Med School Study Strategy

What to study and how to study it

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Studying takes energy

It’s often obvious what needs to be done and how best to do it. Sometimes all that’s really needed is the energy (and motivation) to carry through. So part of studying is managing your energy.

It takes a long time to truly build up the discipline and tolerance to sustain consistent long hours for days on end. As you stretch yourself, you will do a lot of studying when you really don’t want to. It’s critical you figure out ways to manage your energy and stretch your willpower.

Does your mind wandering while studying a diagram or memorizing a table? Recopy it by hand multiple times. It requires only determination to keep copying while you’re brain is (mostly) on autopilot. I’m always amazed at how effective this can be. I usually pull this out when I’ve repeatedly gotten a topic wrong, and I just channel that frustration into recopying a diagram or table. Each iteration, add a new detail to the diagram, simplify a part you already know, go faster.

Break the problem down into easier pieces. Is the entire combined glycolytic, TCA, Urea pathway too daunting? Then just pick one to redraw for now. Work on another later. Similarly, if you’re getting worn down with full blocks of 46 questions, do smaller blocks so you get more immediate feedback. If your worn down by low performance, smaller blocks might show an actual score improvement for some positive feedback to keep you motivated.

Switch tactics to boost energy. If you’re getting bored of answering questions, switch over to watch a video lecture.

Optimize your procrastination equation. What’s keeping you from doing what you know you need to be doing? Do you not think the pay off is worth it? The payoff is too far away? The energy required is too much? Whatever it is, figure out a way to optimize that part of the procrastination equation.

Personal traps

Here are personal mistakes I’ve struggled against.

Glossing over big words. I have a tendency to gloss over big words which leaves it all a blur. For example, I might come across this sentence from biochemistry: “Phenylketonuria is due to a decrease in phenylalanine hydroxylase or decreased tetrahydrobiopterin cofactor”. I would wrongly gloss over the unfamiliar words, so I end up reading something more like “Phenyl— is due to a decrease in phenyl— — or decreased — cofactor”. It’s no wonder that a lot of biochemistry was just a blur to me. I now to force myself to slow down and parse every syllable, and slowly those hard words have become more natural.

Doing what’s easiest. Passively reading and nodding along because it all seems familiar and I believe I know the material. The harder road is to actively do questions that test recall. If material looks familiar but you’re having trouble recalling details necessary to answer questions, then you can probably blame passive review. As a corollary, with so many topics to study, I often found myself avoiding some daunting topic by distracting myself with more interesting (easier) topics. Thinking about the procrastination equation often helped me find a way out of the situation.

Punting down field. Often when I was going through question banks, tired, and hit a topic I didn’t know, I would mark the question and just tell myself I’d come back to study it later. The truth: I never would come back. Fix: Study the material immediately while the emotion of a wrong answer is still present and you’ve got the question context in mind. If you’re too tired to study the explanations, then you’re too tired to do questions. Either pack it in, take a break, or switch to something else like watching Pathoma videos, but don’t get in the habit of telling yourself you’ll do it tomorrow. Tomorrow is always a day away.

Tunnel vision. When a patient has presents with systems involving multiple systems (renal, muscular, pulmonary), I tended to mistakenly jump at answer choices that might explain one or two findings perfectly, but ultimately didn’t explain all the physical exam or lab findings. Now I know my answer choices need to account for every abnormal finding. There are no wasted words in these vignettes.

Going too fast. The more practice questions I did, the quicker I would get, but I also got sloppy. When I noticed myself not improving and making stupid mistakes, I had to slow myself down. Read. Slower.

Mistaking ‘activity’ for ‘active learning’. I often caught myself writing everything down furiously so I can study it later. The truth is, you’ll always be busy and never return to sort out the material. This is a form of autopilot, passive learning. Always think critically about information instead of just passively transcribing.

Organize information the way it gets tested

Questions typically present a clinical vignette with chief complaint and then some secondary information to narrow down the diagnosis.

For example, consider a patient presenting with osteomyelitis. With no clues, S aureus is most likely overall, but the vignette will likely give some history or physical exam findings that point to other causes. You want to put to put together a table like the following.

Make your own tables. Don’t simply reply on those in your textbooks or First Aid. Work out your own versions that start out simpler and only list and compare one or two of the most important features.

Some dimensions you can compare and contrast along:

• epidemiology
  • younger or older patients?
  • risk factors: sex, drugs, smoking
• onset
  • slow, insidious, progressive
  • acute, emergent
  • congenital, shortly after birth

Look for contrasts to distinguish diseases.

• Pernicious anemia (autoimmune destruction) vs. B12 insufficiency (diet)
• Follicular adenoma (encapsulated) vs. follicular carcinoma (capsular breech)
• 21-beta-hydroxylase (hypotensive) vs. 11-beta-hydroxylase (hypertensive)
• Liddle’s Syndrome (hypokalemia) vs. Georges Syndrome (hyperkalemia)
• Thalassemia (defective synthesis of globin) vs. Sickle Cell (defective structure of globin)

To type or write?

