Proven Study Strategies for Learning Medicine and Nursing

All right, let us get started. Welcome to todays webinar on proven study strategies for learning medicine and nursing. Much of this can be applied to any form of learning or studying. Who am I? I am a DO in America and a fourth-year psychiatry resident. I have been with Osmosis for a while now and have done similar webinars in this capacity. I have also worked in other test prep realms for exams including the MCAT and COMLEX. I have helped make practice questions, video content, edited personal statements, mentored applicants, and more. Basically, I have been teaching in some capacity my whole life. The focus of todays session is broad advice for higher-level healthcare educational programs. I imagine much of this could also apply to non-healthcare graduate schools. I am going to cover specific barriers and pitfalls that people can run into. These are the rough learning objectives. I broke them down into a piecemeal format to make things easier to follow. I value webinars that are not too broad, because sometimes being told to study does not actually help you study better. I try to make things specific and actionable, and hopefully that is what you find today. The first general concept for studying in healthcare is that higher-level education creates self-doubt. Even if you are a confident person, it is common to experience self-doubt when entering the healthcare space. For many people, it is their first exposure to either the volume or difficulty of content at this level. Research shows that people in healthcare are at higher risk of feeling intellectual fraudulence and self-doubt, often called imposter syndrome. It is essential to define personal success. I leave that general because it should be general. When you look at your healthcare career and education, make sure you set your own goals, because if you do not, somebody else will tell you their goals for you. That is how a lot of conflict can result. A common question in response to advice is: how do you define success for yourself? It can be anything. For me, I have guitars in the background and Pokémon over there. I kept all my hobbies through medical school and residency. Teaching is also a hobby of mine. That was important to me because, at the end of the day, regardless of whatever grade I got, I was going to wind up being a doctor. I matched well, and I really valued maintaining my sense of self. That was my success. You all have your own unique journeys, aspirations, dreams, and definitions of success. The variety of students here is pretty wide, so it is hard for me to define thriving for anyone. That should be a meditative exercise. A note on ADA accommodations: this is a big deal. In general, the ADA, the Americans with Disabilities Act, has similar equivalents in many countries. Basically, if you have accommodations for schooling in any way, such as extra time on tests, access to notes from a coworker, excused absences, and so on, go ahead and file with your school. Most schools cannot discriminate against you for having accommodations on file, and having them does not force you to use them. For example, if you get accommodations on file for medical school and find you do not need time and a half on an exam, you do not have to use it. But that process can take a long time, usually three to six months in many places. It is best done when you are accepted somewhere, before school starts. It is always better to have access to accommodations than not have access. When I have mentored medical students or premeds, I have often learned that they had accommodations that would have solved many of the barriers they were facing. Then I had to encourage them to get it done before finals. It is usually something you want to take care of at the start. The toolbox approach, which I sometimes call mise en place studying, is important. Other places call it the toolbox approach. It is difficult to use resources if we do not know what is actually available to us. Imagine you have a file cabinet that is twenty drawers deep, and you have no idea what is in the drawers, but someone tells you they are all useful. That is pretty much useless unless you know what is in each drawer. Make a list of essentials. Think back to previous periods of educational success. Many of you are in medical school or nursing school, and you already have academic achievement. Write down what has worked for you before. Sometimes making a graph or list is useful. The idea is to have something in front of you that tells you what works. Osmosis has a great study tool that helps with learning and planning your study regimen. It is a varied tool, and we have blog posts that cover what it can do. I am happy we have it. For this example, let us use a student who has done well by rewriting notes in their own words, reviewing those rewritten notes, using timed benefits, and reviewing lectures. The toolbox approach would be something they can turn to when their brain is in panic mode two weeks before an exam. They can look at the form and say, ?Okay, this is what works for me.? They may have an iPad Pro with an Apple Pencil, a good pen, an organizer, a backpack, and testing accommodations. The second column would include things they need to get, such as a legal pad, submitted accommodations, or a voice recorder for audio lectures. Voice recorders are underrated and inexpensive. The takeaway is to make a list of what you have and what you need. Make sure you have it. It will solve a lot of problems. Now let us talk about strategies to curate a good study plan. Think of