A review of successful study strategies in med school, including retrieval practice (testing effect), spaced repetition, and varied practice. I also discuss common learning myths, including learning styles. And I end with a discussion of popular study resources for med students, including Pathoma, First Aid, Picmonic, SketchyMedical, Anki, Firecracker, Osmosis, Najeeb, and more...
In direct response to some comments, I would like to emphasize that I'm not asserting "Sketchy" doesn't work - I'm just saying that the study technique it uses is unproven and is novel enough to not yet have established a conventional wisdom about it among learning scientists. Also, regarding First Aid, I appreciate that Step 1 is perceived to test the long lists of unconnected esoteric facts that First Aid is great for, however, I also see students use First Aid as a primary resource for their courses, which I think has major drawbacks.
Selected references include:
Make It Stick - The single best layperson guide to learning theory (https://www.amazon.com/Make-Stick-Science-Successful-Learning/dp/0674729013/ref=asap_bc?ie=UTF8)
Learning Scientists Blog - Another great resource for all things related to the science of learning. (http://www.learningscientists.org/blog/)
"Paradoxes of learning and memory" - Free book chapter outlining some successful study strategies, with discussion of how they can be counterintuitive. (http://psych.wustl.edu/memory/Roddy%20article%20PDF's/Butler%20&%20Roediger%20(2011).pdf)
"The Learning Styles Myth is Thriving in Higher Education" (http://journal.frontiersin.org/article/10.3389/fpsyg.2015.01908/full)
"Metacognition and the spacing effect: the role of repetition, feedback, and instruction on judgments of learning for massed and spaced rehearsal" - Also touches on our inability to accurately judge successful learning (http://castel.psych.ucla.edu/papers/Logan%20JOL%20Spacing%20ML.pdf)
"The effect of selected 'desirable difficulties' on the ability to recall anatomy information" - Also touches on retrieval practice and the testing effect (http://www.ncbi.nlm.nih.gov/pubmed/25227209)
"The Picmonic(®) Learning System: enhancing memory retention of medical sciences, using an audiovisual mnemonic Web-based learning platform." - Peer reviewed paper written by founders of Picmonic (http://www.ncbi.nlm.nih.gov/pubmed/24868180)
Links to Resources:
Kaplan Qbank (https://www.kaptest.com/medical-prep/usmle/usmle-prep-course/step-1-qbank)
First Aid for Step 1 (https://www.amazon.com/First-Aid-Usmle-Step-2016/dp/1259587371)
Dr. Najeeb (https://www.drnajeeblectures.com/)
The Noted Anatomist (https://www.youtube.com/channel/UCe9lb3da4XAnN7v3ciTyquQ)
Armando Hasudungan (http://armandoh.org/)
Dr Strong, I totally agree with what you said about students having learning preferences over learning styles. I used to think I have a chaotic method of studying compared to my other med school mates. Most of them use one single method and that's it and myself, different methods for different subjects.
Man, I don't know if you're still around doc but thank you so much for taking the time to make these videos. I'm currently going over your DDx series to solidify my approach to differentials. Thanks again!
I'm glad the videos have been helpful!
Yeah, I'm still around. Needed to take a break from making videos for a while due to personal/family issues. I had wanted to start posting again in September, but it keeps getting pushed back. Any week now...
I saw a comment of yours once saying that a medical student shouldn't be using harrison's to learn medicine, and since then i've been wondering about what is the best resource to learn medicine, not for exams..but simply to be a better doctor, and since i value your opinion so much, i hope you provide me with an answer to my question. Thank you for all your work.
Definitely some good recommendations. But I do have to state a lot of your opinions are typical of older physicians/professors - that is, First Aid and other some other resources give too much "esoteric" info. Reality is, Step 1 and Step 2 isn't what step 1 and 2 used to be. There was a good number of extremely specific and mentioned in passing in one chart in First Aid or something. I just finished up 3rd year and the shelves have some of the same. If I had time to just sit and draw out the blood supply to the pancreas I would be happy to do it. But I have to make sure I've at least read every stupid small association or factoid. Uworld is hands down the best at synthesizing the information and connecting the dots.
Adam, thanks so much for your comment. While I do explicitly recommend that everyone should buy First Aid, perhaps I wasn't as clear in the video as possible.
This video's purpose is to tell you how to study in order to rock medical school as a whole *and* in order to optimally prepare for your future career. It's not just about how to rock the USMLE. Knowing which chromosome a gene is on or which enzyme is faulty in some genetic disease absolutely might show up on Step 1, but it's useless knowledge for understanding how to diagnose and treat patients in real life. This is my biggest gripe with memory-association resources like Sketchy - I have no trouble believing that they help with Step 1, but I'm skeptical that they help people learn to diagnose infectious diseases in actual patients.
