How To Study in Medical School

Less Time, Less Stress, Better Grades

Published by TheMDJourney.com Dallas, TX
www.TheMDJourney.com
© 2018 Lakshya Trivedi
All rights reserved. No portion of this book may be reproduced in any
form without permission from the publisher, except as permitted by U.S.
copyright law. For permissions contact:
[email protected]
Cover by Lakshya Trivedi.
-Dedicated to all stressful medical students
 Table of Contents:
Introduction:

Chapter 1: How Hard Is Medical School?

Chapter 2: Basic Principles You Must First Master

Chapter 3: How Do You Study Best?

Chapter 4: How To Take Notes

Chapter 5: Effective Study Methods

Chapter 6: How To Do Well on Tests

Chapter 7: Increase Your Retention

Chapter 8: How To Speed Up The Process

Chapter 9: How To Maintain Your Energy

Chapter 10: How to Study for Specific Courses

Chapter 11: How To Excel On Step 1

Chapter 12: How To Excel On Step 2 CK

Chapter 13: How to Study For Clinical Rotations

Chapter 14: Misconceptions About Studying in Medical School

Chapter 15: The Most Important Section

Conclusion

About The Author

 Introduction
How do you study in medical school?

It’s by far the most common question and the leading cause of anxiety in new

medical students.

Unfortunately, everyone has a different answer.

So let’s get to it.

In this book, my goal is to provide you with a wide array of techniques. I will

then leave it up to you to decide which technique(s) fits your studying style

the best.

Just remember this – there is no one right way.

While you may not study like me, that won’t stop me from sharing my

strategies to study on average 4 hours every day (including lectures).

I will show you the strategies I used to ace hard courses such as Anatomy,

practical advice on how to crush your Step 1 and 2 exams, and how to study

for your rotations!

Using the techniques I share in this book, studying was never a stressor for

me. I knew what worked and enjoyed the results. I will teach you to do the

same.

Why Listen To Me?

But first, who am I? Also who made me an expert in studying in medical

school? Why should you even trust what I have to say?

My name is Lakshya (Luck-sh). I’m about to begin my 4th-year medical school

and have been blogging about how to succeed in medical school for the past

two years.

I recognized that I saw my medical school experience much different than

my peers. I knew this made all the difference between a stressed-out student

and a calm one. So I set out to teach what I knew and learned.

Regardless if you’re a brand new medical student, a veteran, or a soon-to-

be student doctor, I’ve been in your shoes.

I’ve spent countless hours before med school on Student Doctor forums,

YouTube, and through physical books searching for the answers on how to

succeed in medical school.

The problem was that most common advice surrounded the idea of

spending 8+ hours (including lectures) studying every day.

Now yes there’s no getting around the fact that you have to put the time in

med school, but I wasn’t going to just believe that 8+ hours was mandatory.

If there’s one thing you should know about me, it’s that I love efficiency. In

fact, you can consider me to be a complete dork when it comes to the subject.

Here’s a quick example. In college, I combined a part-time job, two high

leadership roles, a research project, my pre-med courses, graduated in 3

years, and managed to pull off a 3.8 GPA in Neuroscience.

I did this all without ever pulling an all-nighter or feeling much stress.

I took and adapted these same strategies in medical school and have done

much of the same. I’ve managed to grow my blog, TheMDJourney, from a

few hundred visitors a month to a few thousand. I’ve found time to write two

books, got engaged, put out four publications, did well on Step 1 and Step 2,

served in leadership roles, and maintained a near 3.9 GPA.

Again still no all-nighters.

So it’s safe to say that studying well and efficiently weren’t issues for me. But

the same can’t be said for all medical students. Many just can’t get a proper

grasp on studying. It often becomes a source of anxiety, stress, and eventual

burnout.

I’m lucky that I learned what works for me early on. I want to teach you to do

the same.

By the end of this book, I hope you can take a deep breath and relax. Medical

school is not as difficult as we all make it to be.

It will require consistency from you to become successful. But you’ve made

it this far so you have what it takes.

What Will I Teach You?

I was always a big fan of books which permitted me to jump around in the

book to find what resonated with me. I encourage you to do the same.

Chapter 1 addresses why studying in medical school is such an issue. What

makes medical school studying so hard? Is it even hard at all?

Chapter 2 goes over basic principles you need to remember to perform well

in medical school. This is where most med students screw up, so take these

principles seriously.

Even if you just read chapter 2 and nothing else in this book (not highly

recommended) you would have enough tools to decrease your stress and

time by half.

Chapter 3 is all about identifying what works best for you. As I mentioned in

the intro, theirs is no one right way. So we’ll go over how to find your right

way.

Chapter 4 is where the fun begins. First, we will go over how to take notes in

medical school. This is often something many students struggle with and

spend an unnecessary amount of time on.

Chapter 5 is probably what you were looking forward when you bought this

book. This is where I share the most effective study methods I’ve used to

maximize retention and decrease the time spent.

In Chapter 6 we’ll talk about exams – the bain of our existence. We’ll go over

how to approach your studying to excel on your exams. Also, we’ll discuss

how to approach test questions and how to increase your confidence.

Each of the study methods in chapter 5 will do wonders to change your

performance in medical school. Chapter 7-9 is where I get to geek out. Let’s

now add fuel to the fire and turn you into a studying machine. In these

chapters, we’ll go over tips to increase your retention, efficiency, while

maintaining your energy.

Chapter 10 will go over how to approach unique courses such as anatomy,

pharmacology, and microbiology. Some of your courses will be memorization

heavy while others will require you to connect ideas and processes. We’ll go

over how to approach each type of course.

Next, we’ll cover the two words which shall not be named in med school–

Step 1. This is the first of three licensing exams you take midway through

and freaks med students out! So Chapter 11 is all that you need to know to

minimize your stress and do well.

And I know that I can’t talk about Step 1 without also talking about how to

study for Step 2. Chapter 12 will provide my version of Step 2 secrets.

Now I’m sure you may have just thought this book was for your first two years

of medical school. But how do you study when you hit the wards? Chapter

13 will be all about how to study during your clinical rotations.

To wrap up the book chapter 14 will go over common misconceptions about

studying.

Chapter 15 is the most important chapter in this book in my opinion – it’s all

about how to take care of yourself which will ultimately lead to better grades

and a happier you.

Throughout the book I include links (and discounts) to the resources

and services I recommend. Some are affiliate links which, no additional

cost to you, may provide me a commission.

I hope you’re excited as I am to transform your medical school experience!

Now I promised no fillers so let’s get right to it! Your grades are counting on

it.
 Chapter 1:
How Hard Is Medical School?
What makes studying in medical school so hard?

The simple answer comes down to eating pancakes

What? Did I say pancakes?

I’m sure you’ve heard that medical school is like drinking out of a fire hydrant.

I instead prefer the pancake analogy.

Yes, the pancake analogy compares medical school to eating a plate of

pancake every day.

You may be saying “Put me in coach.” But hold on their cowboy (or girl).

While eating a plate of pancakes may not seem like much, imagine having

to do it every day. Even worse, anything you don’t eat today will be added to

tomorrow’s plate.

Similarly, anything you don’t complete on your medical school plate will be

added to the following day and so on.

If you find yourself behind too often in medical school, you will feel just

how you do after a week of pancakes – sick to your stomach.

So let’s first promise to avoid the pancake effect!

You can have the best study plan possible, but it doesn’t matter if you can’t

stay consistent.

So make sure to finish your plate every day.

Medical school won’t seem as bad. In fact, with the rest of the principles in

this book, you’re likely to enjoy it!

Here’s a video of me going over the pancake analogy.
 Chapter 2:
Basic Principles You Must First Master
Regardless of what study strategy you use, you need to understand the

principles laid out in this chapter.

Without these basic principles, it doesn’t matter how great your study method

is, you’re setting yourself up for failure.

Go From Big to Small:

This is how medical school studying should be.

Unfortunately, this is how most students study.

There is no structure and no real goal using this method. The only goal we

have is to try to learn everything. This is a recipe for disaster.

Just accept the fact that you will not know everything in medical school.

You won’t even know everything the day you retire from medicine. This is

why you’re repeatedly exposed to the material during your training and

career.

So for the sake of your sanity, understand that not every bit of

information is equally important. Stick to the high-yield info and move from

there. We’ll go over how to identify the high-yield info later.

As test day gets closer, your goal should be to continually minimize

the info you expect to learn.

What does this mean?

If you take notes on your syllabus, use your notes as the primary form to

study for the test. Don’t go back to reread the syllabus chapter as the test

approaches.

Think of medical school like a funnel. It just continues to get thinner. Don’t

add more work for yourself by adding a thicker layer.

Do A Little Every Day:

Now you’re familiar with the pancake analogy so you understand why this

principle is so important.

Here’s how it applies practically. Let’s say for example you have a busy and

tiring day. You have no motivation to study, but your to-do list didn’t get the

memo.

Your ideal goal every day should be to complete all your studying before bed.

I’m not going to BS you and say this will always happen.
But on the days you’re feeling unmotivated, doing none of your work

is the worst possible choice.

Not only do you put yourself behind, but you also introduce a bit of guilt

everytime you do this. This will only get worse if you have a quiz or test that

doesn’t go well.

So on days where there is a 0% chance you will finish all your work,

compromise and just do a little.

I don’t care what it is - read a syllabus chapter, do some flashcards, or review

your lecture notes. Something every single night will minimize your guilt and

keep you in some state of flow.

Plan Out Everything:

This is the geek in me coming out, but medical school is way too busy for

you to memorize your study schedule.

What’s even worse is just going with the flow without any structure.

Once you decide on your method – which we’ll cover in chapter 5 – you need

to pull out your planner/Google Calendar and plan everything out.

Plan out your hours and not just your day. What hours will you read your

syllabus chapters and when will you review your lectures from last week?

If you fail to plan, you’re planning to fail.

As soon as a new course starts, you need to add every quiz, test, assignment

to your Google Calendar. Then work backwards and decide what day you

will begin officially reviewing and studying for the test.

Once you have your review time frame, plan out which and how many

lectures/flashcards/practice questions you will do each night.

If you know what you have to do every single night, you set yourself up for

success.

Stick To What Works:

We’ve all heard the saying, “If it ain’t broke, don’t fix it.” Med students fail

to listen to this piece of wisdom.

Instead, we keep trying to add new resources, try new techniques, and

setting ourselves up for failure.

Don’t get me wrong; if you are a new to medical school, you should

reevaluate your study method. It’s likely that what you did in college may not

work in med school.

But once you find a method is getting you the grades you want with the

number of hours you’re okay with, don’t touch it!

Follow your system and only change something if your results don’t fit your

goals.

Stop Listening:

No, I don’t mean permanently, but strategically stop listening to your

classmates.

Your classmates will be your best friends and your worst enemies.

Stressful medical students are the worst to be around. They will try their best

to take your composure and convince you that you also have to be stressed

out with them.

But this book will provide you a system, and once that system starts to work

for you, stop listening to your classmates.

Don’t worry about what resources they’re using, how much their studying, or

anything else.

Just avoid talking about medical school with your classmates whenever

possible. You’ll prevent the onslaught of stress which is ever present.

Here’s a well-received video on how to manage this stress of your

classmates.
 Chapter 3:
How Do You Study Best?
Learn Your Style:

This book could be straightforward and short to write if I just gave you my

study techniques. While I will provide the methods I use, I know they are not

universal for all students.

We all learn differently.

So the first step is to identify your learning style.

Below are some helpful and quick surveys to assess your learning style.

What's Your Learning Style Quiz

Vark's Questionnaire (How Do I Learn Best?)

Give them a shot. You’re likely a combination of a visual, auditory, and

tactical learner.

From here on out, think about how each study technique can relate back to

the kind of learner you are.

Since many of you may be a combination of 2 or more styles, find 1-3 study

techniques you enjoy from the upcoming chapters. Use these strategies to

put together your study plan at the end of the book.

Understanding Passive Vs. Active:

You may skim over this section and say “I already know the difference.”

But do you?

Reflect on your study method and come up with a percentage of how

much of your studying is active vs. passive.

If you’re not sure of the distinction, passive studying includes reading your

texts, rewriting your notes, listening to lectures, etc. Active studying contains

methods such as doing flashcards, practice questions, and practicing on a

whiteboard.

You may think you use the active methods, but what’s your breakdown?

Are you spending more time using the active or passive methods? An honest

med student would realize that their typical day may look like the following.

• 3-5 Hours in Lecture

• 2 Hours Reading The Syllabus

 • 1-2 Hours Reviewing

Total = 6-9 Hours

Of these 6-9 hours, only 1-2 hours are spent using active methods. That’s

only at best a third of your time using effective techniques.

We need to work on changing that number to 60-70% active. As you become

more experienced that number will only increase.

Here’s the great thing about using active methods in medical school.

Not only will your retention (short and long-term) increase, you will also

be much faster at learning the material.

All the methods in this book will be designed to spend more time on active

retention. You will not hear me say anything about passively reading the

lecture chapter or rereading your notes. Every technique is focused on

teaching you to learn the material and move on.

 Chapter 4:
How To Take Notes
Taking good notes is a skill that takes practice in medical school. When you

first begin, you’re not sure what is important to know.

Like everything else in this book, you will have your options on the methods

you choose.

Focus On Big Ideas:

I like to call the big ideas your headline. You’ll hear me come back to this a

lot in the study method section.

Here’s the typical flow of how a typical med student may take his/her notes.

Recognize detail -> jot it down -> detail #2 -> jot it down ---> detail #345 ->

jot down -> memorize lecture

This looks terrifying and does echo the drinking out of a fire hydrant analogy.

But let’s change it to this approach.

Every lecture, regardless of how terrible, will have a goal. A lecture about

HIV, for example, will aim to teach you to become informed about HIV.

But there are goals within the goals. It’s a form of inception that exists in

every single one of our lectures.

The big goal may be “understand HIV,” but the smaller goals may be the

following:

• Know the Epidemiology of HIV

• How Does the Virus Work?

• What Are The Complications?

 • How Do We Treat It?

Even within these goals, there may be smaller goals.

• Know the Epidemiology of HIV

o Which group are at higher risks?

o Who and when should we screen?

• How Does the Virus Work?

o Where in the pathway do certain treatments work?

o What are common sites of mutation?

• What Are The Complications?

o What are short-term complications?

o What are long-term complications?

o How do the symptoms relate to how the virus affects

the immune system?

• How Do We Treat It?

o What are they at risk for?

o When do we begin prophylaxis and what do we use?

This may seem rudimentary, but this is how we should approach our note

taking.
First focus on the big ideas and headlines. Then identify the major questions

the chapter is trying to answer.

Now is when you begin to add your details or your evidence. This is the

information you need to answer the goals of the lecture.

Using this approach your notes only try to answer the questions of the

lecture. This helps you avoid unnessary detail in your notes. All you should

have are big idea questions and evidence that’s necessary to answer

it.

So if you were reading this lecture about HIV, your notes would look like this.

Lecture: HIV

• What is the Epidemiology of HIV?

o Which group are at higher risks?

▪ Evidence

o Who and when should we screen?

▪ Evidence

• How Does the Virus Work?

o Evidence

o Where in the pathway do certain treatments work?

 ▪ Evidence

o What are common sites of mutation?

▪ Evidence

• What Are The Complications?

▪ Evidence

o What are short-term complications?

▪ Evidence

And so on.

Go from big headlines to your evidence and your notes will be a goldmine of

information. You can begin to see how you can quickly understand if you

know the material. “Can I answer the big ideas?” If so then you’ve mastered

that lecture with confidence.

In the following chapter, we’ll use this format to expedite our learning and

spend more time focusing on what we don’t know.

Methods To Take Notes:

Now you understand what your notes should look like, lets’ talk about the

different options you have actually to take them.

 Typing Out Your Notes:

If you want a quick way to type your notes alongside lecture, then OneNote

is for you.

Using OneNote, you can transfer your lecture slides and annotate the notes

during lecture.

Now how do we make our typed notes active from the start?

As the lecture is speaking focus on the important topics and the

headlines.

Then come up with a question they could ask regarding the important

topic.

If they’re talking about the complications of hypertension, then put “What are

the complications of hypertension” next to the corresponding slide. Then

follow this with the “evidence” which answers the questions.

This question and answer form of note taking solves a few problems.

It forces you to listen to learn and not just to hear. You’re forced to

understand the concept instead of passively regurgitating the professor’s

words.
Also, it becomes much easier to go through your notes when you review.

You can go through your slides and try to answer the question at the start of

each slide. If you can then perfect!

If not then use your notes + the material from the slides to fill the gaps in your

knowledge.

Basic Pen and Paper:

I was a huge fan of this in college, and it still works (to a point) in medical

school.

Studies do show better retention when we physically write out our notes.

But I’d argue that with the volume of info we learn in med school, that

retention is low on an initial pass of the material.

But you can still use pen and paper, especially if you’re an auditory learner

and/or tactile learner.

During lecture listen for the big ideas again and write your notes in Q&A

format similar to the previous section.

You also don’t have to write a lot. Some of the smartest classmates I know

can use this technique to distill a whole lecture into 1-2 pages of handwritten

notes.

Using Pen and Paper At the End:

If you’re not confident that a listen and write style will work for you, don’t

worry.

You can use pen and paper to create one page Q&A format outlines for the

test.

Let’s say you used the OneNote method from the previous section. When

you get to the reviewing (which we’ll talk more in detail later in the book)

break the lecture into question and answers if they’re not done so

already.Then get ready to write them out on one piece of paper.

I like to break my paper into two halves. I put the question on the left, “i.e.,

What are the risk factors for hypertension?” and the answers on the right.

Distill your whole lecture into 1-2 pages front and back of questions and

answers.
We’ll go more into detail over how to use this method in the next section. But

spoiler alert, to master a lecture, see if you can answer each written question.

Imagine how much you’re distilling the information. Each lecture can have

anywhere from 15-30+ syllabus pages. But you’ve managed to break it down

into a sheet of questions. If you have a test covering 30 lectures, this method

will leave you with only 15-30 pages (front and back) full of high-yield

questions for all your material instead of hundreds of syllabus pages.

If you can answer everything on what is essentially a study guide, then the

test will meet its match in you! :D

Using a Tablet:

This is where note taking is going, and I recommend it if it’s feasible for you.

Use apps like Notability or Goodnotes on an iPad Pro or iPad mini.

