How I Made the Squiggly Lines Make Sense to Me
How I learnt ECG interpretation (and still learning) while enjoying the process!
“Take a deep breath and… DIVE IN!”
This has been a key thought I’ve repeatedly been having since I learnt the life lessons I am about to share in this post.
Let me give you some context first.
(This is not an ECG-specific post, but I think the message here is important. It’s been crucial to my learning (learning of anything), and I want to share it with you.)
How My ECG Interpretation Learning Journey Started
I recall being in my third year of medical school when we began studying ECGs. From the very beginning, ECGs made me feel uneasy. I just couldn't learn the skill.
At the time, no one was really paying attention to learning or teaching ECG interpretation, so it didn't feel important. However, as time passed and I started going to the hospital more often, I could see its significance more and more clearly.
I read a couple of books and attended relevant lectures. At first, I felt like I was learning something, but a few months later, I was back at square one.
The Biggest Mistake I Made as a Medical Student
As I have mentioned in an article on Medium previously, my biggest mistake was always wanting to be prepared before being exposed to unknown territory.
For example, I wanted to have at least a moderate understanding of ECGs before reviewing the ECGs of actual patients at the hospital. I postponed my learning because I thought I wasn’t ready to learn yet (yes, it sounds foolish, but that was essentially what I was doing).
The reality was that I was afraid of being perceived as incompetent by others. This means that the reality wasn’t that I wasn’t ready to learn but that I wasn’t ready to show off.
You’re always ready to learn.
And if learning is your goal, then showing off can only hinder your progress.
Why YOU Should Avoid This Mistake
Don’t wait to be exposed to unknown territory. Take a deep breath and… DIVE IN!
Especially if you’re a medical student, since you shouldn’t be making patient management decisions and assuming that level of responsibility. But even when you DO take responsibility (say, you’re a practising doctor), you still have nothing to gain by avoiding the unknown. If you feel that the risk is too great to handle alone, do not delegate the task to someone else (unless you are genuinely swamped!). Instead, bring along someone who has experience in the area where you lack it. They can observe you, guide you, or even take over if necessary.
Avoiding what scares you only makes your fear grow. Face it head-on, and don't let it stop you from learning.
The first time I tried to take an ABG, my hands were shaking. “Just go for it, Ioannis!” the nurse yelled at me. I did go for it. And you know what? I succeeded! How much did I really have to know before my first try? Probably where the radial artery is, and know about the Allen test in case I damage the artery. I can’t think of anything else that was really crucial to know before trying.
When you first start working as a doctor, you face “first times” daily for the first few months. You face them, and you become better.
“I learn best when my back is against the wall!” - A consultant of Acute Medicine
The Science Behind the Why: The Learning Principle of Generation
Puzzling over a problem BEFORE being shown the solution makes your mind more receptive to learning.
This is what the learning principle of generation states, which is extensively described in the insightful book “Make It Stick’ (by P. Brown, H. Roediger III, M. McDaniel).
A study published in the Journal of Experimental Psychology: Learning, Memory, and Cognition (Kornell N, Hays MJ, Bjork RA, 2009) showed that taking unsuccessful tests (and, therefore, being challenged) enhances learning, provided that appropriate feedback is given afterwards.1
And I would add that engaging with a problem before being shown the solution (or, to say it differently, “before being biased with an existing solution”) promotes problematisation, which is the process of framing a problem in a way that allows for critical examination of its underlying assumptions, causes, and potential solutions.
Showing the solution without allowing the student to engage with the problem is not only less effective as a learning strategy, but it can also limit their ability to innovate and come up with alternative solutions that may be, simply, better.
How YOU Can Avoid This Mistake
Embrace ignorance
We are all ignorant about something, always. If we do not realise this fact, we are being ignorant of our own ignorance.
Embrace your ignorance and leverage the principle of generation.
Ignore non-specific feedback, positive or negative
Positive non-specific feedback is junk food for our ego. Negative non-specific feedback is junk food for our inner critic. Either way, non-specific feedback is like junk food; it has no (nutritional) value.
This is precisely why grades are useless and do not provide us with valuable information about the learner: they lack specificity. As noted in the book "How We Learn" by Stanislas Dehaene, grades are inadequately informative. They do not explain why a student made an error or how they can correct it. Furthermore, grades can sometimes simply attach a social stigma of incompetence to the learner.
Learning is the goal
Showing off is NOT the goal. When we try to show off at the gym, we lift weights incorrectly, risking injuring our muscles and delaying our training for months, if not years. Why do that with our knowledge?
Conclusion
Relax. It’s OK not to know something. Nay… it’s essential!
As long as you are aware that you don’t know it, you will embrace your ignorance, and you’ll learn it faster and better.
This is how I made the squiggly lines make sense to me: I faced my fear of how I was perceived by others. As a result, I gained significantly more exposure to new ECGs, practised, and improved my knowledge.
What others think of you is a vanity metric; how you’ll help patients is the metric that truly matters.
Take a deep breath and… DIVE IN!
Thanks for reading!
I’d LOVE to read YOUR comments! (you can also reply to this email if you’re reading this post from your inbox)
Kornell N, Hays MJ, Bjork RA. Unsuccessful retrieval attempts enhance subsequent learning. J Exp Psychol Learn Mem Cogn. 2009 Jul;35(4):989-98. doi: 10.1037/a0015729. PMID: 19586265.