studying as two broad categories: exposure to new material and reviewing old material. This is how test writers and curriculum writers think about studying. All studying falls into these categories. Reviewing should be an essential part of any study plan. Nearly every issue I have helped someone overcome with studying is because they were not reviewing old content. Reviewing is arguably more important than learning new material because it helps consolidate and retain information. Resist the urge to cut back on review time to learn new material, especially when you are cramming. Reviewing old content often makes it easier to learn new content because medicine and healthcare information builds on itself. We do not learn in a vacuum. If you are good at renal and now learning cardiology, failing to review renal will make cardiology more difficult. If you remember renal well, cardiology becomes easier. For most students, about 60 percent of study time should be exposure to new content and 40 percent review. That may sound like a conflict with reviewing being so important, but healthcare degrees throw a huge volume of content at you quickly. This structure gives your study plan enough wiggle room to cover new content while still having something to review. Practice questions are commonly recommended now. They are one of the few study tools that allow you to learn content and review content at the same time. If a question includes information you are not familiar with, even when you get it wrong, you are reviewing related material and learning something new. Practice questions are also the most specific form of exam practice. Athletic performance research shows that the most specific form of practice improves performance. Doing the thing you want to improve at makes you better at it. Practice questions are like the exam, so the more of them you can do within reasonable limits, the better. Some people say they study only from practice questions. I do not fully believe that, but for reviewing information, they are hard to beat. Osmosis quizzes do a great job because you can target the exact content you want to review each day. If you only want to do renal questions, you can do renal questions. It ties back to the videos, and it is an all-in-one platform. Most educational degrees have tried-and-true methods. For the most part, reinventing the wheel tends to be an exercise in futility. For medical school, resources like First Aid, UWorld, and Anki are commonly recommended for a reason. They have been around long enough to build a wide backlog of information that helps on test day. Incorporating proven methods is usually a good idea. However, if something does not feel helpful, I would not force it. My hot take is that I do not think I looked at First Aid in medical school for more than five minutes. The funny part is that I helped edit USMLE-Rx, which is their website, but I did not find the graphs and format helpful. After about a week, I realized I was not going to use it. But I used other tried-and-true methods. You will realize that the information across these platforms is roughly the same; it is just presented differently. Sometimes that difference makes one resource work better for you. What works for most students does not necessarily work for everyone. Do not be afraid to break away from the mold, because the molds are often about the same content; some just look a little cooler. For studying new material, lectures are great. I recommend attending them. There is a good amount of research showing that attending lectures helps with learning. I know they may be early in the morning and the teacher may talk very slowly, but online lectures can still be helpful. You can attend a recording and speed it up if needed. In medical school, I had a professor who was amazing, but I had to speed him up to six times the normal speed to match my pace. I still remember the most information from him out of everyone I learned from in medical school, but I had to multiply the speed by six to make it durable. Attend lectures if you can, especially if they are recorded. For medical students in the U.S., you may find that many classmates do not go to class. Even then, that can mean fewer distractions. Active participation is essential. Brief note-taking is helpful. If you are taking notes and find that you are not paying attention well to the lecture, you are probably taking too many notes. A note can be as simple as ?review this aspect later,? and then you return to focusing. Even brief shorthand notes can help. You do not have to write down everything the lecturer says. At the end of a school day, briefly review new content before sleeping. This has strong research behind it. Reviewing content right before bed is highly predictive of what you will retain, remember, and use in the future. I still do this. I make little flashcards and review them. Sometimes it leads to having thirty Wikipedia tabs open at two in the morning, but I enjoy it. Rewriting notes can be helpful. I do this personally, so I am biased, but I think it is great. A way to save time is to only rewrite the material you do not remember immediately. If you remember certain facts off the top of your head but do not remember which phases involve the SA node or AV node, write down that part. Do not write the information you already know well, because that way you only rewrite what you need to review. Audio recordings are great. At Tulane, where I went, it was common for students to get voice recorders. You can get very high-quality ones cheaply. Zoom is a great brand, not Zoom the video platform, but