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.

The Good News

Victory!

I've been accepted into medical school!


More details to follow...

Flown Out

I did a fair bit of flying during my medical school interviews. Here's the final tally.

Time period: 4 weeks
# of days: 7
# of airports visited: 6
# of individual flights: 11

Aircraft I've been during the 4 week timespan:
Boeing 737
Boeing 767-300
Embraer 190
Canadair CRJ 705
Canadair CRJ 100
De Havilland Dash 8-100
Beech 1900D

Why didn't I collect frequent flyer points? Stupid me...

Interviews Three and Four: The Ontario Trip

Finally, the last leg of my 'national tour'! This one would take me off to the less-than-stellar cities of Kingston and London in Ontario. I woke up at 4:30 AM on Friday - a cruel and horrible form of punishment. Flights at seven in the morning should be outlawed. I also tend to play it safe, rather than sorry, and end up waiting for an hour at the gate because I'm early. It's worth the cost to me, missing my flight is not something I want to go through just now.

This trip wasn't my first to the province of Ontario. I went to Ottawa in August for Dan's wedding. However, this was my first time in Toronto. Unfortunately, since I was connecting, I didn't have a chance to actually go out into the city. From the air, the city is huge. The CN tower is quite nice too. The smog on the other hand, not so attractive.

Toronto airport.

Toronto smog.

From Toronto, I took the world's smallest airline plane to Kingston. I'm not kidding. The plane sat like 14 people: two per row with an aisle down the middle. It's so small that the co-pilot had to give the preflight briefing! Yeah, not kidding. Turbulence in these things is nothing short of exhilarating. On a positive note, it was the first flight I remember where my pilot was female. Actually, both the pilots were female! Makes you wonder, how come women never get to fly the big Boeing and Airbus jets?

That thing got me to Kingston and back. I think my boat is bigger than this plane.

I arrived in Kingston late in the afternoon. It was my first time in a small regional airport. If you've never been to an airport such as this - well, your not missing out on much. When I say small, I mean the whole terminal is about the size of my house. Small plane, small terminal, I suppose it all matches in some fundamental way.

The city of Kingston lives up to its airport. It's a pretty small city (population 120,000), with a large proportion of its population being students at Queen's University. The taxi ride to my hotel took me past infamous Kingston Penitentiary, and the adjacent jail for Women. Very attractive. I also got a glimpse of the Queen's campus, but I'll hold off on that for just a sec. My hotel was right on the water: Radisson Hotel. This was perhaps the best sight in the whole city. Believe it or not, my room had a king size bed. Yes, king size. It was one of those adjustable firmness beds too. Wow! I had a great view of the lake and part of the city; the room was very spacious and the furniture was excellent. I highly recommend it to anyone who may be traveling into Kingston. I was quite tired that Friday, so I spent the rest of the night in my room. Thank God for complimentary internet access - and an accessible girlfriend! (Mad props)

What a room...check out the king size bed.

My view at sunset.

Same view, twelve hours later.

The next day, I arrived at the Queen's campus just after 11 AM. The campus is architecturally very nice, with old stone/brick style buildings. I joined an impromptu tour of the campus with a first year medical student and some interviewees from McMaster. Suffice it to say, there's a lot of walking involved in studying at Queen's.

Queen's architecture.

Another building on the Queen's campus.

Nice library on the Queen's campus.

At noon, there was an orientation and welcome session for interviewees. This included the usual "what's so great about our school" schpeel. The highlight, however, was the video. That was worth a lot of laughs. Following the orientation, I made my way to the adjacent clinical education centre where the actual interviews were held. I sat around in the waiting room and chatted with other interviewees and some first year students. It was quite relaxing. Oddly, Queen's is the only medical school interview where I wasn't made to sign a confidentiality agreement. Maybe I forgot to, or somehow magically did without knowing. If that's the case, I wasn't properly informed and thus any agreement is void. Long story short, I can talk about the interview!

