Read This Before Medical School: How to Study Smarter and Live Better While Excelling in Class and on Your USMLE or COMLEX Board Exams

By Chase DiMarco, Greg Rodden and Theodore O'Connell

Will medical school make or break you? Whether you’ve just gotten your acceptance or are already in the cadaver lab, you can get through (relatively) unscathed by learning from those who’ve already survived and thrived. Herein, we provide you with the hard-won tips, tools, and insights that helped us to excel during those four grueling years. Beyond providing study tips, we draw on inspiration from fields like psychology, neuroscience, education, business, and even self-help to assemble a complete guide to accelerate your development as a medical student and future physician. You’ll even get our personal recommendations for outside resources, such as specific websites and apps, that gave us a leg-up during medical school. NO OTHER book offers this much information, assembled together in one place, and without the fluff. Below are some of the key topics we chose to cover:

- Study tips to help you sail through classes
- Test-taking strategies to help you ace the USMLE and/or COMLEX board exams
- Accelerated learning techniques like speed reading, memory palaces and mind maps
- Time-management and productivity hacks
- Tools for self-assessment to track your development
- Advice on wellness, work-life balance, and burnout prevention

• Language: English
• Publisher: Indies United Publishing House
• Release date: Oct 23, 2019
• ISBN: 9781644560723

Chase DiMarco

Chase is an MS, MBA-HA and MD/Ph.D-candidate. He is the Founder and educator at FreeMedEd, which he began in 2014 to consolidate free educational resources for his classmates. He also hosts the Medical Mnemonist Podcast, is Chief Development Officer at InsideTheBoards, and CEO of MedMatch Externships clinical rotations service. He has explored many facets of medical education, the psychology of learning, and accelerated learning techniques. As an average student, it wasn’t until after he had attained graduate education that he learned to implement accelerated learning and educational efficiency. Now, with a passion to make studying easier for all students and bring great educational resources to the masses, he has worked to compile some of the top literature out there on Educational Psychology, Academic Medicine, and Memory.

Book preview

About the Authors

Chase DiMarco: Chase is an MS, MBA-HA and MD/Ph.D-candidate. He is the Founder and educator at FreeMedEd, which he began in 2014 to consolidate free educational resources for his classmates. He also hosts the Medical Mnemonist Podcast, is Chief Development Officer at InsideTheBoards, and CEO of MedMatch Externships clinical rotations service. He has explored many facets of medical education, the psychology of learning, and accelerated learning techniques. As an average student, it wasn’t until after he had attained graduate education that he learned to implement accelerated learning and educational efficiency. Now, with a passion to make studying easier for all students and bring great educational resources to the masses, he has worked to compile some of the top literature out there on Educational Psychology, Academic Medicine, and Memory.

Theodore X. O’Connell: Ted is a family physician, educator, and author of many popular books, including the Crush Step series and the USMLE Step Secrets series. He is the founding director of the Family Medicine residency training program at Kaiser Permanente Napa-Solano and is an Associate Clinical Professor in the Department of Family and Community Medicine at the UC San Francisco School of Medicine. Dr. O’Connell is passionate about helping the next generation of physicians become successful, both as clinicians and as future professionals who can confidently navigate medical culture. He hopes his collective works will help cultivate outstanding physicians.

Greg Rodden: Greg is a pediatrics resident in Austin, TX, and founder of the Med School Phys podcast. Now he is hosting a new podcast called Physiology by Physeo, which is one of the newest collaborations powered by InsideTheBoards. When he’s not being a doctor for kids, he tries to stay happy and healthy by plugging in his headphones while at the gym, or by leisurely dining with his wife. Greg is dedicated to providing high-quality, free medical education to anyone who is willing to learn.

PREFACE

How to Use this Book

First off, thank you for choosing to read this book. You will not regret it. We will provide you with a vast array of suggestions for studying, tools we personally used to excel in medical school, tips for self-advancement, and guidance to keep you on the path to success. This is not simply a medical study resource, but rather it is a guidebook filled with wisdom and pearls about everything related to your future career in medicine.

Some books will teach you how to make flashcards, some have tips for test-day, while others focus on efficiency and scheduling. This book incorporates all of those topics, and more! To scratch the surface, we will give you a tried and true approach to tackle board exam-style questions, tips to accelerate your learning speed, and advice on how to use flashcards, while also covering topics like burnout prevention during this challenging time in your life. There is currently NO OTHER resource that offers this much information, assembled together in one place, and without the fluff.

If you are already aware of some of the concepts discussed throughout, you’ve got a big headstart and we will help you to optimize your existing strategies. If it all seems new, don’t worry. We’ll explain everything in detail and provide concrete examples to help you get started. Discovering these kinds of learning techniques and strategies is probably best before you start medical school, but even if you’ve already begun classes, don’t be discouraged. There’s no time like the present!

