StudyWISE

BRAIN HACKING TECHNIQUES

TO STUDY STRONG
Studying Wisely
Over the past 7 years, I’ve spent quite a bit of time learning about
learning. MedStudy users had been telling me that they needed a better
way to learn all the information they were expected to know. Having the
most focused, concise, and easy-to-read content simply was not enough.

Finding a solution took me on quite a journey, reading books on the

current state of the best evidence-based learning techniques, listening
to lectures by leaders in learning engineering, and consulting with
learning experts. What I discovered was an amazing revelation:
Much of what I assumed about best learning practices was wrong.
And I found out I wasn’t alone.

Many of the current well-known methods of learning have been

passed down through generations of educators. We use them ourselves
and teach them to our children. Educators still teach them. But based
on what we now know about how the brain processes memories and
on the results of many empiric and randomized controlled trials of
specific learning techniques, we can conclude that our most used and
taught study techniques are not optimal, not helpful at all, or are even
counterproductive. There are much better learning techniques available.

We’ll go through these one-by-one and then review the best

evidence-based study methods, incorporating them into what I call
the (ahem...) MedStudy Method.

Robert A. “Tony” Hannaman, MD

MedStudy
Contents
The Challenge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

What We Know: How Memory Works. . . . . . . . . . . . . . . . . . . . . . . . 3

What We Know: Myths and Truths. . . . . . . . . . . . . . . . . . . . . . . . . . . 9

The MedStudy Method. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

The Challenge
Why are you taking on this challenge of studying for the boards, and
what exactly does this challenge entail?

It is difficult to start and persevere at a long and difficult journey if the

goal holds little meaning for you. Sit back and ponder this: Even if you
chafe at the “whys” and “wherefores” of the board exam, still, you are
reading this guide to see how it applies to your journey of attaining
competency and passing the boards. So at this moment, whether for
positive or negative reasons, this goal holds great value for you. Good!
Keep that one thought in mind.

Let’s say that, at a minimum, you plan to learn the material well enough
to pass the boards. Some of you want to build your medical knowledge
base and have as much of this information in long-term memory as
possible. And some want to achieve an expert level of knowledge
where all relevant medical information is available instantly. These
3 goals are coherent; all are milestones on the same pathway.

It is also difficult to commit to a journey like this if you don’t have

a good idea of what the project entails. You need to be confident
that your plan of attack is good, that you have the best supportive
materials, and that, given sufficient effort, you will succeed.

By the end of this little treatise, you will have a clear vision of the task
at hand, see the validity of MedStudy’s approach to studying, and be
confident of your success moving forward.

This StudyWise guide has 3 parts:

1. What we currently know about how the brain makes long-term

memories
2. The best evidence-based learning techniques
3. How we have incorporated the best of these brain-hacking
techniques into what we call the MedStudy Method

Let’s jump right in!

The Challenge 1
 A NOTE ON EXPERTISE
As you learn and repeatedly recall medical facts, concepts, processes,
and relationships, you eventually obtain a level of access to those
memories that is immediate. All the associated thinking is fluid and
quick—not delayed by looking information up or attempting to recall
it. At this point you have achieved “expertise” in that area. Attaining
expertise in a medical specialty is a gradual and piecemeal process.
You first learn the facts, concepts, and connections that are most
common in your practice and those that are very dangerous to the
patient if you don’t fully understand them. Next, you master the less
common ones. Finally, you learn the relatively rare ones.

Everybody has expertise in some areas. Think of driving a car.

You do this almost without conscious thought, even though the
process is full of fast, complex calculations and judgments with life and
death consequences. Similarly, all docs have expertise in some area of
medicine. The level of expertise may be only 20% for a resident. It is
probably 60% or higher if you’re in practice.

What are we aiming for? Physicians working at the expert level have
immediate access to much of the medical knowledge of their specialty,
and many of the mental processes that go on in their minds become
automated with time, even complex problem solving. This is called
“automated thinking.” These mental processes are mostly nonverbal.
The expert tends to think in patterns and bases decisions on where the
current patient presentation fits in with matching patterns. Hence, an
expert physician’s care becomes quick and accurate, no matter how
complicated the case.

Using focused study materials and optimal study methods accelerates

your progress toward the goal of becoming an expert physician.
MedStudy’s tools are built from the ground up to fill this need.

2 ©2022 MedStudy
What We Know:
How Memory Works
Types of Memory
There are 2 types of long-term memory and each is important in learning:

1. Episodic memory: Memory of events

2. Semantic memory: Memory of facts and concepts

Episodic memory is the memory of events, and forming these memories

is the way all information is initially coded into our brains. An episodic
memory is rich in content with the “who, what, where, when, why, and
how” of the event. They include associated emotions and what level of
importance that event had in our lives.