Of all the interviews I did this year, I felt the most uncomfortable at the Queen's one. I'm not sure why, I think it got off to a weird start. You see, they always give you water right at the beginning of the interview. Like usual, when they started their introductions, I went for a sip of water. Normally, this is perfect timing: they're talking, and you can hear; you don't need to talk, so you can drink. But my perfectly planned water maneuver took an unexpected twist - they stopped talking and watched me drink my water. It was eerie. Was I shaking with anxiety? Were they watching my cup wondering if I'd spill. I have no idea. That threw me off for a good minute while I went into damage control mode and tried to de-weirdify the interview. It didn't take long to feel back at ease, but that weird start still haunts me.

After the interview, I made me way back to the airport to wait for my flight(s) to London. I met a fellow interviewee from SFU who was also at Queen's that day. It was nice having some company, and we finally parted ways after dinner in Toronto. Lo and behold, the same two female pilots on the same dinky little plane got us back to Toronto. It's like these poor pilots fly circles between Kingston and Toronto all day. After a short stay in Toronto, I took a respectable prop (Dash 8) down to London. Arrival time, almost midnight.

I stayed at the Spencer Leadership Centre in London. This was a conference & hotel affiliated with the Business school at the University of Western Ontario. The price was good, and the room was nice. Not as big as the Radisson in Kingston, but nice nonetheless. After some phone calls and unpacking, I collapsed into a heap of sleeping cells at about 1 AM.

My room in London. Cozy but nice.

The Spencer Leadership Centre in London had a great sitting room.

Waking up at 7 AM was brutal. I could really feel the lack of sleep getting to me. I got to the Western campus at around 10 AM in line for my 11 AM interview. After signing in, I was led into the waiting room to wait it out till my interview. The nice thing was, the number of 1st year medical students pretty much outnumbered interviewees. I spent some time chatting with students and interviewees alike.

A largely uninformative shot of the Western medical building.

Looking at part of the Western campus.

The interview itself went well, for the most part - except for the one time I caught myself staring into blank space with nothing further to say. That was kind of awkward, ahaha. But the start of the interview was great, as one of the panel members made a small slip up during the introduction and we all had a great laugh. I really think the first few minutes of the interview are crucial. First impressions, anyone?

Following the interview, I went to yet another welcome session. If I thought the Queen's video was nice, Western's was just amazing. I laughed pretty hard. Following the orientation, I asked a first year med student to show me around - which he was pleased to do. I thought that was a great touch, the first year students were really there to help us interviewees. Not to mention, this was the only school where the first years were actually dressed up too - and not walking around in slack jeans. Nice, professional, touch.

Finally, I was done! My interviews for this year's application cycle came to an end. What a feeling of relief. But, alas, karma caught up to me. My flight home had a connection in Winnipeg. On the approach and landing into Winnipeg airport, I noticed how low and thick the fog was. And it was covering everything - fog as far as the eye could see. And the eye can see plenty at thirty thousand feet. That pesky fog kept us in Winnipeg an extra two hours. Mind you, we already had to wait a few hours for our connecting flight, so any delay only added insult to injury. And the worst part was that other planes were able to land. Unfortunately, the plane that was supposed to get us to Vancouver was not certified to land in the fog. I think that fly I swatted tried to get back at me. Karma. Fortunately, I was traveling with a fellow UBC student who was also interviewing at Western. Again, traveling with someone makes the whole processes just a little bit more bearable.

The fog in Winnipeg. You can see the shadow of our plane. See the landing gear - yeah, we're that low.

Touching down in Vancouver was such an amazing feeling. I enjoy traveling and flying - but not like this. Going a different place every other week for a day or two at a time is really taxing. I was drained, and very pleased to be finished. Our plane landed at around 12 AM. My total travel time that day was a full 12 hours. All that just to cross the country. I wish I connected in Toronto.

