Note-taking and note-making: The ever-cherished art! : Indian Journal of Ophthalmology

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Note-taking and note-making: The ever-cherished art!

Nachiappan, Sivagami

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Indian Journal of Ophthalmology 70(12):p 4438-4444, December 2022. | DOI: 10.4103/ijo.IJO_1780_22
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Abstract

Just like history taking is an art, Note making is an art too! It is an art to be mastered by all postgraduates to not only enhance their knowledge, make their exam preparation simple and easy, but also surpass others in examination. The quality of information presented in the exam is more important than the quantity. Expressing the content as a table of comparison, pictorial representation, or flowchart will explicitly depict your clarity on the subject and also speak volumes on the effort and time spent in preparing it. It is not a once-and-for-all process, as it requires continuous efforts to make a complete and perfect note!

How different is writing from reading?

Let us recall the Chinese proverb, “I hear and I forget, I see and I remember, I do and I understand.” Reading or learning alone does not aid in transforming data into long-lasting information. Using a pen and paper gives a deeper sensory experience than reading by just seeing. Writing is a combination of motor skills, touch sensation, and visual perception that actually reinforces the natural learning process.[1] It is said that your memory of handwritten words is tied to the movements required to make each letter.[23]

Crafting each word after understanding activates the various parts of the brain and improves the learning process. The information is processed in a more detailed way and is hence retained better.

Why prepare notes?

Assimilating and recollecting huge volumes of information from various sources like textbooks, reference books, websites, webinars, powerpoint presentations from college, and notes from seniors before exam is impossible. We would have read every topic from at least a couple of these sources and many more, during our postgraduate course. Although broad reading gives us an insight about the topic and helps us gain better understanding and depth of knowledge, it is impossible to revise it in the last few days prior to the final examination. That is when our self-handwritten notes come in handy and become our savior. Revision hence becomes effortless, convenient, and appropriate.

Benefits of note-making

Following are the benefits of note-making: [Fig. 1]

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Figure 1:
Various benefits of preparing notes

  • Ready reckoner before exams: Gathering all information in one place is ideal. No book gives all the details completely. Some books may beautifully describe pathogenesis as a flowchart and some others may give a treatment algorithm accurately. Free-hand diagrams with labels may be found in some other resources. Hence, it becomes mandatory to collect all information under one roof and make our notes a one-stop-shop for all possible questions on that topic.
  • Better understanding: Rewriting the information in our own words, in a format that is easy, explicitly helps us to transcribe and process the information rather than just copying down verbatim. It is obvious that unless we have clarity over the subject, it is not possible to create a flowchart or a table of comparison.
  • Recall better: During examinations, we will be able to better recall our handwritten notes even without revising them. It is because of the effort and time spent on understanding the subject and rewriting it in our own style.
  • Handy and readily available: It is easier to locate information at one place rather than go through the various sources once again and read long paragraphs to recall that one keyword.
  • Easy to process: Once we take notes in our own simple language in a table of comparison, it provides clarity regarding the similarities and differentiating points. Instead of reading every topic in detail, a glance of the table covers all topics and saves time [Supplementary material 1a,b,2d].

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Supplementary Material 1
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Supplementary Material 2

  • Improve presentation skills: Preparing notes gives us a mental picture of how we will present answers in our answer sheet. Preparing notes in a similar notebook as the answer sheet (say landscape mode as in DNB exam) gives us a prior experience and exposure as to how much content can be presented and how effectively it can be presented in an attractive way [Supplementary material 1a, b].
  • Improve content point and writing speed: Often, the quantity of information available and the quantity of information that needs to be presented in the exam are disproportionate. Hence, we are compelled to make a wise choice of the content points and enhance our presentation skills in order to accommodate quality information within a stipulated time and space.

What is expected out of your notes?

It must

  • Be extensive and complete
  • Be legible and appealing
  • Be an all-in-one and ready to read/revise notes
  • Make you feel comfortable and confident and not expect you to search for reference books again to understand what was written
  • Be a rehearsal and give you a mind-map/mental picture of what your exam paper is going to look like.

What topics to take notes on

Preparing notes for every single topic that we study is impractical and a burden too. It will only lead to an excessive quantity of notes, such that ultimately we might not have time to revise even the deserved topics. Hence, choosing a right topic before we invest our quality time is crucial.

