How We Learn - The Spiral of Knowledge

This post was written while studying for my last set of university final exams.

"How do we learn? How do we take knowledge and build upon it?"

Have you ever taken a second to consider these questions? As university students, we tend to do plenty of learning. Hopefully. But we may never consider what is going on as we learn. We fail to notice the patterns that repeat themselves time after time. Becoming aware of these patterns has helped me through the long hours of studying. My hope is that it will be of some use to you as well.

During my first few years of university, I spent lots of time thinking about philosophy and religion. This went well with all the course work I was doing, eventually leading to a major in Religion (alongside Biology).

I remember I used to spend a lot of time reflecting on epistemology. Epistemology is the philosophical attempt to answer the question: "how do we know what we know". In other words, it examines the foundations and validity of our knowledge.

Of all the authors I read, a new testament scholar had the greatest impact on my epistemology. Yes, I know, he may not have the philosophical vigor of a true philosopher, but his explanation of "how we can know the world around us" seemed pretty good to me. The scholar's name is N.T. Wright.

Now, religiously, I have come a long way from Wright's position. Wright is no longer a new testament scholar; he has become the Bishop of Durham for the Church of England. But his explanation of the "spiral of knowledge" (or "hermeneutical spiral") has remained with me yet. In brief, the spiral of knowledge states that learning--the formation of knowledge--is cyclical.

We start at a point with what we think is true. We then try to learn more by examining new evidence or reexamining old evidence. In the process, our understanding is modified. Thus, we cycle between a state of having conclusions and a state of challenging conclusions.

But then, why is it called a spiral and not a circle? The reason is that every time we go through a cycle and come back to a set of conclusions, our conclusions are often different from the ones we originally held. Hopefully, with each iteration of the cycle our conclusions come closer and closer to actual reality. Thus, our knowledge metaphorically "spirals upwards".

Oddly enough, I've found this metaphor of the spiral of knowledge to be an accurate description of how I learn. For example, I start with a certain understanding of a physiological process. I then study, read, and reflect, causing my understanding to grow and change. I then end up with a new and improved understanding of the same process. As the cycle repeats, my knowledge becomes more precise, and I even understand related ideas and concepts better.

So next time you're struggling to learn something, remember the spiral.

Closing the File

So the news is in, I am indeed going to become a doctor some day. I have also decided which wonderful Canadian city will have the unfortunate task of training me over the next few years. I'm going to Calgary.

So how did this whole application experience go? Although hindsight would say "not too shabby", it was full of ups and downs along the way.

Rejected - No Interview
University of British Columbia
University of Alberta (Missing prerequisite)
Northern Ontario School of Medicine
University of Ottawa
McMaster University
University of Toronto
Dalhousie University

Interview Granted..Waitlisted
Queen's University

Interview Granted...Admission Offered!
University of Calgary
University of Manitoba
University of Western Ontario

Overall, I applied to most of the English speaking medical schools in Canada - 11 in total. I only got 4 interviews. I think the biggest setback for me was not getting an interview at UBC, my home school. When I found out why, I was quite frustrated at myself. This was compounded by the realization that I might be leaving the city which was my home all these years.

I learned something about applying to medical school: patience is key. One does a lot of waiting during the application process. First, applications start around October; around February, interview offers and rejection letters are mailed out. After interviews, it's another anxiety filled two months until admission offers are released. All in all, there is a lot of waiting. Come to grips with that reality before starting the whole application process.

Fortunately, my anxiety was unnecessary, as I ended up doing just fine. Before the 15th of May, which is when admission and waitlist notices are sent, I had already made predictions. I figured that, if I got into medicine at all, then I'd definitely get into Manitoba and Western. I knew based on their admissions criteria that they were my best shots. Not to mention, my Manitoba and Western interviews went quite well. I also knew that Queen's was highly unlikely to offer me a seat. Not only was I weak based on their final admissions criteria, but I also felt like I bombed that interview.

Calgary, however, threw me off. I felt like I had a solid interview (well, interviews). Despite this, I wasn't putting much hope in Calgary because of my preinterview score. I felt like I was at the low end of the interview pool, especially for out-of-province applicants. For me to then get one of the original out-of-province admission offers on the 15th was a hell of a surprise. I wasn't even thinking about moving to Calgary. In fact, I told people time after time that I'd never go there! My oh my how things change when circumstances are different.

So then, why Calgary? After I received my admission offers, the decision came down to Calgary or Western. Manitoba has a great school and program, but I did not want to live in Winnipeg if I could avoid it. The city isn't very nice, the neighbourhood of the medical school isn't very safe, and the weather is terrible. My pros and cons lists really helped out with my decision making... with one major difference.