I hope you've enjoyed my 'national tour'. I've seen a bit of Canada now, taken a few pictures, and ate a lot of room service. Let's hope I don't have to do this again till CaRMS.

Interview Two: University of Manitoba Medical School

Two weeks after my trip to Calgary, I set off on the second leg of my "national tour". The destination, Winnipeg.

My flight to Winnipeg wasn't as early in the morning as my Calgary. That meant I actually got a respectable amount of sleep, and woke up at a decent hour (7 am). That weekend was a major cram time for me, as I had to finish off my take-home midterm for Endocrinology. Long story short - I wrote a lot over the weekend. You'd be amazed how productive you are when you're sitting very bored in an empty airport terminal!

Bye Vancouver, see ya soon!


Welcome to the prairies: the whole city of Regina in one shot.

Winnipeg airport.

I arrived in Winnipeg around mid-afternoon. I had given myself a few hours to explore the city centre - my first stop: McDonalds in the underground mall for some lunch. I was starving, as I hadn't had a thing to eat since 7am. Alas, Winnipeg has even less to see than Calgary. I walked in the other direction to another mall, and decided I'd had enough and wanted to get back to my hotel and rest. Total touristy time: 1 hour, 15 minutes. I made an excellent purchase, though. I picked up a copy of Freakonomics. What an exciting book to read, I highly recommend it. Part economics, part entertainment - great combo.

My hotel room..two starts at its best.

Going towards the city centre.

I thought this was a pretty cool statue.

That's it...back to my hotel.

I pretty much read the whole thing throughout the course of my trip.

My attempt to sleep was thwarted by a group of youngins. They thought it to be a great idea to party till 3am. I lost count of how many times they slammed the door. At least I could sleep in a little bit the next day. I found out later that my cheerful floormates were probably American teens on spring break. You see, legal drinking age in Manitoba is 18 - it's 21 just across the border. Case closed.

I arrived at the medical school quite a bit earlier than my 2:20 pm interview time. I had a great time sitting down and chatting with other interviewees and first year med students. Everyone was in a good mood, and the vibe was great. The interview itself went well, in my opinion. It was incredibly relaxed, and I felt that it was a very fair chance for me. After the interview, I went on a rather short tour of the building, chatted a bit with some of the first years, then got on my taxi to get to the airport and go back home.

The health sciences building from outside.

The atrium of the health sciences building.

Another angle of the health sciences building atrium.

Finally, my overall summary of the medical school at the University of Manitoba, as well as some comments about the city of Winnipeg. (Some of them may seem a bit, odd...this list is just as much for my memory as it is for public consumption).

Pros:

• The medical program has a small class size. This forms a tight knit class, as well as gives a great chance to get to know instructors if one wants.
• The university seems to really take care of its medical students, I was very impressed by this.
  
• Lots of clinical exposure since the facility is the only major care centre for a very large region.
• St. Boniface Hospital is in a nice place (the French Quarter of town), and it's where I'll spend a lot of time in my clerkship years.
• A new Clinical Skills Centre is in the initial phases of building; unfortunately, it's uncertain whether it will be complete in time for our class.
• Opportunity to do research and graduate with an MD & BSc Med. Research is conducted during Summer 1 and Summer 2. Also, we get a summer stipend of $4500. Research can be conducted in many topics and in many areas.
• Lots of opportunity to get early clinical experience. Doctors are willing to take University of Manitoba med students in an observer role.
• Cost of tuition is VERY low. Cost of living is VERY low.

Cons:

• Health Sciences Centre & Hospital are in a shady part of town.
• The city centre is full of loitering homeless people; downtown Winnipeg is depressing.
  
• The city has no freeways?!
• It's very cold during the winter.
• The transit system is not highly recommended

Unsure:

• Teaching is lecture focussed: starts off with basic sciences, then goes through each system studying physiology/anatomy/pharmacology/pathology/etc in the clinical context.