We aim to provide you with a no-nonsense guide to success in medical school and beyond. As such, we have researched, analyzed, and synthesized dozens of top-rated books, hundreds of research papers, and years of experience in medicine and education to create an excellent product. It would be impossible for us to perform a systematic review of every subject we cover, but we gave it our best shot.

Regardless, it’s healthy to question everything you see, hear, and read these days (without being a contrarian). Remain reasonable and open-minded if you encounter something new here. We urge you to experiment, record the results, reassess, rinse and repeat. When you’ve found something that works, we urge you to engage in Deliberate Practice to maximize your results. But let’s not get ahead of ourselves; this is just the introduction.

If you have already skimmed through the Table of Contents, you may have noticed the overarching structure of this book, which is broken up into four main parts:

Part 1: Overview of Study Skills & Work-Life Balance

Part 2: Test Preparation and Exam Day

Part 3: Accelerated Learning and Mnemonics

Part 4: Self-Assessment

Considering how much content we cover, you should not feel obligated to follow along section-by-section. Some areas may be of greater relevance to you right now, while others can take a back seat. Jump around as needed. For updates and new information, we also offer a Next Steps section in Part 4 that provides concrete examples for implementing the topics discussed. We thank you for your support, and hope you enjoy the book.

Occam’s Razor vs. Hickam's Dictum

Advising learners on something as complicated as medical education is tricky. No two students are the same, so we need to be flexible when providing advice about the approach to learning, the best resources, and the study habits to reinforce. Ultimately, you have to find what works for you. One topic might be learned best by a familiar or obvious method, while another lesson may require uncomfortable or outside-the-box thinking. This is a sort of Occam’s Razor vs. Hickam’s Dictum situation for your medical education where the simplest solution is the best… until it isn’t.

Herein, we attempt to provide a wealth of different recommendations and educational strategies that you can explore. It will require you to spend a little more time upfront to determine what works best for you. A word of caution: you will be tempted to first choose the method that you LIKE best, but keep in mind that it may not be the method that WORKS best for you. This is where an open mind and honest self-assessment will really show their value. Throughout the text, we encourage regular self-assessment and we provide plenty of concrete examples to see how you can gauge your performance.

A Doctor’s Timeline

Before diving into how to thrive in medical school, we should probably lay out the timeline for you. What will your life look like when going through your medical training? Obviously, there will be variations on this theme, but here’s the basic timeline for someone who goes straight from undergrad to attending physician:

Don’t freak out after seeing this! Yes, you’ve got a long way to go, but if you’re passionate about patient care and medical science, you belong on this path.

Other Career Options

Most doctors begin their journey of medical education in the same way. We worked hard during college and stressed out about getting into medical school. Then, we worked hard and stressed out about passing boards and getting a good residency. Some repeat the cycle for fellowship. And then we stress out about our patients, our business, and our administrative duties. While life in medicine is rewarding, it can also be very stressful!

Most doctors do not seriously consider anything other than the default pathway into clinical practice. If this is your goal, great! If you are unsure, also great! Why? Because there is a significant need for highly skilled and educated professionals both in clinical practice and outside of the hospital. If you have never been educated on the other options, or you were never taught the skills related to success in fields outside of medicine, you may feel like you have no other choice. That couldn’t be further from the truth.

Within the confines of this book, we cannot comprehensively teach about all of the important skills for leadership, business, and education related to medicine (and other professions), but we will offer solid advice from trusted resources for your own exploration. If you’re unsure about where you want to take your MD or DO degree, just take a moment to peek outside of the bubble. You can start with a website like Docjobs.com. Just becoming aware of the other options available to you can significantly alleviate the stress you may be feeling.

PART 1:

OVERVIEW OF STUDY SKILLS

& WORK-LIFE BALANCE

Class Study

Education is what survives when what has been learned has been forgotten.

B.F. Skinner

This section was particularly difficult to write for a general audience, as the structure of classes varies greatly across educational institutions. Some students are adamant about attending every lecture, extracurricular activity, and guest speaker available to them. Others prefer to focus on self-study while attending as few classes as possible.

Generally, lecturers will speak at around 100 words per minute, often less. As you will see in the Accelerated Learning section, that is unbearably slow for some students. Though there are pros and cons to attending vs. not, both approaches can be successful. The utility of attending live lectures is determined by a host of factors, but the one you have control over is your personal preference (and hopefully your school doesn’t have an attendance policy).

Your time is valuable. Period. If you don’t get much out of class, do your own thing and don’t feel obligated to listen when you’re there. If you derive greater benefit from class study than personal study, find ways to get the most out of class. This includes regular/active participation, asking well-constructed and properly-timed questions, having a detailed knowledge of your academic schedule, and knowing about the particular resources provided by your school.

Note from Greg Rodden: During the first year of medical school, I tried my best to pay attention in class, but I slowly learned that I could not maximize my time there. Eventually, I found it best to tune into one or two lectures per day and then plug in headphones to study on my own for the remaining lectures.

