Learning Methods
There is no right way to learn medicine. However, the important thing is to have a good learning system when it comes to a knowledge-heavy exam like Step 1. As well as learning concepts deeply in physiology, embryology etc., there will be a lot of facts you just need to memorise (think mutation names, HLA subtypes, chromosomal locations of disease, bacterial and fungal culture mediums and so on). An important concept to keep your learning effective is to 1) find a way to identify what you don’t know and 2) focus more on these less well known/weaker areas. There is one system that has grown in popularity that tackles both of these points directly and that is the spaced repetition systems (SRS). Of all the SRSs that are available, Anki has grown to be the most popular. Anki is a free flashcard-based application in which you create a deck of flashcards, and then test yourself on them. The idea is to test yourself and then rate each card as ‘easy’, ‘good’ ‘hard’ or ‘incorrect’. Rating the card ‘easy’ means you will see the card after a longer interval of days. Rating the card ‘hard’ means you will see the card more frequently, with shorter intervals between testing. This means you see the cards you are weaker at more often, so you strategically focus your work on the weaker parts of your knowledge base.
Anki/SRS has its pros (automated system to tackle weak subject areas in a well-validated way of learning i.e. constantly testing yourself) and cons (can feel like rote-learning, quite boring and repetitive, only really works if you commit to it every day).
Personally, I enjoyed using Anki for my preparations in Step 1 and the value came from the process of writing good personalised flashcards for myself. I didn’t like using any pre-made decks because the details were too granular and unrelated to my specific learning needs. I thought I would continue to use Anki for my medical degree after finishing Step 1, but eventually it fell out of favour with me. After a while, Anki felt more like a daily chore (which made learning medicine very un-exciting) and it seemed like I was spending more time revising the same stuff rather than actively trying to get out there and learn new things (and re-learn old things through this more aggressive process). I’ve stopped using Anki now, but nevertheless it definitely helped me for Step 1. It’s a tool that many students swear by, but this article perfectly explains why I don’t use it all the time: https://www.scotthyoung.com/blog/2012/08/05/forgetting-is-good/
It’s important for you to balance whether it will work for you or not, depending on your learning style. If, after trying it out, you do decide to use Anki, there are great articles on www.yousmle.com which explain how to write good flashcards. There are also very fact-heavy pre-made decks: Zanki, Brosencephalon. These are decks of tens of thousands of cards which test one little fact per flashcard. Again, this is fine if you want to learn facts, but these pre-made decks are not ideal for understanding the mechanistic processes underlying physiology or pathology.
What did I do and how did I learn?
I gave myself around 4 months of dedicated time to study for the exam. Most of my studying was done in the evenings and weekends around clinical placements. I used the 3 most common resources and found they worked well for me – Uworld, First Aid and Pathoma. I also used USMLE Rx and thought it was a good way to make sure I had all of First Aid covered – I powered through this in a couple of weeks just to get a feel for the knowledge I needed. Every time I got a question wrong on the question bank, I made a flashcard for that piece of knowledge and added it to my Anki deck (that way I was only re-learning what I got wrong/didn’t know). Near the end of my study period, I used the free USMLE questions and did 1-2 NBME (National Board of Medical Examiners) papers to test myself before the actual exam. A quick google for random facts was good enough for me – I didn’t really use any textbooks.
I took a couple of days to try out Sketchy, the Goljan textbook, Kaplan resources and Amboss/other resources but found that they didn’t work for me.
In the 5-7 days leading up to the exam I took things very easy – I just went through my Anki flashcards for the day and flicked through some flagged questions that I got wrong over my study period. Ultimately, being well rested and not burning out before this day-long exam is more important than cramming last minute facts.