Similar to OneNote, you can transfer your slides or eBook and take notes on

it!

Once you’re happy with your notes, you can print them out and create a

personal syllabus for your test.

You can also create the Q&A notes from the previous section on your Ipad

and then print them if you like.

For the Visual Learner:

The final note-taking option I’ll give you is for those of you who love to

highlight using different colors.

I learned this from a fellow med student – make each color represents

something different.

For example, a green highlighter can mean mechanism of disease; a red

highlighter can represent treatment, and so on.

When you go through your notes, you can try to learn the treatments at the

same time. Then you focus on the mechanism and pathophysiology at once.

Since you pick your color scheme, the flexibility is endless.

Class Vs. Streaming:

I know this topic doesn’t seem like it pertains to note taking but bear with me.

Going to class vs. streaming lectures is a personal choice. But I’d advise you

(as someone who streams lectures) to ask yourself how efficient you are

when you go to class.

You may be one of those students that just needs to go to lecture. That’s

perfectly fine.

But if you get easily distracted and struggle with retention after lecture,

consider streaming.

Streaming lecture becomes more valuable when we talk about how to reduce

the time spent by half or more in Chapter 7.

If you’re not sure which works best for you, spend a week trying each. See if

there is a significant drop in retention with one vs. the other. Also see if you

can keep yourself accountable if you decide to stream lecture.

If you can stream, I’d recommend you do.

 Chapter 5:
Effective Study Methods
Let’s finally get to the nitty gritty part of this book.

You’ve learned how you study best and how to take notes, but now how the

hell do you actually study the material?

In the next few sections, I’m going to give you a variety of methods. Read

through each and see which fit your style the best.

Each method will have a similar core. They all will require you to review the

material within 24 hours of learning it, reviewing again on the weekend, and

again 1-2 times before an exam. This will assure you see all the info enough

to keep a high retention rate.

Flashcard Method:

I’m notorious for sharing this technique but thought I’d share this first for

those who may not be familiar.

My flashcard method is the reason medical school transformed for me.

I went from 8-10 hour days (including lecture) to 3-5.

The drastic change goes back to a point I made earlier in the book – my

learning became almost all active.

So here’s what you need for the flashcard method – Anki.

Anki, for the few of you who don’t know, is one of the go-to free resources in

med school.

It is a free software which helps you make flashcards and study them using

spaced repetition. Did I mention it’s free?

Using Anki, you can study your flashcards and see the cards you struggle

with more than those you master quickly.

Here’s a link to download the software. It’s also available for IOS (paid) and

Android (free).

How I Studied 3-5 Hours Every Day:

Skim The Text The Day Before (10-15 min/lecture)

To avoid spending excessive time in my syllabus, I would spend no more

than 10-15 minutes skimming a lecture.

Here’s what I’m focused on – the big ideas.

I’d focus on the title of the lecture, the headings, subheadings, figures, etc.

My goal on this skim is to know two things:

1. What Will This Lecture Be About?

2. How Will The Lecture Be Presented? What Is The Flow Of The Lecture?

Make Flashcards Night Before : (10-15 min/lecture)

Next, I’ll quickly make my flashcards for the lecture.

To expedite the process, I will open up the slides/syllabus on a PDF viewer.

I prefer PDF-Xchange Viewer (also free) because it has a built screenshot

tool. We’ll come back to this.

Then open up Anki and create a deck for the lecture.

I like to make each lecture a mini deck. First name a deck for a broad

category (Respiratory, Exam 1, Week 1 material) for example. Then make a

deck for a specific lecture. You can now drag your lecture deck and make it

a subfolder underneath your broad category.

Now it’s time to make our flashcards.

Each flashcard will be a question or big idea which can be answered by a

few slides.

For example, the first few slides may talk about the risk factors for a disease.

In the question section of Anki, type “What Are The Risk Factors For (Insert

Disease?)”

Then screenshot each entire slide which answers this question. Typically it

will be between 1-3 slides per question.

Here’s an example.

Here’s an example with where the answer section to the question “What is

the mechanism of Asthma?” has two slides which help answer the big idea.
Continue through your whole lecture and do this.

An important point to make is that you are not trying to learn the material

right now. I repeat don’t spend time learning! It should be a quick

identificaiton of the big idea and copying and pasting slides which appear

relevant.

This organizes your material into big ideas and questions. The learning will

happen soon!
By the time you’re finished, you should have anywhere from 15-25

flashcards.

Go To Lecture (1 hr/lecture)

Later in the book, I’ll go over how to use speed listening to make this method

even faster.

But for now I’m going to assume you can’t speed up your lecture and each

will take an hour.

By now you have skimmed the lecture, understand the flow, and have

flashcards grouped into big ideas.

It’s now time to open up Anki in the browser window and get ready to edit.

As the lecturer goes through the material, pay attention if they emphasize a

particular item on the slide.

You can add your own text between each screenshot of the slides.

On a similar note, if the lecture indicates something is not important to learn,

delete that slide if you included it.

As lecture is going on, you’re actively listening for what particular to know for

each slide and major topic.

Review Material (30-45 mins/lecture):

Now time for the fun part. You’ve skimmed the lecture, made flashcards

based on big ideas, and actively listened in class. You have the framework

to now learn and retain the info.

You will do all the flashcards for each lecture in one sitting. Thus make sure

you’re grouping your flashcards into big ideas. Try to avoid making one fact

flashcards. They don’t work well with this method and often lead to large

amounts of flashcards.

When you begin your studying, Anki will ask you the question or big idea you

typed. Before revealing the answer, either say out loud or write out

everything you know.

Like myself, many of my readers like to use a whiteboard or scratch paper

along with this method.

The important thing to remember, don’t spend more than 30 seconds

to a minute per card. Since there is likely more than one slide in your

answer section, it can be tricky to remember all the info in one sitting.
Instead first state anything you know on the topic then reveal the answer(s).

Now try to learn the big ideas and info the lecturer emphasized.

Once 30 seconds have passed, click “again” on Anki to have the card shown

to you in a minute. Move on to the next flashcard.

The goal is to quickly understand as much as possible per flashcard without

getting caught in the details.

For example, a flashcard about the risk factors of hypertension may have ten

items on it.

Instead of trying to remember all ten at once use this process.

1.State what you know before seeing the answer

2. Try to learn a few items on the flashcards, click “again.”

3. See the card again. Test yourself on the items you “learned.” Learn

some more. Click “again.”

4. Continue to repeat until you know all ten facts.

Using this method you can see a particular flashcard anywhere from 5-10

times before mastering it.

In a way, you are using spaced repetition in one sitting. You are learning,

self-correcting, and learning some more each time you see a specific

flashcard.

The second advantage of this technique is the ability to tie a big idea

together. Too often flashcards involve one question and a fact. But then

you’re just memorizing facts vs. connecting the ideas.

Now since you have 2-3 slides per flashcard you can understand how the

facts fit in with the big ideas. You will understand, for example, not only the

first line treatment plan but also the secondary options if they are necessary.

Go through each of your lectures for the day. You will get faster with practice.

I can currently get through a lecture in 20 minutes using this technique.

The Next Day (30-45 minutes):

You likely had flashcards you struggled with and needed to see several

times. Anki will show you these flashcards the next day.
Try to do these flashcards before the next day’s lecture. Since you’ve seen

these flashcards several times, they should be easier to get through now.

If a topic still doesn’t stick, write it down and use a supplementary resource

(review book, Youtube video, etc.) to learn it.

Reviewing For Test: Weekends

Weekends are great to review the material for each week. Too often in

medical school, we fail to review until the test gets closer.

Here is how I would recommend reviewing your material each weekend.

On Saturday spend the first half learning the material from Friday (I’m

assuming you take Friday evenings off). Then review the flashcards from

Monday and Tuesday.

On Sunday review the lectures from Wednesday and Thursday, as well as

the tough topics from Friday. On Sunday night you can make the flashcards

for Monday’s lecture.

Each iteration you go through your flashcards will be faster.

Once your quiz/test is 1-1.5 weeks away, decide how you will review each

lecture a 3rd time. For example, if the test is ten days away and will cover 27
lectures then plan to review three lectures each night. Give yourself the day

before the test to do some final review.

Three lectures per night on top of your normal study schedule may seem like

a lot. But remember by now you’ve seen the material several times. Your

classmates may be lucky if they saw the same material twice let alone 6+

times as you have.

Questions About The Flashcard Method:

It’s taking me too long to make my flashcards. Any advice?

Remember that you are not trying to learn the material when making your

flashcards. Quickly come up with a big idea or question you can ask. Then

screenshot then next 2-3 slides which seem relevant. You can always adjust

later if you realize a card doesn’t belong in that topic.

Do you do the review flashcards that Anki suggests?

Good question. Anki will continue to suggest you review old flashcards. But

using this method, we are only reviewing each lecture the day of, the next

morning, and the weekend.

So ignore Anki if it tells you that you have due review flashcards in your mini

decks.

Can You Use The Occlusion Function In Anki?

This was a question I got from a reader who was making her flashcards using

the occlusion function in Anki.

Basically if you have a picture or diagram, you can use the occlusion function

to cover each term. Anki will then make one flashcard for each term and ask

you each individually. This is a great tool for Anatomy.

For this flashcard method, however, the occlusion element adds more time

then it saves. Just focus on going from the big topic when you first learn each

flashcards and move towards the details. You won’t need the occlusion

element then.
If you’d like to watch a walkthrough video on this technique, check out this

video I made.

Outline Method:

Now perhaps flashcards aren’t for you. No worries. The next few techniques

are just as effective.

The outline method is perfect for those who love typing/writing their notes

and having something physical to learn with.

It builds on many of the active techniques which have already been

mentioned.

We’re going to flip outlines on its head using this method.

Typical outlines are often very passive techniques. Yes, you are still distilling

a lecture into a shorter summary. But too often the outline becomes a

collection of the lecture without much thought when we’re making

them.

So here’s how you do it instead.

 Forming the Base Of Your Outline:

Read your lecture and once again focus on the big ideas. As I mentioned

before, write the big ideas on the side margins. This will help make it easier

to make your outlines.

Next, make your headings the big ideas. Instead of saying Hypertension,

Risk Factors, or Treatment, you will put these in the form of questions.

Underneath your heading include what I like to call your evidence. This is the

answer to your heading. You can find this evidence in the corresponding

paragraphs which talk about the big topic.

You can also include diagrams and tables but be wary. Only include them if

you can’t quickly summarize their significance. If you can explain a graph in

your own words, then don’t include the graph.

Go through the entire lecture in a question and answer form.

Going To Lecture:

Now you should have a decent outline, but you still may not understand what

the lecture considers important.

Use lecture to understand a few things:

 1. If the lecturer wants you to focus on big ideas (headings) which

you didn’t include. Add them if so.

2. If you misunderstand the evidence for a specific heading. Readjust

where necessary.

3. If they don’t even discuss one of your big headings. Ask yourself if

you included it for completeness sake.

Time To Review:

After lecture, you have an outline which should be ready to learn from.

Having your outline in Q&A or at least heading/evidence format makes it

easy to quiz yourself.

Go through each heading and see how much info from the evidence/detail

section you know.

Since I’m a visual learner I prefer to star or highlight any evidence I don’t

remember/get correct when I’m quizzing myself.

A great way to learn the entire lecture is what I like to call my Flow

Method.
 1. Quiz yourself on heading 1 “What are the Risk Factors for

Hypertension?” Mark/highlight anything you don’t remember.

2. Repeat and master heading 1.

3. Quiz yourself on heading 2 “What is the mechanism behind

hypertension?”. Mark/highlight anything you don’t remember.

4. Master heading 2.

5. Quiz yourself on heading 1 and 2 before moving to heading 3

“What Are Complications of Hypertension?”.

6. Master heading 3 then master heading 1-3 before moving on to

heading 4 “How Do You Treat Hypertension?”.

By the end of this approach, you will see the material more than once.

I also find it keeps my studying interesting and like a game – to move onto

the next topic I have to first master everything prior.

Similar to the flashcard method, look through your outlines the next day and

focus on any headlines you struggled with. Then review your outlines once

more on Saturday and Sunday.

Increase your outline reviews as your test gets closer just like we did for the

flashcard method.
Notebook Method:

This is a technique, which shares similarities to the outline method, and

helped me do well on my clinical shelf exams.

Grab yourself a small single subject college-bound notebook. The notebook

will be your one-stop shop for the test.

Here’s how it works.

On the left half of the page, you will put your big idea or question. On the

right side, you will include your answers, diagrams, flowcharts, etc.

On the left margin of the page include the lecture name.

Here is an example from my Ob-Gyn rotation.

It’s okay if you don’t understand my notes. The important part is to be able

to understand your own when you make your notebook.

This method continues to keep your material in a proactive manner. But it

also keeps the info in one place.

If you are a student who, like me, gets distracted on your computer, tablet,

or phone then this may be the technique for you.

Take your notes in Q&A format and include material from the text and lecture

like previous sections. Then find a quiet environment (ex. Library) and take

just your notebook.

I recommend using the Flow method I mentioned in the outline section.

Learn and Master the material from lecture 1 -> learn and master lecture 2 -

> master lecture 1 and 2 -> learn lecture 3 -> master lecture 1,2, and 3

Each time you review a lecture, you will be able to go through it faster. Mark

the topics you struggle with to avoid skipping over them in future reviews.

Continue to use my next day, weekend, and pre-test review structure to

prepare for your exams.

By the time the test comes around you will be able to go through several

pages of your notebook in one sitting. It’d be safe to say that if you know
your notebook of high-yield Q&A’s cold, then you will be set for the

exam.

Notebook Method Version 2.0:

This following notebook is inspired by the notebook method but with a little

twist.

Instead of using an actual notebook, have a blank piece of paper or papers

for each major category.

For example, let’s imagine you were in your Internal Medicine rotation as a

third-year student. You’ll be expected to know some cardiology,

pulmonology, GI, renal, etc. Using the Notebook method for so many

subcategories can be tricky.

So instead use a sheet or a few sheets within each category. For example,

if the chapter you were reading about was about cardiology, add those Q&A

to your cardio sheet. If you then transition to a renal chapter, add the new

info to your renal sheet.

If you struggle with any of your flashcards, practice questions, or miss

questions on a quiz, add these topics to the sheet that best fits.
When it’s time to review for the test, you should have sheets and sheets of

just questions and answers. More importantly, it should be a list of questions

you think to be important or got wrong on a quiz or flashcard.

Now learn those sheets of paper. Can you master the cardio section? How

about the GI section?

You will identify categories which you struggle with. Arrange your studying

to focus on these areas primarily. Add in a strong category for confidence.

An example study session may look like the following:

• 4-5:30 PM: Go through Cardio Q&A sheet (Your Difficult Topic) and

answer all the questions correctly

• 5:30-6: Break

• 6-7: Work on Pulmonology questions (Your Confidence Topic) and

answer all questions

You are training yourself to learn in Q&A format. Thus there’s no getting

around the fact of not knowing what the answer is. Either you know it, or you

don’t.
It’s much easier to identify our weaknesses if our study method allows us to

humble ourselves routinely.

Step 1 Focused Method:

This last method is more fluid than the previous suggestions. It will serve you

well if all you (and your school) want to focus on is Step 1.

How does this method work? It’s designed around using two sources of pre-

made questions.

The first involves using premade practice questions. You’ll agree with me

that practice questions are important. But as I mentioned earlier, we spend

too little time doing them. In fact, we don’t do practice questions until the test

gets closer.

We begin to think about using practice questions once we knew everything.

But it may be too late for those of us who realize we didn’t retain anything

during our “studying.”

If you use any of the methods I’ve suggested above, then you are effectively

quizzing yourself to learn the material.

But we can add a more sophisticated way of learning.

Two additional resources I recommend you add to your study plan are

practice questions and premade flashcards.

First, let’s focus on the practice questions. I recommend buying the USMLE-

Rx question bank. This is made by the creators of First Aid, a resource you’ll

become very familiar with. Thus the practice questions are testing you on

First Aid material.

I’ll give a clearer insight of how to use practice questions at the end of this

chapter.

The next resource that is a must have are the Brosencephalon Anki cards.

For Step 1 these 16,000 flashcards include material from both First Aid and

Pathoma. Essentially, if you know these flashcards, you will kill Step 1.

If you choose, these two resources can supplement your courses. But you

can also use them as your primary source of learning. Here’s how.

Every day do just 50-100 flashcards corresponding to the course you’re

currently taking. This may seem like a lot, but the Bros flashcards take

seconds to answer. Here’s an example.

Even if you did 50-100 flashcards for 5-9 months of the year, you would be

able to finish the deck well in time for your Step 1 exam.

If there is a flashcard which doesn’t make sense individually, then open up

your First Aid to understand how that info fits into the big picture.

Also, every day do 20-40 questions from USMLE-Rx.

Yes, I know you may do poorly the first time around. But don’t focus too much

on the score. Instead, do your best on each question and then focus a

majority of your time on the explanations. Understand why the correct

answer is right and why the wrong answers aren’t.

To truly retain this material for a class or Step 1, I recommend making

flashcards or using the notebook method on material you missed or

don’t understand well. Review these (ie. 20 flashcards/day or 2 pages

of notes) every day before learning your new material.

This method is designed for someone whose school teaches to the exam.

Thus there likely won’t be much discrepancy between material taught in

lecture vs. your flashcards/practice questions.

If your school, like mine, doesn’t teach to Step 1, then focus on your class

material first. You can spend 10-20% of your time using Bros flashcards to

give yourself more time to learn lecture material.

I’d still recommend keeping a hefty dose of practice questions in your study

schedule. You can do 20 questions every other day and more on the

weekends if you have time. As the test approaches, increase your frequency

to assess how well you’ve retained the high-yield info.

Using the Anki Deck with the Qbanks will make you much more prepared

when it’s time to study for Step 1!

Hopefully, this chapter painted studying in medical school in a new light.

Going to class, taking notes, and “reviewing” your notes is too broad. These

techniques were designed to go from start to finish spending a majority of

your time using active methods.

 Chapter 6:
How To Do Well on Tests
You’ve put in the work, and you’re ready to kill the exam. But how do we

avoid getting owned by the exam?

This section will be all about the strategy and psychology to approach your

exams.

It’s All About Connecting Ideas:

This section will piggyback on the previous chapter. Make sure to work on

connecting your ideas.

