If you’re not getting the grades you want in school, you may think it’s because you’re not putting in enough effort. After all, working harder should yield better results, right? For many students, the issue isn’t actually a lack of effort. Rather, it’s the way most pre-med and medical students study that is highly ineffective and ultimately holding them back. We’ll separate fact from fiction, explore the scientific research, and give you actionable advice that you can follow.
As an MCAT and USMLE tutor, I’ve seen first-hand how impactful it can be for a student to make the switch from commonly-used, ineffective study methods to evidence-based, effective study methods.
Assessing the Quality of Advice
Ultimately, you’ve probably heard others suggest a variety of study methods, some of which are contradictory to one another. For that reason, it’s important to practice some judgment and critical thinking of your own when sifting through advice. I like to look at a few key elements.
1 | Is it Evidence-Based?
First, is the information I’m receiving backed by evidence? That being said, not all evidence is created equal, and I’ve even gone over how you can assess the strength of a research study in a previous post. Additionally, not every question you have has been addressed with sound scientific research. So if your question isn’t adequately addressed by the scientific research, you’ll need to keep in mind some other factors.
2 | What Were Their Results?
Which bring us to the second point: credentials. I don’t mean the person needs a PhD or an MD after their name, although that certainly helps. If the person giving advice wasn’t able to achieve the results themselves that they are promising you, then where is their authority on the matter? I personally scored in the 99.9th percentile on my MCAT, or the 100th percentile for the statistically illiterate, and I hit the high 260s on my USMLE.
3 | What is the Upside or Downside?
And third, what is the potential upside and downside from following the advice? I’m unlikely to eat mysterious foods or take radical supplements because there is potentially a large downside with relatively limited upside. However, I’m more willing to experiment with my own study methods or productivity strategies since the downside would be relatively limited. That being said, I wouldn’t start a new sleep routine just one week before my MCAT, as that is higher risk. In investing, we call this phenomenon asymmetric risk – you want to take risks when the potential upside or gain is significantly larger than the potential downside or loss.
Knowing that, let’s dive into the five most common mistakes students make while studying.
1 | Misunderstanding the Balance of Comprehension & Memorization
The first mistake is misunderstanding the utility and balance of comprehension and memorization. Recently, there seems to be an attack on memorization, with the idea that comprehension and understanding is all you need. This is idiotic advice that does more harm than good. Like most things in life, the truth is somewhere in the middle. In certain subjects, particularly medicine, memorization actually becomes increasingly important.
Comprehension and memorization are not an either-or proposition. You need to use both in harmony to ultimately get the best grades and be the best doctor.
On one end of the spectrum, you have students who try to create flashcards and memorize every single fact. These students need to focus more on creating a mental scaffolding of comprehension before they start filling in the small details.
On the other end of the spectrum, self proclaimed study experts say memorizing is bad and not to use flashcards, pushing a silly agenda that by simply understanding the concepts deeply, you’ll never have to memorize a fact again. That’s a load of bull honkey and more marketing ploy than substance.
Sure, in cardiology, having an understanding of pressure-volume loops and basic fluid dynamics is foundational, and trying to memorize these relationships rather than understand them will prove detrimental. This is why so many students find cardiology particularly challenging – it’s heavy on concepts. On the other end of the spectrum, anatomy is heavy on memorization. Understanding the relation and functions of different body parts helps in memorizing important information, but at the end of the day, using a mnemonic device to memorize the branches of the external carotid will take you much farther than simply trying to understand it.
Prior to starting plastic surgery residency, I spent a year teaching anatomy to first and second year medical students. I also spent considerable time tutoring students in preparation for USMLE Step 1 and Step 2. I found that different students require different approaches, as do different subjects. For anatomy, students benefited most from learning memory tricks and mnemonics. Comprehension could only take them so far. For students struggling with renal or cardiology, we had to focus more on comprehension, as memorizing facts without a solid foundation has little utility. I’ve covered additional details in how to balance memorization and comprehension in a another post.