I learned two things about Canadian medical schools that I didn't know during my interviews. First, school prestige isn't a major factor in Canadian medicine. All the Canadian schools are excellent, and all put out exceptionally qualified doctors. Second, residency matching statistics for Calgary and Western show little difference. Six years worth of residency matching statistics are available on the CaRMS website. The differences between schools in the specialties I'm interested in are small and insignificant. In other words, no school is obviously better at pumping out surgeons and neurologists. Having these two fears of mine silenced altered my decision making process.

Whereas I would have selected Western unequivocally, I became less settled with that choice. I had thought Western was a better school; the two things I learned nullified my assumption. Furthermore, I was attracted more and more to the program at Calgary.

In summary form, the following is why I ultimately decided to go to Calgary:

• Calgary is a nicer city to live in. It's urban, modern, growing, and wealthy. Of all the places I went to, it most resembles Vancouver's urban feel. You know what they say: once a city boy, always a city boy. And the fact of the matter is, deciding on medical schools is just as much about the city as it is about the school. I spend most of the week at the school, but I spend all my life in the city. When thought of that way, Calgary is clearly superior.
• Calgary has a three year program. Most medical schools have four year programs, giving students 3 months of vacation in the pre-clerkship summers. Students can spend the summer doing research, observerships, working, or traveling. It's free time. Calgary's three year program gives us four weeks of vacation a year: two weeks christmas and two weeks summer. The way I think about it: Calgary gets me to a real paycheque one year sooner. That's one year less tuition, one year less loaning. As someone who is aiming to become a specialist, I have a lot of training left after medical school, so every year counts.
• The program at Calgary is innovative and modern. Calgary seems to be a leader in medical education. They have pioneered the use of clinical presentations to guide and direct their pre-clerkship coursework. I'm really excited about this approach, and I think it will be a great way to learn.
• The facilities at Calgary are excellent. The medical school is located at Foothills Hospital, which is separate from the main University of Calgary campus. This is something I want (at least at this point), as I don't want to spend another 3 years on a massive, sprawling, campus. The health sciences building is also very impressive. Thus, in terms of facilities, Calgary is top of my list. Not to mention, the financial situation of the province hopefully trickles down to the health industry.

So, Cowtown, see you in a few weeks!

The Ontario Trip: A Postscript

I just realized that I never posted my pros/cons list from my Ontario trip to Queen's and Western. For the sake of completeness, as well as my own personal records, I'll go ahead and publish them. Who knows, maybe these lists will help someone else with their decision making someday.

Queen's University
Pros:

• Strong clinical skills program
• Small class size: very tight knit class
• The medical school is highly integrated into the community. All the physicians in Kingston are extended members of the teaching staff, and they are all willing to take on medical students in observerships.

Cons:

• Inconvenient campus: There isn't much food close to the medical sciences building, thus requiring a bit of a walk to the student building.
• Medical school facilities are on the same campus as everyone else.
• Very small, dinky, regional airport.
• Clerkship starts midway through third year, a little late!

Unsure:

• Kingston's population is mostly Queen's students, faculty, and staff. Thus, diversity is a little limited. Moreover, the city is also quite small - in both size and feel.
  

University of Western Ontario
Pros:

• Small class size makes it easier to get to know your class well.
• Convenient layout: everything to do with the medical school is in the same building complex.
• Clerkship structure: All core clerkship rotations are completed in 3rd year, leaving 4th year free to pick electives that you want to pursue. Knowing what you like in 3rd year is a major bonus when deciding upon electives. This clerkship layout is great for those who need help making a career decision.
• End of 4th year has a unique back to school component where you go back into the classroom environment and take advanced courses in areas of specialty.
• Many areas in the medical school building are key-carded for medical students only. The lounge is great! It has a nice TV, pool table, sofas. There is also quiet study space and a large computer lab.
• Local doctors seem willing to take on medical students in observership roles.
• Summer online forum is available to find roommates.

Cons:

• Medical school is on the main university campus, and thus shared with all other undergraduate and graduate programs.
• The medical school building doesn't look or feel new. Labyrinth like hallways. It isn't a very open feel.
• London isn't a large, modern, urban centre.

Unsure:

• Curriculum stresses independent, self-directed learning. However, the schedule seems to include equal lecture/small group time to any other medical program. Generally, mornings from 8:30am to 12:30pm are spent in lecture. One afternoon a week is community health lecture; two other afternoons are spent in small groups or doing clinical skills.