How to Study Medicine Effectively: Why I Started a Daily MCQ Practice Group

Since starting medical school three years ago, I’ve spent a lot of time thinking about how to study medicine effectively. In that time, I’ve developed a good strategy thanks to books talking about the act of learning itself. Techniques outlined in titles like Make it Stick and Learning How to Learn, for example, are particularly valuable. So much so that I haven’t failed an exam yet!

In that time however I’ve seen a good amount of other students around me struggle. Developing a tendency to over-think things or get in the habit of looking for short-cuts (cheating etc); they derail their own progress. If only they learned the content effectively the first-time around, and actively worked to retain it? More time would be available to do the other stuff they like. Reducing a lot of stress in the process.

I started a Whatsapp group, in late June, with a small group of friends, mainly because of this. The concept of the group was simple. I’d post a daily medicine-related multiple choice question (MCQ) covering the major subjects we’d taken the past three years. Doing this, I figured, could prove useful on a couple of fronts. The practice of writing the questions would help me understand the concepts better. While the end-result could provide value to my friends. Giving them a chance to practice (or revise) things that might improve their test-taking moving forwards.

The hard-sell with this however, despite it being free, is to convince others of its value. So that’s what I want to expand on here. Explaining more my thinking behind it. And fleshing out some of the deeper principles of effective study theory I think could help better your grades and save you time studying.

What is Active Recall?

One of the big reasons I started this group? To get people (me included) into a daily habit of quick and easy active recall.

Active recall, as a study concept, has a lot written and said about it. Despite that I’m still surprised by the amount of medical students who don’t know about it! The number of people I see in the library uselessly re-reading, highlighting and re-writing notes etc, gets me every time.

At its core, its the practice of actively stimulating your memory during the learning process. Unlike passive review (the stuff you might be doing), it exploits a psychological testing effect that helps build long-term memory. Meaning you’re more likely to recall these facts months and years down the line (thus drastically reducing your study time). 

Online Flashcards for Active Recall and Spaced Repetition ...
The forgetting curve – what active recall and spaced repetition aim to overcome

Research (there’s been a lot), suggests active recall is the “quickest, most efficient, and effective way to study written materials, at least for factual and problem-solving tests” (i.e. medicine) [1]. It works by testing you at all stages of the revision process – not just the cramming you probably do a couple of days before an exam.

Besides being better than reading and watching heaps of information though, active recall is better than mind-mapping and note-taking too. This 2010 study, for example, shows what happens when you drop those old techniques and substitute them with active recall. Producing “superior retention [that] transfers on the final test.”

How Does Active Recall Work?

In a nut-shell, I like to describe active recall as simply “challenging your brain”. A more detailed explanation however, might suggest the following strategies:

  • Question strategy: This is one my aim of regular MCQ practice capitalizes on. It means instead of note-taking (alongside however you consume info), you write simple questions instead. Questions designed to target specific pieces of information so you can better recall the broader context. The ‘Cornell Note-Taking‘ system, for example, also centres on this. Moving students away from pages and pages of re-writing, it gets students to actively hard-wire their neural pathways to better piece together information instead. I used this technique to get an A in physiology, collecting questions on a spreadsheet and re-visiting them periodically over an ever-increasing number of weeks. Click here to see how that looked.
  • Closed book/paused video strategy: This is a good method for people who enjoy (and don’t want to stop) reading text books or watching videos. It works by breaking down your passive activity and forcing yourself to think actively. You start by consuming a small amount of information. Then you pause what you’re doing while looking away. Then you begin to recall the main points aloud (or summarise to a friend). After you get to a point where you’re unable to go further (or you get confused)? You can then check back with the content, review the details and start the process again. Doing this helps reinforce harder concepts and lets you recall them faster come exam time. New York Times bestselling author, Cal Newport, highlights this as a key strategy in How to Win at College. An amazing read. 
  • Feynman Technique: Named after the famous physicist Richard Feynman (check out Surely You’re Joking Mr. Feynman – one of my all-time favourite books), this technique is similar to the closed book strategy. How it works? You put yourself in the imaginary role of a teacher. Then you pretend to explain a concept or topic to a really young learner. Thus forcing you to use simple language and metaphor, while breaking complex topics down into easily understandable parts. This YouTube explainer is quick and does an excellent job of explaining it if you’re keen to try.
  • Flashcards/Rapid Quizzing: Similar to the “question strategy”, you use flashcards to reinforce your learning. Netters flashcards for Anatomy, for example, is a great example of this. A super comprehensive resource that helps you 80/20 (more on this later) a huge course, the images and frequent recall supercharges your brain. Likewise, you can also use digital apps like Anki (my favourite) and SuperMemo (Professor Zhelezov’s favourite) in the same way. These build-in special learning algorithms too, that incorporate another method for studying medicine more effectively; spaced repetition

How to Study Medicine Effectively: The One-Two Punch

Aside from these techniques, what else can you do to save time and maximise your efforts as a medical student? Based on what I’ve learned spending hours on the excellent subreddit r/medicalschoolanki, there’s another good way. A method I like to call the “one-two punch”.

