Blog

Molly Johannessen, PhD (She/Her)

University of Medicine and Health Sciences
Director of Education and Teaching 
Associate Professor of Physiology

As the saying goes, “the early bird gets the worm”.  This implies that if you start early, you will be rewarded.  As an aspiring physician, this can be hard to wrap your head around with the multitude of responsibilities, the number of requirements that must be met to continue forward from grades in learning and scores on standardized tests, and financial obligations to get to the place where you feel the actual reward is granted.  So, what if, rather than motivating yourself by aiming to get the worm, we thought about another saying: “Start with the end in mind” (1)? And what if that ending is to become an effective clinician and practitioner?

If our goal of medical school is to become an effective clinician and practitioner, it reasons well to think about that end-goal when you start to think about learning medicine.  The end-goal requires a level of interpersonal skills and engagement with patients that allows them to feel heard and cared for.   A level of commitment that allows patients to trust the work of their practitioner and trusting them with their care.  The end-goal also requires a level of knowledge-demonstration that is beyond that which typically comes easily and naturally to the general public, and this knowledge and application, therein presented on a number of standardized exams, is critical to success in the journey into medicine.  Ultimately, in medicine, you should not be studying to pass the test but for the day when you’re the only thing between your patient and the grave.  Unfortunately, the end goal can get lost in the shuffle of learning everything necessary to achieve the end goal.  The end-goal is to become an effective clinician and practitioner, but we get lost in what-all is necessary to know in order to do that, and getting multiple-choice questions correct repeatedly. We get lost in thinking that the multiple-choice questions or studying for the test is either the goal or the enemy and we get lost in the practice to memorize, answer and move-on. 

The evidence that testing improves learning is clear in that there are neurocognitive improvements when you assess learning (2). Furthermore, the research supports that testing improves learning more than restudying information (3).  Many institutions training medical practitioners integrate this into student learning activities either through curricular practices or through deliberate opportunities designed to enhance self-directed learning.  However, it is still up to the learner to continue to improve their outcome of becoming an effective clinician and practitioner by ensuring they are deliberately practicing to become an expert in their field (4, 5). It is up to the learner to see and reach the end-goal amongst the curriculum designed to test moments.

What if, then, rather than thinking about the daunting task of what-all needs to be covered and learned and how many exam questions need to be answered correctly to become an effective clinician and practitioner, we reframed all that is achieved in medical education to start with the end in mind?  If the end-goal is to understand the signs-and-symptoms that a patient presents with on a scientific level, to anticipate what questions are necessary to ask to define that presentation, to determine what additional tests might be needed to diagnose a patient specifically and what types of support may be offered to a patient either to cure or support their ailments, then starting with that end-in-mind allows us to study and experience that from the very beginning.  Starting with the end in mind allows us to consider the learning as training for the end-goal.  From the beginning, we are a physician-in-training.  Each patient presenting with a medical complaint, therefore, is a potential set of multiple-choice questions. The questions that pertain to patients’ signs-and-symptoms and to the scientific reasoning behind those signs-and-symptoms are formulated during the learning of basic sciences.  These questions explain the clinical application of anatomy or the pathophysiological basis of a presentation of a disease or the biochemical connection to a family of diseases.  Questions exploring what tests to run, what results would be anticipated from those tests and what next-steps to take with a patient become the basis of clinical learning. Lastly, questions that start with a patient, ask the scientific basis of their presentation, how to differentiate their presentation from others and what support to offer their ailments allow for effective clinicians and practitioners to demonstrate competence to the roll as a whole and on an independent-basis. 

With the end goal of becoming an effective clinician and practitioner in mind, we can approach medical learning, each lesson, and each patient as opportunities to learn.  We can look at a multiple-choice question as our future patients.  A patient who presents with signs and symptoms that we know the basic science of, a patient who we need to do more tests on in order to determine their diagnosis from a set of differentials, and a patient who needs our response to their concerns either verbally or through medical interventions.  We can start early in learning and support an effective outcome by looking at each lesson in medical learning as a piece of the big puzzle that we are building to learn to be an effective clinician and practitioner.  Starting early has always been the “quintessence of life” (6), and this is no different, but with the end-in-mind of medical practice, we can build our training in medicine around the end-goal of becoming an effective clinician and practitioner with the patients at the root of all the extensive training it takes to get there.  With this, each lesson we learn becomes a part of our goal and more than just a single point in the process.  Each question we answer and learn from becomes a part of our end goa.  Starting with the end in-mind will get us more-clearly and more-efficiently to the end and to the practice of medicine.

1. Covey, Stephen. The 7 Habits of Highly Effective People. Simon & Schuster. 1989.

2. van den Broek, Gesa, Takashima, A., Wiklund-Hornqvist, C., Wirebring, L.K., Segers, E., Verhoeven, L., Nybert, L. (2016). Neurocognitive mechanism of the “testing effect”: A review. Trends in Neuroscience Education, 5(2), 52-66. https://doi.org/10.1016/j.tine.2016.05.001

3. Rowland, C.A. (2014). The effect of testing versus restudy on retention: A meta-analytic review of the testing effect. Psychological Bulletin, 140(6), 1432–1463. https://doi.org/10.1037/a0037559

4. Hambrick, D.C., Oswald, F.L., Altmann, E.M. Meinz, E.J., Gobet, F., Campitelli, G. (2014). Deliberate practice: Is that all it takes to become an expert? Intelligence, 45(1), 34-45. https://doi.org/10.1016/j.intell.2013.04.001

5. Croce, Michael. (2019). On What it Takes to be an Expert. The Philosophical Quarterly, 69(274), 1-21. https://doi.org/10.1016/j.intell.2013.04.001

6. Brooks, Arthur C. (2025). Why an Early Start is the ‘Quintessence of Life’. The Atlantic. Obtained from: https://www.theatlantic.com/ideas/archive/2025/01/happiness-early-rising/681026/