  • Topics that require multiple reference books
  • Parts of a topic that require a different layout of presentation/hand-drawn illustrations/mnemonic. Attach them to your base book if possible
  • Frequently asked questions in the exam
  • Topics to be read partly in books and partly online. They can also be combined as sticky notes
  • Recent advancements that are not found in books and require digital research from many websites
  • Difficult topics that we are not able to understand/remember
  • If a topic is the only topic from that reference book, there is no need to carry it along or open it before exams unnecessarily and become confused while flipping through other pages
  • Online webinars consisting of two-hour videos that cannot be revised by listening all over again.

When to take notes: Before, during, and after lecture

Note-taking starts prior to a class and is never-ending. It requires dedication and perseverance with investment of quality time. Both smart work and hard work are imperative. A clear knowledge of what has to be done prior and after a class is needed for preparing complete notes [Fig. 2].

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Figure 2:
What has to be done on the previous day of a lecture, during the lecture, and the day after the lecture for effective preparation of notes

Where to take notes

  • Handwritten in note book - The age-old concept: Self-writing incorporates the concept into your brain. Reading handwritten text involves more parts of your brain than reading typed text.[4] It makes us pick up the important points and hence filter the essential information. It improves writing speed and presentation skill. However, it is cumbersome to store, search, and carry plenty of notes before exams, especially when our exam centers are elsewhere.
  • At the same time, it is important to keep the notes organized else it becomes a waste of time. It is ideal to allocate separate notebooks or divide the book into parts for each subject. To compile and compare huge information (e.g., corneal dystrophies, various anti-glaucoma medications) the back side of the calendar sheets can be used [Fig. 3].

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Figure 3:
A comparison of a few corneal dystrophies on the plain side of a calendar sheet

  • Digital notes: It’s a go-green and environment-friendly method. Although it has many limitations like cost, variable acclimatization curve, and lacks the paper-pen feel of an exam, it is easy to carry around, edit, and add data later, search easily, and add screenshots of PDFs and images from internet. It saves a lot of time by copy pasting information from PDFs and helps compile a lot of information from various sources effectively. Annotating over downloaded images makes work easier and faster. Many applications like Microsoft OneNote, Evernote, Colla note, Notability are available to prepare notes [Fig. 4].

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Figure 4:
A digital form of note-taking using CollaNote application. (a) Ocular manifestations of tuberculosis from anterior to posterior segment. (b) The various anterior and posterior segment manifestations of ocular ischemic syndrome. (c) Ocular side-effects of prostaglandin analogues

When to start

As note-taking is a time-consuming process, it is essential to start early. How early is the question! If we start note-taking at the very beginning of postgraduation without having a basic knowledge about the subject, we end up writing every point in book as we still haven’t realized the key points. So, a sincere start by the end of the first year could be ideal. It is optimal to follow the same lecture schedule as your institute up to 9 months prior to the examination. After that, a subject-wise approach based on question banks without missing any question for examination purposes is suggested. Also reading about a case seen in the OPD that same day will stay etched in the brain forever.