In the next chapter, I’ll teach you how to use my brain dump technique to

master connections.

Here’s why this is important. Your exam may ask you a give me a question,

but everyone in your class is likely to get that question.

Where you separate yourself from your classmates is being able to answer

questions which require you to make connections.

This may be connections within a lecture or connection between two

separate lectures.

For example, you may be given the following vignette:

68-year-old man is brought to ED by his wife because he appears confused.

Yada Yada. His blood pressure comes back 80/50, and he is afebrile.

Which of the following would you expect from a heart cath? (PCWP, SVP,

CO)

Keep in mind that this question may have been a long paragraph with loads

of distractor. While reading the paragraph you may have been thinking the

patient was hypovolemic, but you didn’t expect a heart cath question.

This is what I mean to connect ideas. This patient could have easily been

septic with the low blood pressure, but his lack of an abnormal temperature

makes hypovolemia more likely. Do you know how to differentiate between

the two?

Then once you know what the patient has, can you relate that to their heart

cath findings?
It’s okay if you’re early along in your medical journey if the vignette didn’t

make sense. Just know that you shouldn’t be satisfied with just

knowing fact and answer. This is why I ask you to make your notes,

flashcards, and outlines in question/big idea and answer/evidence format.

Use The Question/Answers/Stem Format:

Medical school exams can be long. If you haven’t taken Step 1 or Step 2 the

biggest issue (aside from the information) is timing.

Why do so many med students struggle? It’s because they fall into the trap.

They go from vignette to question to answers.

This wastes too much time. Because the most annoying thing is when the

last line of the paragraph is all you have to read to answer the question.

So give me the permission to geek out again. I hate finishing an exam right

when the time is running out. In fact, I typically finish most of my exams (even

Step 1) with 5-10 minutes left.

How?

Go from quesiton -> answer -> stem.

Read the question and find out what is being asked. Going back to my

example vignette, you immediately find out that the question is about heart

cath findings.

You know the question will be about someone with some form of shock

(hypovolemia, septic, cardiogenic, etc.).

Then look at your answer choices. In our vignette you’ll the answers will be

the different cath findings (cardiac output, SVP, PCWP) and will likely say

increased or decreased.

Other times the choices will be a list of diseases, treatments, imaging, etc.

Once you know what the question is asking and what the options are, now

look for the evidence.

In our vignette, you would go back to the stem and quickly identify which type

of shock the patient has. If you know shock well you know vitals are the most

important so you’d go there first. That may be all you need.

But hopefully, you get the idea. Find out what is being asked and what the

options are. Then find your evidence.

As you go back through the stem, you will be able to rule out answer choices

immediately.

This will save you so much time.

It will also likely help your grades. How? You’re less likely to fall for the traps

that your professors and test writers put out for you. They’re not expecting

you to use the question -> answer -> stem flow. Instead, they know a med

student may latch on to one piece of information and come biased towards

one question.

Learn The Important Of Question Banks:

I mentioned question banks in the Step 1 focused study method from the

previous chapter. But I recommend Qbanks for everyone.

My favorite question bank for your first two years of medical school is

USMLE-Rx. The questions are made by the same creators of First Aid. Using

these questions will help you master First Aid for Step 1 before you ever

begin your dedicated prep.

But use whatever question bank you want. I recommend against UWORLD

until you begin your Step 1 prep, but Kaplan, OnlineMedEd, Firecracker, etc.

are all great options.

Question banks will serve two purposes. One they will get you comfortable

with reading board like questions. They also help you evaluate how well you

know the material outside the comfort of your class syllabus.

It’s About Earning Not Losing Points

Let’s get to the psychology of testing. As I mentioned before, med school

exams can be hard. Thus it’s easy to get down on yourself. You may not

always make A’s on your exams like you’re used to doing.

But this is why most medical students get down and anxious when it comes

to tests. Yes, it can be difficult when your results don’t match your effort. But

we also don’t look at the tests the right way.

When do you perceive a test as hard? It’s typically when you have a group

of difficult questions which occupy your focus. You may have a 30 question

test which feels difficult due to 7-8 hard ones. But we don’t focus on the 20+

that we knew well.

So let’s flip the typical mindset of exam taking. Instead of seeing each

question as a potential to lose points, view them as opportunities to score

higher.

I used this method during my Step 2 exam, and it worked wonders. I knew

there were going to be tons of WTF questions, but I didn’t give them much

attention. Instead, I smiled when I saw the questions I could answer. Thus

the test was filled with questions I knew instead of the bulk which gives

every student trouble.

Use this approach throughout med school, and you will just see things,

including test, differently.

 Part Two: Speeding Up The Process

Hope you found something in the previous section which makes you say, “I

want to try that.”

But I’m sure this book isn’t your first exposure to a variety of study

techniques. Unfortunately, this is where many books stop.

But there is usually one question they never answer. How do you make your

selected method as efficient and effective as possible?

The next few chapters of the book will be all about teaching you techniques

which maximize your retention and minimize your time. This will include a

mixture of study tips and time management tools I’ve used to decrease my

studying in half.

This is my favorite part of the book. So again I apologize if my writing reveals

my inner productivity geek.

Let’s get started.

 Chapter 7:
Increase Your Retention
The Brain Dump:

Probably not my finest name for a technique but it’s one of the most effective.

This technique is something I learned early in college and was made famous

by award-winning physicist, Richard Feynman. Feynman was notorious for

learning difficult topics exceptionally fast.

He shared his approach and revealed he actively sought out gaps in his

knowledge. Here are the two ways he did so.

The Feynman technique which bears his name is a practice a mental vomit.

Take any topic you want to improve on and write/speak out everything you

know about it.

To illustrate this, let’s continue on our hypertension example. You may start

out great with the risk factors, but you may get stumped when you try to

explain the mechanism. This is a gap in your knowledge.

As you continue, you’ll find more gaps in your knowledge. You will also find

things you remember verbatim from the text or lecture, but you don’t

understand them.

So here is how you use my well-named brain dump.

Let’s say you’re reviewing a lecture as an exam approaches. Review your

flashcards, outlines, or notes. Then grab a blank piece of paper.

On this paper write out as much as you can about the lecture topic.

Don’t focus on making this look pretty or writing in full sentences. You’re

more focused on identifying areas where you don’t know how to get from

point A to point C.

You may start out scribbling the risk factors for hypertension. You manage

to get 3-4, but you know that there were a few more from the lecture. Since

this is a gap in your knowledge, put a star. We’ll come back to it.

Continue through the entire lecture. By the end, you’re likely going to have a

lot of stars. This is typical during our first review pass. We often convince

ourselves that we know more than we do. The brain dump is a slap back to

the reality of how much work we have left to do.

Now go back to your notes or flashcards and try to fill in the gaps you’ve

found on your brain dump. Write out next to the star what that missing piece

of information was.

Then grab another piece of paper (or the back of the first one) and do it all

over again. You’re likely to make fewer mistakes. But there will still be stars

and often new stars. Do a few iterations of the brain dump (each time being

faster than before) until there are very few gaps left.

A few notes to help you on your brain dump. Make sure you’re not writing in

full sentences or even full words. You can abbreviate, scribble, etc. This

whole technique is about finding gaps not creating another written outlines.

You know you’ve done an effective brain dump if you can’t read what you

wrote by the end. Just use the stars to identify what areas you need to review

on.

The second point to remember is act like you’re teaching a high school or

college student. This is important especially on your 1st and 2nd pass. This

helps identify any information we’ve memorized vs. truly understand.

The final point is the brain dump doesn’t have to be done on paper. Since

I’m a visual learner, I find staring my “gaps” highlights how much I have left

to learn.

But you can do the brain dump in a verbal form. Try to speak out the key

concepts of a lecture. If you get stuck, jot down the topic and move on.

Review the missing info and try again.

You can also use a whiteboard - a technique many of my readers love to

share with me.

The Brain Dump is something you can do by yourself or even with

classmates. Ask each other to teach a lecture in 5-10 minutes. Focus on the

areas you to start to struggle.

Where you use the brain dump is up to you. You can apply to every lecture

or particular lectures with a lot of info or difficulty. I recommend using this

technique during your final review for an exam.

This practice of actively looking for your weak points will make you much

more prepared and confident for the exam.

Memory Palace:

Ever wonder how memory champions can memorize decks of cards in order

in just minutes?

What if I told you that these champions are no geniuses. You and I can both

do what they do with a little practice.

In fact, I challenge myself to learn a deck of cards in under 10 minutes and

was able to do it in less than a week.

My first real exposure to the memory palace was through a TedTalk by the

author of Moonwalking with Einstein Joshua Foer. He went from covering the

memory championships as a journalist to winning it a year later.

What’s the secret? It’s based on a technique known as the memory palace.

You may have heard about the memory palace before. And like me, you may

not have given it much attention. You can’t use such a technique in medical

school, can you?

It can actually be quite effective.

Here’s how the memory palace works.

Pick a place or path you know well. This will be your memory palace. This

can be your living room or your drive to school.

Now think of big items on this path. For example, this may be your door,

couch, TV, and an art piece in your living room. On your path to school, you

may note a restaurant, a prominent billboard, etc.

Let’s stick to the living room example. Imagine yourself taking a

predetermined walk in your living room. For me I imagine opening my door,

seeing my couch, and then turning to see my TV. Just create a mental movie

how you’ll walk through your memory palace.

Now it’s time to add in the items we need to remember. Let’s use three drugs

that we may have to remember.

• Pilocarpine – Drug for Glaucoma

• Tiotropium – COPD

• Benzotropine – Parkinsons

The next part is where the fun begins with the memory palace. Think of a

funny image for each drug.

Pilocarpine makes me think of a pile of cars. Since it treats glaucoma, I’ll

imagine a person looking at the scene with big filled (about to explode) eyes

as they notice all these cars. I’m sure your image will be much better.

Tiotropium can be represented by a Spanish uncle (tio) with a tropical shirt

(for the tropium) whose smoking and coughing (COPD).

Finally, Benzotropine instantly makes me think of a Mercedes. I would

imagine Michael J Fox (Parkinson's) riding inside with a tropical shirt

(tropine).

Now time to put them together. If we were to go through the palace we

created before (door, couch, TV) this is how it would look like.
 1. Open the door and see a pile of cars with some stranger with near

exploding eyes (Pilocarpine)

2. My couch has a some uncle with a tropical shirt who is smoking and

coughing (Tiotropium)

3. Then I look at my TV and see a commercial with Michael J Fox wearing

a tropical shirt in a Mercedes. (Benzotropine)

Yes, this is silly, but you can’t deny the images are vivid, and the learning is

quick.

The memory palace is effective for anything which involves a sequence or a

list of items. You can use it to remember the steps how electrolyte transport

through the kidneys (give each step a fun image) or a list of drugs in the

same class.

You have to be creative and spend some initial time creating your palace

and images. But then the images stick with you forever. That image of

pilocarpine was made two years ago- I still remember it.

Group Studying:

This is a tricky one because group studying is often misused. They begin

with the good intention of learning with your peers. But they turn into social

hours and distractions.

Here’s is how you can approach group studying and keep them effective.

First, find a group of peers just as smart if not smarter than you. Make sure

they are dedicated, dependable, and don’t wear their stress of their sleeves.

If don’t meet this checklist they’re likely going to cause a strain on your

studying.

Once you find your peers, come up with a schedule together. I’d recommend

against doing it every day. You first need to come up with a basic

understanding of yourself. But a meetup 2-3 times a week is reasonable.

A great way to use your group studying session is to make them into a Q&A

session. If use my approach to take your notes and flashcards in a Q&A

format, this will easy for you. Ask your classmates these questions and see

how well they know their stuff.

When you’re asked a question see how well you can do. Did you find yourself

getting stumped? Did you miss anything important in your notes that you

should have added? These session can be a great way to identify these

missing items.

Your group sessions will also help distill complicated material into easier to

understand bits of info.

A word to the wise. I know some groups assign a student to teach a specific

lecture to the rest of the group. I’d advise against this. You do well on the

lecture you teach but realize your classmate may not have done a good

enough job. The test is a bad place to learn this. So make sure to learn

everything yourself first and use the group to test yourself.

 Chapter 8:
How To Speed Up The Process
Speed Listening:

If there is a technique which I know might scare you but beg for you to try

out, it would be speed listening.

Many medical schools are or have been offering recordings of their lectures.

But why listen to a lecture for an hour if you can do it in half the time (or even

less?)

I recommend trying to listen to your lectures at 2x if not faster.

Whenever I bring this up with my peers there is at least one student who

rebutted with “I can’t listen to a lecture that fast.”

If you’re one of those students, I promise you that your brain, which is likely

smarter than mine, is capable of listening to a lecture at 2.5x at least.

It simply requires practice for our brain to become comfortable with the

speed. But just like typing and reading speed, our listening abilities can also

be sharpened.

So here is how you use speed listening to your advantage.

If the platform your school records their lecture can speed up lectures, then

use that.

But in case your streaming service doesn’t allow accelerated listening (or

speed it up enough), here are some options.

Google Chrome provides several free extensions which can speed up

HMTL5 videos. This is typically the format of Youtube videos, Netflix, and

often lectures.

My favorite extension is Video Speed Controller. With just a push of your

keyboard, you can accelerate the video by 0.1x at a time.

If you have downloaded lectures on your PC, then VLC player allows you to

speed up videos by using the “+” and “-“ buttons by 0.5x increments. You

can change the increments for your preferences.

If you listen to audio lectures on your phone or iPad, Audiopo is a free app

(IOS and Android) which allows you to speed up your audio as well.

How Fast Should You Listen?

The common approach is to listen only to your comfort level. But I’m not a

believer in this method, especially if you want to be able to listen to a lecture

a 2.7-3x (this is currently my listening speed).

Just like lifting the same weight every week won’t make you stronger,

listening to the same speed will keep your brain comfortable with the specific

speed.

This is probably why you may think you can’t listen faster than 1.5-2x. You

haven’t trained your brain enough.

To reap the benefits of speed listening. Try listening at 0.25x faster than you

are comfortable with. If you miss something, pause the lecture and go back.

That’s why streaming lecture is such a plus.

After just a week of doing this, you will notice that your new speed will your

new comfort level. You can continue to push this limit at 0.25-0.5x a week at

a time. I wouldn’t recommend going past 3x if you make it that far.

Now, what are the benefits? I’m sure you understand that time is an obvious

one. But here is the how dramatic the change can be.

Let’s assume you have 3 hours of lecture each day (a typical amount at most

schools). If you go to class or listen to a lecture at 1x, you’ll spend 3 hours.

You, unfortunately, won’t retain 3 hours worth. You’d be lucky if you retain

1.5 hours worth of material.

Now if you listened to those same lectures at 2x, you’ve spent 1.5 hours of

total listening time. Yes, there will be incomplete retention but that doesn’t

mean you will retain half because you spent half the time listening. It is not a

linear relationship between listening time (of the same material) and

retention.

Over a span of a week, you’ve saved yourself 7.5 hours by listening at 2x! If

you trained your brain to listen at 2.5x (a respectable speed), you’d save

yourself 9 hours! That’s a full night of sleep!

If you are not an auditory learner, speed listening will allow you the freedom

to spend more of your study time on a method which works for you.

I recommend speed listening to all my readers. Even if you think it’s not for

you, try it for a week and see the difference in your study and free time.
A few points to remember regarding speed listening. It is critical that you limit

distractions. Don’t open up tabs for social media on your browser. Put your

phone on silence and out of sight. Have your note-taking method out and

ready.

You want to commit to actively listening if you’re going to commit to listening

faster. This also means knowing when to pause and going back if you missed

something.

Speed listening with the flashcard method from Chapter 5 helped me

decrease my studying to 3 hours (1.2 hours at 2.5x and 1.8 hours of

studying/making flashcard).

Forget about 3 hours. Imagine what you could do if your study plan could be

just 5 hours a day including your lectures! You could wake up at 9 AM and

be done by one every day!

Hope this advice was an eye-opening tip for you. Even if you do speed

listening, there is a good chance that you have even more room for

improvement.
Post-It Method:

Let’s face it; we prefer easy over hard. Thus we much rather review the topics

we do well on or struggle with slightly. But those lectures where everything

went over our heads, we avoid them like the plague.

Here’s a great method I found to not only focus on these topics but make it

easier to face. All you need are post-its and your notes.

Think of the 1-5 facts that you, regardless of how hard you try, can’t manage

to remember. Write these on the post-its.

Put these post-its on the front page of your notes. You can also put them on

your wall if you please.

Every day, find 10 minutes and just focus on learning just the post-its for 3-

4 lectures. Once you finish all the lectures, go back and do them again. If

you put them on a wall, do a few post-its every morning or before bed.

Just seeing this information repeatedly will make you much more

comfortable. This technique allows you to focus on the thought material likely

to cause anxiety on the test.

Waking Up Early:

How does waking up early have anything to do with studying?

Let me tell you a quick story which transformed my academic journey.

As part of my blog, TheMDJourney.com I began with a mixture of med school

tips and personal 20-day challenges. One of the challenges was to wake up

4:30 AM for 20 straight days.

Why 4:30? I’m just crazy. But here’s what happened. I absolutely loved what

waking up early did for me! Yes, I didn’t want to get out of bed, but once I

started – watch out!

Waking up at 4:30 allowed me almost all of my work before the first lecture

stream went live. By 12 PM I was done with all my work and had the rest of

the day to myself!

Do you need to wake up at 4:30? Absolutely not!

I’d recommend trying to wake up an hour early every day. Then use that

extra hour to do the most enjoyable part of your studying. Sure you may not

enjoy studying, but you may hate flashcard the least. Use this time to get

your flashcards done.

You become much more productive if you can get some work done before

your day starts.

You may not want to give this piece of advice much consideration. But try it

for 2-3 days in a row. Just pay attention to how much you get done and how

much free time you have at the end of the day!

 Chapter 9:
How To Maintain Your Energy
Studying is draining. There’s not much getting around it. But being a tired

day in and day out leads to procrastination, fatigue, and burnout.

This section will aim to give you some tips to avoid overdoing it. The next

few tips will be focusing on how to maximizing your energy, focus, and

motivation.

Pomodoro Technique:

The first technique you should add to your studying technique is the

Pomodoro technique.

If you’re unfamiliar, the Pomodoro technique is just a set timing of when to

study and take your break. The most popular splits are 25/5 and 50/10

minutes of studying and break respectively.

