Medical school has been likened to drinking from a fire hose. Students have just 4 years to absorb the deluge of content they'll need to practice medicine. It takes 3-4 hours of studying every day just to stay on track, and as medical candidates approach their board exams, the study time commitment jumps to 10-12 hours per day.
Learning and retaining medical knowledge is literally a full-time job. But it's only time well spent if students are using proven study habits.
It turns out some of the most common study strategies aren't as effective as they seem. In fact, they can leave students more anxious about the content and more likely forget it. Medscape Medical News talked to the experts to find out which study tips offer the greatest dividends.
"You spend hours and hours and hours and hours doing it, so why not do it efficiently and effectively?" said Ryan Kraemer, MD, medical education researcher and program director of the Internal Medicine Residency Program at The University of Alabama at Birmingham.
For some students, studying smarter will require an overhaul of their study schedule.
That's because many of the most common study strategies -- think reading, highlighting, and relistening to lectures -- actually have low effectiveness, according to a 2013 meta-analysis of study techniques. While these passive study approaches are frequently used, they don't consistently boost student performance in the long term.
Students who use these tactics may feel like they're learning effectively in the moment, but "don't buy into the myth of familiarity," Kraemer said. That sense of confidence is actually the "fluency illusion," a false sense of mastery humans get when they passively take in information.
The truth is that humans remember very little of what they read, Kraemer said. A student may read and reread about a process or listen to a long podcast about a diagnosis and start to feel very familiar with it.
But "just because you are familiar with content doesn't mean you can recall it," Tony Hannaman, MD, founder of MedStudy, wrote in an article on the site. In fact, a 2012 study (also cited by Hannaman) showed the two processes create activity in the different parts of the brain: Recall is associated with the hippocampus while familiarity is associated with the right perirhinal cortex.
It's possible to read and review enough to build the short-term memory needed to get through an exam, after all that's the basics of cramming. But these passive approaches won't build the long-term memories you need to take board exams or care for patients.
They also don't boost your confidence. A 2024 study, which hasn't been peer-reviewed, found that Spanish students had more test anxiety when they used rote memorization tactics like rereading and highlighting.
A better strategy, according to the research, is to practice remembering or retrieving the information you're going to need.
The same 2024 study found that students who committed to these retrieval strategies -- like flash cards, practice tests and quizzes -- reported more positive beliefs like growth mindset and self-efficacy and less test anxiety. A 2013 meta-analysis found retrieval practice was one of only two methods able to repeatedly and significantly boost student scores.
Most students use the practice questions to gauge their knowledge gap and decide what to study next. And while that works, practice tests can do much more. They require students to critically think about the content and reinforce knowledge recall -- both of which help with long-term memory.
"Retrieval is the study technique," Kraemer said.
There are lots of ways to customize it. You can draw a process or anatomy from memory. You can do a practice test, teach a friend, or go through flashcards.
"The key is that you have to do it from your own memory without prompts," Kraemer said.
You actively engage with and practice remembering the material. And when you fail -- and you will -- you figure out what you missed and try again, he said.
Even if you don't have an answer key, practice questions are still significantly better than repeatedly reviewing the material. But best results, according to a 2023 study, happen when you repeat a question, card, or practice test multiple times.
While busy medical students might be tempted to discard a question once they get it correct, studies say to leave it if you have time. Every time you practice remembering something, you strengthen the memory connections in your brain, Kraemer said.
Ian Bogdanowicz, MD, a first-year neurology resident at Yale School of Medicine, New Haven, Connecticut, knew from his undergraduate days that repetition was essential for him to learn. And thanks to learning scientists at his medical school, he knew retrieval practice was a proven approach. So every week, he made a simple schedule that combined the two. He set the number of flashcards and practice questions he needed to work through every day to stay on task. Week after week, he cycled through thousands of cards and questions, steadily cementing his memory.
"You don't really realize it until you're working every single day, but so many of those things I worked on in med school, they come so naturally now because we worked on it so long," Bogdanowicz told Medscape Medical News.
There are a host of online resources that offer practice tests and help medical students make flashcards. Artificial intelligence education expert Ethan Mollick recommended asking ChatGPT to quiz you on the content. It's essential to remember that ChatGPT is prone to error, so you can't blindly trust the answers it generates.
But thinking critically about the answers and finding subtle inaccuracies will add to your learning, he wrote.
Once you have a long-term memory, you need to maintain it with practice, Kraemer said.
Distributed practice is the other study strategy that's repeatedly been deemed highly effective. There's a long history of evidence to show students remember better when they space out their study sessions.
In a 2015 study, students listened to a 45-minute lecture and half reviewed the content one day later. The other half reviewed the content 8 days later. When the students were tested 5 weeks after their respective reviews, the 8-day group significantly outperformed the 1-day review group. That's the benefit of distributed practice -- or the spacing effect.
To use spacing effect simply try answering questions about a concept a week after you learned about it, then a month later, recommended Mark Siegel, MD, the program director of the Internal Medicine Traditional Residency Program at Yale School of Medicine who also wrote about medical education. "As painful as it might seem, it's that process of forgetting and reminding yourself again...that builds long-term memory," he said.
So students should not be discouraged when they forget.
"It's part of how the brain works," Siegel said. You forget and then remind yourself, again and again. "It's that repetition that builds up these neural pathways that make everything smoother" in the long run, he said.
Siegel also recommends switching up your study approach.
Instead of mastering one subject at a time, alternate between the subjects. This kind of interleaved practice is challenging but it improves memory and problem-solving.
Switch up your exposure to the material too, Siegal said. Read and do practice tests. Teach your peers and listen to podcasts. Watch YouTube videos -- as long as you're careful you're from credible sources.
"And if you're in clinical rotations -- nothing beats reading about your patient," Siegel said. If you have a patient with pneumonia -- "that's your moment to read all about pneumonia." The real-world context really helps content sink in, he said.
Importantly, learning is not a phase you get through in medicine -- it's a way of life. Good doctors are always studying, Siegel said. But none of these study strategies will have their desired effect -- in medical school or in your career -- if you don't take care of yourself first.
"You can't learn at the pace you need to if you don't," Siegel said. Bogdanowicz agreed. He quickly learned to set hard stops on his study time. His goal was to be done studying every day learning in time to have dinner with his wife and to keep weekend studying -- outside of big exam periods -- to a minimum. Self-care was a cornerstone of his schedule.
If you're putting in the time and using the best strategies but "stuff is just not sticking, go to the gym. Go to sleep," Siegel said. "You're not going to figure out everything in one night."