2 | Re-Reading & Re-Listening
I’m guilty of this next one. Back in college, I often studied by re-reading my notes, which was terribly inefficient. By re-reading notes or re-listening to a lecture, you’re spending most of the time hearing things you already know,. That time would be better spent (1) applying your new knowledge with spaced repetition to improve memory consolidation, (2) challenging the newfound knowledge with practice questions, or (3) learning about it from a different angle to address inconsistencies or holes in your understanding. Don’t worry about making sure you heard every single last word. You can still set the curve and have top marks if you miss a small detail here or there.
For the MCAT and USMLE, students often brag about how many “passes” they’ve done through their prep books, such as First Aid. There’s nothing wrong with referencing the text when you see a gap in your knowledge, but reading the whole thing cover to cover multiple times is a perfect example of the law of diminishing returns in action.
3 | Playback Speed Glorification
This next mistake is a perfect summation of the previous two. Students have pride in how rapidly they listened to a lecture recording or podcast. Oh, you only listened at 1.5x? I was at 2x! Oh, you did only 2x? I’m more of a 3x kind of guy.
Here’s the reality: I personally rarely went over 1.5 or 1.7x for lecture recordings, but I had many friends who were going at 2x or greater. Guess who was getting better scores in class, on the MCAT, and on the USMLE? I’ll let you figure that one out.
Don’t fall into the trap of thinking that listening at higher speeds is always better. I consider myself quite fast when it comes to learning new information and test-taking. I’m usually one of the first to finish my exam or think through a challenging concept presented in class. Yet I choose to listen to my lecture recordings at a moderate speed. What gives?
When you are presented information for the first time, it’s not a race to hear the words as fast as possible. Your goal is to comprehend what is being said and build a mental scaffolding of understanding as you go. By going at too rapid a pace, you end up comprehending much less, as you’re unable to make the necessary real time connections. The rate I chose varied based on the subject material, the lecturer, and how fresh and alert I was feeling.
As someone who processes relatively quickly, I found my mind wandering while waiting for the speaker to get to the next topic. Therefore I sped up the lecture to the point I was able to maximize both engagement and therefore understanding without compromise.
If you want to know more, I made a post about speed reading which goes over these details in more depth.
4 | Highlighting & Underlining
Despite commonly being used, highlighting has been demonstrated to provide little to no benefit for students studying for a test and may even worsen inferential recall. This detrimental effect on higher level functions may be due to highlighting drawing attention to individual items rather than to connections across items. This goes back to the balance between comprehension and memorization.
For most of your college courses, and certainly for the MCAT and USMLE, you’ll need to rely on critical thinking and higher level functions to perform optimally. Skip the highlighting, and opt for flashcards, the Feynman technique, or other active learning methods instead.
5 | Not Using Active Learning
Which brings us to the last and final mistake. Not using active learning study methods. Across multiple studies, active learning methods have consistently demonstrated far superior results. There are two primary ways you should be practicing active learning.
First, self-testing. A study of Texas medical students demonstrated that time management and self-testing were the strongest predictors in academic performance, more so than even GPA or MCAT scores. Studies have also demonstrated that practicing retrieval produces greater gains in meaningful learning – more specifically, test results up to 50 percent higher than concept mapping and 100 percent higher than reading alone.
Taking practice tests frequently and regularly is one of the best ways to prepare for exams, particularly for the MCAT or USMLE. Many students push their practice tests too far off, focusing only on content review in the early stages of prep. However, the benefits of taking practice tests occur even when you don’t have as solid of a foundation, as you’re not only learning and consolidating new information effectively, but also learning how to apply said information.
Second, spaced repetition. In short, spaced repetition helps consolidate working memory into long-term memory, which is ultimately what you want on test day, thereby allowing you to spend your brain cycles on applying the information rather than remembering it. Cramming may work for quizzes and smaller tests, but you’re not going to remember the information long term, and cramming simply won’t cut it for larger tests like the MCAT or USMLE. Spaced repetition is daunting and the overwhelming majority of students don’t practice it effectively. For that reason, I’ve created an entire playlist on Youtube describing how to use Anki, the best spaced repetition software for pre-med and medical students.
These are the most common mistakes I’ve seen from personally tutoring and mentoring dozens of students. If you haven’t already, be sure to check out my Study Less, Study Smart blog post where I cover the study methods I learned in medical school, but wish I knew in college.