Semantic memory is that of facts, concepts, and processes. Any fact.

Any concept. Any process. Names of medications, diagnostic criteria for
a disease, treatment protocols, names of colors, heck, why the sky is blue.

A key point about semantic memory is that each semantic memory trace
is formed from episodic memories. You can’t intentionally program facts,
concepts, or processes directly into your semantic memory. Semantic
memories form automatically—they are initially derived and then further
strengthened during the process of consolidating multiple episodic memories
that include the same information. As episodic memories are encoded
and consolidated, there is a continuously ongoing background process in
which the same information within those different events is encoded into a
completely separate semantic memory network. So, by scheduling learning
events (readings, Q&As, lectures) that repeat must know information, you
will strengthen these semantic memories and their associations.

Speaking of associations, your semantic memories are the elements of

the semantic network, which is basically all your factual and conceptual
knowledge. Think of this network as spherical nodes connected together
with bars. The nodes represent the facts, concepts, and processes, while
the size of each interconnecting bar indicates your level of understanding

What We Know: How Memor y Works 3

 the similarities and differences between the nodes. You do this by
contrasting and comparing similar information.

Again, based on the dependent relationship of semantic memory to

episodic memory, you can see that solidly learning a fact or concept
requires experiencing multiple events that explain or contain that fact
or concept. This is a key study principle!

Okay, let’s look at how memories are made and how they can be
strengthened.

The Memory Process

There are 3 stages of the memory process:

1. Encoding
2. Consolidation
3. Retrieval

When you experience an event, all the information is funneled to the

hippocampus and converted into a neural code that can be stored and
accessed, first as working short-term memory and later as distributed
long-term memory. As mentioned above, this episodic memory contains
all relevant information of the event, the “who, what, when, why, and
where,” the emotions, the sensations, and the personal importance.
This hippocampal processing is called encoding, and there are a few
factors that can influence it.

Hippocampus

4 ©2022 MedStudy
Stronger encoding occurs with:

• General factors
– Good health—physical and mental. Eat well, sleep well,
exercise routinely.
– Strong motivation to learn

• Event factors
– Increased personal importance of the event
– Novel associated sensory input—new or different
sights, sounds, smells, etc.—adds robustness to a
memory, even if it is not the main focus of the event.
– An interesting storyline within the event
– Strong emotion engendered by the event

• Study techniques
– Practicing recall of the study material while
previewing, studying, and reviewing it
– Interleaving study content (combining nonrelated
topics; see page 21)
– Writing your own questions and making concept maps
while studying

Weaker encoding results from, basically, the reverse of the above

factors: lack of attention or motivation, physical or psychological
stress, poor sleep, and use of various psychoactive drugs.

For hours to days after the encoding, the new memory code gets
converted into long-term storage by undergoing a completely
automatic process, called consolidation. During this period, elements
of the new memory are associated with similar previously stored
memory elements. Although the consolidation process is automatic,
it can be disrupted by many of the same factors just mentioned that
cause weak encoding, especially poor sleep, physical or psychological
stress, and use of psychoactive drugs.

Retrieval is the process of recalling a memory. Recalling the memory

is an end in itself, but every time retrieval occurs, another round of

What We Know: How Memor y Works 5

 the memory storage process occurs—the memory, along with any new
information, is reencoded and then automatically reconsolidated over
hours to days. Each round of recall, reencoding, and reconsolidation
results in a memory that is more robust, better defined, more durable,
and more easily recalled. This is a key study principle!

Memory Storage
and Retrieval Strengths
We tend to worry about whether our puny brains can hold all the
information we want to remember. However, the storage capacity of
the brain is virtually unlimited; what we are trying to add is merely a
drop in a swimming pool. So, capacity is not a problem. Accessibility is
the problem. And this is fixable!

A stored memory has 2 intertwined components of strength:

1. Storage strength (durability)

2. Retrieval strength (ease of recall)

Storage strength is how durable a memory is. A learning session that

is not repeated produces a memory with low storage strength. But
each time the information is recalled, reconsidered, reencoded, and
reconsolidated, the memory is made more durable. An odd finding
is that, even when the memory is not recalled, storage strength of a
memory appears to stay the same over time—so storage strength can
increase with recall, but it doesn’t really decrease.