Too often students will try to study as much as possible in one sitting. This

lead to burnout and a decrease in motivation over time.

To avoid this use predesignated study and break intervals. The split you

choose is entirely up to you but give yourself routine 5-10 minute breaks.

Here’s a link to an online Pomodoro timer.

Anti-Distraction Apps:

The two most common distractors from effective studying are our phones

and social media. Luckily there’s an app for that.

One that I would recommend is the StayFocused app. This is available for

Android and can also be added to your Chrome browser.

The app has several great features. First, it allows you to pick restrict access

to apps/websites when you’re studying. (We can all live without Instagram

and Facebook for a few hours)

It also allows you to set restricted times of the day and total use time limits

on your apps. This will work wonders in making sure you’re as focused as

possible during your studying.

There are many alternatives for both IOS and Android you can use.

Even if you install an anti-distraction app, put your phone on silence and put

it in another room or away inside your backpack. Staying focused on your

studying can easily cut half an hour to an hour of studying time. That’s plenty

of free time to do whatever your heart pleases afterward.

Reward Reading:

Reading lectures was always a drag for me. Even with my skimming

technique, I mentioned earlier, the motivation to read several 20-30 page

lectures is always low.

A technique I love to spice up your reading is adding a reward throughout

the pages. Small pieces of candy is a common one I’ve seen. You get each

reward as you make your way through the page or lecture.

If candy doesn’t intrigue you (I don’t believe you), you can also reward

yourself with phone usage halfway through each lecture. Keep yourself to <5

minutes of usage, but this reward may be enough for some of you to keep

on going.

Give Yourself A Cut Off Time:

Medical school is a 4-year job. But unlike other jobs, no one will tell you to

stop working and clock out.

So you must have a clock out time that you set yourself.
This can be 5 PM, 7 PM, 10 PM, or whatever works best for you. Don’t give

yourself free reigns.

This is effective for those of you who have families and significant others

which require your attention.

While you may initially feel guilty for not doing more, you will preserve your

energy to work again tomorrow.

Know when to call it a day.

 Chapter 10:
How to Study for Specific Courses
I’ve been deliberate to mention that there is no one right way to study. Not

only does one technique not work for every student, one technique may not

work for every class.

In this chapter, we will go over how to approach studying for the unique

courses in medical school.

Yes, they’re all unique in their own way. But some tend to give students a

harder time. Often the difficulty comes from the frustration of one study

method not working universally throughout medical school. While I do

believe the study methods we discussed throughout the book are quite

flexible, these following classes may require your study method to become

more focused.

We will split our classes into two main categories: memorization heavy and

process heavy. The heavy memorization category is easy to understand.

The heavy process classes are your biochemistry, cell bio, physiology, and
others which require a good understanding of how everything works together

as a unit.

Let’s get started.

Memorization Heavy Courses:

Anatomy:

I know when I began medical school, anatomy was the course I was the most

nervous about. I had never done anything like it before. Now I was supposed

to somehow remember hundreds (if not thousands) of muscles, nerves,

vessels, and bones?

But when all was said and done, it was by far my favorite course during my

first year. So much so that I’m going back during my last year of medical

school to become a tutor.

It was also my best class grades wise. I did well enough on my first three

exams to require a ‘0’ on my final test to pass the course (my school is

pass/fail for the first two years)!

To help you succeed in anatomy, I want to give the breakdown of how I

approach the course. This will lay out a nice step by step plan from dissection

to exam on how to study.

Before Dissection:

Read the dissection instructions your school provides and begin forming a

mental picture of what your dissection will look like.

Try to imagine where you expect things to be relative to other major

structures. This is your first time encountering much of this anatomy so don’t

be concerned if your mental picture is off. Just start to form one.

I recommend having an online or text resource along with your class

syllabus. Most students prefer to use Netter’s Anatomy as a physical

resource. If you prefer an online resource, I recommend AnatomyZone.com

will work wonders. They’re great videos depicting 3D illustrations of high-

yield anatomy.

Use your online or text resource and read through the section relevant to that

dissection. For example, if you’re going to dissecting out the cranial nerves,

read about what each one is, where they come from and go to, and what

they do.
Again this is a lot of information but learn as much as you can.

Go To Anatomy Lab:

Participate actively in the dissection. Use this experience to evaluate how

close your mental image was to the real thing. You were likely off in some

regard.

Also, without being obnoxious, try to teach your tank mates what you’ve

learned in your prereading. They will agree with you where you’re right,

correct you when you’re wrong and will create a learning-centered

experience.

Once you finish the dissection, it’s likely you had a mental picture of the

dissection which was incorrect in some aspects. Now you’ve learned from

your mistakes and have a more solid mental image.

Review Your Dissection:

Once you go home review your online or supplemental text and see how

things start to stick.

This time try to walk through what each structure is verbally. If you dissected

out a lot of various muscles, practice labeling them out on a picture. Say out
loud what it’s arterial and venous supply is. What nerve innervates that

muscle? Continue this practice of active learning.

Prepping For Exam:

Before an exam, create a list of structure you’ve identified during each

dissection.

Find time the week before the test to go the anatomy lab 3-5 times. I know

this may seem like a lot, but it works wonders compared to frantically trying

to study the weekend before (along with everyone else).

When you’re in lab, spend 1-2 hours finding the structures on your cadaver

and if possible another group’s.

If you’re being tested on 12 dissections, then split each lab visit to cover 3-4

dissections - Monday you can cover dissection 1-4, Wednesday would be

dissection 5-9, and so on.

To speed up the process, focus on your weak points. If you can point to the

structures of the heart, great – now move on to the lungs!

During your last study session, go 1-2 classmates and quiz each other. If

they know something you don’t then be grateful, you’re learning it now. Drop

some of your knowledge on them too as well!

As you’re going through the week keep looking back at that list of structures

you’ve identified. You can practice imagining how a test would label that

structure. You don’t even need to be in the anatomy lab to do this!

With this approach, I aced every single anatomy test I took. I loved the class

and never felt like I was studying hours at the very end just to sneak by with

a pass. Hope you can have similar if not better results!

Prepping For the Written Portion:

Most anatomy tests will involve an identification practical portion where you

go into the lab and identify structures on the cadavers. There is usually also

a multiple choice exam which tests your understanding of how things work

together.

For example, you may get asked a question about a brachial plexus

(complex nerve bundle in your upper extremities) injury and what deficits the

patient may have. Just identifying a muscle doesn’t help you much.
So how do you approach these questions? Start to connect ideas like we’ve

talked about in the previous section. Don’t just be satisfied with saying, “Oh

this is the name of this muscle.” No! Instead, begin to connect ideas when

you’re identifying structures.

This would look something like this, “Oh this is the supraspinatus muscle

which is part of the rotator cuff. It’s innervated by the suprascapular nerve.

That comes from.. umm.. C5 and C6 of the brachial plexus. So if a patient

had issues with C5 and C6, they would have issues using their supraspinatus

and abducting their shoulder.”

Do you notice the difference? We’re not simplying playing “What’s Waldo”

in the anatomy lab. Get in the habit of asking “Who’s, What Happens To, and

Why Waldo.” Enough with the Waldo references.

Hopefully, this will help you form a better approach for anatomy. It’s a

fantastic class and having a solid method will keep the course enjoyable for

you!

Pharmacology and Microbiology:

These courses were the worst! So many terms to remember. It also doesn’t

help that many of them sound alike.

Unlike anatomy, there’s no lab you can go into to practice your identification

and memorization skills. These courses will require a different approach.

What do most medical students do? They first write the different drugs and

bug with all the pertinent info down. Then they try to memorize it. No wonder

so many students hate these courses during their first year.

But you’re not like any medical student. You will approach this courses with

the intention to retain info long term. This will serve you well when you have

to study for Step 1.

Remember the memory palace technique we talked about earlier? Pharm

and micro are two great classes to use that technique in.

Now you don’t even have to create full-on palaces; funny images will serve

you well.

Instead of thinking of each drug or bug as a list of info, view them as a

collective silly image. Each component of the image will represent an

important feature of that drug or bug.

Sketchy Medical:
You can do this by yourself or with a paid resource. Almost every student I

know uses Sketchy Micro and Pharm. These are a collection of videos which

do exactly what we just talked about – they create long-lasting silly images.

This is an image of Staph Aureus.

The videos are overall short and to the point. They average between 10-20

minutes, and they’re fantastic! I’d highly recommend Sketchy Micro and

Pharm for anyone during their pharmacology and microbiology courses.

A great way to use these resources is to time the video topics a day before

when you cover them in lecture. So if you were learning about E.Coli in class

tomorrow, watch the relevant video the day before. Then piece together the
mental image Sketchy Micro helped you create with what you learned in

class.

Sketchy Medical (the parent company) has also released workbooks to test

yourself on how well you memorize the content in the videos. This is great if

you desire a physical product.

Picmonic:

Another similar resource to Sketchy is Picmonic. It’s a resource which has

been around for much longer, and many students rave about it.

The biggest difference between the two are Picmonic video’s are much

shorter. Often they’re broken down into mini-topics.

Picmonic also includes quizzes after you watch a video to assess how much

you’ve retained.
Another great feature of Picmonic is the ability to create a playlist. Let’s say

you were going to learn about a few classes of organisms. You can then add

these organisms to your playlist for that week and start to watch them before

class. Since they’re so short, it becomes much easier to go back and watch

them several times.

TheMDJourney does have a partnership with Picmonic which provides my

readers a discount on the service. Here’s the link to a 20% discount if

you’re interested.

Pathology:

To be honest, I hated pathology during medical school. I found looking at

diseased organs or microscope slides to be futile in my ability to understand

what was going on. It took a while, but sure enough, like physiology, it wore

me down until I enjoyed it.

There are also a few resources which I thank for converting me into a

pathology buff. First and foremost is Pathoma. I mentioned this resource

already in my Brosencehpalon section.

Pathoma is a resource which includes text and videos. The videos, I would

argue, is where most of the value is. To truly be able to understand a disease
process and why it results in specific symptoms is key. This is where you

transition from memory king to future clinician. These videos are great tools

for walking you through step-by-step the high-yield pathology of a disease.

During your organ system blocks and your pathology section, watch a

Pathoma video every other night. If you know you’ll be learning about

vasculitis in lecture tomorrow, watch the corresponding video the night

before.

If you master pathology by learning Pathoma and using the corresponding

Brosencephalon flashcards, Step 1 will be a walk in the park for you!

If you enjoy Pathoma but can’t always find time to sit in front of a computer

screen, I’ve got you covered. The second resource I loved for pathology was

Golijan’s Pathology audio lectures.

Dr. Goljan provided these great pathology lectures to his medical school

classes, and someone was smart enough to record them. Won’t have to look

hard to find these recordings and I’m sure you’ll enjoy his Long Island accent

giving you high-yield information. I attribute my Step 1 success on my weaker

areas (ex. Reproductive Pathology) to him!

Process Heavy:

As mentioned in the intro to this chapter, process heavy refers to your

physiology, biochemistry, cardiology, and other courses which require a

good understanding of how things work together.

I’ll recommend resources for each that students find helpful.

Physiology:

It’s funny because I hated this class in college but love it in medical school.

Perhaps it’s because I can finally appreciate its importance. Regardless

physiology will require a different approach than anatomy. Memorization only

gets you so far.

For physiology, you will need a keen ability to walk through cause and effect

patterns. What causes hypernatremia. How do you explain different forms?

Why do the treatments for hyperkalemia work the way they do? These are

important to understanding the final treatment a patient receives.

Learning physiology depends on how your school teaches. If there is a

specific physiology course, I recommend buying a copy of BRS physiology

and making this your physiology bible.

If your school teaches like mine, then the relevant physiology will be

discussed at each organ system block. Similarly, use BRS to learn the

specific physiology portions as they come up. Perform the question bank at

the end of each section to see if you’re truly mastered the material. If you

don’t score > 90%, go back and reread it.

If you manage to truly drill in physiology, learning difficult topics like

Cardiology, Renal, Neurology, and Pharmacology will become similar.

Studying for Step 1 will also become that much easier.

Biochemistry:

This course gives many medical students (even biochem majors) a tough

time.

There is simply a lot that can go wrong in the human body. It feels like we’re

expected to know too much.

This is not a course where I found a particularly great resource to share with

you. But I’d suggest having an old copy of First Aid for Step 1 around.

Honestly, all the biochem you’re expected to know (and it’s still a lot) is in

that book.
But this is how you approach the course. Like everything else I’ve mentioned

in this book, you go from big idea to small details.

When you’re learning about the Krebs Cycle, and Oxidative Phosphorylation

don’t immediately go into trying to memorize each step. First, ask the

following questions:

• Why is this system necessary in the body?

• What are common diseases that present when something goes wrong

(First Aid is a great resource)

• Where is it happening in the cell?

• What are the start and end product?

This provides you a good understanding of why something is necessary.

Next start to view your biochemical pathways like a subway system.

There are often many different paths to get to the same place. This means

there is also a lot of potential for something to happen.

Now just like a subway system, what happens when a specific path closes

down? You take another route! It’s the same idea in Biochem.

If a specific pathway is not working, two things are likely to happen:

 • A product will continue to increase because it can’t continue down the

pathway

• That product will go down some other route

If you can view biochem in such a manner things will become easier.

So first create your subway system. Create the maps of the pathways on a

blank piece of paper. Add in each step, enzyme, and product. Also, add in

where a specific disease such as phenylketonuria occurs.

Once your diagram is done, study it a bit every day. I prefer to use the look,

recite, reevaluate, repeat method.

1. Look at the diagram and talk yourself through it

2. Recite the diagram without the aid of your visual

3. Reevaluate by looking back at the diagram where you got stuck

4. Repeat

This is the first phase of studying for your biochem exam. But we’re not done.

You will only get a few questions correct if you can memorize the pathways.

The difference between a C and an A student comes from being able to

connect ideas.
Now start to cover a specific step in your diagram with your hand, a quarter,

etc.

• How is the system affected?

• Can you still make the final product?

• Does anything start to increase because the pathway has a break in

it?

• Is this specific step related to any major disease?

As complex as biochem seems, it only requires these two steps. First, go

through the entire process, then start to break stuff and evaluate where

things go wrong.

While it may ever get easy, you once again have a method which works.

Master the biochem in the First Aid for Step 1, and I promise you that your

dedicated studying will be so much easier!

Organ Systems:

Once you start learning about the diseases of each organ system (cardio,

pulm, etc.) you will be expected to learn how the system works together.

Here’s the approach to master each course.

Map out your syllabus lecture with sections from Pathoma, First Aid,

Brosencephalon, and (if you’re a visual learner) Picmonic.

This may seem like a lot but remember that each of these resources is

focused on teaching you the high yield material for that course.

This also doesn’t mean you have to use every resource every day. You can

do 20-30 Brosencephalon flashcards every day. This will likely take you 15-

20 minutes. Then you can either watch a Pathoma video if you covered

pathology or a few Picmonic videos. At the end of the week, review First Aid

and see how much you’ve retained. You can then add 20-40 questions of

USMLE-Rx to assess your retention.

This approach will serve you well in your classes but also set you up nicely

to do well on Step 1.

With the above tips, I’m sure you have enough to begin studying in medical

school and thriving! Just remember that it’s important to have a plan and

structure. Keep tinkering with your style. Keep what works and get rid of what

doesn't.
 Chapter 11:
How To Excel On Step 1
The worst two words in medical school aside from standardized patient –

Step 1.

This chapter will be all about how to calm your nerves on the most nerve-

wracking exam you take in your medical career.

My Own Experience:

I thought it would be helpful to walk you through my shoes by sharing my

own Step 1 experience. I did well and better than I expected. I’ll share the

revelations that I made while studying for the exam.

Your Best Preparation is Doing Well Your First Two Years:

I’m sure you’ve heard this piece of advice before. “How do I do well on Step

1?” Then some big shot tells you “just do well in your classes.” You thank

him/her for their lack of help.

But it’s so true.

If you are a ways from taking your Step 1 exam, then listen clearly. Read this

section, understand the principles I lay out, and which resources you should
be using. Then use these resources and principles to do well in your

preclinical courses.

You are just setting yourself up to be at a much better starting position

compared to other students.

Mindset can Make a 20-30 Point Difference:

I wanted to start with a lesson that was the most surprising during my study

period.

I started my Step 1 experience thinking five weeks to be enough to cover the

material (many times) to get a high score. While this is true, I found a fragile

mental fortitude can overshadow your knowledge.

When I was taking my first few practice exams, I thought I was doing fine. I

felt like my knowledge base was there. When I saw my score, however, I

was disappointed – my score was lower than what I thought I had earned.

After I reviewed my test, there was a pattern. Anytime I came across a

question I had no clue about, I not only missed it but I also often missed

the next 2-4 questions. The worst part was that I knew the answer to those

2-4 additionally missed questions!

My mindset was thrown off by the tough question, and I became unfocused.

2-4 missed questions here, and there may not seem that bad, but it can make

a 20-30 point difference if it continues to happen over a practice exam.

Remember back to earlier in the book where we talked about the

psychology of test taking. View each question as an opportunity to earn

points, not lose them. If you don’t know then move on. Gain the confidence

on the ones you know, not lose it on the ones you don’t.

So before my test day, I told myself that there would be questions I either

didn’t know the answer or forgot the pertinent fact. I, in a way, had planned

for the worst. If I forgot a previously known fact I told myself it was no big

deal and moved on. It was all about earning points for me.

Using this approach, by the end of my exam, there was a fair amount of the

exam that I was comfortable with. The rest was out of my control.

This idea of mindset is not the only key for test day, but it’s important to get

through the dedicated period without burning out.

You may find that you’re not improving as much as you had hoped. You will

have bad days where either you’re not focused or are not performing well on

questions. It’s okay! It happens.

Your mindset, however, will make the difference between whether the next

day will be similar or not.

It’s Going To Be Okay:

I remember when one of my close medical school friends called me in the

middle of his Step 1 prep. “I’m just not getting better. My scores aren’t

budging man”, he would tell me.

My advice to him? “Take a deep breath,” I told him to trust his efforts thus

far, work on his weak points, continue to gain confidence, and that it was

going to be okay.

Sure enough, he did fine on his exam and is now looking towards a potential

career in orthopedic surgery.

Positivity is key during Step 1 studying.