another company. Some recorders have noise cancellation and can hone in on your professors voice. Sometimes they are better than the software your school uses to record lectures. With software like VLC, which is free and open source, you can speed the recording up as much as you want. If reviewing lectures works for you, this lets you do it at the gym or elsewhere, even if your school does not record lectures. In most states, you technically need consent first, so ask your professor. Usually they will say yes. If you are outside the U.S., check your local laws, but most of the time it is fine. Now, let us talk about reviewing material. Reviewing should be the most active learning. It should make you feel tired. Prioritize content that feels less comfortable and less familiar. Yes, this is hard, but if you finish reviewing without feeling a little tired, or without thinking, ?I really did not know this material,? you may be studying content you already know well. This is very common. People like to review content they already know because it feels good. Try to focus on the hard things. When you do this, your study time may be shorter than usual. That is not a problem. It means your study time is more productive. I would take the person who studied four hours of content they found really hard over the person who studied twelve hours of content they already knew every time. The first person will probably learn more and do better on the test. One of the best ways to review is to link unfamiliar content back to familiar content. With the heart example, maybe you already know diastole and the phases of the heartbeat. Then you can connect the SA node and AV node to those phases and understand why they work the way they do. That is related to neural network memory. It sounds like common sense, but when you use it in practice, it becomes powerful because you can recall information in all sorts of ways. When reviewing material, think outside the box. One professor at Tulane used to say, ?Teach a cactus.? If you are trying to learn material and you have a plant nearby, teach the plant. You cannot really teach material unless you understand it well. If you cannot explain it to an inanimate object, you probably need to review it more. When you do this, you rephrase the material in your own words, which is basically active rewriting. Some people do great with Anki. I recommend making your own cards if you use it. Premade decks are fine, but writing your own cards is why Anki was made. The person who created Anki has a long discussion about why he thinks medical students use it incorrectly. His argument is that it should not be used for new content. If you are using someone elses premade cards, your brain may treat that as new content. If you make your own cards, you are reviewing content, which is what it is designed for. Visual aids and graph creation work well for many people. I am not a visual person, so this is not great for me, but it works for others. Rewriting and rereading notes work well for me because I am a writer. The variety of approaches allows you to personalize your studying, and that is where studying can become fun. You get to identify what works well for you. It is best to rewrite notes by hand for memory retention. The main point is to review hard things you find difficult and link them back to things that are easier. Anki uses spaced repetition. The idea is that if you find something difficult, you study it more often than something you find easy. Anki does that by spacing content based on difficulty. But it is designed to review material, not teach new material. Premade decks are a blessing and a curse. They solve many problems because the information they cover is often the same for Step One, Step Two, NCLEX, and other exams. But because they are not in your own words, your brain may see the card as a new idea. That can take time to adjust to, which is why many people think Anki takes too long. Making your own cards is easier than you might think, and I recommend trying it. A good Anki card is usually concise. A busy card tends to be harder to get through than a single sentence. A single sentence could say, ?You can use this antibiotic to treat this condition,? with the antibiotic name blocked out. That is enough for an Anki card. Some premade decks have long paragraphs on one card, and it is hard to recall all of that from one index card. Body doubling is another strategy I strongly support. It can be difficult to study on your own, but if someone is in the room with you, even if they are studying something entirely different and you do not interact, it can improve your ability to study. We do not fully know why that happens. Humans are social animals, so there may be a brain-based explanation, but it is interesting. Some startups offer this through webcam services. Or you can use FaceTime with a friend who is also studying. This does not work for everyone, but it works for enough people that I always mention it. It can also make breaks better because there is a social element and you can vent. Movement can help. If you have trouble sitting in one place, there is nothing wrong with studying on a treadmill or walking outside. Podcasts are great for this. Watching videos on your phone on a treadmill can also work. Just make sure you are not distracted if you are running outside. Now, diet. I am a doctor, so I am going to tell you to eat healthy. Nothing derails studying faster than not feeling good. A hangover is a classic example. Hunger, feeling angry and hungry, or feeling sick in general makes studying difficult. Fruits