Hey everyone, I'm Brandon Odo.
And I'm Brian Bowling.
And this is Critical Care Scenarios, the podcast where we use clinical cases, narrative storytelling
and expert guests to impact how critical care is practiced in the real world.
Hey everyone, welcome back, it's Brandon Odo with another Turbo.
Today I wanted to talk about the idea of what we'll call external brains.
We all have our internal brains, the ones that sit inside our craniums, and obviously
we rely on these a lot when it comes to remembering, understanding, learning, medicine.
But one of the increasingly accepted shrewisms of the modern era of medical education, I
think, is accepting, not trying to fight or deny the fact that our brains are not that
good at a lot of things.
Of course, they're wonders as far as they go.
But in the modern world of medicine, where there is so much to learn, relying on what
we have in our heads is not good enough, or at least is not necessary, because there
are other ways to retain information.
So the old days where everything you ever wanted to learn, you would just have to memorize,
have transitioned to the current era where I think you memorize the things that make sense
to memorize, and things that don't make sense, you look up.
So of course there are many resources for looking things up, textbooks, things online.
A lot of us like up to date, great resources like that.
But what I want to talk about today is a sort of middle ground, which is a personalized
note taking tool, which allows you to keep track of information that you'd like to have
readily available, but you don't want to memorize, or at least you don't see yourself memorizing.
So what does this look like?
Usually it means an app.
You want something that you can have in your pocket on your device at all times, and
quickly and easily go to it to find information.
How does this play out?
Usually something like this, you have learned something that you think is valuable to you.
You didn't know it, and you know that it's not kind of in your existing lexicon of information,
and you kind of don't expect that you're going to remember it this time.
You'd have to go to a lot more work to make that happen, make some flashcards, revisit
it, whatever.
So you know you're going to forget it, but you don't want to, because you think it is valuable.
Let's say it pertains to a disease you see somewhat infrequently, but you could come
across it.
So what do you do?
You put it into your note taking app.
This is something that you can just pull out, and when this situation does come along,
you can find that information, and here's the key part.
The only thing you need to actually remember is that you have it.
So just tucked away in your brain, you knew that at one point you had useful information
on this.
Let's go see what it was.
As a matter of fact, you don't even need to memorize that.
You could just go and look to see, did I have something on this topic?
Maybe you're not even sure.
As long as you have a searchable or easily indexed tool, it's all in there.
So the reason this is so key, I think you just have to have something like this in this
day and age.
It's because it's so easy to forget things you've learned, and that makes it a waste.
You took the time and the effort to read an article, or you read something in a book,
or you attended a lecture, or early in your training, somebody taught something to you.
They were taking their time to do this.
What do you do with all that stuff you just learned?
All this fresh information, which is high yield and valuable to you.
You got two choices.
You can sit back and say, that was fun.
It's all very interesting.
I'm sure I'll retain that forever.
Or if you're a little older and more mature, you can say, that was interesting and useful,
and I know that tomorrow, I'm going to forget almost all of it.
Other things are going to come along.
Some new thing to learn will present itself.
That will take the attention of my small working brain, and this other stuff is going to be
gone.
But I don't want that, so I want to hold on to it.
This takes the pressure off you to even try to memorize all these things.
There's a role from a memorization, but it's probably mostly for things that you use
so often.
It'll be a waste of time.
They have to look them up.
Or they're so important that there may not be time to do that.
Of course, it's for things like understanding on a deeper level, how something works.
That's not really to me memorization.
That's understanding.
memorization is like facts and figures and lists, things like that.
Or again, those teaching pearls that until and unless you do begin to apply them in a
more everyday way, they're probably just kind of factoids to you.
Now if you do end up using these, then you'll start to internalize them.
I have many things on my notes that at the time we're novel and interesting to me, now
when I go back and look at them, they're obvious.
Because I have since internalized them and those can be removed.
I hope you see how this splits the difference.
This lets you make a hybrid between these dichotomies of memorizing everything and looking
up everything.
Some people have started to act like modern medicine.
You could just look everything up, which I think is not realistic.
This splits the difference because you can learn things.
You can put them away and then you can quote, look them up, but in a much more useful
way, then going to primary sources or other references.
If I need to learn something and let's say I go somewhere up to date, which is intended
to be about as easy to use and access and quick to apply as any resource could be, certainly
much better than if I pull the textbook off the shelf to answer a question.
But even then, I have to go and find the right page that has the information I want.
I need to read through it, find where it says what I need.
It's not even there.
And if I do find it, I have to understand what it says, crunch it through my head, learn
to apply it.
And decide if it even applies to me.
If I trust it, if I think it's credible, that's a lot of work that, yes, you may have
to do, but you should only have to do it once.
Look things up or learn them a single time.
Don't waste learning.
Life is too short.
The career is too short.
And if you had to learn on something like, gosh, an actual patient, or again, someone
took the time to teach you.
Like when you're training, they sit you down, you have a little talk, you go to a lecture.
If you come back next week and they have to teach you that same thing again, that, I
mean, as an educator, that's a little offensive.
And of course, it happens absolutely all the time.
I don't expect everything I teach people to stick.
But man, when very little of it does, I start to think that, you know, you know, you
don't care.
You're kind of wasting my time because I don't want to go through the same thing eight
different ways.
I'd like you to retain some of it.
And guess what?
You're not going to, unless, hey, you put it down somewhere.
When you have created your own reference system, your own notes, then the next time you
need to look it up, it is so much faster because it's like it's in your brain, but on
the periphery.
It's like you've put it on the shelves of your brain.