Questions >> Reading:

I’ve always stressed active studying, and it’s a topic I’ve spoken about

extensively throughout the book. While most medical students are aware of

the principle, it’s only half-practiced during Step 1 studying.

A typical day during Step studying includes some First Aid reading, watching

a few Pathoma videos, maybe a little bit of Sketchy, and some UWORLD

questions.

Out of all these resources, the questions are the only true form of active

studying.

Most study schedules, start with more reading than questions and I get that.

The problem is when there is still more reading than questions in the latter

half of the study period.

While it’s important to get through resources like First Aid and Pathoma

during the first two weeks, the rest of the block should focus on questions.

I’ve gotten more questions right from getting questions initially wrong

than I have by rereading a First Aid chapter.

As enticing as it is to go through as many passes of First Aid as you can, the

questions will determine your final score.

Once I completed UWORLD after three weeks, I thought I’d go over missed

questions. I quickly realized I remembered most of them, so I stopped.

I then began to do USMLE-Rx Qbank which I recommend if you need the

additional practice.

By test day, I had completed 2400 UWORLD questions, the 1200 USMLE-

Rx questions I was able to get through, and an additional 1890 questions

through various practice tests. This equals to almost 5500 questions I got

during my five weeks of studying! On top of that, I completed almost 10,000

flashcards (Broencephalon + Sketchy Micro).

This was a lot of questions (and time), but I was much more comfortable on

test day then if I had flipped through texts for five weeks. (I was guilty of this

from time to time still.)

Be Ready to Take Unplanned Long Breaks:

Step 1 and rest seem to be two things which don’t mix well. To survive and

thrive you’ll have to force them together.

As someone who is used to waking at 4 or 5 AM, I knew I couldn’t do that

during Step 1.

I aimed for 7-9 hours of sleep a night. Sometimes I had more and sometimes

less, but there was no specific wake up time.

Rest is more important than when you start.

Most of my days happened to start at 8 and had a long break around 12 or

1 to work out and have lunch. Other days I was exhausted by 10 AM and

would go to sleep for an extra 1-2 hours to regain energy.

Take Care of Yourself:

The days I felt the worst were also the days where I had more granola bars

than an actual meal. Take care of yourself people!

Either make food in bulk on an off day or learn some easy, quick recipes for

your meals. You’ll perform better and will feel better. Corny but it’s true.

Since I finished my test with five weeks of studying, I met a few classmates

that were taking the full six weeks to prepare to give them some confidence.

They looked awful. They hadn’t eaten correctly in days and looked like they

need to hibernate.

Don’t let this be you!

Make sure your friends can still recognize you when you come outside for

the first time.

 When You’re Done Studying, You’re Done:

Just like we talked about earlier in the book, pick a time when you’re finished.

I tended to end my studying by 6 PM. So from 6 to 10, I did whatever I

pleased.

It’s odd, but med students make Step 1 feel like something you’ll have to

focus on 24/7 until your test day. 8-12 hours/day is what the typical student

spends during their dedicated. That still leaves plenty of time to have meals,

workout, and spend evenings with your favorite people or shows!

I still played Xbox during my five weeks, still went out with friends, went to

church on Sundays, and spent time with family. You can still fit the key parts

of your life during this prep!

It’s funny; I had more free time during my Step 1 experience then I did during

my pediatric rotation! Obviously, the stress makes the studying the dreaded

experience it is.

Just understand that it’s important to have those core hobbies and people

around you to get to the finish line!

 Be Ready for the Unexpected:

Plain and simple, stuff happens. You will have streaks of days where no

progress is noticeable. Some days will seem like setbacks.

You may also have no motivation to study on others. I came across these at

all phases of studying - beginning and end.

Dedicated studying is a great analogy to the actual test. You’ll have a great

streak of days (questions), and then you’ll feel blindsided by other days

(questions) that throw you off balance.

The better you can handle adversity and surprises during prep, the better

you’ll be able to tackle the questions on the real thing.

Don’t Forget to Breath and Reward Yourself:

I have to be honest; I became a killer self-motivator during Step prep. My

words of wisdom during test day were things of legend. Partially kidding.

My test started off pretty rough. A few hard sections in a row and my brain

felt as if it wasn’t cooperating.

Deep breaths and an exciting reward post-test (some delicious Indian food

for me) got me through the last few blocks. I’m sure you can use them

strategically throughout your study period to get you through the finish line.

Step 1 Resources:

So now that we have that out of the way, lets’ talk about what resources you

should use.

I like to give grades to resources to help you understand its utility. I’ll also

discuss how my score improved using each resource.

UWORLD: A+

Questions are key to excel on Step. You can read First Aid as many times

as you want but the exam tests your ability to combine clues to answer a

question.

UWORLD is the resource among Step 1 resources that all medical students

swear by. 2400+ questions are available for you during your dedicated

period. The questions cover both high-yield info as well as lower yield items

which can make the difference between a 230 and a 250+ score.
To avoid some of the stresses I encountered, don’t pay too much attention

to your percent correct.

Many students will try to correlate their percent correct on UWORLD with

their actual score. While scoring in the 80-90% on random questions will lead

to a good score, getting 60-80% correct is where the typical student will be

at.

Use UWORLD as a learning resource, not as a testing source for Step 1.

Learn the explanations well and review the ones you get wrong. Many

students make a word doc, Powerpoint, or a spreadsheet of missed

questions with a brief explanation.

The two provided practice exams are also great resources. Try your best to

fit them in. While the projected score is said to be a little inflated, the style

and length of questions are similar to the real deal.

First Aid: A

Often physicians will describe treatments or screening tests as the gold

standard in that field. For medical school, and more specifically studying for

Step 1, First Aid is the golden standard.

First Aid has concise information on all the relevant topics you learn during

your first two years in medical school. It’s often used by second years

preparing for their boards, but I also recommend it for pre-clinical years not

preparing for Step 1. Grab an old version of First Aid from an upperclassman

and use it when you’re preparing for a quiz or test. Often First Aid will do a

better job than your lecturers in explaining a topic.

The key point is that if it’s in First Aid, learn it!

Now how did I use First Aid during my dedicated?

I did my typical first pass over the first two weeks.

What I found interesting is my lack of focus while reading First Aid after my

first pass. The first day I started my second pass of First Aid, I realized quickly

it was going to be a waste of time.

So I ended up doing one real focused pass-through of First Aid and several

quick flips through reviews when reviewing a weaker topic. By the end, I had

done one detailed review and 5+ full but quick passes. I spent using active

studying sources during the remaining period.

Here’s a link to the most recent (as of this writing) of First Aid.
If you join some top medical organizations such as AMA, you may be able to

get a free version. (All about saving that money!)

NBME Practice Exams: A

If money is an issue, then plan to do at least 2-3 tests during your dedicated

study. They each cost $50 (60 if you want to see what you missed) so it can

easily become expensive. I bought every available one just because the

money was worth the practice.

Before beginning your dedicated study period, it’s important to plan out when

and how many practice exams you take.

I found these exams to be a nice slap in the face each time. Full disclosure,

my first one I took (courtesy of my school) without any studying was a 159.

Yikes!!

Now I’ll be honest that I found that score funny since I hadn’t done any

UWORLD or First Aid. I also had three months before I began my dedicated

studying. Then when I calculated my percent grade, I was shocked that a

60% was so low! It was a nice rude awakening that to do well on this

exam, you’ll have to do well.

Luckily that first practice exam was three months before my real test, and I

was able to boost my score by a significant amount. 60% turned into scores

in the 80-90% range towards the middle of my dedicated. A score of about

85% was approximately a 230 if you’re curious. Each practice exam has

a different curve so be prepared to see a range.

During test day, seeing so many actual test style questions was valuable. I

was able to relax when I didn’t know something and remained level-headed

throughout.

Simple enough, take as many practice exam as you can.

Pathoma: A+

Pathoma saved me many times on my pre-clinical exams, and it sure saved

my butt on the actual exam.

While it comes with both text and video, I preferred the videos – I’m not

someone who enjoys getting information from text, so the high-yield videos

were amazing.

During dedicated studying, it took me about 1.5 weeks to finish all the videos.

I only allocated approximately an hour a day and used VLC Player to watch
the videos at 2-2.5x. If you’re not comfortable with the speed, you can easily

allocate more time to watch the videos.

It was also a nice compliment to First Aid. Compared to older editions I found

that First Aid has a lot of info from Pathoma with phrasing very similar to the

videos. Thus on many mornings, I would watch a specific set of videos, such

as Cardio, and then read First Aid.

You can use the opposite approach as well, but it was much easier to wake

up to videos then it was to read a First Aid chapter.

I also did a quick flip through during the last week. If you Google Pathoma

notes, many students have done the luxury of making high-yield notes of the

Pathoma texts and videos. After using the actual source, these were helpful

to put all the info together after five weeks of studying.

Broencephalon Anki Deck: A++

If I had to attribute my improvement to a few Step 1 resources,

Broencephalon has to be one of them. If you’re not familiar, a very very kind

student made flashcards for all the info from First Aid and Pathoma.

The only problem - there are over 15,000!

Is it possible to do them during dedicated? Not really. I tried, but I gave up

reviewing old cards to see newer cards every day.

Since I used Anki to study for my pre-clinical courses (you can learn more

about that here), I could get through 1000 cards after a long day of studying.

Still, it wasn’t feasible to get through them all effectively during dedicated.

If you, however, want to master First Aid, start using Broencephalon as early

as possible. Even if you’re approaching the end of your first or second year,

you can still get through the deck effectively. Not only will you be prepared

for Step 1, but you’ll do well in your classes.

USMLE-Rx: A

I mentioned how I couldn’t do more than one pass of UWORLD. I

remembered the questions, and it became ineffective. So I turned to Rx as

my next source of questions. It was time well spent without a doubt.

Rx is made by the same company who writes First Aid. So you can expect

the questions to attack the high-yield points from the book. Aside from testing

you on your First Aid knowledge, Rx questions are also shorter and more to

the point. This is good to develop a firm base of Step 1 knowledge.

Also, you can get through the questions much faster and thus do more. There

were days I was easily doing 150-250.

On the other hand, because they’re shorter and more straightforward, they’re

not fully reflective of the real thing – UWORLD takes that prize all day long.

Also if you choose to use their self-assessment option be prepared to receive

an inflated score. I used this a few days before my test and received a

“projected score” of 269. Not even in my dreams is that possible.

If you’re far removed from your Step 1 exam, then Rx may be a great

supplement to your studies!

SketchyMicro and Pharm: A+

Using SketchyMicro and Pharm, I could have easily answered over 90% of

micro and pharm related questions on the real thing. The remaining details

can be found in First Aid and UWORLD questions.

This easily makes Sketchy something that should be in your repertoire of

Step 1 resources.
We’ve talked now a few times about the memory palace, how you can use

the technique to improve your retention in medical school. Who better to turn

to then SketchyMicro when you can’t make so many images by yourself?

Firecracker: A (with time) B (without)

I added this at the very end because time is a huge factor.

If you’re unfamiliar with Firecracker, it’s a comprehensive tool of topics,

questions, and flashcards. It’s meant to be used alongside your classes. As

you learn a specific topic in class, tag it on Firecracker, and you begin to

create a personalized set of flashcards and questions for your learning.

If you can stick with doing a specific amount of flashcards every day and the

appropriate review, Firecracker will work wonders.

If on the other hand, you tend to skip a few days or weeks here and there,

Firecracker may not be for you.

Firecracker has good results from those who stick with it and have added

some great updates since I started using them.

If you want to try out Firecracker, you can try a trial. If you’re interested in

buying you can find a great Firecracker discount here. Just remember that

you’ll have to commit to Firecracker to see the results.

 Chapter 12:
How To Excel On Step 2 CK
By the time the stress, anxiety, and nightmares of Step 1 disappears it’s

usually time to get ready for Step 2.

Step 1 went well enough for me, but my Step 2 Ck score surprised me. I had

to do a double take when I saw the score.

This section will go over how to do well on your Step 2CK exam.

Recommended Resources:

UWORLD:

I’ll keep it simple. The only resource you need is UWORLD.

Do it as many times as you can.

But what books should you use? Don’t worry I’ll get to that because I know

many of you still want that info.

But if you want to do well on your Step 2 exam, you will do UWORLD as

many iterations as possible.

 OnlineMedEd:

I get it, Step 1 has a lot of info, and Step 2 has a lot of info. You need

something to consolidate everything you’ve learned over your rotations.

Unfortunately, First Aid for Step 2 is not as useful as it’s Step 1 counterpart.

OnlineMedEd is the best thing I found to help you consolidate all of this info.

Regardless if you like text, video, flashcards, practice questions – OME has

something for you.

This is how I used OME for my study prep.

Make a list of all the major organ systems or specialities that OME covers.

Then order them in order of comfort level. Do you do well on surgery

questions but get panic attacks with pediatrics? Order them accordingly.

Then arrange your study prep to spend 2/3 of the time on your weaker

subjects and 1/3 on your strengths. The videos were great refresher for

topics I hadn't seen in several months.

I found this ratio helped keep my confidence up while still working on my

weak points.
Check out the free video and note example that OME provides. If you think

OME is for you, then use the discount link to make the cost cheaper. Enter

the Code OME17 to get $80 off an annual subscription

Step 2 Secrets:

I noticed this book was being recommended by many former students. I

highly recommend this resource if you must have a book!

Step 2 Secrets reminds me of Pestana for your surgery rotation (we’ll get to

that). It’s relatively short (300 pages) of Q&A format review.

I absolutely loved this book towards the end of my review. The review

questions are high-yield and will help develop a sense of confidence towards

the last few days.

Make sure you can answer these questions on the test. They should honestly

appear easy to you after all the studying you’ve done.

My one disclaimer is that Step 2 Secrets in not all inclusive. There are

important concepts which are not covered in the book. So don’t depend on it

as your primary resource.

NBME Practice Exams:

Listen (read) carefully. Use the NMBE practice exams exactly what

they’re meant for – practice.

Do not, I repeat, do not worry about the score. My Step 2 score was 20

points higher than my highest NMBE score!

The curves on these exams are everywhere. I would use them for practice

and reevaluate your strengths and weakness.

UWORLD Self Assesment Exams:

These are the tests you can use to see where you stand. Unlike Step 1,

UWORLD self assessments (UWSA) tend to predict your score pretty well.

I will still say that my actual Step 2 score was 15 points higher, but most

people fall near their UWSA scores.

That’s it for the resources. Step 2 is where simple is better. Avoid using many

resources, and you’ll be golden.

How To Study for Step 2:

If there was one thing I learned from Step 1, it’s that you can rapidly increase

your score by avoiding making the same mistakes.

So here’s the layout to do well on your Step 2 exam.

• Do UWORLD 1.5 times if possible (all questions + marked and missed)

• Make flashcards for each missed and correctly guessed question

• OME for any weak topics

If you were expecting a more complicated framework, then I’m sorry to say

it’s more simple than you think.

Do UWORLD 1.5 Times:

This will require you to do some preplanning. Once you know when your Step

2 date is confirmed, begin doing UWORLD questions. Do this on random

tutor mode.

Try to plan to finish UWORLD 1-2 weeks before your dedicated studying

begins. This may not be possible for all of you.

This can be as simple as ten questions every day. That’s not a crazy amount

but create whatever schedule works best for you.

Now here’s what earns you a better score. Whenever you miss a question

or guess and get a question correct, make a flashcard. I recommend using

Anki to make them. Also, make sure to mark that question in UWORLD>

Then do 10-20 flashcards according to your schedule.

Do your best to remain consistent. You will thank yourself the more questions

you get done before your dedicated study prep.

If flashcards aren’t your thing, then try my notebook method for Step 2.

Instead of making a flashcard for your marked UWORLD questions, split the

page in half and fill it up in a Q&A format.

The last part is to fill in your weak points with OME. Watch the videos, review

all the notes, and add anything you struggle with to your Anki deck or

notebook.

If you planned correctly, spend the last 1-2 weeks before you begin your

dedicated and redo your marked questions. Do this until you no longer have

questions marked.
Dedicated Study Prep:

Dedicated studying for Step 2 is trickier because not every student takes a

month off to study. I scheduled lighter electives and studied during Spring

break.

But here’s another (simple) framework for your dedicated:

• Do UWORLD again 1.5 times

• Continue creating and doing flashcards/notebook method

• Take NBME practice exams with one full-length practice day

• Use OME for weak points

• Read Step 2 Secrets your last two weeks

The UWORLD portion of dedicated is similar to my previous

recommendations. Do all the questions and then redo your marked

questions.

Begin to slowly ramp up your question load. Gradually increase this amount

to the point where you can do two 40 question blocks with a short break in

between. Continue to build your stamina.

If you are taking a month off then, similar to Step 1, make sure to take care

of yourself. Keep your day fresh by alternating between questions,

flashcards, and review.

Perhaps do two question blocks in the morning. Then head to the gym and

do flashcards while on an elliptical. Finally, eat lunch while watching an OME

video. You don’t have to stick to this but have systems in place to avoid

burnout.

How To Plan Out Your Practice Exams:

If you’re taking a typical four weeks to study here is how you can arrange

your practice exams:

• Week 1: Do NBME 6

• Week 2: Do NBME 7 and UWSA 1

• Week 3: Do NBME 8 and UWSA 2

• Week 4: Review Tests, Free 120 sample questions, or take one of the

older versions (you can find these online)

As I mentioned before, don’t pay attention to your NBME scores. The curves

are erratic and typically not predictive. Use them as practice.

NBME 7 is notorious for having a steep curve. Everyone tends to freak out

so keep that in mind. This is why I recommend taking it in the middle.

I would also recommend trying to take a full-length exam Week 3 or early

Week 4 if possible. You can combine an NBME and UWSA if you’d like. This

will help you gauge your stamina for test day.

The final options for practice exams are taking the free 120 questions that

NBME provides for Step 2. Here’s a link. You can also find questions to older

retired NBME practice exams. Use this only if you want more practice.

Tips for Test Day:

Plan Your Breaks Out Before Hand

Decide how you intend to split your 1 hour break time during your 8-hour

exam. Skip the tutorial to get the full hour of break.

Give yourself time for a decent lunch, bathroom breaks, and delays in

checking and out at your testing center.

You do get additional time added if you finish a section early. Step 2 tends

to have longer vignettes compared to Step 1, so I wouldn’t count on having

additional time. It’s only a plus if you do.