How to take notes

  • Know thyself! Understand your learning style—what works best for you. Some prefer comparative study, while others are good at visual and photographic memory.
  • Gather all resources: Some books usually do not give explanations for symptoms or discuss treatments in detail. Hence, referring recent review articles, specialty books, Basic and Clinical Science Course from the American Academy of Ophthalmology textbooks or All India Ophthalmological Society Continuing Medical Education (AIOS CME) series is mandatory.
  • Before you start: Get a wholesome idea of the topic through a quick reading before you start to write down the notes. Sit with all the material and time required, else the flow tends to break.
  • Methods: If you can afford time only for one reading, read and simultaneously take notes from a maximum of two resources of information. For instance, the recommended book for the subject and a review article must suffice. If you are a bookworm with lot of time on hand, read all the content, mark important points, then compile over the weekends. If you are lethargic or too lazy to write, at least jot down the page number and source of the additional information alongside the base book or use sticky notes.
  • Strategy: Strategize your notes. Plan the layout. Usually, answering the “7-WH” words completes a topic: What (definition), why, when, which (etiology), how (pathogenesis leading to the signs and symptoms + how to identify and treat), where, who (predisposing factors).
  • Stick to the imperative points: Write only the important key points. Repeating the same point from various sources makes your notes redundant and boring. Writing consumes a lot of time; hence it forces us to critically analyze the content and write only what is worth noting down. This way we realize the important and key points of the subject too. On the other hand, hint writing has a limitation, as we tend to forget and hence, the unwritten explanations become gaps in knowledge.
  • How to write: Use legible handwriting. Write as points. Make it colorful, appealing, and impressive. Use standard abbreviations and symbols to make content shorter. Write the key points in simple language which can be reproduced without difficulty during the examination. As much as possible, try to express the content as a pictorial representation [Figs. 4a-c and 5a-c]. For instance, represent the side effects of prostaglandins by drawing arrows on the figure of an eye [Fig. 4c]. All signs of diseases can be classified as anterior and posterior segment and a diagram can be drawn to show them accordingly [Fig. 4a and b]. Classify the content and write as line diagrams [Fig. 5d]. Leave space to add information later. Highlight key words with highlighters (green for headings, yellow for definitions, pink for named appearances/triads/syndromes, and orange for mnemonics). Have an index on the first page of the book with the pages numbered for a quick search.

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Figure 5:
(a) Diagrammatic explanation of structure of rods and cones. (b) Diagrammatic representation of course of third cranial nerve. (c) A complete course of visual pathway along with the blood supply starting from arch of aorta. (d) An efficient way of representing the classification of grafts in orbit and oculoplasty

  • Do not overlook the fundamentals: Sometimes we tend to ignore the fundamentals assuming we might practically remember and it is not essential to write it down. Jotting down the anatomical points of importance and relevant fundamental physiology or biochemistry will remind us later to mention them in our answers and reinforce the basics.
  • It is ideal if we keep the fundamental pathogenesis of the disease as the starting point and build up on it as to how it produces the various signs and what are the manifestations (symptoms) of these signs and what will happen in the process if untreated (complications). Next, logically think as to how the etiology and disease process can be identified with investigations and what are the treatment options, steps necessary for prophylaxis and ways to prevent complications.
  • Mnemonics: Make mnemonics correlating to the topic so that you do not end up keeping a mnemonic for remembering the mnemonics. Make sure the mnemonic includes all key points and a part of the topic so that remembering it becomes easy. Make a separate notebook for mnemonics, syndromes, named appearances and triads [Supplementary material 2b, c]. It will be of help during quiz preparation too.
  • Examples:
  • Classification of fungi: Fly septate pig – Filamentous/Yeast – septate/nonseptate – pigmented/non pigmented
  • Order of TED treatment – DSLR PLASTY – Decompression of orbit – Squint correction – Lid Reconstruction – Blepharoplasty
  • Hartmann (heart) Shack – Outgoing aberrometer – Think of the male or mars symbol (♂) or wounded heart symbol with arrow going out
  • Biological agents – ILICIT DAP – Interferons, Lymphocyte antagonists, Interleukin receptor antagonists, Colchicine, Immunoglobulins, TNF-alpha blockers, Dapsone
  • Parts of Randleman Ectasia score – PARTS – Pachymetry pre-operative, Age, Residual stromal bed thickness, Topography pattern, Spherical equivalent preoperative
  • ROP Studies – Hope you stop the crying kid early with photo light. (HOPE ROP, STOP ROP, CRYO ROP, KID ROP, Early- ETROP, Photo ROP, LIGHT ROP)
  • ICE = I – Iris nevus of Cogan Reese, C – Chandler syndrome, E – Essential iris atrophy
  • Transposition Surgeries for 6th N palsy – Best Friend JOHN – Beren Girard full transposition, Foster modification of Beren, Jensen (J-J = Join split parts of LR to the vertical muscles), O’Connor (C-C = Cinching of LR), Hummelscheim (H-H = Hemi parts of vertical muscles), Nishida (N -N = New insertion of both vertical recti with split LR at 10 mm behind limbus)
  • SWAP = 5 BONY = size 5 stimulus, Blue ON Yellow perimetry
  • Duration and expansion of vitreous substitutes: Air – 3 letter word – duration is 3 days and does not expand. SF6 – can be studied as S1F6– approx. 16 (12–16) days duration and 1.6 (=2) times expansion (doubles). C3F8 – approx. 38 days duration and 3.8 (=4) times expansion (quadruples).
  • Make a summary: At the beginning of a question, leave space and make a summary as hints with keywords, syndromes, mnemonics, and names of studies related to the topic [Supplementary material 2a].
  • Revise: Preparation alone is not sufficient. Upgrade your notes time and again. Revise it frequently so that it is transformed from temporary memory to a permanent one. If you have to read a book four times to retain it, reading your handwritten notes twice will be sufficient.
  • Teach: According to the Feynman technique, anyone can make a subject complicated but only someone who understands can make it simple.[5] Teaching others helps us to learn with a sense of deeper understanding.
  • How to learn the key points of the studies:Studies should be logically studied in the order they were done historically. An understanding of the background, aim, methodology, and conclusion of the study is essential. Classify the retina studies as studies based on laser, based on steroids, and anti-VEGF.