But all you have to do to retrieve it is to go to that, the shelf you know is there,
pick it up and the page is already marked.
You just flip it open.
You're like, that's, that's the thing.
Great.
That's what a good note app is like.
There are a lot of things that I know in this sense that I have the information tucked
away.
I know where to get it, but I couldn't spout it off to you if you restricted me from
getting to my phone, for instance.
But with it, 10 seconds, I can have it.
That is, I think, a tool that if you are not using in this day and age, I don't want
to say it's mandatory, but man, I, you almost, I must, I'd be a very different person than
me, or I think you could be a much better clinician if you did use it.
So what should this tool look like?
There are a variety of different software solutions, but I think they should fulfill
a few requirements.
Number one, it has to be searchable.
There's too much information for you to find any other way.
You need to be able to just put in a word, a couple words, a search term, and have it find
those words wherever you may have put them.
It may or may not be, organizable in other ways, such as by filing things into categories
or more complex schemes with keywords and so on.
That can be helpful.
Like mine, I do have my notes organized by a sort of medical specialty or by system sort
of.
And then within those, I have individual topics.
But frankly, if you can search that pretty much handles most of this, that's generally
how you're going to find information.
So that's the most important thing.
For me, it's mandatory that you can access your tool both remotely, usually on your phone,
and on your desktop computer.
Now, that's both because I want to be able to retrieve information in both settings.
Usually if I'm in the ICU with a patient or something, I'll pull up my phone, but if I'm
doing something else on my computer, I'd like to get it that way.
But most importantly, because I want to be able to put information in both ways, I can
create or add to a note on my phone.
But if I have a number of things to put in, I'll generally want to do it on my computer.
It's just much easier.
You could type more easily.
And you can use another tool that a lot of these apps will let you do, which is multimedia
storage.
So well, a lot of what I do is just type in text, few words, few sentences, few notes.
You can format in a lot of these tools, or you can even drop in images, videos, screenshots,
tables.
And that gives you a lot of flexibility.
So for instance, you're reading an article and you see a great table that has an algorithm.
An approach to something.
How are you ever going to keep track of this?
You say, well, that's interesting, but unless you're going to cut it out and put it on
your wall or something and how much wall space do you have, it's going to be gone tomorrow.
Take a screenshot of that thing and just stick it in your notes.
Now you can go find it and you can apply that the next time you come across that thing.
How you want to use this is up to you, but there's a lot of flexibility.
You come across an interesting article that, you know, heck, maybe it just proves a point.
It makes one interesting, useful point that you either want to remember or you want to
be able to cite to people, you know, something that's not obvious or controversial.
Are you going to have to go find this article?
Next time it comes up, that's a pain in the butt.
Just put in, you know, it's dump in the link or the actual file.
And then it's easy to get to to even to share with people.
You start to see how this works, you know.
You have information that is one step removed from immediate recall, but is so much easier
to get to than trying to find it again the first time.
So those are my requirements.
Many of these apps will require you to pay a little bit for the more robust ones.
I use EverNote, which is a common pretty robust one.
I think it's available Mac and Windows and of course on my iPhone and pretty sure Android
devices.
It does cost a little bit for a full subscription, but it's not much.
I've seen people use Microsoft has one note.
You could probably do something with Google systems.
Just experiment, find something that is easy to use and has all the functionality that
you need.
This is probably something you also want to use for other things in life, other kinds
of notes.
I use it for all kinds of things, but certainly for your medical stuff.
There's an app called Glassdoor people have been playing with that have heard good things.
I don't know that it has a desktop platform as well, but things to try out.
And then what do you put into here again, teaching points.
So a little pearl about one thing or another that you learn again, when you're training
I find there was a ton of this when I was like in residency, all the stuff you'd learn
on your shift.
I would jot down on my scrap paper.
I'd go home and then you know, I had to put it on paper because otherwise there's no
other way to keep it again, it'd be gone for my brain the next minute.
But if I leave it on paper, it's never going to go anywhere, line up with the trash.
So when I got home or after a couple of shifts when I had time, I would transcribe it.
I put it into my notap in some kind of organization.
And that way that information transformed from something I heard once and you know, maybe
one percent of it stayed with me to stuff that I still have access to today many years
later.
And of course, some of it I have learned and I can recall now.
But a lot of it I can't necessarily, but it's still available to me.
All that great stuff I learned from maybe that great teacher, I still have access to.
Again, algorithms, schemas, approaches to things that you come across somewhere, you learned
it, you read about it, stick those in there.
The thing you encounter infrequently, you don't want to have to go to PubMed, find a review
article, someone describing their approach to it.
You know, do that once and then save it.
Numbers, you know, statistics or like a cut off or something, you know, at what percent
do I call it this disease or what's this scoring system or, you know, what point do I give
this mad or something?
You don't want to have to memorize those things unless you use it all the time, tuck it
in there, don't try to go and look it up fresh.
Just know where to find it.
And then finally, things like checklists, things that are really intended as reference and
intended as acknowledgement of the fact that you expect to forget things, perfect thing
to have in here.
You can bring them up, you can skim through it, you can see what your faulty brain failed
you.
Guys, I'd love to hear your approach to this stuff because I'm sure you have your own,
you know, what apps you're using and what are your kind of tricks for getting the best
yield out of them.
Again, I really think this is not talked about enough, not taught explicitly.
And so I feel like I can't complain or judge when you have that learner who you taught
something two, three times and it hasn't forgotten that thing or whatever.
We're not giving people the tools to, in this current era of learning, really maximize
the use of the brain they have in the technological brains that we can use to supplement those
things.
Tell me what you guys are doing and I'll talk to you guys next time.