 Remember It’s About Earning Points:

WTF questions will show up. Just be ready for it. In fact, don’t worry about

them.

Instead, worry about earning points. You get a question and know the answer

is pancreatitis? Perfect use that to raise your confidence!

It’s very easy to focus on the 7-15 questions out of 40 which gave us a hard

time. But remember that means there were 25-30 that you knew well! Use

this mindset shift to keep your confidence up to where most students tend to

crumble.
Part 3: How To Excel On The Wards

Doing well during your third and fourth year of medical school can be tricky.

You have less time, and you’re learning more by doing than reading.

In this section, we’ll go over how to do well on your rotations, advice for each

rotation, and what resources you should for each major rotation you will have

to do!
 Chapter 13:
How to Study For Clinical Rotations
So we’ve gone through the preclinical courses and board exams but how do

we study once we’re on the wards?

In this section, we’ll go through everything about how to do well in clinical

rotation and yes how to study. Also I’ll cover resources and tips for each

major rotation!

How To Do Well on Any Rotation:

First, let’s start with some tips in general on how to do well on your shelf

exams and rotation.

I’ve made a YouTube video on the topic that you can check out here.

Stop Worrying About Your Grades, Worry About Your Progress

May seem a little strange to tell you not to worry about your grades but hear

me out. This is the biggest tip and the one I feel most medical students fall

short on during their third year of med school.

If you haven’t learned already – you will soon – but grading for the third year

of med school can be very subjective.

Often the things we care about the most (i.e. good evaluations from our

attendings) are out of our control.

But we spend the most time worrying about creating a good impression.

No! Instead, let’s do a 180 and become impressive to our attendings without

trying!

How?

Worry about your progress and not your grades!

We all have weaknesses and strengths. So worry about being aware of your

shortcomings and work on them every day.

You may be good with your patient interactions, but not the best with coming

up with an assessment or plan. (This was me)

So everyday work on getting better at that weakness.

Don’t do what most medical students do – which is to cover up their flaws.

Actively work on them.

If you’re not sure what weakness you should work on first, ask your attending

for feedback.

If they tell you to have more concise presentations, then make it a goal to

improve on that every day!

Your attending will be able to notice the change you make from the first day

to the last.

I’ve tried my best to be aware of my strengths and weaknesses. And I’ve

gotten better throughout my third year to work on them before the attending

even mentions it.

Thus my evaluations continue to highlight the strengths I already had

(interacting with patients) but also speak highly of my growth on my weaker

points (coming up with plans, etc.)

So stop worrying about your grade. You’ll be less stressed out and likely will

improve the evals you get at the end.

Always Ask Why

If you want to grow your medical knowledge beyond just what you learn for

your shelf exam then follow this one tip – always ask “why.”
Learn to become curious about your patients, their management, and work

up.

You will learn and remember much more when you have a patient with a

specific condition.

You can expand your knowledge about them and their condition if you

become extra curious about everything surrounding their care.

Why did they get this specific medication? How do you dose their insulin?

Why did we not do this imaging exam?

Ask your residents and attendings when appropriate. You can show your

interest in the patient as long as your questions are well thought out.

So don’t just be satisfied with what your shelf exam resources tell you. Keep

asking “why”!

You’ll tend to get questions on your shelf exam correct just because you

understand all aspects of your patient’s care.

Gather Your Resources Early and Stick With Them

Now since we’re talking about the shelf exam, pick your resources early!
Once you pick your resources, stick with them!

We’ll go over which resource to use for each rotation! So pick from that list

once you get to a specific rotation.

Don’t switch from one text to another halfway into your rotation.

Pick a highly recommended resource and finish it.

Start Studying For Your Shelf Exam Day One

Once you pick your resources, start studying your first day.

Don’t be one of the medical students who want to “save” their UWORLD

questions for the end.

No! Make sure to start your practice questions from the very start.

You will become more prepared for the rotation and shelf if you do!

My Step-By-Step Study Method:

Before I begin I want to repeat that there is no one right way. I thought I’d

give you my approach and allow you to tinker with it for your liking.

There are a lot of “recommended resources” for each rotation and little time

to get through even one of them.

Medical students become stressed by having too many choices. Often,

especially early in their clinical years, students will try to use a little bit of

everything. I was one of them.

This is the first trick to study for your rotations in medical school. Don’t pick

too many resources. Stick to the ones you choose. Then schedule how you’ll

use each medical school resource.

Often this will include one question bank (almost always UWORLD), a text,

and maybe an additional text/question bank depending on the rotation.

I also recommend adding OnlineMedEd to your recommended resources!

They have amazing videos, notes, and flashcards to make clinical rotations

much easier.

Again TheMDJourney has a partnership with OnlineMedEd and provides you

a discount on annual subscription. If you sign up for an annual subscription,

you’ll receive $80 through the link! Just use promo code OME17 at checkout.

Define a Calendar for Completing Each Resource:

Once you pick your resources, come up with a realistic deadline. When will

you finish the book?

First, go through your book and determine how many pages and questions

it has. Now come up with a goal on how fast you want to finish it.

Everyone has different reading speeds and spend various amounts of time

reading explanations. (I’m a skimmer) But it’s a good practice to have your

text completed two-thirds of the way into the rotation. So if you have a

6-week rotation, aim to complete your book by the end of week four at the

latest.

This practice allows you to spend the home stretch studying for your shelf

exams actively. This involves spending a majority of your time (if not all)

doing practice questions.

You can break the text by sections or pages. It becomes personal preference

at this point.

For example, on my Ob/Gyn rotation, my text of choice was Case Files.

Similar to others in the series, Case Files Ob/Gyn has 60 cases. I honestly

went too slow through the text (too many nights off) and averaged little more

than 2 cases a night.

Regardless, I finished the book two-thirds of the way, giving me plenty of

time to finalize preparations for the shelf exam.

If you’re particularly organized, you can add in the chapters you intend to

read each day on your Google or personal calendar.

If you’re like me and are semi-organized then just have a chapter or page

number you want to complete by the end of the week.

Schedule Your Questions:

I recommend doing questions throughout your rotation.

I’ve seen students defer their questions until they complete their text or

flashcards. This just doesn’t make sense to me. By the time you finish your

text, you’ve likely already forgotten the first half of the book.

If you’re using UWORLD, then attempt to finish the questions halfway

through your rotation. (For certain rotations such as internal medicine, this is

highly unlikely.)

For most other rotations, you’re likely to have 200-300 questions per rotation.

You can manage to complete your UWORLD questions in 2-3 weeks.

I like to spend 2-3 weeks learning through UWORLD (alongside my text).

While I’m doing the questions, I will mark any question I get incorrect or

guessed correctly on.

I then use week 4 to go through all my marked questions until I get them all

right.

Why should you want to complete the questions in 2-3 weeks? While I think

UWORLD is great as a learning tool, their questions are often more difficult

than the real thing. Also, UWORLD tries (harder than the NBME) to trick you.

Thus I prefer to use the final stretch for practice questions similar to the real

thing. In particular, I attempt to do all the NBME practice exams.

Ultimately doing more questions will lead to a higher shelf-exam score. Use

UWORLD initially to develop a strong base. Then transition to the NBME

exams to understand where you stand, become comfortable with the format,

and focus on weaker topics.

Using the Notebook Method to Study for Rotations in Medical School:

See even I use a variety of techniques in medical school. This technique

works wonders with clinical rotations.

During my first few rotations, I struggled to remember the topics I learned

week 1. It felt like I was in an endless circle of learning and forgetting.

This is frustrating and often how medical school feels at times. But I wanted

a study strategy which got me out of this passive learning hole. I was tired of

reading and highlighting the text, just to forget I ever learned it a few weeks

later.

So I messed around with my study strategy until I found an active way to use

my designated text and that’s how my notebook method was born!

The notebook method is the reason I’m no longer stressed when studying

for my shelf exams but my grades have gotten higher. I try to rid my

dependence on the text as soon as I finish each chapter.

Here’s how you use it on your rotations!

Once you have your designated text of choice, read through and be on the

lookout for high yield information.

For example, let’s stick to my Ob/Gyn example. I may be reading a chapter

about labor. If I’m reading a paragraph about the different stages of labor, I’ll

grab my spiral notebook and write “different stages of labor” on the left half

of the sheet. This will be my question side.

Then I read the passage and use the right side of the page, the answer side,

to fill out any high-yield information regarding the topic.

Here once again are examples from my notebook from my Ob-Gyn rotation.

(Pardon the small handwriting)

As you can see, the questions or topics are on the left and the relevant

“answers” are on the right.

You will also notice that I write the topic of the chapter on the far left margins.

I try to keep each question and answer section short and sweet. It’s my

attempt at actively breaking down the text into the most relevant points.
There’s no need for full sentences, correct spelling, and it doesn’t have to be

legible to anyone but you.

This notebook will be a collection of the high-yield facts from the books. Your

notebook doesn’t have the “ands,” “buts,” and extra words which are useless.

You just have what’s important to know.

Actively Studying in Medical School Using The NoteBook Method:

After completing Case Files for Ob/Gyn, my notebook of high-yield spanned

28 pages.

This may seem like a lot, but as you can see from notes above, there’s not

much on each page. Also, the Case Files book is over 500 pages! I’ll take

the 28 pages any day.

So how do you use your high-yield notebook?

Well since it’s nicely played out as a question-answer format, go through a

designated number of pages each morning or night. I prefer the morning

before I start my day. I find it gets me into the groove before rotations.

Reviewing 3-4 pages of my high-yield notes takes no more than 20 minutes.

I prefer to do two new pages of new material and two pages each day. The

two pages of review take me less than 5 minutes since each page has less

than 7-10 Q&A’s.

I also study the new material strategically.

First I learn one page by reading the questions and answers together. Then

I attempt to review the page without looking at the answer. My review for that

page is complete once I get the entire page correct.

Then I move to the next page. Once I master page 2, I’ll go back to page 1

and try to master page 1 and 2 together. If you choose to review more than

2 pages, then review page 3 by itself and then try to do page 1-3 without any

mistakes.

If what you wrote doesn’t make sense, then this is when you refer back to

the book. Make your question and answer more clear in your notebook.

Using the notebook method, you’re no longer dependent on the 500-page

textbooks. Also, the notebook method will help you study in your clinical

rotations without forgetting material from week 1.

In fact, you’ll constantly be in a state of actively reviewing and learning. More

importantly, all this information will be high-yield.

To add an extra dimension to your notebook, you can add missed UWORLD

questions.

By the end of your rotation, the notebook should be all you need to ace the

shelf exam. By test day, you’ve likely reviewed each page at least 2-3 times.

Thus a full review of your notebook can easily be done the final days before

your shelf exam.

A quick note, you can also use the alternative version of the Notebook

method we talked about earlier.

For larger rotations like IM, use an individual sheet(s) for each major

category. Add pertinent questions, missed UWORLD questions, and

flashcards to this sheet. Then just review a few sheets a day until you feel

you’ve mastered the topics.

Final Week Before Your Shelf Exam:

By now you’ve finished your designated text. You should have also finished

UWORLD once and gone through your marked questions.

If you’re using the notebook method I’ve laid out above, then you should feel

comfortable with the material on your shelf exam.

This week is designated to focus on NBME exams, hitting your weak points,

and doing a final review of the material.

Keep a List of Weaker Topics:

These are the topics which make you tachycardic if you have a shelf exam

question on it. This is also where you earn your points and separate yourself

and score in the 90s for your exams.

The best way to identify these weak topics is to take the NBME practice

questions. Jot the subject down if you get a question wrong and felt uneasy

approaching it. Also, add any topics you may have gotten right by guessing

on.

While doing your NBME practice exams, be on the lookout for answers

choices which may not be correct, but you’re still uncomfortable with. If you

don’t recognize a medication, even if it’s not a correct answer, jot it down to

review later.

Every night on the final week I attempt to approach a few topics on my list.

Google them, use your text, or watch a youtube video. Do whatever it takes.

As you feel like you grasp it, put a checkmark next to it. Come back the next

night and see if you truly understand it.

Evaluate your whole list during the last two days before the shelf exam.

Focus on the topics that still give you a hard time even after reviewing. This

will prevent an anxiety exam during the exam. They likely may not even show

up. But you get a large boost of confidence if they do and you know it!

Hope you enjoyed my step-by-step approach on how to study for rotations in

medical school. Even if you don’t use all the above strategies and tips, it’s

important to develop a plan from the very start.

How To Honor Each Rotation:

I want this book to solve as many problems as it can for you. Thus next we’re

going to talk about how to excel in each rotation. What resource do you use

and I’ll study schedules for longer rotations.

First, we’ll cover some common resources that you should expect to use

throughout your rotations. This will help avoid redundancy later on. I will

mention them again in each section but will avoid being repetitive.

UWORLD for Step 2:

This is the best resource for your clerkships. In total, I did about 2.5 cycles

of all 2400 questions. My Step 2 grade tells me that this was a good idea.
There’s two important things I want you to know about UWORLD. One, make

sure you begin early into your rotation. You will begin to understand what

topics are important. You will also begin to think in the manner that specialty

requires.

The second thing to remember is to mark any questions you miss or guess

correctly on. I recommend making these questions into Anki flashcards. This

will help you master all the questions in UWORLD you miss for a specific

rotation.

Then, as a bonus, you’ll have a nice UWORLD study deck when it’s time for

Step 2. We mentioned this strategy in our Step 2 section but making these

flashcards earlier will save you much more time.

OnlineMedEd:

The second resource which will show up for every rotation is OnlineMedEd

(OME).

We’ve mentioned this already in our Step 2 section so I’ll reiterate the

important points.

OME is great for all sorts of learners. There are videos for visual and auditory

learners. They have flashcards and practice questions for those who love to
test themselves. They also have amazing 1-2 page notes on high-yield topics

which you’ll want to use for all your rotations.

If you’re unsure how to use the OME resources I recommend a sandwich

approach. Start with OME to develop a strong base for each rotation. Then

use UWORLD, a high-quality text, and your clinical experience to learn the

details. Then come back to OME near the end to make sure you still know

the basics.

NBME Practice Exams:

If your school makes you take the NBME subject exams at the end of your

rotation, then make sure to use the practice exams.

Each rotation has a lot of info to learn. Add that to the hectic clinical schedule,

and you’re likely to be stressed about the shelf exams.

The practice exams are great resources to help you understand the

structure, difficulty, and information that the real thing will have.

Brosencephalon Anki Decks:

I was a huge fan of these flashcards for Step 1 that I was ecstatic when I

learned there was a Step 2 version.

Here’s a link.

There are also other helpful Anki decks I enjoyed. Here’s a link to one of my

favorites.

These Anki cards were greate to once again focus on the high yield topics.

But they’re also just very quick to do. I would often be able to do 30-50 during

a lunch lecture without difficulty. I remembered a lot of info on my shelf and

Step 2 exam. Don’t remember much of the lunch lectures though (oh well).

Internal Medicine:

Recommended Resources:

Internal medicine covers a lot of material, so no time to waste. Let’s get to it.

UWORLD: (A+)

UWORLD for the internal medicine rotation is a must.

You can argue, in fact, it’s all you need. The question bank has over 1400

questions! You’ll be well prepared for the rotation and the shelf if you

complete them all.

How is it even possible to fit 1400 questions into a busy internal medicine

rotation? It’s challenging but doable.

I’ll break this down in the next section where we’ll go over a sample study

schedule.

Spoiler alert, expect to do at least 40 questions every day. Some days will

be easier than others, but that’s the blunt truth of how to get through them

all.

After completing UWORLD 1.25 x, I had little anxiety before the test. Make

this question bank a priority above all else to excel as well.

Anki Decks: (A)

While practice questions in UWORLD are great for testing my knowledge, I

use Anki actually to learn the material.

The Brosencephalon deck is geared towards Step 2 but are also helpful on

the shelf. Each deck is about 40-50 cards. For internal medicine, there is

about 2000 cards total in this Anki deck.

The cards are each brief yet high-yield. I could easily get through a deck of

30- 50 cards during a lunch talk (which I should have been paying attention

to).
One thing I loved about this premade deck is the questions are presented as

vignettes. It gets you into the testing taking mode.

Step Up To Medicine: (A)

Step Up To Medicine was my text of choice and frankly very good and easy

to read.

People seem to have a love-hate relationship with this book. Although

there’s more love than hate. It’s often the text clinical students use to

supplement with for Step 2.

The pros of the book include that it’s easy to follow, hits the high points, and

covers a variety of topics well with illustrations.

The cons include that it’s long (>500 pages) and thus hard to get through.
I managed to finish the book cover to cover while doing the questions. Also,

I also did a rapid skim two days before my exam.

I used the text as a way to assess my comfort level with different topics. If I

were comfortable with the subject, I’d skim through.

But the book became beneficial whenever I cringed reading the headers. For

example, I’m terrible at remembering the different types of nephrotic and

nephritic syndromes. So when I attempted to skim through those pages, I

had to stop myself. I knew I didn’t know those topics well enough to skim and

thus dedicated more of my time to them.

This “weakness designated reading” is how I utilized the book. I recommend

you do the same. You don’t need to read in depth about heart failure if you’ve

already taken care of 10+ patients with it and understand it well.

If you feel comfortable, skip it. If you keep missing questions on UWORLD,

then dedicate more time to reading about that topic.

OnlineMedEd: (A+)

I’ve talked about OME a lot, so I won’t belabor the point. Use it!

Determine how many notes you have to get through. This would include the

cardiology, respiratory, GI, renal, infectious disease, preventive medicine,

hem/onc and rheumatology sections for sure. Then decide how you’ll split

them up over your 8-12 week rotation.

Combine OnlineMedEd with UWORLD (plus clinical experience), and you

may not even have to use a text.

Pocket Medicine: (A+)

You’ve probably seen this book floating around in all the resident’s white

coat.
This is pocket size 250+ page reference guide to everything you needed to

know for your internal medicine rotation.

I don’t recommend it as a tool to study for your shelf, but it can make you

look like a rockstar on the rotation.

For example, if I had a patient with pancreatitis, I would read the section.

Each section is about half a page so you can get through it in minutes.

While I may be comfortable with pancreatitis, I would still read the section to

access if there is anything I’ve missed.

Sure enough on a real patient, I noticed the different scoring systems for

pancreatitis and my attending pimped me on it. I looked impressive being

able to list 2-3 scoring systems and which would work best for this patient.