What to do when you feel the notes is incomplete?

Preparing notes itself is time-consuming. Finding it incomplete at a later point when we get better understanding of the subject is definitely frustrating. For instance, our understanding of diabetic retinopathy in our first year of postgraduate study is limited to knowing the pathogenesis of the various fundus lesions like what is a hard exudate, soft exudate, intra-retinal microvascular abnormalities, and how it occurs. Later at final year, the same information stands no longer sufficient. Hence, we have to improvise on our notes.

It does not mean that the notes we made were futile. Remember that the fundamentals are always essential. It is always better to leave some space or a few blank pages to add on information later. This inconvenience of not having enough space to add notes prompted me to shift to writing notes in A4 sheets and filing them subject wise in an expandable file folder with subject tags [Fig. 6].

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Figure 6:
(a) A screenshot of the voice recordings in mobile phone. (b) A photo of the expandable file folder with subject tags

Nevertheless, if it happens that you feel the notes once made are not up to the mark and require a complete makeover, never lose hope. Reassure yourself that re-writing combines the benefits of restructuring and reorganizing the content in a better way and improvise on your understanding and presentation of the distilled key points.

What to do if I do not want to take notes?

  • Reading from others’ notes: It is not advisable to read from someone else’s notes as we do not know the mindset in which it was written. Maybe they omitted the basic points that they already knew. Utilizing some flowcharts, tables, and ideas can be time-saving, but it is essential we verify the source of the information too.
  • Other options: For those not finding time and energy to sit and make notes diligently, you can opt to using sticky notes or jotting down page numbers in the question bank. I use voice memos in my phone to record a topic like a story flowing coherently from the etiology to treatment. I listen to them in my free time before sleep or while travelling [Fig. 6].

Conclusion

Note-taking and note-making are not just about writing and compiling information from multiple resources. It is all about understanding the essence of the topic and presenting it in a simplified yet attractive manner. It will exemplify the time and effort that you have invested to impresses the examiner. Note-making requires patience, whole-heartedness, commitment, systematic and continuous learning with quality time dedicated for making and revising the notes frequently. It is a skill that every student ought to master.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Acknowledgements

All my teachers and professors. Special thanks to Dr. Rengaraj Venkatesh for his guidance and encouragement to write this article.

References

1. Longcamp M, Hlushchuk Y, Hari R. What differs in visual recognition of handwritten vs. printed letters?An fMRI study. Hum Brain Mapp 2011; 32:1250–9.
2. Mangen A, Anda LG, Oxborough GH, Brřnnick K. Handwriting versus keyboard writing:Effect on word recall. J Writ Res 2015; 7:227–47.
3. Smoker TJ, Murphy CE, Rockwell AK. Comparing memory for handwriting versus typing. Proc Hum Factors Ergon Soc Annu Meet 2009; 53:1744–7.
4. Alamargot D, Chesnet D, Dansac C, Ros C. Eye and Pen:A new device for studying reading during writing. Behav Res Methods 2006; 38:287–99.
5. Reyes E, Blanco RMF, Doroon DR, Limana JL, Torcende AM. Feynman technique as a heutagogical learning strategy for independent and remote learning. Recoletos Multidiscip Res J 2021; 9:1–3.
Keywords:

Examination; learning; notes; postgraduate; revision

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