and vegetables can improve memory more than people often think. When I taught the MCAT, I became somewhat known for recommending a cup of blueberries a day. Blueberries have been compared with some dementia medications in memory research, and they seem to help healthy adults as well. Antioxidants in fruits and vegetables seem to improve brain function, so eat healthy while studying. During exam weeks, maintain your variables and routines. Rely on what you have already worked on throughout the school year. Do not try new things the week of your exam. Stick to your proven foods, routines, and habits. Trying new things often leads to stress from planning the new thing or from it not working as expected. If you want to try something new, do it after an exam ends so you have enough time to see whether it works for you. Cramming is common at all levels of schooling, even in grade school. Research does not support cramming. It is a cultural norm that happens because it has always happened. Spaced repetition beats cramming every time. Even sleeping eight hours can beat cramming, even if you do not know the material well. Some people feel that cramming works for them. It may be that certain people are productive with a deadline right in front of them. If it works for you, evaluate whether it will continue to work for you. But it will probably work even better if you are doing the other things discussed in this presentation. The night before and during exam day, sleep is ideal. Many people say sleep is the most important thing you do every day. I am terrible at getting eight hours, but it is important. Keep your coffee and caffeine intake consistent. I am not saying to limit it; just keep it the same. Give yourself time to wake up and make sure you are fully alert before the exam. Do not wake up twenty minutes before the test and spend the first half of the exam still groggy while your coffee has not kicked in. Caffeine takes about thirty to forty-five minutes to start working. Coffee and energy drinks both take about that long. Sometimes people feel it faster because of a Pavlovian response to the smell, but the chemical effect takes thirty to forty-five minutes. Wake up at least an hour before an exam, especially if you drink coffee. After the exam, remember that comparison is the thief of joy. That is an underlying theme of this whole talk. Set your own measures of thriving and success. Comparing one question out of three hundred with someone else is probably not useful. You may try to justify it by saying you are reviewing content after the exam, but you are likely just trying to see how well you did. It is not useful. Finish your exam, go home, and take a nap. Rest and recovery are underrated. Plan something fun to do. I used to go to the movies after exams or try a new restaurant with friends outside medicine to reset my brain. Do not check specific answers afterward. You are probably not going to remember them accurately. Your brain is trying to relieve anxiety, but it can lead to a spiral. It is not worth it. Curating your education is also important. Healthcare is broad, which can mean topics of interest are not always covered deeply. I went to medical school to do psychiatry, but I did not do anything psychiatry-related until my third year. I got involved in networking through professional organizations, shadowing, clubs, and similar opportunities. That helped with motivation. Most professional organizations are free or discounted for students. Get a mentor. I have many mentors whom I value greatly. Once a year, reach out to your old mentors. Send them an email and keep the connection open. You would be surprised how powerful that is and how much they appreciate it. Wellness is crucial. Set reasonable expectations. Try to maintain your important hobbies because when you apply for residency or a job, they do not just ask about school. They ask what you do for fun. I think I had an advantage in residency applications because I had interesting things to talk about that were not just, ?I am a medical student and I did medical school.? I also support socializing with friends and family outside medicine. Ground yourself in reality. Healthcare education is a very unusual pursuit for most people, and staying grounded helps you stay balanced. I am sure there are many questions. I went slightly over what I wanted to, but that is fine. For attending, we have a QR code that gives you about 15 percent off our services. We cover many types of content and learning tools, and I think it is helpful to look into. I will now look at questions. These are my references. I have references for this even though it is a philosophical presentation. For practice questions, someone asked what I suggest using for a grade equivalent. I am getting two possible interpretations from that question: whether you are asking as a teacher or as a student. For Step One, the score conversions related to performance tend to be pretty good. For Step Two, they are not very reliable. If you take a self-assessment for Step Two, its ability to predict your actual Step Two score is not great. It is a complicated question in terms of grade equivalents. I would use practice questions more as learning opportunities. The more you get wrong, the better, in a certain sense. Every time you get a question right, there is less to learn from it. But if you get a question wrong and can process why you got it wrong, you will get much more out of that question. If you go through a question set and think, ?I have not seen this content before,? that is a good thing. It may not feel that way because