All the information you once learned but are now unable to dredge
up is still there (good storage strength). Why can’t you remember it?
It is because you have lost access to those memories. The retrieval
strength is low. Retrieval strength, unlike storage strength, does
always decrease with time, but it is increased in exactly the same way
that storage strength is—by recalling the information. In the same
way that retrieval makes the memory more durable, it also makes the
memory more easily recalled. And this is key: Repeated retrieval of a
memory progressively spaced out over weeks to months can make that

6 ©2022 MedStudy
memory easily recalled for years. Purposefully repeating the process
of recalling previously learned information is called retrieval practice,
and doing retrieval practice on the same material multiple times with
progressively longer periods between is called spaced retrieval. In the
following text, “strength” is used to reflect both storage and retrieval
strengths.

Using the above information, you have the basis for how to go about
building a powerful and accessible mental knowledge base:

• Use retrieval practice to strengthen the memories.

• Incorporate the factors for stronger encoding and consolidation
into your learning and retrieval practice.

Now we’ll use the combined results from many studies evaluating
learning methods to expose 6 learning myths and explain the 2 learning
truths (only 2!). The learning truths will sound familiar as they are based
on the 2 items in the above list! Then we’ll go over the MedStudy
Method, which will make perfect sense.

A 2015 Salk Institute study found that the brain’s storage capacity
may be around a quadrillion bytes.

What We Know: How Memor y Works 7

 6 common learning myths
1. Read and reread the material;
highlight and rehighlight it
until you know it.

2. Study one topic at a time.

Move on to the next topic
once you’ve mastered the
first one.

3. Study at the same time and

place each day, in a location
free of distractions.

4. Find your learning style and

study accordingly.

5. Use practice questions to

confirm your mastery
after extensive study.

6. Cram before exams.

8 ©2022 MedStudy
What We Know:
Myths and Truths
Learning Myths
Over the last 50+ years, a tremendous amount of work has been done
rigorously testing study techniques to determine which ones result in
better learning. This has been empiric testing—testing each method
against a control group. All the results I present here have been
confirmed by many studies.

Correct the Myths

Self-correction is an important step in learning. Better learning occurs
when the student has an active role and corrects their own errors—
rather than simply being told the right answer. Well, let’s take a big
step back and see if you can apply this concept to fixing the way you’ve
been learning in the first place! Here we present 6 commonly used
and taught techniques of studying that turn out to be not optimal and
maybe even counterproductive.

What We Know: My ths and Truths 9

 Learning Myth 1:
Read and reread the study material; highlight and rehighlight it until
you know it.

This is the method most of us have used for studying throughout our
schooling. When you read and reread, highlight and rehighlight, and
underline and reunderline material, you feel that you are learning the
material better and better. Once you understand it all, you think you
don’t need to study it again. But you are being tricked by what is now
known as the “fluency illusion,” the very powerful but utterly false
sense that you have a much greater grasp of the material than you do—
simply because the information has become more and more familiar.
In fact, rereading, rehighlighting, and reunderlining have been proven
to not improve test scores at all—no matter how many times you do it!
Instead, see Learning Truth 1 on page 13.

Fluency Illusion

Just because you are familiar with material doesn’t mean you can
accurately recall it on a board exam or in practice. An fMRI study
(Ryals et al., 2012) found evidence that familiarity and recall are not
the same. They are processed in two separate parts of the brain:
Recall is moderated in the hippocampus while familiarity involves
anterior parts of the parahippocampal region, or MTL cortex. Subjects
who found items familiar knew they had seen them before, but they
couldn’t tell you where or when. To accurately and reliably recall
information, you must practice recalling it over progressively longer
intervals of time.

10 ©2022 MedStudy
 Learning Myth 2:
Study one topic at a time. Move on to the next topic once you’ve
mastered the first one.

This technique seems intuitively logical and sound. It is still being used
in most schools. Study one concept or set of related material before
moving on to the next. Well, counterintuitive as it may seem, studies
show that there is a better way to learn—essentially by mixing up the
topics. See more on this in Learning Truth 2 on page 15.

Learning Myth 3:
Study at the same time and place each day, in a location free of
distractions.

This is almost as hallowed a tradition as Learning Myth 1. Students

have spent countless hours studying in the same, boring room because
they were erroneously told it would help them focus and learn more.
What works better? See Learning Truth 2.

Learning Myth 4:
Find your learning style and study accordingly.

Evidence from many studies shows no support for the idea that you
learn better if you study according to your learning preferences (visual,
aural, verbal, physical, logical, social, solitary, etc.). This is an insidiously
pervasive myth that is still believed by the majority of teachers—in
higher and lower education. Many teachers arrange their assignments
around the different learning preferences of their students.

Rather, studies show, again and again, that spaced retrieval is the
most effective way to lock the study material into long-term memory,
regardless of anyone’s favored learning style. This is explained in
Learning Truth 1.

