Learning How to Use Spaced Repetition in Medical School

Apr 8, 2019 by Austin Eakin-Love

Second year med student dramatically improved ability to memorize and recall medical facts with spaced-repetition.

As a Canadian graduate entry student, I believed I began my medical degree with a solid understanding of the way I learned best. Having completed a BSc in biochemistry, I felt well prepared to face whatever challenging topics medical school had to teach me. At the Royal College of Surgeons in Ireland, the distinction of First Class Honours is given for an overall mark above 70%. Many students find it hard to achieve this overall mark on written exams even with rigorous study and review. That’s because scoring higher than 70% on short note questions requires students to integrate external knowledge on the subject that relates to the test question’s topic. Being able to do this became my major focus for improving my study habits. I realized my studying was no longer just about finding how to efficiently memorize, understand and recall as many pertinent facts as possible in a short amount of time. Learning how to link the facts together between the particular symptoms and the situation made me excel in my class short note and oral exams. Similarly, board exam questions require understanding of the information you’ve recalled and being able to apply the recovered knowledge to the unique situation at hand.

Scoring top marks on class and board exams requires students to answer the following when they encounter test questions: 1) Do I understand the question? and 2) how is the information given important here? One might see this latter question to be the “Achilles heel” of using spaced-repetition flashcards, since it requires understanding and application of your knowledge; however, there is a way to improve this studying flashcards in a way that test you on exactly the material you need to know while reminding you as soon as you begin to forget the information.

Weeks before discovering the power of the Osmosis-vetted flashcards, I tried coming up with clever mnemonics and writing cards based on the learning outcomes of each lecture; however, I simply could not keep up with the sheer volume of material I thought I was expected to memorize. When I saw with Osmosis I could upload a PDF of my lecture and have the relevant flashcards associated with their slides, I knew I had found a way to streamline my education preparation for the many board exam I knew I had to pass.

One day I noticed my friend from class using his phone to do his flashcards on the Luas (one of Ireland's main public transport systems). At first I was skeptical because I was not sure how I’d make great flashcards quickly; however, he showed me how to take on electronic flashcard decks made by other students and verified by an entire network of healthcare professionals around the world. Apps like Osmosis with built-in spaced-repetition algorithms are a scientifically proven way to improve memorization and recall. The difference is that Osmosis teaches you the material with videos first, which helps you recall the information when going through the associated flashcards so you’re really building those connections before you test yourself with the case questions.

I found most board exam questions don’t just want you to know just one set of facts like the amino acids associated with acidaemia in Maple Syrup Urine Disease or the branches of the facial nerve, for which rote memorization is key, but instead want you to take that information and apply it in another context. This requires an intimate understanding of the material, which can only be achieved through clarity of thought through confidence in knowledge after a polished performance reviewing high quality spaced-repetition study material.

Immediately, I began distilling the important details of my lectures into flashcards, which I’d review before and after class during my daily commute. This helped a lot with my time management, as I no longer felt the need to review an overwhelming number of lecture slides, and I could quickly update flashcards with images from my phone; adding extra detail wherever and whenever. After doing some more research into how to make proper flashcards, I found it best to make one flashcard per fact rather than flashcards with lists of facts to recall. Additionally, I found I learned anatomy best by making image occlusion flashcards. For example, I’d take a labelled image of the brain and occlude the names of each label such that I’d be able to test myself on the appearance and the name of the brain region.

This year I saw my grades increase tremendously after downloading some highly recommended Step 1 decks. I kept catching myself remembering facts on clinical placements that I was unaware I even knew, yet at some point the knowledge must have found its way into my brain.

Overall, I believe spaced-repetition studying using electronic flashcards has dramatically improved my ability to memorize and recall medical facts. I would encourage anyone to invest the time towards learning how to make and use flashcards in first year and beyond.

About Austin

Austin is a 2nd year graduate entry medical student at the Royal College of Surgeons in Ireland. He’s interested in the combined specialty of Hematology and Oncology. When Austin isn’t studying, he likes taking long hikes with his dog Chica and plays the drums in a med student band called Thrombosis. He is also very keen on improving anatomy lessons in medical school through the use of 3D resources.