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Spaced Repetition Saves You Time and Sanity for USMLE Step 1


Sometimes I feel frustrated by how simple the truth is.

Perhaps this is because I don’t like to think that the challenges I face are manageable using universal strategies. Perhaps I like to think that my struggles are unique, or else, why would they be… struggles? For example, it doesn’t seem like something as hyped as studying for the USMLE Step 1 (a.k.a. the most-important-exam-in-the-history-of-the-world-AAAAAHHHHHHH!!!) should be formulaic or simple.

But studying for the USMLE Step 1 can be formulaic. And I want to argue that it should be formulaic.

When viewed through the rearview mirror, there are many things I’ve experienced that I didn’t understand completely as I was passing through them. More specifically, while I knew that flashcards had been useful learning tools throughout college and the first two years of medical school, I didn’t understand the concept of spaced repetition and how this technique was making it possible for me to achieve my USMLE Step 1 goals.

What is spaced repetition?

Spaced repetition is a learning technique in which increasing intervals of time are inserted between each review of an item so that:

  • Difficult material eventually appears more often
  • Easier material is reviewed less frequently

(Here‘s what Wiki has to say.)

Spaced repetition is ideally employed anytime an individual needs to acquire a large volume of information in a relatively short amount of time.

Sound familiar?

Many language-learning programs utilize spaced repetition. It is also an ideal technique to employ when studying for the USMLE Step 1.

One of my favorite things to remind students is that, as C.S. Lewis writes, “We need to be reminded far more than we need to be instructed.”

It can be hard to accept, but everything that you’ve ever learned will ultimately be forgotten if that information is not exercised and rehearsed on a regular basis. Your brain and its intricate circuitry are analogous to a muscle in this way. Spaced repetition is a systematic and algorithmic approach to making sure that you don’t forget what you’ve worked so hard to learn.

We have written before about the spaced repetition flashcard software Anki Web, available to download free of charge here.

September 2015 Update: Memorang also has the promise to be a new and possibly better Anki, so be sure to check them both out to see which one works best for you.

How can you use Anki most effectively to score high on the USMLE Step 1?

1. Create Flashcards from First Aid:

  • Pick up the latest edition of First Aid
  • Create multiple decks corresponding to its various sections
  • Make individual flashcards from the facts on each page
  • The more individual flashcards, the better
  • The less amount of information each flashcard contains, the better

2. Create Flashcards from UWorld Questions:

  • UWorld is NOT simply a way to practice what you’ve learned while reviewing First Aid; it’s a way to learn new information!
  • Don’t simply type information blindly from the UWorld explanations into your Anki Web software—instead, think about and process what you’re learning, and use Anki Web to paraphrase the important points
  • Your goal is to push beyond the “buzzwords” that you know from memorizing First Aid, and get to the bottom of what items in a question you should focus on when it’s time to sit for the actual exam
  • It’s okay to make several cards from a single question!!
  • I recommend creating a separate deck based on the UWorld questions

3. Review Flashcards Every Single Day:

I can’t tell you how often I meet with students to review their progress from the past few days, and realize that they have been doing all of their assigned UWorld blocks, moving through sections of First Aid, and even making flashcards from the material, but they haven’t been reviewing their flashcards. At all. These are often the same students who tell me, “Flashcards just don’t work for me…”

I don’t say this to minimize the difficulty of trying new techniques, but rather, in the hopes that I can reach you if this sentiment resonates with you.
  • It is just as important to prioritize reviewing flashcards as it is to prioritize making them
  • This means incorporating flashcard review into your formal schedule (i.e. on Google Calendar)
  • This means rearranging your schedule if you’re not making time for flashcard review; some of my students have had to move “quality time with Anki Web” to the morning (when they are most fresh) to make sure that they’re utilizing this learning technique most effectively
  • Don’t be afraid to adjust according to your needs!

“I do believe in simplicity. It is astonishing as well as sad, how many trivial affairs even the wisest thinks he must attend to in a day; how singular an affair he thinks he must omit. When the mathematician would solve a difficult problem, he first frees the equation of all incumbrances, and reduces it to its simplest terms. So simplify the problem of life, distinguish the necessary and the real. Probe the earth to see where your main roots run.” ~Henry David Thoreau to H.G.O. Blake, 27 March 1848

Or, whack a mole…