What We Know: My ths and Truths 11

 Learning Myth 5:
Use practice questions to confirm your mastery after
extensive study.

Okay, this myth is partially true. For instance, quizzes that cover
an area you have studied extensively are a good means of self-
assessment of your current knowledge of that area. But Q&As do so
much more! They are the ideal presentation of facts, concepts, and
processes during all stages of studying—assessing your knowledge
of a topic, previewing the material, studying it, and as a means of
processing the material into long-term memory. For previewing, using
questions to check how much you can recall of a concept or process
lets you evaluate your current knowledge and preps your mind for
learning more on that topic. Of course, you can take self-assessments
after extensive study to evaluate what you know. But even more
importantly, Q&As actually help you study and learn more effectively!
We’ll discuss this in Learning Truth 1 and in the MedStudy Method.

Learning Myth 6:
Cram before exams.

This is a tried-and-true test prep method that we’ve all depended on

when we’ve realized that we weren’t ready for an impending exam.
There may be some short-term benefit in cramming, such as passing
the exam. The overarching problem, however, is that most of what you
crammed is—pfttt!—gone, shortly after the exam. It is much better to
learn the material in a way that makes the information immediately
accessible whenever you need it, even long after the exam. The fix is in
Learning Truth 1.

12 ©2022 MedStudy
Learning Truths
The following details the techniques that are most useful for effective
learning. I categorize these methods into 2 essential learning truths.
The first learning truth is all about using and practicing recall.
The second is a bit longer because it digs into the many ways to
strengthen encoding during your study periods.

Learning Truth 1:
Recall, recall, recall.

As studies have proven, practicing recall of facts, concepts, and

processes is the sole way to convert that information into durable, easily
recalled long-term memories. We tend to do this naturally as we gain
proficiency in any area of endeavor, from hobbies to our profession.
We frequently rewind and replay new information, fitting it in to what
we already know. The more you practice recall, the better your results.
By including structured recall sessions during your daily practice and
studies, you can more easily and efficiently learn new information.

There is a specific way you must engage with the recall process for it
to be effective. You can’t just spend a few seconds trying to recall the
information and say, “Nope, don’t remember much” and then jump back
into reading about that topic. This will drop you right back into your soft
and fuzzy illusion-of-fluency world where you are not really learning
anything. Rather, even if you don’t remember anything at first, strive to
dredge up all the information you can that is related to the topic. This
is termed “effortful recall,” and the more effort you put into recalling
the facts or concepts, the stronger your memory becomes when it is
reencoded and reconsolidated with new information.

Purposefully repeating the recall of previously learned information is

called retrieval practice. This process has been studied extensively,
and the best way to practice retrieval is with spaced retrieval. Spaced
retrieval is when you practice recalling a topic multiple times—with
a progressively longer time between each session. Each session

What We Know: My ths and Truths 13

 results in memories of that topic that are even more durable and
even more easily accessible. The review session itself is best set up
with structured content that reliably quizzes you about the same
information with each session.

Look at the graph titled 20% Forgetting Curve. You can see that the time
to forget 20% (i.e., retain 80%) of the information becomes longer and
longer as time goes by. Similar results occur even if you wait until you’ve
forgotten 60 or even 80% of the info. Because there is so much medical
information you are trying to make easily accessible, I recommend you
spread out the retrieval sessions. After the initial study session, practice
recall on the topics in 2 days, 10 days, 6 weeks, and 4 months (or whatever
progressive spacing fits best for you). And always follow the cardinal rule:
Recall as much as you possibly can before looking up the answer!

Your ultimate goal may be to become an expert physician who is truly

fluent with all relevant medical facts, concepts, and processes. Making
retrieval practice a second‑nature part of your clinical work will allow
you to continually grow your knowledge base and level of expertise.
Using it in the office boils down to simply following the most important
rule: Recall as much as you possibly can before looking up the answer
(same as when studying!).

20% Forgetting Curve

First
Learned Reviewed

100%

90%
Retention

80%

70%

60%
0 1 2 3 4 5 6 7
Days

This reflects the finding of increased memory durability after each

successive study session on the same content.

14 ©2022 MedStudy
Learning Truth 2:
Use techniques and behaviors that strengthen encoding.

We outlined these factors earlier. Now, let’s delve into them a bit.
You’ll see that there are many factors that affect encoding. But it’s all
important!

Optimize physical and mental health

On the physical side, watch what you eat, get plenty of sleep, and
exercise regularly. (Yes, your mother was right!)

