Becoming the High Achieving Student (again)

1. The Death of the Cram

Congratulations on making it into the DDS. You got here because you are an expert at the "Academic Sprint." You learned to absorb information quickly, deliver the answer on an exam, and move on.

In your undergraduate years, you could survive on short-term memory. In the DDS, your knowledge base must be permanent. You are no longer studying to pass a test; you are building a mental architecture that must support your clinical decisions for the next 40 years.

If you "cram and forget" the foundations of Year 1, you will find yourself fundamentally incapable of solving the clinical paradoxes of Year 4.

How to Stop the Leaky Bucket

To transition from high performance in short-term "cramming" to long-term mastery, students must shift from passive exposure to active, retrieval-based learning. This process moves information from fragile working memory into stable, long-term memory schemas.

The following strategies are scientifically proven to ensure knowledge remains accessible years after initial study:

A. Active Retrieval Practice
Instead of rereading notes or highlighting, which only creates a false sense of familiarity, students must force their brains to work to retrieve information from within.

• Self-Testing: Use flashcards or practice questions to pull information out of memory.
• "Blurting": Write down everything remembered about a topic on a blank sheet of paper without looking at notes, then fill in gaps afterward.
• Teaching Others: Explaining a concept in simple terms to another person (or even an imaginary one) forces a deeper organization of knowledge and reveals gaps in understanding.

B. Spaced Repetition (Distributed Practice)
To counter the "forgetting curve," students must review material at increasing intervals over time rather than in a single block.

• The Spacing Schedule: Review material one day after learning, then 3 days, one week, one month, and six months later.
• Digital Tools: Use apps like Knowt that use algorithms to automate this schedule, prompting reviews just as a student is about to forget the information.

C. Deep Encoding and Association
Knowledge is more durable when it is "anchored" to existing information already in the brain.

• Elaboration: Ask "why" a concept works and how it relates to what is already known.
• Interleaving: Mix different topics or types of problems within a single study session. This forces the brain to distinguish between similar concepts, leading to better long-term application.
• Dual Coding: Pair verbal information with visual aids like mind maps, diagrams, or "memory palaces" (visualizing concepts in a familiar physical space).

D. Real-World Application and Context
Memory is strengthened when knowledge is put into practice or given personal relevance.

• Practical Use: Apply theory to a project, hobby, or real-world problem as soon as possible.
• Contextual Cues: Linking information to specific emotional or personal experiences creates more powerful pathways for future retrieval.

2. The Supervisor Paradox

The most common frustration in the clinic is when two supervisors give different answers to the same problem:

• Supervisor 1: A + B + C + D + E = x

• Supervisor 2: A + B + C + D + E = y

• The Result: x ≠ y

Your first instinct is to ask, "Who is right?" This is a search for a "Gold Standard" that doesn't exist in complex medicine. If there were always one right answer, we could replace clinicians with AI. The disagreement between supervisors is not a "mistake" -it is the secret to your growth. Frustration + curiosity = Growth (and good marks)

Our response to ambivalence may be genetic and will influence how this supervisor paradox is experienced.

[If maths was your "thing" you will have worked out that if Ax80% + Bx30% + Cx25% + D x 70% + E x 60% ≠ A x75% + B x 50% + C x 25% + E x 60%.]

As a student you are expected to gain knowledge of A, B, C, D, E via clinical experience which links more formally acquired knowledge with real-world application.
It is the task of the student to question (and question and question) each supervisor to work out how they "weighted" the information for that particular patient with that particular context. This is critical thinking and recognising that for many things there will not be one answer. (See productive stupidity below)
Easy evaluation of what is right - pick the supervisor you like or the supervisor most qualified. The problem with doing this is it doesn't lead to any increased ability to make an independent evaluation.
If you want to be a high achiever/thinker this is where you will gain the most traction.
The university tries to standardise teaching where there is evidence-based information so you don't suffer from the supervisor paradox - they will both weight the information the same way. (easy stuff)

3. Embracing "Negative Capability"

To thrive in this environment, you must develop Negative Capability*. This is the ability to remain in uncertainties, mysteries, and doubts without "irritable reaching" after fact and reason. All the while you are continuing to pay attention and probe in order to understand it more completely.

High achievers often have an "itch" to find the single correct answer immediately.
"Negative Capability" is the strength to sit with the discomfort of X and Y being different. It is the willingness to stay in the "grey area" long enough to ask the questions that move knowledge from your notes into your clinical DNA.

An alternative way of thinking about this is look at Dialectical thinking.

Dialectical thinking- is a cognitive approach that reconciles contradictory ideas, viewing reality as complex rather than black-and-white. It involves adopting a "both/and" perspective, synthesizing opposing viewpoints to reach a more comprehensive understanding. This method reduces rigid, polarized, and automatic negative thinking, fostering emotional regulation and improved problem-solving. 