Of course, this highlights a huge problem in med school - perhaps one of it's biggest: That Step 1 and 2 are very poorly designed exams that have very little to do with one's skill at being a doctor. (And believe it or not, they've always been that way, even for us "older" physicians! =P )
This is the first video of yours I see and I have to say I am impressed. I will definitely see more.
Man, the part about learning modality made me feel so uneasy. I was so sure about the learning styles.
I was really happy to see you mention active recall and spaced repetition. Probably the most important aspects of learning. I always thought its more about review than the initial studying. As for cramming, the wooorst.
The concept of varied practice/interweaved practice is really interesting, I recently have been doing this intuitively but never knew this had a proper name and was a study method. I wish I could do the synthesis practice, but I just don’t have enough time.
As for sketchy and picmonic, totally agree. Never worked for me. I used lecturio and najeeb and found them to be amazingly helpful, especially lecturio. It accompanied me all throughout med school.
thank you very much ..it is very helpful ,i have enter to pathoma site but it require credit card to sign in and the videos that i saw was so helpful
i am from iraq and we don not have credit card is there any other way to get the videos ....please
I will be staring as an M1 this fall. Would you recommend watching a general overview of a topic from external resources (such as osmosis) before tackling the details of a powerpoint or text book from a given course?
When you said interleave learning, do you mean learning different topics in one discipline? Like going from ACS to Cardiomyopathies? Or do you mean learning wildly different topics like Antibiotics to Pulmonary Edema?
As an undergraduate senior at UC Berkeley, I must say your videos are beyond helpful. Aspiring to become a psychiatrist, there are many questions I had initially in which your videos have answered . To everyone reading this comment, please have self-belief that improvement is possible. Mastering skills such as discipline, resiliency, and having a determined attitude while studying now will cultivate a better you in the future. THANK YOU Eric 😊☺️
Thanks for this. I'm currently going over pathoma as well as the step 2 Kaplan material. They are nice for reviewing things we did in prior semesters of medical school but most of the content is summarized and high yield for exams. I also try my best to read daily from textbooks as well as treatment guidelines. Osmosis is great, I've subscribed to their YouTube channel and I usually watch a video a day of their content. At the end of the day, I want to be a proficient doctor and not just someone who can ace an exam. Good luck to all those out there, study hard and try your best.
Varied practise... this is what I needed. I found myself doing a pile of flashcards on every subject, and was easily overwhelmed when switching to the next subject. Now incorporating your tips, it is much more enjoytable. Thank you!
Just wanted to say while I'm not in medical school, your EKG videos were awesome and really informative. I'm still going to a cardiologist for another issue, but I recently got an EKG in a packet that said "Possible left atrial enlargement, ST deviation and moderate t-wave abnormality, consider anterior ischemia" ... obviously that's a little shocking to see for a patient with no mention from my PCP! Now I know why my PCP didn't say anything was wrong. Your videos reassured me my EKG was actually pretty dang normal, and I'm sure at least I have no enlargement since that video of yours about atrial enlargement was so in depth. Amazing how fast doctors can read EKG reports, though.
Great video! At 14:00 you discuss "integrated/synthesis" learning. Check out OnlineMedEd.org, they do what you are discussing, but call it the "Blended Learning Model." Probably the best I've seen at it. Thanks again!
Excellent video, I wish this was around a year ago when I started med school. I'm pleased to hear that my main technique of devoted flashcard making is a time tested method. I've been encouraging my classmates to use flashcards to capitalize on the "active learning" of the retrieval practice style that you describe. I'd like to add 2 things to your list, that from my experience have been beneficial: 1) Katzung and Trevor Pharmacology Examination and Board Review is essentially the Pathoma of pharm and 2) Quizlet.com is an excellent flashcard alternative to Anki that is somewhat more simplistic, and also allows you to share your sets (many of my classmates appreciate this as I make a set for every lecture and have gotten rather proficient at it)
Thanks again for the video! I look forward to seeing what else is in your channel.
Excellent Video, Dr. Strong!!!!
Due to the popularity of some of these study methods, there are studies beginning to peak into the literature.
I'll mention a few that are relevant (because you mentioned their popularity).
1. Anki improves step-1 scores, but firecracker does not
2. A study done by Einstein college of medicine predicts how many questions (from each resource) you must do in order to gain one point on your Step-1 score
- Uworld: every 123 questions increases 1 point on step-1 - Kaplan Qbank: every 325 questions increases 1 point on step-1 - NMBEQs: 968 questions increase 1 point on step-1
*This was presumably a study done by Einstein college of medicine, but I can only find online PPT-like presentations (PDF file) explaining the study an the results, I cannot find a journal that published this study (which makes it a little suspicious).
https://members.aamc.org/eweb/upload/Are%20Questions%20the%20Answer%20PPT%2011-6-12%2010PM.pdfLastly, I have to say, in my practice questions for pharmacology, Sketchymedical (Sketchypharm) has increased my %correct.