humans like confidence, and ego is a major part of healthcare training. The more you can separate ?I got this wrong? from shame and instead think, ?I can learn a lot right now,? the better off you will be with practice questions. How early should you do practice questions? That is a great question. I did them from the start because the culture at Tulane emphasized practice questions, and I found great benefit in that. When you get a practice question wrong, you have an opportunity to learn something. If you learn new material in a rigorous course, you can go to the lecture and then try one or two practice questions at night. That becomes your review before bed. It builds momentum, makes questions less intimidating, and helps you retain and learn information. If you prefer doing practice questions a week or two before the exam, that is fine. You will probably just have to do more practice questions per day. I like data, so if I know I have an exam three months away, I look at the number of questions available and divide that number by the number of days. That tells me exactly how many questions I need to do per day. If I want one or two days off per week, I factor that in. That way, you build momentum and repetition without burning yourself out. Another point about leaving questions until the end: part of practice questions is learning test-taking strategies. Even if you do one or two questions per day, you start to identify your test-taking patterns. Some people change correct answers to incorrect answers; others change incorrect answers to correct ones. You only learn that by doing many practice questions. If you do them throughout the semester or trimester, you learn those habits and have time to address them. Habits take a long time to reverse. I would sprinkle practice questions throughout, but you do not have to do a ton at the start. Another question asks about practical ways to connect classroom learning to real-world patient care during clinical rotations. During clinical rotations, where you are seeing patients, it often happens automatically. The way I approached it was this: if you see a patient case remotely related to what you are learning, use that patient experience as review time. Listening to experienced clinicians talk about unusual cases is also helpful. If your attending or preceptor starts talking about a case and you usually tune them out because they talk for a long time, you may be surprised how much of a gold mine that can be. I remember getting Step Two questions right because I listened to older doctors talk about unusual cases. Those were often the people writing the questions. Another question is about balancing studying for several classes while working full-time. Working full-time and studying is difficult, so I applaud anyone doing it. It is a matter of segmenting your time appropriately. Make a list of the content you need to get through by a certain date, then divide it evenly across the number of days you have. That gives you a specific minimum to do each day. You cannot balance something unless it is quantified. ?I need to study today? is much harder to manage than ?I need to read fifty pages and do ten questions today.? If you have a hard number and one day you cannot complete it, you can push those topics to the next day, and the number increases slightly. That avoids the snowball effect of thinking, ?I did not study yesterday, so I am awful.? Instead, it becomes, ?I just need to study a little more today.? Defining things specifically makes them easier to manage. People are often more afraid of vague concepts in their minds than specific tasks. If you know exactly what you are trying to balance, it becomes much easier to tackle the problem. For maintaining mental health and avoiding burnout while managing the intense workload of a healthcare program, find a hobby, develop the hobby, and stick to the hobby. That advice may seem goofy, but playing guitar during medical school helped me tremendously, probably more than some vacations I took. Having something that is not healthcare, where you can unplug and say, ?Medical school is not happening right now,? is extremely valuable. I also love anime because a lot of it is silly and relaxing. If you feel like you need to watch something vaguely medicine-related, Cells at Work has accurate microbiology in it, which is funny. Sketchy does not count as relaxation time; that is studying. For daily or weekly habits to stay motivated and consistent, the general answer is to do a little bit every day and review every week. That may sound like a copout, but it is hard to be more specific without knowing you personally. How far in advance should you start preparing for major exams, and what study plan works best? There are many tried-and-true timelines in these fields. For Step One, before it went pass-fail, the recommendation was roughly eight to ten weeks. I do not think that has changed much. Look at common study plans from different resources, including Osmosis. If one plan feels better to you, use it. For me, I am comfortable with a marathon approach. I do not like quick, front-loaded studying. I would rather study for something over a year if it means I only need to study ten minutes a day. For some people, that slow burn would drive them crazy. Think about what works for you and what you can tolerate and balance. The best study plan is the one that allows you to be consistent while maintaining adequate performance and balance. How can you make reviewing material more interesting? It depends on what you enjoy. Review is underrated, and it can make studying more