Without this guide, I wouldn’t have known that info.

A resident of mine gave me a great tip on how to use Pocket Medicine. He

said that for every patient, he would read the corresponding section to their

disease(s). Even if he had seen it a thousand times already. This helped him

solidify all the nuanced details and the big concepts.

So add in the Pocket Medicine book into your white coat. Check out the

current reviews on prices on Amazon here.

NBME Practice Tests: (A+)

There are four practice tests for the internal medicine rotation.

I felt the questions were easier and more straight-forward than UWORLD.

So make sure you get through the Qbank!

Attempt to take at least 1-2 tests during your final week. You’ll be able to

gauge your comfort level and tailor your final studying.

San Antonio Review Powerpoint: (A+)

I haven’t talked about this resource before, but it’s fantastic.

UT San Antonio Health Science Center has excellent review powerpoint

slides for the internal medicine rotation (also slides for Peds, Psych, and

Surgery).

The slides are high-yield and easy to skim several times 1-2 days before

your exam. I got questions correct on the actual test because of these slides.

Each powerpoint slide also has a video lecture if you’re an auditory learner.

Here’s a link to website and slides.

Review Articles: (B)

I referred to review articles in my post about the top tips for the internal

medicine rotation.

While my flashcards, UWORLD, and Step Up To Medicine were great, I used

review articles to help acquire a deep fund of knowledge.

If you’re taking care of your first patient with a typical complication (heart

failure, cirrhosis, renal failure, etc.) google “(your topic) review article.” Save

the pdf and refer to it regarding diagnosis and management for your patient.

I was able to have an in-depth discussion with the resident and attendings

about treatment plans after reading these articles. Our resources for the shelf

are still superficial. Use review articles to receive a more in-depth grasp of

the topic. It doesn’t take much time but can result in better evaluations by

attendings!

Study Schedule For Internal Medicine:

Internal medicine is probably one of the hardest to study for. You’re usually

busy, and there are a lot of questions and information to get through. So I’ve

gone ahead and provided you a sample study schedule. You can apply this

to your other rotations as well.

I’m going to assume your IM rotation is eight weeks like mine. If it’s longer or

shorter, adjust accordingly.

Internal Medicine Rotation Week 1:

Begin UWORLD

Your first objective should be to begin UWORLD as soon as possible. As of

this writing, there are close to 1400 internal medicine questions. It’s a

marathon getting through it, and at times it feels like studying for Step 1

again.

If you have a typical 8-12 week internal medicine rotation, your goal should

be to finish all questions by the end of week 5.

This averages out to about 40 questions a day. I wish it were less, but there’s

no getting around that number.

In fact, I recommend raising that number to 60-80 on days you have a half

day or full day off. This will help keep you on track even if you skip a day or

two.

There were days I came home and wanted to do nothing except sleep. Doing

extra questions on my “lighter” days helped prevent digging too deep a hole.
So goal number 1 (and can be your only goal) is to finish 40 questions of

UWORLD every day.

Do this in random tutor mode. Learn from all the questions, not just the ones

you get wrong. The explanations are where the money lies. This will make

the difference between doing well on the shelf and be barely passing.

If you get a question wrong, make sure you mark it. If you get a question

correct but realize it was a lucky guess or incorrect reasoning, mark it. We

will come back to these questions again.

Hope you’re still with me.

Begin Anki

The second resource I recommended in my resource post in internal

medicine was Anki flashcards.

There are about 2400 flashcards in this deck. Yes, that’s a lot, but you don’t

have to finish them all.

Instead, use these cards as a way to constantly test yourself with small bits

of info at a time.
I recommend doing 50 flashcards a day. Ideally, you can get 5-10 cards done

during downtime. For example, I would use my walk into the hospital as an

opportunity to begin. I would often finish the rest during the lunch lecture for

the day.

Use Anki to develop your base of knowledge. The cards in my Anki deck

included high-yield bits of information. They were terrific whenever I didn’t

have enough energy to do UWORLD questions.

Begin Skimming Your Text:

I used Step Up To Medicine as my text of choice. You can learn more about

the book in my recommended resource post for the internal medicine

rotation.

The book has 12 chapters and about 500 pages. That’s a lot and honestly

more than you need to excel on the shelf.

Instead, begin skimming the chapters. Aim to pass through the entire book

once by the end of Week 3.

Skimming 20 pages in the book shouldn’t take more than 30 minutes a night.

The point of the skim is to glance at topics you know well and instead

dedicate more time to weaker material.

Internal Medicine Rotation Week 2-5:

By the end of week 5, you should have finished UWORLD once.

If you had a busy first couple of weeks, then readjust your schedule. Either

do more questions per night or extend your deadline to complete UWORLD.

Once you finish all of the internal medicine questions, go back again but just

do the marked questions. Divide however many questions you have by 21-

24 days. This way you can complete your second round of UWORLD by the

start/middle of week 8.

By the end of week 3-4, you likely finished skimming your text of choice. Now

we’re going to pick what to read for the next three weeks strategically.

Look at your UWORLD scores and identify your struggling topics. Order the

topics based on the percent correct you’re getting.

For example, you may be getting 75% of the cardio question correct, 45% of

GI, and 55% of infectious disease. You would then first read about GI, then

ID, and finally cardio.

Progress while studying and testing during the internal medicine rotation
This is what your grades will start to do with more practice questions during

your internal medicine rotation!

Your reading can now be more directed this time around. You already know

the subjects you’re not scoring well on. Thus spending reading and

understanding these topics is worth the time.

But at the same time, avoid rereading through topics you’re scoring well on.

It's become diminishing returns to passively read about topics you’re scoring

highly on.

Internal Medicine Rotation Week 5-7:

During these weeks you’re putting the final touches. You should be

sharpening up your knowledge base by redoing your marked question on

UWORLD. Also, you’re rereading the text based on your weakest topics.

Don’t forget to continue your Anki cards as well. Do these during downtime

to quickly gain tiny bits of high-yield facts. The flashcards will help improve

your UWORLD scores and thus your targeted reading.

Aim to have finished all the UWORLD questions by the end of week 7. Week

8 is meant only to test yourself.

Internal Medicine Rotation Week 8:

Studying during the internal medicine rotation

The home stretch. This week is all about testing and strategic learning.

If your test is on a Friday, then plan on doing 2-3 NBME exams by Thursday.

Schedule the first on perhaps the Sunday/Monday and the second on

Tuesday/Wednesday.

I prefer taking the test under self-paced conditions but pretending as if it was

timed.

Why?

The sad thing about the NBME exams is that you don’t know the correct

answers. It just tells you which questions you missed.

But thankfully, med students love to post answers and explanations to NBME

questions online. So I set my timer for 110 minutes and begin the test as if it

was the real thing.

When the clock hits zero, I Google the answers to every question and try to

understand the explanations. This is just as important for the correct

questions as it is for the wrong ones.

Begin to make a list of weaker areas as you go through the test. For instance,

you may have had a question about hepatitis you struggled with – write

“Hepatitis” down on a scratch piece of paper.

By the end of your test, you’ll know what material you need to review. Go

through your text of choice and read about these topics.

Make sure to take at least two, if not three, NBME exams. They’re helpful to

determine how prepared you are and helps to familiarize yourself with the

difficult of questioning. I found the NBME exams to be easier than UWORLD

and equal in difficulty to the real thing.

Finally, take a look at the helpful review PowerPoint from UT San Antonio

Health Science Center. You can find more about it in my recommend

resource post for the internal medicine rotation here. Here’s a link to the

review PowerPoint.

I found it helpful to review the PowerPoint 2-3 times. The first two passes

were slow and methodical. The last pass was a quick skim through. It’s a

great resource to compile all of the internal medicine rotation into a few high-

yield slides.

The only thing left is to take that exam and kill it!
 The OnlineMedEd Sandwich Method:

One question I had from a reader was where do I recommend using

OnlineMedEd?

I recommend the sandwich method. Use it at the start and the end.

Develop your foundation using OME. Then use other resources to sharpen

up on the detail. Then before the test, go back to OME to confirm you still

know the basics.

You can use this method with OME on every rotation.

Surgery:

You either love surgery, or you hate it. I was the latter. Still, that won’t stop

me from giving you the top resources which helped me achieve honors in

the rotation!

Pestana’s Surgery Notes (A+)

In my opinion, this is equivalent to Pathoma for pathology or First Aid

for Step 1 – everyone should use it. It’s golden high-yield material.
It’s only about 140 pages (+ 180 practice questions). Honestly, you can read

it in a few days.

I recommend reading this during your first two weeks of surgery. This

will help form your base of surgery knowledge you need to know.

Unfortunately, Pestana does not cover everything you’ll need to know for the

shelf; it’s just a very good overview. Below I recommend other texts you

can use throughout your rotation.

During your last week try to go through Pestana 1-2 more times. It’ll be

much easier to skim this time around. The information will also click much

better since you’ve been exposed to several weeks of surgery by this point.

You can find a link to the book and its many reviews here.
UWORLD (A)

You’ll hear that the surgery shelf is much more of a medicine shelf. This

is true. Not every patient who presents to the ER will need surgery. Thus

you’ll need to know who needs medical care vs. surgical intervention.

The instances where the answer is medical management requires you to

remember the pharmaceuticals and diagnosis you learned for Step 1.

If you’ve done your internal medicine rotation already, then you’ll be in good

shape. If you haven’t then first do the ~150 UWORLD questions for surgery

and then do some GI, Cards, and Pulm IM questions. Do this only if you have

time.

Honestly, most of the medical management comes back to you after doing

numerous practice questions.

Devirgilio Surgery (A)

This was the text recommended by my school. There are several pros and

cons to it which I’ll illustrate below. Overall it’s a great resource and go-to

text for your rotation.

Pros:

The text presents high yield cases similar to the Case File series but goes

over them in much more detail. It also presents you with questions about

each case and then provides a paragraph or two of explanation. It’s a format

that breaks down the material nicely to learn.

There are also nice images of CT and X-ray findings. You’ll also find useful

flowcharts on how to work up common conditions (thyroid, adrenal

adenomas, pancreatitis, etc.).

Regardless of your style of learning, Devirgilio has a good combination of

textual and visual aids to facilitate your learning.

Also, each section has questions in the back of the book. I selected to do

them all towards the end of my studying to help review all the material. The
questions are a good mix of difficulty and prepare you well for what

you’ll see on the shelf.

Here’s a link to the text.

Cons:

The book is long (~700 pages including questions/explanations). If your

surgery rotation is a q3 call for eight weeks, this book may not be feasible for

you. If so I’d recommend Pestana, UWORLD, and perhaps the NMS

Casebook.

Also, there are sections dedicated to areas of controversy (choice of

treatment) which aren’t necessary for the shelf. You won’t be asked

questions about a treatment plan which is commonly disputed. Thus you can

skim or skip these areas if you want to be efficient.

The book can also be redundant within the same chapter. In a way, this is

good to reinforce important topics. You can also skip these sections once

you notice any repetition.

Even with a busy schedule, it is possible to use this book. I was fortunate to

have a lighter schedule at the start of my eight weeks and planned to finish

the book in 3 weeks. There are about 60 chapters which came out to be
reading 3+ chapters a night. Most nights this wasn’t an issue since the text

is easy to follow.

With a typical surgery rotation, you can still manage to finish this book within

4-5 weeks. If you’re on an 8-week rotation that gives you 3-4 weeks to do

questions and review.

While the length of the text deters many students to stick with it, I believe it

was a good text to read and refer back to during my rotation. I was also

reasonably comfortable when taking my shelf.

You can find the link to the book here.

OnlineMedEd Outlines (A+)

There are quite a few OME Surgery topics. Each has a great outline on the

topics most likely to show up on the shelf. Each section is 1-2 pages and

takes less than 10 minutes to read through. They served as a great review

at the end of my studying.

NBME Practice Exams (A)

These are invaluable tools. As I said before, the surgery shelf is medicine

heavy. You don’t want to learn what that means on test day. Take a few (if

not all) of the practice tests.

Plan to take at least one your last week to prepare yourself for the format.

Surgical Recall (B)

When I was the first year, this is the resource I would hear about the most.

Ironically it’s the resource I barely used.

Surgical Recall is a thick reference guide with common questions you’re

likely to be pimped in the OR. If you know what cases you’re doing the next

day, it would be good to read through those particular sections.

Please, however, do not read it cover to cover. It’s not meant for that. A great

tool to be ready for pimp questions, but not much more than that.
Here’s a link to Surgical Recall.

NMS Surgery Casebook (B+)

I’ll disclose that I didn’t finish using this book. I decided on the resources I

intended to use but still gave this one a shot.

NMS Casebook is a workbook that walks you through the management of a

patient with different presentations. It’s slightly shorter than Devirgilio

surgery, and perhaps more interacting for some of you.

Along with being helpful for the shelf, it also breaks down common

procedures. Thus it can serve as a good guide for the shelf and rotation.

If Devirgilio surgery weren’t available, this would be the text I would have

used along with Pestana and UWORLD.

Here’s a link to NMS Surgery Casebook.

Broenchephalon Surgery Deck (A)

Use them. There should be some down time (minutes usually). Have your

phone on you and do some flashcards.

The surgery deck has about 100 cards which incorporate questions from

UWORLD and Pestana. Thus it’s a great review once you’ve completed both

of those resources.

Pediatrics:

UWORLD for Step 2: A+:

For the pediatrics rotation, there are about under 400 questions in

UWORLD. To get the most out of the questions I recommend you start as

soon as the rotation starts.

Even doing just 10-20 questions a night is enough time to complete the

questions within a few weeks. This gives you enough time to review weaker

points as well as attack other questions later on.

The UWORLD questions, in my opinion, are not all you’ll need for the

test. The real thing is 110 questions long, so you’re bound to see things on

the test that are not in UWORLD.

Regardless, the question bank serves as a great resource with high yield

material for everything pediatrics. They also do a good job of mimicking the

style and length of many questions that you’ll see on the shelf.

This was my first rotation and one where I waited too long to begin UWORLD.

Learn from my mistake, start early.

Why? Not just for the shelf. Instead, I would have seemed more

knowledgeable in front of my attendings. Many of the questions attending

physicians asks are high-yield topics that you need to know.

Yes, some seem to come out of nowhere, but most questions could have

had been answered if I had done my UWORLD earlier on.

Pre-Test Pediatrics: A+

Pre-Test is a book with 500 sample questions covering both high-yield and

tiny minutiae. This wide array of questions can make the difference between

passing and honor the rotation. It also helps with the pediatric shelf exam.
I loved this book!

My only regret about Pre-Test is not starting it sooner.

I rushed the last few days to complete all the questions, but they’re a great

source of practice after you complete UWORLD.

I would recommend doing these questions towards the end of the rotation.

Ideally, you have finished the UWORLD questions before two weeks before

your shelf.

The last few weeks would be great just to spend your time doing questions.

I also recommend buying the physical book. I had an electronic copy and

wished I had the paperback to study when I had some downtime during the

day.
You can find and learn more about the book here.

BRS Pediatrics: A:

BRS Pediatrics is commonly said to be comparable to First Aid for Step 1.

It’s a 600 + page textbook with high-yield info on every things pediatrics.

BRS Pediatrics is broken into major pediatric topics (Development, Cardio,

GI, Infections,) and has questions at the end of each chapter.

The two common complaints about BRS Pediatrics, and the reason I gave

it just an A is that it’s long and therefore tough to get through during your

rotation.

It is, however, very doable.

I designated this as my text of choice and split each chapter over the first

four weeks of the rotation.

This gave me enough time to focus on doing questions the remaining two

weeks.

There is also a test at the end of the book which you can turn to during your

last few days of prep.

Similar to First Aid for Step 1, if you know BRS Pediatrics well then you’ll

do just fine on your pediatric shelf exam.

Click here to find out more about BRS Pediatrics.

OnlineMedEd: A+

This was the first time I was introduced to OME, and I loved it!

The pediatric section has 7 hours of content so that should be easy to split

over your rotation.

NBME Practice Exams: A

While questions from UWORLD, Pre-Test, and BRS are great, you want to

see what the real pediatric shelf exam will be like.

This is where the NBME practice exams come in.

This in itself can make a huge difference on test day, especially if you’ve

never seen a shelf exam before (like me).

Being familiar with question lengths and styles is a huge advantage.

I had enough time to take all three, and every single one of them

underpredicted my score by at least 8 points. It may be different for you.

If you can’t find the time or money to take them all, definitely try to take at

least one before you site for the actual test.

Case Files for Pediatrics: B

I find that those who don’t use BRS as their text of choice tend to use Case

Files. On a superficial level Case File looks shorter and feels simpler than

the mammoth that is BRS.

Overall, this is a good resource for someone pressed for time or one who

refuses to study extensively when they get home.

The biggest drawback for Case Files for me was the lack and strength of

questions at the end of each case.

Still, the questions and text serve as a quick and good learning tool for the

shelf.

So if you want simple and quick, Case Files may be for you!

Check out Case Files here.

Neurology:

Students either love or hate neurology. Regardless use these tips to learn

the material well and excel on your exams.

Learn The Neuro Exam Cold

Knowing how to do the neuro exam is intimidating at first. There are many

components to a complete exam, and we likely haven’t learned it well.

In my rotation, I was fortunate to have an evaluated neurology exam be part

of the final grade. This forced me to learn it cold. After 10+ times of doing a

full version, the neuro exam becomes second nature.

Here’s a link from NYU nicely breaking down the different parts of the exam.

My school gave me the rubric for the evaluated neurology exam. As silly as

it sounds, I imagined doing a neuro exam on my office chair. (The chair had

a poor mental exam but would I have known that if I didn’t do the exam?)

I would do one part of the exam (ex. cranial nerves) and then look back onto

the rubric to see if I missed anything. If I did, then I’d repeat it. If not then I’d

add on another component (motor exam) until I had done a perfect neuro

exam a few times.

The next step is to practice on your patients and have your residents and

attendings critique you.

Learn the neurology exam, and the rest of the rotation becomes a whole lot

easier!

Learn to Localize Your Lesions

Neurology is all about location location location. You need to be able to relate

symptoms to a lesion (or lesions) somewhere in the nervous system.

Know the functional, geographic map of the brain. Where in the brain do you

expect upper extremity weakness? What about a blown pupil?

There may be multiple areas along the CNS/PNS which can result in a similar

symptom. You will have to practice and look at all the symptoms of the

patient. Which area fits the best?

