategies they used in college are inadequate to permit them to succeed in professional programs, such as medical school. Tragically, some people who experience these setbacks prematurely abandon their chosen path because they assume that their struggles mean that they are "not cut out" for the path that they have chosen.

Dr. Yellin notes that once these struggling students or young professionals understand how they learn and how to use their cognitive and personal strengths to get past their areas of relative weakness, it is usually possible for them to bounce back and succeed. He adds that he has been consulting with NYU Medical School for almost ten years and that it has been enormously satisfying to see how the students with whom he has worked have been able to improve their performance and move ahead in their careers.