Why This Matters

You’re studying to become a paramedic. That means you’re expected to learn complex physiological systems, memorize numerous medication indications and doses, interpret critical signs and symptoms, and make life-saving decisions under pressure. But here’s the truth: most students are never taught how to learn.

This guide is your starting point for changing that.

You’ll explore how memory works, why passive studying doesn’t cut it, and how to begin using strategies that are scientifically proven to improve retention and understanding. Learning how to learn isn’t fluff—it’s your foundation for mastering everything else.

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What You’ll Learn in This Section

• Why your brain forgets, and how to combat it
• The difference between passive and active studying
• Why cramming fails (and what to do instead)
• How to build your own learning system for paramedicine
• How to take notes that you can actually use later

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Understanding the Problem: The Forgetting Curve

Right after a lecture or lab, your memory of the material starts to fade almost immediately. Within 24 hours, you may lose up to 50% of what you heard. Within a week, up to 90%. This is called the Forgetting Curve.

But it’s not hopeless. The cure is spaced repetition: reviewing information at strategic intervals, especially right before you’re about to forget it. Every time you recall it correctly, the memory strengthens.

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Passive vs. Active Learning

Here’s what most students do:

• Re-read notes
• Highlight textbooks
• Watch recorded lectures

These are passive methods, and while they feel productive, they don’t challenge your brain to retrieve information. They’re like reading about how to do CPR, instead of practicing chest compressions.

Active learning, on the other hand, makes your brain work:

• Self-quizzing
• Teaching the concept out loud
• Writing what you learned in your own words
• Testing yourself without looking at notes

This is how real memory is built.

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Key Strategy: Zettelkasten Thinking

Zettelkasten is a German word meaning “slip-box.” But it really describes a method for building a long-term thinking system. It gives you a structured way to capture, organize, and link what you learn so it becomes easier to remember and apply.

At the core of this method are three types of notes:

1. Fleeting Notes

These are quick, unstructured thoughts you jot down during or right after a class, lab, or even a conversation. They’re raw, temporary, and often messy. Their job is to capture a thought before you forget it, not to be organized or polished.

Examples:

• “CHF = fluid in lungs?”
• “Why do we delay fluid boluses in suspected heart failure?”
• “Patient on scene had crackles but stable vitals—CHF or pneumonia?”

These notes are like mental sticky notes. You process or delete them later, but they help prevent idea loss in the moment.

2. Literature Notes

These are notes taken from a source—a textbook, a lecture, or a protocol. They’re written in your own words to help you understand what you’re reading or hearing. The goal is to capture the core ideas clearly so you can turn them into permanent notes later.

Examples:

• “Lecture stated that left-sided CHF causes pulmonary congestion, leading to crackles.”
• “ALS PCS says to withhold fluid bolus in patients with crackles or suspected CHF.”
• “CHF patients often report orthopnea and PND due to pulmonary congestion during recumbency.”

Use these to digest what others are telling you. Don’t copy—translate.

3. Permanent Notes

These are the gold standard. Written in your own words, one per idea, and linked to other notes. They reflect what you understand and are confident enough to build on.

They should:

• Be written as if explaining to your future self
• Be specific and atomic (one idea per note)
• Be connected to at least one other note

Example: “In CHF, crackles are caused by left-sided heart failure. As the left ventricle fails, blood backs up into the pulmonary circulation, increasing hydrostatic pressure and leading to fluid leaking into the alveoli. This is why CHF often presents with wet lung sounds and orthopnea.”

Why These Notes Work Together

• Fleeting Notes capture ideas before they’re lost.
• Literature Notes process and clarify what you’re learning.
• Permanent Notes build your actual long-term understanding.

Together, they form a cycle:

Fleeting ➝ Literature ➝ Permanent ➝ Linked Knowledge

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Learning Congestive Heart Failure (CHF) Instead of copying your entire lecture slide into a notebook, break it down like this:

Fleeting Note (initial idea): CHF = fluid in lungs?

Literature Note (source-based): Crackles in CHF occur due to left-sided heart failure. Blood backs up into pulmonary circulation, causing fluid to leak into alveoli.

Permanent Note (your own words): CHF often presents with orthopnea, crackles, and fatigue. These symptoms occur due to fluid overload in the lungs from left ventricular failure. Often triggered by hypertension or previous MI.

Linked Notes:

• [[Pulmonary Edema]]
• [[Cardiac Output]]
• [[Hypertension as a CHF Precursor]]

This kind of thinking helps you understand—not just memorize—a condition like CHF.

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Reflection Questions

Before moving on, take a moment to reflect:

1. What’s one thing you’ve done in the past that felt like studying, but didn’t actually help?
2. How often do you test yourself without looking at the answers?
3. What’s one topic you could break into smaller chunks today?

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Quick Summary

• Your brain forgets unless you review.
• Re-reading is not enough—recall is key.
• Organizing your thoughts in small, linked notes builds better memory.
• Learning how to learn is not a luxury. It’s how good clinicians are built.