A great way to sharpen your skills is to draw a diagram of the brain and spinal

cord. No artistic skills needed. If you’re feeling lazy just print one out like the

images below.
Now grab a coin and cover a region on your diagram and explain what the

deficits would be. If you can great! If you can’t, look it up or ask your

residents/attendings.

This works great with the spinal cord diagram. Being able to understand what

spinal cord level you should expect symptoms is important. Beyond that,

being able to pinpoint which side you should expect findings of your motor,

sensory (temp, vibration, pain, etc.), and the reflex exam is a necessary skill.

If you’re not a neuro person then this rotation will push you to continually

work on localization. Just practice on your own body and try to picture the

neuro system at work.

Blueprint Neurology/Case Files/Pre-Test:

Neurology was a rotation where I didn’t relate my success to a particular

book. Still, there are a set of resources which can be helpful for a short

rotation.

Blueprints was my go to text. At first glance, the book seems too wordy but

in reality, it’s very direct and to the point. It also comes with good questions

in between chapters and at the end of the text.

I managed to finish the text in about a week and used the rest of the time to

do practice questions. In all honesty, you can honor the rotation by just

beginning with questions if you’d like.

Here’s a link to Blueprints Neurology.

Case Files is something I suggest to anyone that needs a more regimented

and simple schedule. If you can’t find the motivation to “study” after clinical

duties, Case Files is for you.

Just do 3 cases an evening (there are about 60). This will give you over a

week to do practice questions.

I also used Pre-Test. The series has a reputation for having a mixture of

great but also very specific questions.

I enjoyed the Pre-Test questions overall. Ever so often I got one of those off

the wall questions. The kind of question where the answer has an incidence

of 1 in the history of humanity. Yeah, skip those.

UWORLD/NBME:
Neurology has about 150 UWORLD questions. Try to do two passes through

these during your rotation. At least try to redo the questions you get wrong.

It’s completely doable!

We’ve talked enough about UWORLD and NBME exams already. You get

the point!

Family Medicine:

I’ll keep this chapter short. Use OnlineMedEd and UWORLD. You can add

the other resources we talk about below if you wish.

OnlineMedEd:(A+)

I found OME the most useful during family medicine rotation. With all there

is to know, OnlineMedEd was perfect to focus on the high points.

My school provided a free premium subscription during my 4-week rotation.

If you can’t afford it no sweat.

If you can afford it, I think the videos and notes are where the money is.

Download the notes (which are 1-2 pages per topic) and keep them on your

laptop and tablet.

With the premium access, my school also gave a sample study plan which

you can see below.

Watching the videos on a scheduled basis will help serve as your foundation.

Then use the notes to review the topics. Combine this with practice

questions, and you’ll be golden for the shelf and rotation.

Case Files Family Medicine (B+)

I haven’t been the biggest fan of Case Files because I find their questions to

be subpar. For the family medicine rotation, however, I found the text to be

quite good.

Again if you’re looking for something simple, to the point, and relatively

short, Case Files is a good addition.

Attempt to finish the text in the first 2-2.5 weeks of the rotation. That’s about

3-4 cases a day. Spend the rest of the time doing practice questions.

Depending on how busy your rotation is it can be hard to fit in study time. Try

to do a case before you leave your apartment in the morning. Then perhaps

another one during lunch. Knock out the final 1-2 cases before you call it a

night. Use the weekend if you find yourself getting behind schedule.
NBME Practice Tests (B+):

These are relatively new for family medicine.

Regardless the tool is out there. Thus I recommend you take advantage to

see how comfortable you are with the variety of topics which can show up on

the test.

UWORLD (B+):

Now there is not a specific section in the UWORLD just for family medicine.

So you can either do internal medicine questions or focus on FM areas you

may struggle with.

Particular topics in UWORLD such as dermatology, rheumatology, ObGyn,

and preventative medicine may be a good place to start if you’re short on

time.

AAFP Podcast:

This may not help you on the boards, but it will help you look smarter in front

of your attendings. These are short 15-30 min podcasts which go over the

most recent addition of American Academy of Family Physicians (AAFP).

They are easy to follow and entertaining.

I would just go to the most recent episodes with common topics I was likely

to see in the clinic (hypertension, diabetes, chronic pain, etc.).

If you have to do some form a presentation for your rotation, the podcast may

highlight a recent study or topic you can talk about.

I would listen to one at 1.5-2x speed on my drive to the clinic. This was a

good way to get into my family medicine mode of thinking.

Here’s a link to their homepage.

Make Your Own Cheat Sheet:

There are some things that you need always to be ready to know.

Immunization guidelines, antibiotic ladders, diabetes management, and

hypertension control are some common ones.

To ease your anxiety create a cheat sheet on one piece of paper which

lays down the basic. For example, list the steps of diabetes management.

What treatment do you start with, what the max dose you can go, what are

the side effects, and what do you add next if it doesn’t work?

Do these with other common topics so you’ll have something to refer to avoid

forgetting the basics.

Eventually, you’ll memorize these guidelines, and you won’t need the paper.

This means you’ll be closer to being prepared for the shelf.

Ob/Gyn:

UWISE (A):

I never thought I’d find a question bank I liked as much as UWORLD. But

UWISE for the Ob/Gyn rotation is it.

UWISE is an online module which has over 600 questions.

The best part of UWISE is the questions are split into their respective

sections. The sections are each ten questions.

You can thus do ten questions on contraception, another ten on post-term

labor, and finally ten on post-menopausal bleeding.

This allows your studying to be very focused.

The questions are overall well written and high-yield information.

The only caveat I would give is the explanations are at times hard to decipher

on which answer choice is correct.

If you can’t get access to UWISE, then try out this Anki cards which cover

the topics. Full disclaimer I didn’t know of these during my rotation! Hope

they help!

At the end of your rotation, it would be helpful to do the random 50 or 100

question tests. They do reuse the questions from each section, but I found

them helpful as a final review before my shelf.

Case Files for Ob/Gyn (A):

Ob/Gyn is a subject which can easily lead you down a rabbit hole.

There are several high-yield basic knowledge you need to know, but you

manage to master those pretty quickly.

Thus I noticed classmates try to memorize obscure facts, nerves,

procedures, etc. which were low yield.

Case Files for the Ob-Gyn shelf, on the other hand, was the exact amount of

high-yield information I needed.

The tables, figures, and end of chapter quizzes were all helpful.

Some students used Blueprints for Ob/Gyn and enjoyed it. You can learn

more about the book here.

I just found Case Files to cover what I needed to know.

When I completed the text, I felt I had a good grasp on how to differentiate

between common obstetric complications and gynecology pathology.

Here’s a link to the text.

UWORLD (A):

For Ob/Gyn, there are about 280 questions.

But make sure you do them!

Brosencephalon Deck (A+):

They were very helpful for my Ob/Gyn rotation.

I would often do 50 flashcards on my walk into the hospital (about 15-minute

walk).

They are very brief, high-yield, and appear to stem from UWORLD and Case

Files anyways.

Try to add these to your schedule if possible.

NBME Subject Exams (A):

Doing these practice exams is why I can say resources like Case Files and

UWISE were great.

The NBME practice exams confirmed that the above material is enough to

learn the material you need and still do well on the exam.

OnlineMedEd (A+):

I had forgotten about using OnlineMedEd for the Ob-Gyn rotation until a

week away from my exam.

But I am so glad I remembered!

There are about 20+ notes on Ob/Gyn, and they’re all wonderful.
The notes touch on a lot of the high-yield info from Case Files with the

additional helpful material.

Pre-Test Ob-Gyn (B):

I’m a sucker for more questions.

Thus after finishing UWISE, UWORLD, and Case Files, I gave Pre-Test for

Ob/Gyn a shot.

Pre-Test for Ob-Gyn has 500 questions which are great for anyone needing

extra practice.

I would say 60-70% of questions test you on high-yield information. The rest

is a toss up of useless or resident level info.

Still, I found it helpful to go through sections about labor, abnormal bleeding,

etc. and to get extra practice.

You can check out Pre-Test for Ob/Gyn here on Amazon.

What To Know For Ob-Gyn:

Revisit Your Female Anatomy:

I needed help on this big time!

For the life of me I couldn’t remember which nerve and artery went where in

the pelvis.

I obviously didn’t pay well enough attention to that section of anatomy lab.

But to avoid looking like a fool during OR procedures, I found some helpful

YouTube videos about the female anatomy.

Here’s an example of one that covers the high-yield material.

Anatomy Review for Ob/Gyn Rotation

Watch these at 2x (using our speed listening tools) before a surgery day.

You will look like a rockstar!

Rely on Decision Trees:

This isn’t unique to Ob/Gyn.

But Ob/Gyn does rely on decision trees a lot.

It’s important to know how to work up abnormal menstrual bleeding from start

to finish. How does the lab value of prolactin or FSH change your next step?

You don’t have to look very hard to find some good decision trees.

I used OnlineMedEd which worked like a charm.

Using these decision trees, you will know the next step regarding workout,

management, and treatment for a variety of diseases.

But it’s best to get in the habit of not only what your plan would be but what

your series of a plan would look like.

Master Your Understanding of Contraceptions:

I dreaded having to talk about contraception before the Ob/Gyn rotation in

medical school.

I simply hadn’t’ learned it well enough. There was never the opportunity to

practice those Step 1 facts practically.

But once you understand the pros and cons of the variety of methods, you

can serve your patients well.

To understand who you would offer OCP to and who you wouldn’t.

I once caught my intern before she gave an uncontrolled hypertensive

patients OCPs. Because I understood the concept of an estrogen-based

contraceptive, I could serve that patient well.

Have a good grasp on the pros and cons for OCP, IUDs (Copper and

Progestin Based), Implants, Shots, and condoms.

These will cover a majority of your patients.

Understand Interventions During Labor:

This is important especially regarding your shelf.

All deliveries have a similar structure. “X-year-old women with GxPxAx at X

weeks gestational age is in labor. Labor has happened for X hours, and she

is dilated to X inches. What do you do?”

So you have to be able to decipher based on mom’s and baby’s age if

anything different has to be done.

Then you must look at if the time span of labor is abnormal. Is she taking too

long to dilate? Is baby not progressing down the vaginal canal?

If none of that is the problem, then you’ll likely be giving information about

either bleeding, heart rate of the child, or abdominal pain in the mother. What

do you do next?

So use those decision trees from earlier and be able to walk yourself through

a vignette.

The shelf exam will be a piece of cake if you can do this!

Psychiatry:

Similar to the family medicine section I’ll keep this short. Use UWORLD and

First Aid For Psychiatry. That’s all you need.

UWORLD (A):

The hardest thing about psych is recognizing the nuances between two

different patients. This can make the difference in their diagnosis and also

their treatment.

So go through all of the UWORLD questions and be able to identify the

differences between diseases such as:

 • Anorexia and Bulimia

• Conduct vs. Oppositional Defiant Disorder

• OCD vs. OCD Personality Disorder

UWORLD is great to help you with this.

First Aid For Psychiatry:

The good thing about this resource is that it’s short. The bad thing is that

there’s a lot going on in the few pages there are.

With all the side boxes and reminders which First Aid is notorious for, it can

be distracting.

Still, everything and anything you need for your shelf exam should be in this

book. Honestly, there’s probably too much info.

Since it’s short, you can finish it within the first two weeks.

Here’s a link to the text.

Online Med Ed: (A)

The great thing that Dr. William does for Psych is to help you distinguish

diseases and medications that appear similar.

I found this extremely helpful for Step 2 studying. If you, like many other

students, have issues with psych medications, watch his videos. Then do

practice questions and assess how well you understand the patterns Dr.

Williams lays out for you.

Emergency Medicine:

I know this is not a core clerkship for most, but many end up doing it during

their medical school career.

SAEM Quizlet Deck:

Some schools use SAEM’s test as their end of the rotation exam. Others use

NBME.
If your school does use SAEM, this quizlet breakdown all 500+ practice

questions on their website. Whoever made this is a saint.

The flashcards, for the most part, reflect what the practice questions from the

SMAS website. There are a few exceptions where the question mentions an

image which the flashcard does not have. I didn’t find this a big deal.

If your school uses NBME subject exams, then use the practice tests as you

would for any rotation.

Case Files for Emergency Medicine (B+)

If you’re going into EM or don’t know much about the field, Case Files breaks

our typical IM topics in the ER setting. For example, we learn about

arrhythmias all the time but how do you manage them on the first

presentation?
Case Files is a great resource to parse these small details out.

Life in The Fast Lane:

ER, docs seem to have a lot of time to blog (maybe that was supposed to be

my calling?). Regardless, life in the fast lane is a great resource, and it’s not

only for EM providers.

LIFL provides great resources for EKG, imaging, and toxicology. I loved their

EKG sections and recommended looking at the site to learn the basics before

starting your rotation. Here’s a link to their website.

 Chapter 14:
Misconceptions About Studying in
Medical School
This whole book has been designed to tackle misconceptions. But let’s keep

tackling them while we’re at it.

Having To Use Every Resource:

This is something you have to get over as soon as possible. Don’t go

overboard with your resources!

This is true for your classes, Step 1, rotations, and Step 2.

If you can I recommend no more than 2-3 resources!

Because in the end you rather know a few resources well vs.knowing a little

about multiple resources.

I’m not going to do beat the point any longer. For your own sake, please stick

to fewer resources!
What Works For One May Not Work For You:

In my book, The Preclinical Guide, I speak extensively about how to

approach your relationship with your classmates masterfully.

Here’s the thing, your classmates are amazing. But they are also awful at

the same time?

What do I mean?

Your classmates will likely stress you out. They’ll make you believe that

you’re not working hard enough and need to change your approach.

A classmate may be using some “secret method” which you think you need

to change to.

But if it ain’t broke, don’t fix it! Stick to your method and ignore your

classmates in these situations.

Similarly, don’t be the student that proactively tells everyone how “they’ve

figured it out”. Don’t start offering unwanted advice.

You Need to Be An All-A Student All The Time:

We talked already about not being a 24/7 medical student. Hopefully, you’ll

commit now to having a cut off time every day.

But now we need to talk about this desire for an ‘A’ that we all have.

Here’s the truth, there’s a good chance that you may not be an all ‘A’ student

in medical school. I hope you can be one of the few to prove me wrong, but

the chances are that you’ll be near the middle of the pack.

And you know what? There is nothing wrong with being in the middle of the

pack. What do they call the student with the lowest rank at Harvard when

they graduate – doctor.

In fact, I encourage you to get away from this desire from “needing” to get an

‘A’.

I get it; you’re so used to doing well in school. You’ve made it this far which

means you’re grades have always been well above average. Now I’m asking

you to be okay with average?

Yes.
Medical school claims the sanity of students because it has so many Type A

personality individuals chase what only a few can have – a perfect GPA.

But the cost, I’d argue, to have perfect grades in med school is too high. It

requires extensive hours of studying, personal sacrifice, and likely burnout.

Yes, you should work hard in medical school. But you don’t have to lose your

sanity for the sake of an ‘A’ anymore.

I’ll share a little bit of my own experience. This whole book has been a

reflection of my studying. I made each method to be more efficient and help

me do better in school. But notice that I never promise that these methods

will get you a 4.0.

Why? Because that’s not my goal.

I want you to use those extra hours you save from using these techniques to

enjoy your life.

I used my time to create what (as of this writing) has become a source for

medical school advice for over 100,000 readers! My GPA? It’s still doing just

fine.
So I’m not asking you to become a ‘C’ student, just stop making that

illustrious ‘A’ your only goal!

 Chapter 15:
The Most Important Section
I want to end this book with what I consider to be the most important section.

To be honest, it’s my last attempt to beg you to enjoy yourself in medical

school.

Use the extra hours you save for your hobbies and your love ones.

Here’s why.

Wellness = Better Grades

I’m not the smartest individual in my class. I don’t have the highest GPA

(quite far from it actually). But I’ve done well for myself because I have kept

myself well.

I used my extra hours to workout everyday, cook my meals, spent time with

my loved ones, and just freaking relax.

If you can’t find the balance in medical school to do this, you honestly never

will. Life will continue to get busier, and your excuses will only appear more

valid.
So take care of yourself.

This includes the obvious – sleep, eat well, exercise. But this also includes

keeping a life outside of medical school. Learn about yourself and grow.

Don’t make these four years only be a medical transformation for you. Every

aspect of you should be able to change.

Have A Venue To Release from Med School:

You will have tough days. You may have already had them – you will have

more.

Have a source to vent and release your emotions and stress. Obvious

sources are families, classmates, or turning to peaceful hobbies.

Just have something. More importantly, have that venue scheduled into your

week. Do this even before you schedule your studying blocks. This forces

you to prioritize your health and wellbeing over a syllabus chapter.

This is what many of my readers know as my “schedule your fun first”

motto. It’s helped me through some dark days and weeks in medical school.

It will do the same for you.

 Conclusion
Well friend we’re approaching the end. I’m hoping this book had at least one

golden nugget that you can take away and try.

Remember, medical school is a life-changing 4-year experience. But it’s only

truly life changing once we get our noses out of our books and look.

Embrace the experience and challenge, connect with your patients, and

remain humble. Use the tools the book lays out for you to dedicate your extra

energy elsewhere. And make it count.

I’m grateful you’ve taken this journey with me. Again I truly hope there was

something of value you’ve taken away. My goal has always been to help

individuals like yourself have an easier experience in medical school than I

did.

I hope our time together does not end with these last pages. If you have any

questions about medical school at all, don’t hesitate to contact me at

[email protected].

You can interact with me with on social media, namely Instagram and

YouTube to receive more advice but also a sneak peek into my own crazy

life.
Finally, TheMDJourney.com will continue to be my main source of sharing

tips about this medical journey. It won’t just end with medical school. As I

progress through the residency application process, intern year, and beyond,

you can expect me to pass that information back towards you.

I thank you once again for being a part of this book. I wish you the best on

your journey.

Until next time my friends…

Lakshya (Luck-sh) Trivedi

 About The Author
Lakshya Trivedi is an upcoming 4th-year medical

student. He has been writing about how to succeed in

medical school at TheMDJourney.com since his 2nd

year of medical school. He is also the author of The

Preclinical Guide. In addition to writing and mentoring

others on their medical journey, he also enjoys sports

and reading. He plans to apply for an Internal Medicine rotation in Fall 2018.