Barbara Burton, Class of 2017
What makes medical school (and really all graduate school) challenging when you first start is not just the work load itself, but the fact that you have to change the way that you study. I tried to study the way that I did in college at first, and I passed my tests, but my grades weren’t very good. It’s extremely frustrating when the habits that came to be trustworthy to you for the past several years suddenly do not work. Almost everyone ends up having to overhaul their approach to the material, so don’t feel that you’re the only one hitting road blocks.
With that in mind, you’ll end up gradually shifting and tweaking your study strategy until you get to a point where you have a reliable method, and all of your classmates will be doing the same thing. By the end of the first semester, everyone will have their own unique way of doing things. Believe it or not, it starts to get pretty interesting to talk to other students about the different approaches they use (wow, we’re nerds). I’ll tell you how I did things during the classroom years vs the clinical years, and I hope it’s helpful, but ultimately you will figure out what’s best for your brain.
Obviously, I tried tons of stuff before I got to a point where I was comfortable. What I ended up doing for most courses was centered on the syllabus. I’d ultimately make about 5 passes through it before an exam. Prior to that day’s lecture, I would do a first read on the corresponding portion of the syllabus and highlight as I went. Inevitably, there would be things I didn’t understand on the first read. Then, I would either go to lecture or stream it and pay close attention to sections that were less clear to me. I would also underline in black ink the concepts the lecturer emphasized. Before moving on, I made sure that I understood all the material, and made short notes in black ink in the syllabus to help me remember. I considered this my second pass. The following day, I would do a third pass where I began genuinely attempting to memorize everything I had both highlighted and underlined. I think that this helped cut down on the sheer number of words I was looking at, and made my memorization more efficient. If something seemed difficult to memorize, I made a note of it next to the text, usually just rewording the concept in my own way. The fourth and fifth passes I would do the same thing. I didn’t always make it to a fifth pass. During the clinical years, I made no attempt to memorize any text. I relied on UWorld and other practice questions for the most part, sometimes passively reading a textbook on the side. I was too tired to do other stuff.
No matter what you end up doing, you’ll probably end up having to sit and work for multiple (sometimes several) hours at a time. The best thing you can do is find a way to zone out and immerse yourself in the task at hand. It sounds weird, but you have to sort of get lost in what you’re doing. This was the only way that I could be productive, because I always had too much on my mind otherwise. I had to turn the rest of my brain off. That’s why anytime somebody touched my shoulder in the library, I startled like I’d been hit with a paintball gun. Music also helps, even for me. If you can find something that helps you get on a certain wavelength and stay there, it’ll be way easier to concentrate and you’ll feel like you got a lot done at the end of the day.
Also, whatever you do, use pretty colors. It’s a pick-up.
Gaurav Chattree, Class of 2017
Learning the preclinical material well is critical for becoming a physician who can handle a wide variety of clinical situations including those that are more unusual/complex. Many clinical situations you encounter will be well understood and there will be a standard set of guidelines or algorithms to follow. Often, however, you will encounter situations that fall outside of this zone – where diagnoses and treatment are unclear. For these situations a deeper understanding of the human body, developed through pre-clinical classes, is required to make hypotheses about what might be occurring and what should be done.
Therefore the big picture of your pre-clinical years should be to understand the structure and function of the human body at various levels (molecular, cellular, anatomical, physiological) in both normal states and abnormal states so that you develop an intuition to deal with the more complex/unusual clinical cases you encounter in the future. No matter what study method you use, I also recommend taking notes in such a way that you can easily come back to them in the future whenever you need to quickly refresh your understanding about a topic.
My study plan: I will now detail specifically how I studied. It worked well for me and I recommend it. However, understand that it may not work for everyone.
For each exam I would take the days available to study and split them in half. The first half I would watch lectures online, take notes in the associated power point slides (I have a Microsoft surface and would use the pen to write on the slides), and make anki flashcards, but I would not do any of the flashcards yet. If there were some more conceptual topics I would take time to read and understand them during this first half and write short summaries of these topics and put them in my flashcards. The idea during the first half would be to get a general idea of the topic without getting too into details. In the second half I would continue all of the above (watch lectures, take notes, make more flashcards) but now I would start doing the flashcards. As it got closer and closer to the test I would start doing more and more flashcards. Then on the last day I would try to do a rapid review of as many flashcards as possible and then also meet up with friends and go over the syllabus over a few hours.