Class Participation

Do you arrive to class prepared, or do you just wing it? Do you download, print, and pre-read the syllabus and all other course content before the first day of class? Or do you wait for the instructor to point out what they think is important? There are many ways to be prepared for class, whether it be your first day or your last semester. Though Wifi and digital resources make it increasingly easy to have the proper materials with you at all times, mental preparation can be a little more ambiguous.

The majority of Americans actually rate fear of public speaking as worse than their fear of death [1], and class participation can feel very similar. We may think, What if they think I’m stupid for asking that question? The best response is, So what? In all likelihood, your classmates won’t spend their day judging your every move; they have their own issues to deal with. But if this is a real concern for you, the Anxiety and Depression Association of America has some tips [2]:

Focus on the contribution to your audience, not yourself.

Focus on calming and reassuring images instead of dreading what may go wrong.

Point out and eliminate negative thoughts.

Use calming practices such as deep breathing, yoga, and meditation.

Prepare ahead of time and practice.

Connect with your audience.

Confident posture! External confidence can help your internal confidence.

Give up perfection. Accept mistakes and learn from them.

Equating a phobia of public speaking to asking a quick question in class may seem a little extreme, but it can produce significant anxiety in the moment. Try using the recommendations above if you’re struggling. Learning to be relaxed and prepared can help prevent the fidgeting, sweating, stammering, and shaking presentation that everyone fears. Believe us, we’ve been there.

One other factor that will help the nervous public speaker is to prepare your question or comment properly. Blurting out every thought or question that pops into your head doesn’t make you an active participant, it makes you an ask-hole. On the other hand, you may have a very valuable question that could benefit the whole class. How do you decide?

If you prepared for the class ahead of time, you might have a helpful question that is not covered by the lecture materials. Even a cursory glance at the material may save you from posing an obvious question/comment that is answered by the next slide. Your next step, if applicable, could be a quick internet search while the lecture continues on. This can answer most questions without disrupting the class. In medical school, the more important questions for you and your classmates will usually revolve around concepts.

Some subjects, like physiology or pharmacology, require a lot of background conceptual knowledge. So, the questions posed in these areas are not always easily answered by a quick internet search. If you are prepared for class and still are not sure what is going on, it may be a good time to raise those four fingers and a thumb. Chances are if you prepared and still don’t get it, then there are plenty of other people who are lost. This would be a shortcoming on the part of the presenter, not the student.

If the answer provided by the instructor is not sufficient, try to rephrase your question in a very direct and specific manner. Be clear. Be tactful. Be respectful both to the lecturer and other students. Give examples, if possible, because it is very hard for most instructors to answer an overgeneralized or vague question in the moment [3]. When in-class questions are used properly, you can be sure your classmates will appreciate the effort.

Sometimes you cannot ask a question in the moment, so you will have to look it up at home, send an email, or ask at the next class. Don’t accept not knowing. Many topics in medicine will build upon themselves, so you should do your very best to quench your thirst for knowledge.

Now that we have a guide to self-confidence, and knowing how to ask proper questions, what is the best way to proactively set up your environment in class for successful learning? First, you don’t need to sit in the front row to make the best of your situation, but the back of the room is not a great choice for those who want to participate. Sit close enough that you can clearly hear the lecturer and see any of the visuals used for instruction. This also helps your questions to be easily heard. If your class has windows, you may want to account for the time of day and the effect of glare on screens. Also, it’s not a bad idea to have a buffer seat between you and your friends, if at all possible, just to avoid distractions. If you plan to do your own thing during class, consider sitting in the back so your computer screen doesn’t distract the people who sit behind you.

Effective Use of Teacher Time and Resources

Every educator is different, so this requires a bit of common sense on the part of the student. Some teachers are very clear about office hours, their expectations, if they allow extra credit or not, etc. Respect their time and their system. Your instructors have family obligations, research projects, and clinical duties to worry about. Feel free to jump ahead to the Emotional Intelligence section later in Part 1 if you need a better understanding of what a mile in their shoes feels like.

Once you understand your instructor’s schedule and willingness to assist outside of class, set up a meeting with them. Bring a clear list of questions if that will help. At the very least, setting up an appointment to clarify confusing material before an exam - or going over questions after the exam - is a great way to benefit from their expertise.

Email Template: Dr./Professor ____, I seem to be having trouble with (subject, concept, process). I think at this point I may need more direct guidance here. May I schedule an appointment to discuss this with you? Perhaps if I show you (what I’m doing, how I’m thinking), you might be able to help me understand the topic better? I believe that (time A, B, or C) could work for both of us. Which would you prefer?

The email template above is short, direct, and polite. When you communicate this clearly and deliberately, the instructor will have a better idea of how to prepare for the meeting and where they may need to tweak their existing materials. If the one-on-one meeting doesn’t help, ask them for another resource (or even an old exam). Most instructors are happy to provide assistance to motivated and courteous students, so don’t worry about being a burden to them.

Side note: if an instructor is