I didn't like picmonic and found it completely unhelpful and way too incomplete. With Sketchy, you get a more complete picture, and it's presented in a way that makes it easier to remember than picmonic... I don't have a study for that, but that's my personal experience.
Over-all, Love your video, and I'm going to try to find a better way to incorporate "Varied Practice" into my study habits.
- Najeeb is incredible, but it takes him WAY TOO LONG to get to the point, and playing him at 2x makes his accent incomprehensible... Some people like the repetition he provides, though and I have to admit, he does a great job at presenting stuff as simple as possible -- drawn on a white-board.
Those are good points!
I agree that the study probably lacks a certain amount of rigor and may only reflect a sub-population of med students.
But when I was in the process of choosing the study method I wanted, several upperclassmen told me that the sheer amount of time spent setting up FC for each new block makes it more burdensome than creating your own anki cards (assuming an upperclassman hasn't already made them and shared them).
I haven't used FC and have no idea how it works, but this small study may be an early indication that FC needs to be better organized, at the least.
I would like to see the study repeated prospectively, and on a larger (representative) population.
Mike, thanks for the comments and additional references! Regarding the "Anki vs. Firecracker" study, it's certainly interesting. However, with only 72 students, and given how many variables they examined, with it being based on retrospective self-reported data, I wouldn't write off Firecracker quite yet. I actually expected to see the authors report a financial interest in Anki at the end of the paper...(they don't).
I've heard about the Einstein study, but have never looked at it. Unfortunately, it doesn't look to have been actually published in a peer-reviewed journal (maybe it was presented in person at an AAMC meeting?). Lots to dissect from it; I'll have to look through the presentation some more when I have time.
I've only watched a handful of Najeeb videos, but agree that they are very detailed. Make mine seem overly brief in comparison! =)
I'm a brazilian graduate. Its different how US professors think about board exam materials. He just recommended pathoma, FA, UWorld... In Brazil we also have board exam materials (Medcurso, medcel...). But most professors will tell you not to use them, instead, to read dense books such as Cecil, Harrison, Robbins, Braunwald, Goodman. To be honest, I think board materials are much more time efficient. Brazilian board exam material (Medcurso), is so good that is such a pity that is in portuguese and people around the world cant use it.
I don't intend to disagree with you about the matter in a whole, but the problem is brazilian students tend to face Medcurso as a substitute for the solid understanding of basic medical sciences that comes from studying for knowledge outside of what is required in exams. I see it everyday, people pretend they study for four years and want to get away with studying what is necessary to pass the exam, regardless of how ignorant they are about the subject really. Medcurso is good and all but is not the holy grail of medicine learning, and never will be. Also, for students proficient in english there are plenty of material available, at a much lower cost or for free, that WILL prepare them if they know what they're doing.
I can't imagine any US faculty recommending Cecil or Robbins and the like for dedicated board studying, although most do recommend those texts for their courses (Guyton and Hall for physiology is also a fairly standard recommendation here). Most med school faculty aren't very familiar with the resources that students actually use for their courses, as well as for test prep. We had a faculty meeting several months ago to discuss a new preclerkship curriculum, and someone mentioned that the students were all using Pathoma to study for our pathology course instead of the official course materials (which were of very inconsistent quality). The basic science faculty (some of whom taught in the path course) were like "what is Pathoma?" Although I don't blame them, and I understand why this is the case, it's unfortunate that more faculty aren't familiar with the resources their students are using. That's not to say that we should be "teaching to the test" in med school, because being a doctor is about way more than what's currently covered on board exams. However, I also don't think that med school faculty should ignore the boards entirely and expect students to just figure it out on their own via peer groups and Student Doctor Network.
Thank you so much for this vid, sir. I was mixing different techniques and topics and I was afraid: "perhaps I am doing it wrong, I should maybe stop and do one type of tasks for a day not to mix it too much as I usually do". This video relieved my worries ^^ Have a wonderful day.
Thanks for the suggestion. Unfortunately, I couldn't take the time to include every decent resource. For example, in addition to B&B, there's also OnLine MedEd and Goljin (though the audio lectures which many people use are bootlegged). I've also heard a couple students talk about Doctors in Training, but the only thing I know about it is that it seems excessively expensive ($825 for their Step 1 review course)
Thanks a lot for your helping tips, I am already subscribed to your Channels and most of the channels which you mentioned in this video. Your videos are extremely helpful and updated and easy to understand.
God bless you.
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