-1st half of study time: Watch lectures (online; 2x speed) & take notes on the power points slides. Make anki cards. Read and understand big picture concepts.
-2nd half of study time: Watch lectures (online; 2x speed) & take notes on the power point slides. Make anki cards. Start doing cards so that you can cram details.
How I made my anki cards:
For approximately each paragraph in the syllabus, I would make one anki card. I would copy+paste the paragraph directly into anki to make the card. I would make the first sentence of the paragraph the ‘Front’ of the card and the rest of the paragraph the ‘Back’ of the card. Then I would take screen shots of any related slides from the associated power point for that section and also add it to the back of that card. If I needed any more clarifying images I would find them online and copy them over to the back of the card. When making cards I would do it as rapidly as possible and I would not read the whole paragraph that I was copying over, only briefly skim it.
How I did my anki cards:
I used these settings for my decks (Steps (in minutes): 1 8. Graduating Interval: 1 day. Easy interval: 4 days. Interval modifier (reviews tab): 100%). The amount of new cards I did each day depended on how many cards there were in total and how close I was to the exam. As it got closer to the exam I would do more and more new cards (maximum around 100 new cards in a day). I would try to do all the review cards for that day (though sometimes this is infeasible). When I first encountered a ‘new card’ I would fully read the paragraph and look at the slides and images I included in that card. I would then edit the card and highlight certain key words so that next time I read the card I could read through it much quicker. If the paragraph contained any conceptual concepts I would add a little summary sentence or two to again make it quicker to understand next time I came to the card. When I did my ‘review cards’ I would try to read it as quickly as possible; often times I could just read the highlighted words and look at the associated slides/images and get what I needed from that card. I think this was the trick to doing these cards quickly. Since I was studying on the computer there was a tendency for me to go on reddit/yelp/facebook so I had to set up timers to block these websites after a certain amount of time. I would also keep my phone away from me.
You can find all my anki cards on the O drive (in the MS2017 folder; e.g. MS2017\First Year\Physiology\Anki Decks). Keep in mind the syllabus has likely changed since when I took those classes, but it can at least give you an example of how I made my cards. I think the big advantage to making these anki cards is that you can come back to them easily in the future. You can search through all your cards to find all the cards on a specific topic. If you have any questions about these cards you can always email me (email@example.com).
This is the time to learn the algorithms that allow you to go from your encounter with the patient where you understand their symptoms and signs to deciding on diagnoses and management plans. Pre-clinical knowledge is critical to understanding how these algorithms have been created and give you the ability to adjust these algorithms for the individual patient.
Here you have to balance between learning about your patients and their conditions and studying for the shelf exam. Luckily, sometimes they go hand in hand and it is often easier to read and learn about topics when they directly apply to your patient.
My general strategy was the same as the pre-clinical years; for the first half of the rotation I would focus on learning some of the big picture concepts about that rotation. Then the second half I would start getting into more of the details that would be on the shelf and ramp up the cramming of details as it got closer to the shelf. In general there was not enough time to make anki cards so instead I would choose one text resource to read and one question bank to do for each rotation. I would do an initial skim through the text during the first half and mainly focus on reading uptodate.com and aafp.org to learn about my patients. The second half I would do a detailed read through the text and then start doing a lot more questions. If there was not enough time to do both the reading and the questions I put priority on the questions. I typically used the Blueprints books as my text (or whatever the course director recommended) and used UWorld as my question bank. The 2-3 days before the shelf I would watch the relevant Emma Holliday lectures (http://som.uthscsa.edu/StudentAffairs/thirdyear.asp). They are extremely high yield for the shelfs. (They are also great for Step 2).
On a lot of your rotations there will be down time; don’t be afraid to use this time to study or do questions; residents understand, just be available if they do need any help during this time.
Also I did have time to turn the ‘Step Up to Medicine’ book to anki cards. I absolutely loved this book and I found it very helpful going through these anki cards when studying for Step 2. You can find these on the O drive (MS2017\Third Year\Anki\ MS3__Step Up to Medicine.apkg). I also put some other anki decks made by other students (at other schools) in there. If you search reddit or student doctor I’m sure you can find other decks. If you have any questions, email me at: firstname.lastname@example.org