Over the last five and a half years in medical school, along with giving both Step 1 and Step 2. I have learnt a lot of study strategies that have helped me. These didn’t come to me naturally.

Some people know how to manage instinctively, which is good. But if you are struggling with your course or just looking to see how you can improve. Here are my two cents.  

Since medical school has a lot of course matter, studying alone for exams can become very isolating. To me, it didn’t feel like you were living in a society. It felt like you were living in your mind: just your book and you. Also, it felt like you were just a 20-something person with so much to experience in life. Instead, here you are with your faithful books and the exam hanging like an impending doom. 

Purpose:

Knowing that you are doing this because you want to do this and want the outcome is motivating—especially the why aspect of it.  

There may be inherent enjoyment and fascination about reading medical science. A passion for patient welfare, health equity, etc. that contributes to your drive.

There are other types of motivation – parental pressure and societal pressure. Unfortunately, they may or may not work or may not be pleasing even if they do. 

With every goal, there will be tasks more or less enjoyable and as I said, remember why you are doing it and take the not-so-enjoyable things into your stride. 

Remove Distractions: I cannot stress this enough. From TV to social media, everything is trying to grab our attention. These instant dopamine hits are not only wasting our time but decreasing our ability to do focused work. 

Social media addiction/ Internet Addiction: it may be surfing Instagram, just reading Twitter posts, or sneakingly watch dramas or Netflix. Whatever your “drug” may be, they creep on you with every notification. You were just going to peak, and before you know, you have slipped into that rabbit hole. And one hour has passed. 

Have fixed hours. Like, whether you plan to study for 3 hours or 8 hrs, for that time, keep your mobile switched off or on silent.

I deleted all of my social media apps and told my friends not to message me for a month unless urgent on WhatsApp before Step 2 CK.

Otherwise, If you need your phone. Use app blockers to limit the use of whatever is distracting you.

Daydreaming:

Okay, now you have removed external distractions. No new opportunities, interesting gossip, random stuff popping into your notifications and into your mind.

But as soon as you do thirty questions, you find yourself drifting, daydreaming perhaps of things you would like to do. Or people that you miss. Or they may be just immediately gratifying fantasies. Or it may be food.

Now what?

Timer. Those forty pages can take 50 min. Those forty pages can take three hours. Are you a person who can keep track of time? Keep a timed prevented me from drifting. 

See how much time you need to finish these ten pages/ 30 ques.

Be realistic; give yourself some time for the brain to rejuvenate. 

Take planned, scheduled breaks. 40- 50 minutes seems to be the general consensus at one go. Then take a ten minutes break.

You can also use the promodoro technique.

REMEMBER: 

One should read without the stress of whether you are retaining this information or not.  (Even if it is important, stressing about it won’t help.)

To read and not aim for perfection but to aim to understand.

For retaining information:

Flashcards 

I love them.

There already made decks available in ANKI, so I think every US grad knows this. Most IMGs too.

But to the rest of the population, this is one of my favorite things. I didn’t use it for Step 1. I still regret it. It uses recall. which is (much better than re-reading) and spaced repetition. Spaced repetition, put simply is learning matter over time. (spaced in time). It is wonderful.  It allows you to strengthen the neural connections without the the stress of racking your brain in an all-nighter.  Around 5-6 reviews are good. But see what works for you. 

For example, if you had to learn all the HIV Drugs. You do a quick reading , the mechanism, the side effects (also specific comorbidities where some of the drugs are not preferred). commonly used combinations etc. 

Then you have make or have a ready-made HIV Drugs Flashcards and review them after 24 hours. then after 7 days. after 21 days. You may remove the ones you already remember.  Then maybe 1 and a half to two months later.

It uses these two qualities that make learning so much more fun than reading the same thing over and over again and still not being sure of what you remember.

Question Banks: questions will help in recall and reasoning. And also help you develop an approach. Analyzing which questions you got wrong and learning from it- is obviously vital.

Study partner :

I spent more than half of my third and final year group studying. They were fun. We practiced all the general and systemic examinations on each other. We would discuss things we found confusing.

 During the pandemic, group studying for Step 2 basically involved a lot of video calling.

We would have a fixed course we want to complete before our scheduled meeting. Then we would call and discuss. Sometimes we would leave the video on and just self-study. Or we would cover the same system in a week and then ask questions to each other. This basically allows you to connect (social needs), bounce ideas and concepts and hold you accountable.

If you don’t have a friend giving USMLE with you, you can find someone on USMLE forums, twitter etc.

Mnemonics:

You can’t make a mnemonic for everything. But for some really rote memorization stuff, it does help.

I used to try to make mnemonics with the name of the drug.

Like Ranolazine- The first two letters RA expanded into Refractory angina. (Use)

I used to try to embed the uses and side effects in the drug name itself. 

Differentiating features:

One thing you will realize that sometimes you know the case being described in the question. But you are confused between two options. This led me to develop an approach of finding key points to differentiate it from its common differential diagnosis.

One simple example is Fibroid Uterus and Adenomyosis: Irregular contours and firm vs. uniform enlargement and boggy consistency. 

Remembering this single key point allowed me to answer nearly all my fibroid related questions.

You can check out my Instagram page- @USMLEFLASHCARDS  

in which I put around 500 flashcards I made. I made more but haven’t gotten around to putting them.

Stamina: Let nobody scare into you thinking that you have to study like a zombie and comprise your sleep.

With adequate preparation, sleep can be easily managed. 

That being said, of course, you have to put in a required number of hours (Hours depend on person to person)

Nutrition: Fruits, vegetables, whole-grain foods, and protein should sustain you better than processed carbohydrates and refined sugars. The latter will give you a short high…and follow it with a low. 

Feed yourself. I can barely work if I am very hungry.

NOTE:

Some of you may be overthinking too much of the results or, in general, get anxiety while giving the exam or even may have concentration difficulties. After all, it is one of the longest exams you will ever give.

If you feel like any of these things are affecting your ability to study or your score. Don’t hesitate. I repeat. Don’t hesitate to reach out for help.

Some medical schools may have therapists for students. Which is unlikely in India. But certainly, most medical colleges will have a Psychiatry Department, and you could reach out to a resident or Professor, who may help directly or guide you to the right person.

Also, consider getting a proper evaluation for depression, anxiety, or even ADHD.

There are also some general strategies for working and studying more effectively, which I will discuss in a separate article.

I would also like to say studying for both Step exams improved my approach. I am grateful for the things I got to learn from both these experiences. 

Hope this helped you as much as it helped me. If you feel something can be added, please give your feedback. I would appreciate it.