Key Aspects of Dialectical Thinking:

• Synthesis of Opposites: It encourages recognizing that two seemingly opposite things can be true simultaneously (e.g., "I can be frustrated with someone AND love them").
• Moving Beyond Binary: It challenges rigid "either/or" thinking, preferring to find a "middle path" or balance.
• Core of DBT: It is the foundation of Dialectical Behavior Therapy (DBT), balancing the need for acceptance of oneself with the necessity of change.
• Flexibility and Perspective: It involves examining situations from multiple angles to reduce emotional reactivity.

Note:

• Paradoxical thinking is being able to embrace the tension without solving it. Instead of merging the two sides you hold both at once. It is a tension that you need to manage. e.g. the person is both stubborn and flexible. Both are traits that make the person good.
• Ambivalance is uncomfortable. Once we are stuck it is very uncomfortable. Permission to take the pressure off (self compassion - self affirmation. People who did a 5 minute write activity on why a value is important to them had a massive effect for years later; safe space -a real place where they felt safe - tell me what you see, what do you feel; smell and this makes it place they can call up when they need it.)
• Am I ambivalence because I don't know what is right (what I want to do) or if I can do it or both? (confidence (skills, capacity, others stopping us) in succeding | importance) Lots of research - if we think that there is something we really should do or be but we don't think we can do it then we persuade ourselves that we really don't want to be that way at all. (e.g. Imagine if we could make your confidence is an 8-9; then if they will relate the importance higher so the problem is confidence. This is false low importance because we try to preserve our positive self-views).
  Values - don't do it in the same area from whatever we are ambivalent about because that can end up with negative feelings about ourselves. Remember that different values have different weight.
  If I "could", then what matters most to me.
  
• Preference for consistency (your view of yourself and your logic). Avoiding cognitive dissonance.
• Intolerance for uncertainity (your view of the future and the world). Avoiding anxiety/fear.
• Life must be lived forwards but can only be understood backwards (Danish philosoper)

Once we make a choice we have to give something up and we wont know until after which one was right

The true benefits of ambivalance - Dr Allan Zuckoff

• It is the signal to slow down (thinking fast and slow) . Thinking system No.1 Cognitive bias, small, quick, not right or wrong. Solved with short cuts. Thinking system No.2 - require slow thinking, important, new problems, really important decisions. (Cognitive benefit)
• People who are willing and able to experience ambivalence show a greater level of resiliance in the face of stress.
  

If we think that we can help a person 100% resolve ambivalence then we are going to hold a person back from making a choice.
Committment is kind of a wager - we can be half sure and whole hearted. If we are only half hearted then the likelihood of being able to succeed is lowered (e.g. make the change) because change is hard. If it was easy we would have already have done it. The whole hearted committment is the important bit.
Can we help people tolerate ambivalence so they can benefit from ambivalence? Uncomfortable or anxious from ambivalence => avoidence (which can be self compassionate ) must be only temporary or it will come back and often the pressure of it will rise so pressure builds and builds. Hence to get out of this cycle we can pick an impulsive decision. Impulsive decisions often lead to failure.
Reassurance that the feeling wont overwhelm you. Help people use their own capacity to tolerate the feelings. Feelings are important - not what we should feel but what do we actually feel.
Vertical ambivalence - we don't know we are ambivalent or we don't know why we are ambivalent. e.g . value cards tool. not important/ important| important /most important | then why...Often we don't know what we don't know. Big question is what keep something vertical - often this is because it is repressed because it was incogruent with a value (a conflict of core values - we protect ourselves by putting it out of mind so we are not aware that we are in conflict). Question - is there something else that can give us the feeling we are seeking by doing something that is actually incogruent with our core values? Hence we can remove a dilema of how do I get this reward or feeling without being incogruent to my core values.
Gaining insight into ambivalence may reveal vertical ambivalence and by bringing that to the surface we have the dialectic moment when we have resolution via the THIRD way.

4. Productive Stupidity vs. Relative Stupidity

To bridge the gap between X and Y, you must be willing to engage in Productive Stupidity.

• Relative Stupidity is being unprepared. It's not knowing what variables A through E even are. It is a failure of work ethic.
• Productive Stupidity is a deliberate choice. It is the courage to ask "stupid" questions of your supervisors to uncover the "missing variables" in their logic.

By being "happily ignorant" enough to question the experts, you stop being a calculator and start being a clinician. You learn to synthesize your own "Z" - a decision you have the critical thinking skills to defend.

The Bottom Line
If you seek a single answer, you seek a shortcut. If you embrace the paradox, you seek mastery. Welcome to the clinic.

*Negacity capability was coined by John Keats in 1817.