It works by combining two of the most powerful combinations above. First you use the 30,000+ flashcard deck made by Anking (check out the YouTube channel for more). Then you actively practice the information you learn with question banks and books.

How does AnKing card create a gray background in dark mode ...
An example of an Anking flashcard using the ‘cloze’ format

Don’t take my word for it though. Here’s what a US med student wrote me personally when recommending this approach on Reddit (I dug the analogy):

Test taking is like a muscle you need to work out on the regular with practice questions. Anki is the nutrients and diet regimen you follow to maintain those sweet gains when you’re out of the gym.

For those of you unfamiliar, r/medicalschoolanki is a community mainly for US students planning to take the USMLE Step 1. For International Medical Graduates (IMGs) though, this portal is an invaluable resource. Free decks, question banks and excellent active recall strategies appear here almost everyday.

As for how I recommend using Anking’s Step I deck on an IMG curricula? Start by suspending all cards in the deck and unlock things as you go. You can use Anki’s search function to help you, finding the key terms you cover in class and making sure you go through your deck regularly.

An important thing to note; pre-made decks don’t all have all the minutiae you’re required to learn for some of your courses. But decks like Anking definitely have all the high-yield (most important) facts. And going through them will, at the very least, guarantee you a pass. Saving you a heap of time in the process.

One last thing; using USMLE resources to study for medical school, no matter what country you go to school in, is definitely the way to go. Their resources are the best for explaining pre-clinical medicine in as simple terms as possible. Case in point: the brilliance that is First Aid for Medicine as a general summary book. Don’t confuse it by thinking it’s just a boring book about ”First Aid”!

How to Study Medicine Effectively: Pareto Principle

The Pareto principle (also known as the 80/20 rule) is a useful concept to think about when learning how to study better. Named after Italian economist Vilfredo Pareto, the rule states that 80% of effects come from 20% of the causes.

Earlier in this article I mentioned this rule when recommending certain resources. What I mean by using it, especially in terms of studying medicine, is that certain books/courses are better than others in terms of input vs output.

Lippincotts Biochemistry, for example, is a book I feel doesn’t match this 80/20 rule. It takes ages to read. It’s also difficult to retain all its information. Time attempting to go through it then, I’d argue, would be better spent elsewhere. You could save more of it (and master the key principles better) by skimming over summary/recap books. Or blasting Anking’s biochemistry flashcard deck and then doing a bunch of practice questions.

USMLE Step 2 Study Plan & Resources - YouTube
Popular USMLE resources that operate by this 80/20 rule

The Pareto principle is also another reason why I set up the daily MCQ group. The time-cost of spending a minute a day deliberately practising your mental retrieval skills? Compound and add up over time. Thus yielding a greater chance of a positive result (80/20) from a tiny amount of work.

Why You Should Practice a Question a Day

After spending time going over some ways I think the average student can better study medicine, let me end this article by returning back to the original project in question. The MCQ group.

Why I think the habit of practising a question (one at least!) a day is particularly powerful?

In the long run, I think it can help the following:

  • Better understand the strengths and weaknesses in your medical education. Show you the knowledge gaps (we all have them) that you can address now in order to save time later
  • Expose and prepare you (even if just a little) to concepts you’ll cover later in your education
  • Get used to the concept of failure and begin to fear it less
  • Gradually develop your technique for answering multiple choice-style questions
  • Give you something quick and productive to do with your day

Hopefully this article can help convince you of the power of active recall – as well as the importance of getting in the habit of regular question practice.

Although I’m no expert, I’m pretty convinced implementing some of these things can make studying medicine a lot easier. And not least because I want us all to have a life outside!

If you want to join our little practice group (we’re a 200+ group of med students and doctors) and see what it’s all about, click here (you must have Whatsapp).

Footnotes

[1] Nilson, Linda (2010). Teaching at Its Best. A Research-Based Resource for College Instructors