It was the 1970s, and along with Disney World opening and the Dolphins going undefeated, a machine was invented that would change the face of medicine forever. This machine was the MRI or Magnetic Resonance Imaging Machine. While this would go on to be one of the greatest things to happen to medicine, there was an unintended consequence to all this extra information now being presented to doctors.
Back surgery rates went up significantly, but patient outcomes did not to change much. The reason was that this new MRI information was helpful, but it also overloaded physicians with too much information, making them rely too heavily on these detailed pictures over their clinical knowledge. This wasn’t something specific to doctors, but rather an inborn error in thinking. We, as humans, are awful at sorting information for appropriate relevance when presented with too much of it.
Early on in my career as medical student, it became clear there was far too much information to learn it all. After realizing that I would have to review things multiple times for ideal retention, it then begged the question of how I’d ever have time to read it all. What became clear to me was that a lot of my time was wasted doing things that would not add to retention of knowledge or were simply too inefficient to be viable.
I needed to find a way to shorten the information intake and do it in a time-efficient manner, without missing any key information (easier said than done, unfortunately). Rewriting took too long and inevitably left out parts of the source material which I later found out, during the exam unfortunately, were important. So I came up with something simple yet highly effective… active highlighting. Active highlighting is the concept of reading while actively determining what the minimum amount of information is that would have to be seen on a re-read to understand the source material. While you may sit here and think “Really, highlighting?!” let me explain why this can lead to astonishing jumps in retention of vast quantities of information.
First, by constantly thinking about your own existing level of comprehension and retention of that information (to determine how much of it to highlight), you are forced to actively read, rather than inattentively gazing over a paragraph and then moving on. Second, when you re-read it , as I will soon explain, paragraphs of information will now be “actively highlighted” down to maybe a dozen words, making it possible to cover significantly more information in a short period. Third, and most important, by cutting down information to only the essential, our mind is no longer bogged down by all the extraneous information.
As you’ll see below, “active highlighting” forces you to zero in on only the information that is actually useful to you, and it is therefore even more effective than the text in its entirety, since you will no longer be led astray by other extraneous information. This may seem counter-intuitive, but ask yourself how many times you’ve read something long, especially a medical text, and come out confused, only to realize that all of it could have been summarized into a few lines.
So how does one actually use this to improve their USMLE score? Well it all starts with our good friend USMLE World. As I stated before, USMLE World is both a great USMLE textbook and a great Qbank. Some of the most random lines in there can end up being USMLE gold, and therefore a written summary would be both highly time consuming and likely miss important stuff. The problem is, it’s so extensive that we need to cut the out fat to enable us to make multiple passes through the answers before the exam
As you are reading an answer (Learning objective, answer, and wrong answer), ask yourself, “What is the least amount of information I could read from this and still understand the concept?” For example, because UWorld tends to repeat high-yield concepts a lot, let’s say you’ve already read about pneumonia treatment three times in another question’s wrong answer and know it very well. BUT this particular question in front of you has two long, and admittedly cumbersome, paragraphs in it. All you would need to highlight is CAP, atypical, azithromycin, typical, add ceftriaxone, HAP, add coverage for pseudomonas, and Staph. Now when you re-read it, you will know exactly what to take out of this, rather than getting lost in multiple paragraphs and coming out confused. As a side note, OnlineMedEd does a fantastic job of bolding the most important stuff in their notes, to the point that highlighting is almost unnecessary.
While reading UWorld answers, ask yourself, “What is the minimum amount of information I would have to see on re-read to understand this?” and then highlight it. Less is better, by the way, since you can always read around a highlight.
When re-reading information, read only highlights (preferably with a timer), only reading around the highlight if you find you still do not understand a concept. And be disciplined about it!
This is how you drink from the USMLE fire hose, cover basically everything on the test multiple times, and walk into the exam like a USMLE super computer.