Moving Beyond Cramming

Dr. Jill Alban, Ed.D., is Director of Academic Support at Touro University California.

As the recently-appointed Director of Academic Support at Touro University California, I was hired to make sure that as many students as possible succeed — including, passing their tests and their national and state boards. Although I work primarily with the Osteopathic Medicine students, I see students in all of the programs.

As a Learning Specialist, my job is to make sure that students who qualify for
academic accommodations receive their accommodations; counsel students that score more than one standard deviation below the mean on tests, and are thus in AlbanJilljeopardy of being on probation; and meet with students that are on probation and help them develop compensatory strategies to succeed. In addition, part of my  job is to assist them with study strategies, time management, and most of all, encourage them.

Our goal is to have 100% graduation rate, and at this time, we are at 98%.

As is the case with many medical students, I also have very clear memories of my first day at the medical school. My background is in special education and as a learning specialist and, up until a few weeks ago, I taught everything from kindergarten through graduate school. However, on my first day at Touro, I had as much anxiety as medical students on their first day of class.

On my first day at Touro, I had as much anxiety as medical students on their first day of class.

I was presented with a student who had failed COMLEX 1 two times, which is overseen by NBOME, was unable to pass the OSCE (SOAP) due to disorganized notes. The student had also taken the USMLE and failed. There was only one more chance to pass COMLEX 1 before this student was unable to finish the program. As I listened to the Dean of the College of Medicine speak in a novel language, I tried to commit to memory each of the tests. I dashed back to my office and tried to remember the different acronyms. The only one I could remember was what sounded like U.S.EMILY.

Fortunately, with some detective work and the help of Google, I was able to ascertain the names of the exams and what was being tested. I only wished that from the beginning, I had been given a list of exams, their names, when they were taken, what they were testing, what was required to pass and how many chances a student had to retake an exam.

I learned that the NBOME (National Board of Osteopathic Medical Examiners) was the assessment organization for the osteopathic medical profession. COMLEX 1 (Comprehensive Osteopathic Medical Licensing Examination) was the first of three exams designed to assess osteopathic clinical skillsUSMLE (United States Medical Licensing Examination) assessed a physician’s ability to apply knowledge, concepts and principles and to demonstrate fundamental patient-centered skills. The OSCE (Objective Structured Clinical Encounter) evaluated the patient examination and SOAP (Subjective, Objective, Assessment, and Plan; also, Symptoms, Observation, Assessment, Prescription) was the patient write up.

The second part of my challenge, after deciphering acronyms, and establishing that the student had only one more chance at passing before dismissal, was to talk to the student and inquire about study strategies.

I knew, before my initial job interview at Touro, that the study skills perfected as undergraduates were not the same as the study skills required in graduate school, much less medical school. I knew that there was too much information, in too short a period of time, to successfully cram.

I knew that the study skills perfected as undergraduates were not the same as the study skills required in graduate school, much less medical school.

What I did not know, until I read Learning Medicine: An Evidence-Based Guide by Peter Wei & Alexander Chamessian, was that students who cram have a learning and forgetting curve: “Forgetting happens almost immediately after a student learns something. Within twenty minutes of learning some new information, students can only recall about 60 percent of the information they just learned. By nine hours, retention is less than 40 percent and 20 percent by 10 days.”

Wei and Chamessian posit that, “spaced repetition, a technique in which students review material according to a schedule determined by the spacing effect, has been found to be effective in numerous educational contexts … Some researchers have investigated the spacing effect in medical education.” The spacing effect greatly improves and enhances students’ abilities to retain information. One study found that spaced learning improved the retention of clinical knowledge by medical students at Harvard.

spaced rep graphic

My orientation PowerPoint presentation in the first week of the semester would have been much stronger had I been able to cite Wei and Chemessian. Cramming can have a big payoff when you are studying for quizzes, and there is limited information that needs to be remembered. In fact, many of the students accepted to graduate school have perfected the art of cramming. They were able to achieve superior grades by ingesting huge amounts of caffeine and pulling all-nighters. But the question is: will the skills one’s gained as an undergraduate be enough to carry you through the marathon of medical school?

Unfortunately, because so much of their undergraduate coursework was passed by cramming, the information is not in their long term memory banks. They have forgotten massive amounts of material.

Unfortunately, because so much of their undergraduate coursework was passed by cramming, the information is not in their long term memory banks.

Wei and Chamessian suggest that, “Spaced repetition is a powerful, evidence-based study technique that can enhance learning and long-term retention of medical knowledge.” Graduate students who develop the discipline to learn information in small clusters over time will have the retention of knowledge required to pass their boards and will be able to apply their coursework to their clinical practice.

Next year, when I introduce myself, I will have the research to substantiate my thesis: Properly paced studying provides greater long term retention than does cramming, but cramming is a hard habit to break. Over the next few months, I hope to share my learning and teaching experiences in this venue. My primary job is to make a difference in the lives of graduate students and in the broader community of students in the medical field. I would be interested in hearing from you about your experiences with learning specialists at your university and any stories from the front lines.

[This essay originally appeared as “Lessons from the New Director of Academic Support at Touro University California” at]


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