The Greatest Discovery in Learning History, and You’ve Probably Never Even Heard About It

It’s ironic, the post-bacc class that had the least to do with medicine ended up being the most relevant to medical school. That class was called Learning Strategies, and it began with a graph, with memory on the Y axis and time on the X axis. What it showed was if you do not review a subject, your memory of it will tend to fade by 80–90% after around 24 hours, after 7 days, and after 30 days without proper review.

Being the neurotic man I was, and maybe still am, I looked further into it and it turned out there were multiple studies done on the subject, with some dating back to the 1930s. There were also multiple programs out there that were based on this principle of spaced repetition (Anki, Firecracker, and Pimsleur’s language learning system, to name a few).

From then on, I never studied anything without using spaced repetition and just like it promised, I rarely forgot anything. What was interesting was that because I was using it to learn medicine rather than vocabulary, I added a new level of understanding with every pass. Suddenly I was scoring insanely high on exams, and generally appearing smarter than I really was. The results were astonishing!

Before I go into how you can use this to great advantage on USMLE, let me explain what spaced repetition is. It’s the concept that if you review things over a progressively longer span of time, you will commit them to memory in a predictable and reproducible way. While there are many iterations of this method, I personally prefer, for simplicity’s sake, Day 1, Day 2, Day 5-8, Days 30+.

For a more common sense example, imagine you have a small group where you hear everyone’s name during attendance. If you have that group five or six times in a month you are significantly more likely to remember that person’s name than if you had it five or six times in a year, because that memory is created in your brain and solidified before it has time to be lost.

While the science of memory formation is the subject of ongoing research, and I am far from a neuroscientist, the best theory states that memories are formed by chemical and synaptic connections between neurons, and a connection is strengthened with every recall. But over time, if not strengthened/reinforced, then that connection weakens, and eventually fades, until the memory/concept can no longer be accessed readily.

So how can we apply this to USMLE Step 2 CK? Well, everything you need to do extremely well on Step 2 CK lies in only a handful of resources, with the vast majority of what you need lying in USMLE World, OnlineMedEd, and FA Step 1 bio stats only (MTB can also be added, but it’s the lowest yield of the four). Therefore, when studying you should do high yield OnlineMedEd lectures (Notes + videos + Notes again), then UWorld (Tutor by section, one minute per question reviewing after 10 – 15 questions).

After reading the explanation of 10 – 15 questions, you’ll find you’ve learned a lot of information that will be tested in future questions within that UWorld section. Remember what I said about UWorld: incorrect answers are often high-yield summaries of answers to other Uworld questions, and this is why it is so crucial that you do it by section.

You see, by studying this way, you are hammering high-yield content by doing a few questions and learning a lot of content (through the answers to those questions), then being tested on it (through the rest of the UWorld Qs in that particular section), then once again recalling it (through the answers to those questions). Through this constant cycle of learning, being tested, then re-learning, you will be strengthening the memory and understanding of a concept before it has time to fade (since it will be seen multiple times within 24 – 48 hours).

You then want to ensure you re-read those OnlineMedEd notes + UWorld explanation within 5 – 9 days after seeing them initially, but this time 2-4 times faster since you need only to strengthen that memory. Something I highly suggest, as you go through UWorld the first time, is highlighting important words and concepts in UWworld answers. This ensures you are focused while reading (since it is an active process rather than a passive read), and also when you re-read the highlighted answers you’ll save significant time (your number one resource).

If you find reading/highlighting UWorld answers is taking too long (more than three minutes), then you should read and highlight the learning objectives, wrong answers and only the bolded words/graphs or pictures in the main explanation. This may seem like strange advice — skipping the main explanation — however, I have found that between the bolded words and learning objectives, everything of relevance is covered, and there isn’t much need to read the main answer to that question unless you truly do not understand a concept. Always read incorrect answers, as they are typically summaries of high-yield concepts. Once you get through everything (about 1-2 weeks before your test), you’ll want to re-review everything one more time, further solidifying those memories and making it fresh for the exam.

You may be asking yourself, “How the heck am I going to fit all of that into the 300 – 350 hours I have to study for USMLE?” Well here’s the amazing part. Because USMLE is a recognition test (as opposed to a recall test), you don’t need to have facts down cold! You only need to know enough to recognize the answer (a concept I will go into further in later articles), so you actually do not need to spend that much time on any individual fact. Because you will be seeing the high-yield topics so frequently (literally 30 – 40 times before the test, because of how frequently UWorld tends to repeat them), you will be able to recognize them without needing to spend large amounts of time actively putting those concepts to memory.

In summary:

  • First, do High Yield OnlineMedEd (Pre-read Notes + Videos + reread Notes)
  • Then do UWorld (Tutor by section, one minute per question reviewing after 10 – 15 questions [2.5 – 3 minutes per answer, review with highlighting])
  • Then 5 – 9 days later, re-review high yield OnlineMedEd notes + Uworld answer highlights at 2-3 times the speed you did originally.
  • Once you’ve completed the process with every section, re-read everything again at that speed.

This will ensure you know these concepts very well on exam day. While you may be skeptical about the short list of resources, I can say I used ONLY OnlineMedEd, Uworld, FA-Step 1 (biostats only), and MTB throughout all of third year and for USMLE, and honored every shelf exam, then scored 264 on CK. Even if you were to argue that I am a good test taker, I still cannot invent medical facts/concepts, so the information must have been contained within the above resources. You now know my greatest study secret for both USMLE and Medical school. Go forth and use it to crush this exam.