The Greatest Discovery in Learning History, and You’ve Probably Never Even Heard About It.

It’s ironic, the post-bacc class that had the least to do with medicine ended up being the most relevant to medical school. That class was learning strategies and it began with a graph, memory on the Y axis and time on the X. What it showed was if you do not review a subject your memory of it will tend to fade by 80 – 90% around 24 hours, 7 days and 30 days without proper review. Being the neurotic man I was, and maybe still am, I looked further and it turned out there were multiple studies done on the subject with some dating back to the thirties. There were also multiple programs out there that were based on this principle of spaced repetition ( Anki, firecracker, Pimsleur’s language learning to name a few).

From then on I never studied anything without using spaced repetition and just like it promised I rarely forgot anything. What was interesting was because I was using it to learn medicine rather than vocabulary I added a new level of understanding with every pass. Suddenly I was scoring insanely high on exams, and generally appearing smarter than I really was, the results were astonishing.

Before I go into how you can use this to great advantage on USMLE let me explain what spaced repetition is. It’s the concept that if you review things over a progressively longer span of time you will commit them to memory in a predictable and reproducible way.  While there are many iterations of this I prefer, for simplicity sake, Day 1, Day 2 Day 5-8, Days 30+.

For a more common sense example, imagine you have a small group where you hear everyone’s name during attendance. If you have that group five or six times in a month you are significantly more likely to remember that person’s name than if you had it five or six times in a year because that memory is made and solidified before it has time to be lost. While the science of memory formation is ongoing, and I am far for a neuroscientist, the best theory is that memories are formed by chemical and synaptic connections between neurons, with every recall that connection is strengthened, but over time that connection weakens and eventually fades until the memory/concept can no longer be accessed readily.

So how can we apply this to USMLE ? Well, everything you need to do extremely well on USMLE lies in only a handful of resources. Everything you need for Step 1 being: Uworld,  Pathoma, and FA for Step 1 and the Step 2 CK being:  Uworld, OnlineMedEd (IM, Surg only), MTB step 3 (non- IM , surg subjects), FA for boards and Wards (Ob-Gyn and Peds only) and FA Step 1 (bio stats only). Therefore when studying, do a resource (Pathoma or Onlinemeded for example) then the corresponding Uworld section ( Tutor by section, one minute per question reviewing after 10 – 15 questions).

After reading the explanation of 10 – 15 Qs you’ll find you’ve learned a lot of information that will come be tested in future questions within that Uworld section. Remember what I said about UWorld, incorrect answers are often high-yield summaries of answers to other Uworld questions; this is why it is so crucial you do it by section. You see by studying this way you are hammering high yield content by doing a few questions and learning a lot of content (through the answers to those questions), then being tested on it (through the rest of the Uworld Qs in that particular section) then once again recalling it ( through the answers to those questions). Through this constant cycle of learning, being tested, then re-learning, you will be strengthening the memory and understanding of a concept before it has time to fade (since it will be seen multiple times within 24  – 48 hours).

You then want to ensure you re-read those same resources (pathoma, FA step 1, OnlineMedEd notes, MTB etc)  + their corresponding Uworld explanation within 5 – 9 days after seeing them initially, but this time 2-4x faster since you need only to strengthen that memory.  Something I highly suggest, as you go through UWorld the first time, is highlighting important words and concepts in Uworld answers. This ensures you are focused while reading ( since it is an active process rather than a passive read) and when you re-read the highlighted answers you’ll save significant time (your number one resource).

If you find reading\highlighting Uworld answers is taking too long ( more than three minutes) read and highlight the learning objectives, wrong answers and only the bolded words/graphs or pictures in the main explanation. This may seem like strange advice, skipping the main explanation, however I have found that between the bolded words and learning objectives everything of relevance is covered and there isn’t much need to read the main answer to that question unless you truly do not understand a concept. Always read incorrect answers as they are typically summaries of high yield concepts. Once you get through everything (about 1-2 weeks before your test) you’ll want to re-review everything again further solidifying that memory and making it fresh for the exam.

You may be asking yourself how the hell am I going to fit all of that in in the numerous hours I have to study for USMLE? Well here’s that amazing part. Because USMLE is a recognition test vs a recall test you don’t need to have facts down cold you only need to know enough to recognize the answer (a concept I will go into further in later articles), so you actually do not need to spend that much time on any individual fact. Because you will be seeing the high yield topics so frequently (literally 30 – 40 x before the test because of how frequently Uworld tends to repeat them) you will be able to recognize them without needing to spend large amounts of time actively putting those concepts to memory.

In summary:

  • Do High Yield resources (Pathoma, FA Step 1, Onlinmeded, MTB step 3, FA Boards and Wards) ( Pre-read Notes + Videos + reread Notes) then
  • UWorld ( Tutor by section, one minute per question reviewing after 10 – 15 questions ( 2.5 – 3 minutes per answer review with highlighting)),
  • 5 – 9 days later re-review high yield OnlineMedEd notes + Uworld answer highlights at 2-3x the speed you did originally.
  • Once complete with every section reread everything again at that speed.

This will ensure you know these concepts very well on exam day. While you may be skeptical about the short list of resources I can say I used ONLY the above for Step 1 and Step 2 and scored in the 250s and 260s respectively. You can argue I am a good test taker but regardless I cannot invent medical facts/concepts so the information must have been contained within the above resources. You now know my greatest study secret for both USMLE and Medical school, go forth and use it to crush these exams.