You’re about to scale the pyramid of learning towards the next written exams.   So many times in my role of Medical Education Consultant I’ve been asked – where do I start? What approach do I use?  Is it enough to read the (last x) years of Murtagh, Check and AFP and be able to recite all of the guidelines ?

Of course not, otherwise anyone could pass the exam by rote learning.  Let’s consider a new perspective – the Pyramid of Learning.

So let’s use the analogy of a pyramid of knowledge. Pyramids are quite common in Medical Education – have a look at Miller’s pyramid, Maslow’s hierarchy of needs and Bloom’s taxonomy.   They’re common because they make sense and they work as an stepped approach (or maybe Medical Educators are just trying to be less ‘square’).



The AKT is about application of core knowledge.   The KFP is about demonstrating you know the key decision making steps in making a diagnosis.   Reciting the texts is not enough, and you certainly can’t demonstrate decision-making if you don’t have the facts to reason with.

Right from infancy, learning pyramids have been important – like building blocks.   We start with the essentials and build onto them  more complex steps and I think this is a good way to approach your General Practice study.   The base of the pyramid is core knowledge, and the top is where we want be.    We may be able to make it to the top by treading a known path but in doing so we may miss the treasures that lie deep within the pyramid – and finding these treasures is the key to passing the exam.

There are three steps that you need to consider before ascending the pyramid:

Step 1:   Know your stuff.   Have a look at a pyramid.   What is it made of?   What information and materials did they use to put the blocks together and why did they chose that particular way of building?  What information do you need as a base to build on?  And how did the environment affect they way they constructed the pyramid?

Here is another pyramid – it doesn’t have a name yet as I can’t think of one, but I find it a useful in helping doctors plan their study.   If you can think of a great name other than ‘Stewart’s pyramid’ please feel free to comment or message me!   It works on a sensible premise – some topics are bread and butter and most likely to be on the exam.  We need to know these topics for our everyday practice, for the exam and they also constitute the building blocks for the more complex topics.   What constitutes a Level 1, 2, 3, or 4 topic is different for everyone – also influenced by their personal experiences, patient demographics and particular skills sets – but certain things are core.   For e.g.  Chronic illness falls into Level 1 but Oncology falls into Level 4 – we can’t approach Oncology until we understand chronic illness.  So I suggest that you think about the curriculum areas and rank them where they fall for you and allocate your time appropriately.  I call this approach the 40:30:20:10 rule.    If you are having difficulty prioritising,  there are study planning processes available can will assist you and a APP coming out soon that will make it so much easier!

Learning pyramid

Step 2:   Take time to appreciate different approaches to the pyramid- you may see different things from different perspectives.   Walk around the base of the pyramid (the curriculum topics) and think about how they might look from the Domains of General Practice.   Actually, adding the Domains of Practice to the triangle provides the depth to make it a pyramid.


Now if I was really tech savvy, I’d love to overlay the domain star onto my pyramid – I’m not sure what that shape would be called but it would look pretty cool!

Step 3:  Synthesise and contextualise your knowledge.  Now that you know the facts, and how to interpret them from each Domain of Practice, consider how they fit in with a presentation, problem and a patient!

So enough theory, now for some pragmatics:

  1. Identify which topics are of what priority – study the facts allowing for adequate time depending on their prevalence and importance.
  2. Look at the topics from the domains of practice as knowing  ‘Applied clinical knowledge and skills’ is not enough.
  3. Synthesise the knowledge by using case studies and patient reflection.   Some techniques for doing this are ‘Check magazine’, case studies, clinical presentations, audits, random case analysis – consider podcasts, patient videos – expand your learning approaches.

When you look at the steps above, it very much fits with Miller’s pyramid – Knows, Knows how, Shows how – the Does is the bit we find hard to assess.   So doesn’t it make sense to learn in this way?   Importantly, don’t do the synthesis just before the exam – it is important to have revision weeks interspersed within your study plan to enable you to reflect on and synthesise your knowledge to enable group learning.

Please take time to consider your approach.  Checking off a list of resources and having a generic map is not the answer.  As an experienced medical education pyramid expedition leader I recommend that you:

  • take the time to plan your approach;
  • think about how you like to learn and make it interesting – try a learning approach questionnaire.
  • ensure you have considered alternative approaches;
  • have contingencies for ‘detours’;
  • take the journey with others;
  • consider the unforeseen traps  that you might encounter on your journey; and,
  • most importantly, have a really good idea of what the end goal is.

Conquering the pyramid is not about having the knowledge to make it to the top – it’s about knowing what resources you will need, how you will approach them, when, and with whom, and how you will avoid the unexpected traps, to find the hidden treasures within.





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