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Reaching the Top of the Pyramid

Drop your highlighters, put down the textbook, and let’s talk about learning to learn. If you are reading a FOAMed blog, you are either a dedicated EMS professional striving to continue your education or you are a student looking to expand your learning in new ways. Either way, if you have arrived here you have realized that lifelong learning is essential to becoming the best professional you can be. The challenge is that learning is hard, and it is something that in order to be efficient and effective at learning, you have to learn how to learn. Learning should be fun, entertaining, and a challenge. The FOAMed movement has largely succeeded in accomplishing this goal, but what happens when you have to break out the textbooks again? The following are some strategies I have found along the way that are supported by the existing science.

Drop the Highlighters and Read the Book Only Once

Some people set out to highlight with the best of intentions and it is a strategy I see often among my student colleagues and fellow educators. It is also a strategy I have used myself and fallen into “the highlighter trap.” The[bb1] goal of highlighting is to highlight what is important on the page. Instead, we have trouble identifying what is important and we find ourselves highlighting entire pages and the only way to review this becomes re-reading the entire page again in context. Highlighting is a very passive action and does not help us consolidate the information we highlight into a meaningful form to store in our long term memory.

Is there a time highlighting can be helpful?

Yes. The one use for highlighting is to identify key words or phrases that you intend to come back to or that help you find your place again if you plan to use the textbook as a reference. Use that highlighter to create an efficient reference text for yourself instead of a strategy to learn the information.

CAUTION: Re-reading the book WILL fool you.

Another common strategy many learners use is to re-read the textbook. If you read it a second time it must help solidify the information better, right? Your brain tricks you into thinking you know the material because it looks familiar. It creates the illusion of knowledge instead of actually reinforcing the information. Instead, try reading the book only once to gain your familiarity with the material and then use other higher-level strategies to review and reinforce.

Setting and Using Objectives

A number of people skim by these as “fluff” at the beginning of a chapter, but they can be particularly useful for helping you in your learning process. You will find many objectives written similarly to the examples below:

Example 1: Describe the pathophysiology of left sided heart failure

Example 2: Explain the mechanism of the adverse effects of the following drugs: …

Good objectives begin with a verb at the beginning, giving you an indication of what you should know or be able to do at the outcome of your learning. A helpful strategy is to read these ahead of time and then as you read or learn, see if you can find the information that will help you accomplish those goals. After your reading, come back to the objectives and see if you can complete these tasks; if[bb2] you can, you accomplished that goal! If you cannot, you now have identified where the gaps in your knowledge are and can target your review based off of those instead of wasting time and energy re-reading and then fooling yourself into thinking you know it.

What if I have no objectives to go off of? If you write 2-3 objectives for yourself and then answer those, you will feel more accomplished at the end of your learning. In taking it a step further, keep a journal of this and use it to come back to and transform it into lifelong learning resource! If you are a practicing clinician, you can even write these objectives as you reflect on your patient encounters, then when you look them up, add the answers to your journal. This makes learning active, fun, and useful.

Making Connections

Many medical schools in the United States and abroad have switched their curriculums to a systems-based or problem-based approach. Instead of learning medicine in individual boxes with separate courses like anatomy, pharmacology, physiology, they have transitioned to teaching these in a way that integrates subjects. Making connections in your own learning is extremely important. Break out a whiteboard or use one of the many apps available and start connecting the dots between what you are learning and what you already know. You will be amazed at how quickly this helps you to understand and integrate concepts into your current knowledgebase. The following flowchart is an[bb3] example of a quick learning exercise to help remember seizures vs. posturing and how it ties into cardiology. Try making a few of these to enhance your own learning and post them in the comments!

Find A Way to Test Yourself

The act of testing yourself is an incredibly effective way to test the outcome of your learning. Use any available practice questions to your advantage and see if you can analyze and apply your knowledge to a clinical problem using the information you just learned. There are many sources of practice questions for a lot of subjects, but if you cannot find any another effective strategy is to write your own. What makes a good clinical question?

  • A patient presentation that leads you toward that clinical problem

  • Distractors include other diagnoses/therapies you have to differentiate between

After a few days, come back to these questions and see if you can still answer them. Spaced repetition of knowledge is a key learning strategy that is very effective. Flashcards are a very effective method of spaced repetition. The Leitner method, a formalized system for organizing this starts with you sorting your flashcards into how well you know them and then basing the frequency of your repetition based on how well you knew the material. The image below is the basic concept. There are also many apps available for this (I personally use Anki) that allow you to create virtual flashcards and takes care of the spaced repetition for you.

A Note on Technology

There is a lot of debate and literature out there surrounding the use of technology as opposed to more traditional methods. Personally, I am almost completely paperless in my learning at this point (with the exception of a whiteboard). There are numerous apps available for notetaking, annotation, organizing, flashcards, and online sources of practice questions and virtual books.

I think the jury is still out on whether or not the use of technology for learning has made us better or more mediocre learners. It is a matter of personal preference and the best suggestion I can make here is, use what works best for you to give you the best learning experience possible. Multiple resources are available in multiple formats to help make your learning convenient and tailored to fit your needs.

Climbing the Pyramid

Educators and learners alike have been hearing about Bloom’s taxonomy for years. Education requires a strong foundation followed by understanding, application, and beyond. Here is where I personally find the strategies above fit into this taxonomy, to help you visualize your steps to learning success.

Each one of us is a unique and individual learner. If you have strategies not mentioned here or great ways to learn, post them in the comments or re-tweet so they can be shared with the FOAMed community!


Brown, P. C., Roediger, H. L., & McDaniel, M. A. (2014). Make It Stick. Cambridge, MA: Harvard University Press.

Tom Latosek, MS, NRP, CCP-C

Tom is a practicing paramedic and EMS educator who is interested in EMS research, and advancing the profession of EMS through education. Tom has practiced in a variety of EMS clinical settings and teaches a variety of courses for a healthcare education company. Tom holds an MS in neuroscience and a bachelor’s degree in biology and psychology and is currently a second-year medical student.

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