How to study in medical school: a system that scales

Why studying in medical school is different

Most students arrive with methods that worked at school: reread the notes, highlight, cram the week before. Those methods survive small syllabi and exams that test one topic at a time. Medicine breaks them in three ways.

• Volume: a single week can bring hundreds of new facts, names, numbers and mechanisms.
• It's cumulative: physiology underpins pathology, which underpins pharmacology, which you'll use for the rest of your career. Material you crammed and forgot has to be learned again.
• Exams test application: clinical vignettes and licensing exams ask you to recognise a disease from a description, pick the next step, or explain a mechanism, not recite a slide.

The answer isn't more hours. It's a system where most of your time goes into the two techniques with the strongest evidence: testing yourself and spacing that testing out over time. Our ranking of study techniques by the research explains why.

The core loop: lecture, cards, reviews, questions

1. Lecture: attend or watch it, with the slides open. Aim to understand, not to transcribe.
2. Cards: within 24 to 48 hours, turn the lecture into flashcards for the ideas that matter.
3. Reviews: every day, do the cards that are due, then learn the new ones.
4. Questions: a few times a week, answer mixed practice questions, and turn every miss into a card or a fix.

Everything else, from textbooks to videos to group study, supports this loop. If a week goes badly, protect the reviews first: they hold everything you've already learned.

After the lecture: cards within a day or two

Most forgetting happens in the first day after learning (see the forgetting curve), so cards made the same week as the lecture start working while the material is still there. Cards made in the week before the exam mostly relearn it.

What to put on cards

• Definitions and classifications your lecturer uses.
• Numbers you're expected to know: thresholds, normal ranges, doses where the course asks for them.
• Classic findings and the diseases they point to, in both directions.
• Mechanisms, as “why” questions.
• Contrasts between things that are easy to confuse.
• Labelled structures on diagrams and images.

What to leave off

• Everything on a slide just because it's there: card the ideas, not the sentences.
• Long lists as one card. Split them, or ask for the item that matters.
• Facts your exams never ask about. Past papers tell you which ones these are.

Examples of good medical flashcards

For more on wording, see how to make flashcards that work.

Daily reviews: the part you don't skip

Spaced repetition only works if you do the reviews on the day they're due, or close to it. Make them the first study task of the day, before new cards and before lectures if you can.

How many new cards can you afford? In our simulation of a year of FSRS reviews, 20 new cards a day led to about 100 reviews a day after a month and about 200 after a year: roughly 15 minutes and 35 minutes at 10 seconds a card. Most medical students add more on heavy weeks and fewer on light ones; the point is to know the cost before you pay it.

Keep your cards after each exam. In medicine, almost nothing is truly finished: second-year pharmacology needs first-year physiology. Old cards are cheap to keep, because a card you know well comes up only a few times a year.

Practice questions: where knowledge becomes performance

Flashcards build the knowledge; questions train you to use it the way exams ask. Clinical vignettes make you recognise a pattern in a description, choose between similar options and reason through mechanisms. That's a different skill from recalling a fact on its own, and it needs its own practice.

In a 2015 study at Washington University in St. Louis, Fan Deng, Jeffrey Gluckstein and Douglas Larsen surveyed students who had taken the USMLE Step 1. The number of practice questions they had done and the number of unique Anki flashcards they had studied both predicted their scores, even after accounting for factors such as their MCAT and earlier grades: about one extra point for every 445 extra questions or 1,700 extra unique cards. It's a correlation from one school, and Step 1 has since become pass/fail, but the pattern is the same as everywhere else in the research: more retrieval, better results.

• Start questions early, not only in the last month. Do a few after each block of lectures.
• Use mixed sets rather than one topic at a time. Exams mix topics, and mixing trains you to tell similar conditions apart.
• Read the explanation for every question, including the ones you got right by guessing.
• Turn each miss into something: a new card, a fixed card, or a note to ask about.

Ready-made decks or your own cards?

Many medical students use large shared decks, especially for licensing exams with a well-known syllabus such as the USMLE. Others make their own cards from their lectures. Both work; they solve different problems.

If your exams are written by your own faculty, as they are in most of Europe, your own lectures are the syllabus, and cards made from them pay off directly. A common approach is both: a shared deck for the licensing exam, your own cards for your courses. FlashCardz makes the second part fast: it writes cards from your own slides and notes, each quoting the line and page it came from, and its card maker lets you write your own beside the PDF. See flashcards for medical school.

Anatomy, histology and images

Much of medicine is visual: structures, slides, scans, ECGs. Words alone make poor cards for them. Combining a picture with words is known as dual coding, and pictures are the natural way to test recognition.

• Image occlusion: hide one label on a diagram at a time and name it. Make the hidden labels individually, not all at once.
• Reverse it: show a structure's description or function and ask for its name, then where it is.
• Draw from memory: sketch the brachial plexus or the coronary arteries on a blank page, then check against the atlas.
• For histology and radiology, use several different images of the same thing, so you learn the feature, not the picture.

FlashCardz can make cards from image-led slides, citing the region of the slide they come from, and marks the ones its independent check couldn't confirm so you look at them first. Its card maker crops images and makes occlusion cards straight from the PDF.

Understand mechanisms, don't just memorise

Flashcards are often blamed for rote learning, but the problem is the cards, not the method. Ask why. Why does this drug cause that side effect? Why does this lesion produce that sign? Asking and answering “why” questions (elaborative interrogation) ties facts together, and connected facts are easier to remember and to use in a vignette you've never seen.

A good routine: when you miss a card twice, don't just see it again. Look up why the answer is what it is, and add a “why” card. FlashCardz does a version of this for you on Plus: a card you miss comes back the next night from a different angle.

A week that works

Adjust the numbers to your timetable; keep the shape. Reviews daily, cards within two days, questions every week, and one day mostly off. FlashCardz lets you set rest days for your whole account, and the scheduler moves reviews off them rather than piling them up.

Before exams: from system to sprint

1. Four to six weeks out: finish cards for every lecture in the exam, and increase practice questions to most days.
2. Give the course its exam date. In FlashCardz, no card is then scheduled for after the day before the exam, so everything has been reviewed in time.
3. Two weeks out: stop adding new resources. Focus on missed questions and the cards you keep forgetting.
4. The last week: at least one timed practice paper or question block, light reviews, and normal sleep.
5. The night before: a short review of weak cards, then sleep. Sleep is when the day's learning settles.

More detail in how to study for exams.

The mistakes we see most

• Making cards weeks after the lecture, when most of it has already gone.
• Cards with a paragraph on the back. They feel thorough and are forgotten again and again.
• Only cards, no questions, so knowledge never gets practised in exam form.
• Too many resources: three question banks and four video series, none finished.
• Skipping reviews for a week, then giving up when the pile looks impossible. Do a little every day, and when you fall behind, pause new cards until you've caught up.
• Rereading slides as the main way of studying.