fun. I used to record lectures from one of my mentors and see how fast I could speed up his voice before it sounded like Kermit the Frog. It was about five times speed. I told him, and he thought it was funny. You can create little mental games to make review more bearable. Some people like listening to audio lectures while running. I like audiobooks while driving. Even if they are not exam-specific, good audiobooks can help you learn more broadly. The core of learning is relating new material to something you already know and to your own identity. If you read a book vaguely related to medicine and later learn a related concept in school, you will remember that concept better. Podcasts are also useful because they are designed to be entertaining and can help you learn. I like the Divine Intervention podcast. It is fun to listen to. For weaving studying into full-time healthcare work, try to use downtime for micro-study sessions or review. There is pressure to scroll on your phone or social media during downtime, but sneaking in small review sessions during the day means that when you get home, you do not have to overcome as much fatigue. Do I recommend studying very early in the morning before classes? Only if you are a morning person. If I told myself I could only study early in the morning, I know my motivation would be lower than if I worked with my natural tendencies. If you are a morning person, go for it. If not, figure out the time of day that works best for you. How can you study when you lack motivation? Motivation should not be the goal. The goal should be discipline. Motivation waxes and wanes, but discipline is a life skill. Being able to stay consistent even when it does not feel good is essential in healthcare. The way to study when you lack motivation is to develop discipline by creating habits that are sustainable in your situation over time. Should you test yourself before or after studying? I always did it first because testing is usually the most draining. Learning new material tends to be easier, at least in my opinion. Reading or watching a new lecture is easier than reviewing information, because I try to focus on what I do not know. So I prefer to test myself first. If you want to implement spaced repetition, how do you know how often to review content? It is based on you. Anki does a great job of this. Different algorithms exist, but it depends on how often you need to see something to remember it. Shifting from rote memorization to true understanding, especially for purely factual topics, involves linking topics and facts to things you already know. That is when you start to truly understand. True understanding is integrating information into how you experience the world. Recommended study time for the MCAT used to be about two to four months, but I have been out of the MCAT tutoring space for a while. When I tutored the MCAT, Anki was not even a consideration, and UWorld did not have an MCAT product. Someone asked about remembering treatments and doses, especially when studying similar pathologies such as dermatological conditions. Unfortunately, the answer is repetition. The more you do it, the easier it becomes to remember differences. Dermatology is infamous for this. Practice questions can help because they force you to apply slight differences in treatment choices. Reading something repeatedly is one way to understand it, but applying it through questions helps your brain develop ways to separate nuanced differences. Dermatology is tough. How can you avoid procrastination after coming back from a long day at university? The answer is balance. Most people need a certain amount of time between activities before they can be productive again. If you usually need an hour after classes before doing anything, build that hour into your study plan and see it as a mandatory part of studying. That emphasizes wellness and allows you to be more productive. When I was taking science classes at Tulane, I knew I needed two or three hours before doing anything afterward, and I used that time for the gym. I was not thinking about how much I had to study that night. I knew the gym helped me balance and study effectively. Figure out how much time you need versus how much time you actually use. People often relax longer than they need, so relax, but do not let it become too much. We also have a discount for 15 percent off and a free two-week trial. I highly recommend it. Our content is great. I am biased because I work with Osmosis and used it in medical school, but I am very happy to be working with them. If you have general questions, feel free to send them. If something is too specific, I may recommend reaching out to a tutor. Someone asked about audiobook recommendations. I listen to one or two a week, so it is hard to pick one. I really like Mary Roach. She is a nonfiction writer. Her book Stiff is incredible. I read Stiff and then read her entire bibliography in about two weeks. Mary Roach books are great. Look for things that make you excited and interested. That is what you want. This webinar will be recorded. I host these a few times a year. If you like my presentation style, it is a little unusual, but I do these often. Our next webinar is about fellowships made simple. Fellowship applications are tougher than people think, so I recommend attending that. You also have access to a free two-week trial of Osmosis and a 15 percent discount code. Thank you so much for joining us. I look forward to hearing from you and seeing you again soon. Helping current and future clinicians focus, learn, retain, and thrive. Learn more.