Typing is fast. Writing is slow, but it forces you to think critically about what’s important to record.

Typing lets you copy and paste previous notes. Writing forces you to be economical in what you choose to record. Typing lets you copy and paste a figure into your notes. Writing forces you to recopy the figure from scratch. Writing ultimately forces you to work with the information slowly and deliberately, and hence you’re more likely to remember.

Typing lulls you into a false security of being able to quickly search and look up information. Writing forces you to scan manually, and so you end up reviewing more ancillary information while searching for what you really want.

I started out typing to record the deluge of information, but ultimately I ended up writing so I’d exercise my memory every time I had to rewrite a fact.

Scratch work

Draw diagrams and simple tables. Don’t transcribe everything; these notes should be much simpler than your textbooks and review. Only record 1-2 key distinguishing facts. Those key facts will jog your memory of additional ancillary facts.

When you revisit a topic, try to reproduce (redraw) as much as you can from memory. Resist the urge to immediately flip back in your notes. Every time you stretch your recall, it strengthens those neurons. Every time you redraw a diagram, you’ll get faster. I was dumb as bricks when it came to metabolic biochemistry. Repeatedly redrawing metabolic pathways was the only way I could get it through my thick skull.

Keep this all bound, in order (dated) in a notebook so you can flip back (“Oh, I remember that from last week … let me find that …”). At the start of each day’s study session, skim your pages from yesterday or the day before. Since these notes are all the things you got wrong or want to remember, this is like a poor man’s version of spaced repetition.

No figure or table is sacred. I often fall into the trap of trying to make things pretty, or shying away from even starting a table or figure because I think it’ll be a mess. Go fast and loose, and repeat frequently.

Daily Review

Every day during my Step 1 & 2 study blocks I would start with a blank sheet of paper and record scratch notes on anything I got wrong or lessons learned – mostly just two or three word associations or small lists. What was a key fact I should know? This was very fast, loose, and cursory. It wasn’t meant to be saved. What did I do with this? At the start of every new day I would scan that list to refresh my brain. It typically took less than five minutes. No need to look stuff up, just read what the page has. I filed these away in a stack but rarely looked at them again. Afterward, I was warmed up and would begin with a fresh sheet of paper.

When studying

Control your environment, or it will control you. If there’s something distracting, get rid of it. If you are at a coffee shop distracted by someone nearby, move your table or move to a different area. If you’re attention keeps drifting to something outside the window, draw the shades or move locations. If you keep getting the impulse to check the news, block the website. Move to a high traffic location where fellow students can see over your shoulder that you’re goofing off. Erect whatever barriers are necessary to make studying the easy road.

Unload distractions. If you realize you need to do laundry, don’t. Instead, write that on a piece of paper for something to do during your upcoming break. Anything that is on your mind that’s not about studying, simply write it on this list to think about later. The simple act of writing something down and pushing that aside helps me de-clutter my mind. When a distracting urge rises up, learn to say “No” to yourself.

Set timers. This will force you to be conscious of time and not simply let study time fill all your time. During the first half of medical school you have plenty of time so you can study for hours, but during the clinical years you have very little time and you need to get faster at covering material. Use the clock to up your game.

Be disciplined about short breaks. Many times my 15min break would easily stretch to 30, 45min. Set a timer to kick you back in to gear when the time comes.

Use your breaks to re-energize. While studying, make a list of what you are looking forward to doing during your next break. Plan fun things to look forward to. When I get really worn down and start dragging in my studies, one remedy I use it to plan something super fun for the next break or that evening.

When Not Studying. What you do outside your study time will affect what you do during your study time.

• Sleep. Decrease stress and let your brain process the info you’ve fed it.

• Exercise. Decrease stress, release energy.

STEP1

It will punish those who do not put in the time. As a cumulative exam, anything you failed to learn during your modules will show up here and cost you points again. If you didn’t learn something the first time, now is your last chance.

It is a test of endurance and discipline. I’m not talking about test day. I’m talking about endurance and discipline in the weeks leading up to test day. If you fail to work diligently during your dedicated period, you will be punished.

It is also a very straight forward test for anyone willing to dedicate the energy to working through question banks.

How badly do you want it? All the tactics in the world are not going to work if you don’t have the motivation to push forward. Strong motivation energizes and fully engages your senses. Step back and think about what you want in a career and what you’re willing to trade for it. Do you want that subspecialty residency so much that you’re willing to prioritize weekend study over social outings?

It’s not just about a test score and getting into a top residency. It’s about becoming the best physician possible. It’s about being able to answer patient questions, explaining to them what’s happening to their bodies. It’s about being able to notice a disease pattern that others might have missed.