• Eat a sensible diet. Avoid a diet high in carbs; it adds an

increased risk of weight gain, diabetes, and heart disease—and
the ups and downs in blood sugar interfere with concentration.
• Sufficient sleep is crucial for decreasing stress and for
optimizing the encoding and consolidation processes. Aim for
7–8 hours per night. Minimize alcohol ingestion at bedtime—it
disrupts normal sleep cycles by decreasing your amount of
REM sleep and by decreasing deep sleep (a.k.a. stage 3 sleep,
slow-wave sleep, delta wave sleep), which is the restorative
part of the sleep cycle thought to be important for memory
consolidation.
• Get at least 30 minutes of exercise 5 days a week. This results
in decreased stress, anxiety, depression, and better deep
sleep. Did you know that regular aerobic exercise not only
improves short-term memory but also increases the size of the
hippocampus?
• Manage stress. This is a key necessity! Maintaining physical
health with the above recommendations is a great starting
point. Balance your work with relaxation and play. Place mental
boundaries around work time, study time, and family time.
Don’t let these distinct activities interfere with each other.
• Meditate. Meditation is being studied and, although there is
a lot of hype associated with various practices, there are not
many sound clinical trials yet. A few good trials on mindfulness
meditation, however, do show a benefit for stress reduction

What We Know: My ths and Truths 15

 and for decreasing anxiety and depression. Regular meditation
practice also appears to help with maintaining focus and staying
on task.
• Address learning disabilities. Many physicians have a learning
disability that they have never recognized. If you’ve had
trouble with reading, calculating, learning, or testing, get a
thorough learning disability assessment. For it to be useful, the
assessment must evaluate for both specific learning disorders
and psychological issues. A good starting point for more
information is the Learning Disabilities Association of America
at LDAamerica.org/adults.

SLEEP ON IT:
HOW SLEEP HELPS YOU
CONSOLIDATE KNOWLEDGE
Everyone knows it’s important to get a good night’s sleep before
learning something new. But did you know sleep is just as important—
maybe even more so—after learning? That’s because a vital part of
learning—consolidation—happens while you sleep.

Neuroscientists haven’t yet pinned down the mechanisms involved,

but consolidation appears to entail an interchange between the
hippocampus and the neocortex, two parts of the brain particularly
active during sleep.

Recent studies have focused on EEG activity that takes place during
NREM (non-REM) or slow-wave sleep. Additional studies have also
brought to light the importance of REM sleep—the dream cycle—in
knowledge integration.

The bottom line? When it comes to consolidation and learning, there is

no part of the sleep cycle that’s expendable. How well you “sleep on”
what you’ve just learned directly impacts how well you will recall the
information later.

16 ©2022 MedStudy
Develop a strong motivation to learn
To reach a goal requiring significant mental effort over a long time,
you must have commitment. Commitment is, basically, persisting in
efforts to attain a goal until it is achieved. To succeed, your degree of
commitment must match the mental and physical effort required to
reach the goal. Motivation, in the engineering world, is the process
of getting an object moving. A certain amount of force is required
to accelerate an object from standstill to a set velocity against
a set amount of frictional force. In learning, motivation powers
your commitment and provides you with the enthusiasm, focus,
determination, and persistence to reach your goal. How can you boost
motivation and decrease factors that interfere with it?

Here are the 4 main influencers of motivation:

1. Value what you do and why you are taking on this challenge.
Realize that you are progressing toward the incredibly desirable
goal of ... passing the boards, becoming an expert‑level physician,
etc. ..., which is attainable only by taking on and conquering this
challenge.

2. Self-efficacy: Realize that you can do this. Put yourself in a

“growth” mindset rather than a “fixed” mindset. These mindsets
determine how you handle challenges and setbacks:

a. Fixed mindset is learning behavior based on the belief

that intelligence is innate, fixed, and static. You are either
smart or not smart. Period. And that intelligence and talent
alone are responsible for success. People with a fixed
mindset fear failing at a task or challenge because doing
so will “prove” that they are not so intelligent after all. A
setback is felt as a confirmation of inability, and “failures”
are felt as just that—with profound negative emotion.
People with fixed mindsets tend to stick with what they
find easy to do and with what they already know. They
tend to not take on challenges they might fail at.

What We Know: My ths and Truths 17

 b. Growth mindset is the belief that learning and intelligence
grow with experience, effort, and persistence. And that the
amount of effort put into overcoming a challenge has a direct
effect on success. Setbacks are simply learning nuggets, and
“failures” are big learning experiences—important stepping-
stones on the path to success. This belief allows people to
take on big challenges without fear of failure.

The funny thing about these mindsets is that they are a self-
fulfilling prophecy: Your actions will follow whichever mindset you
adopt! These mindsets are shorthand for core beliefs that guide
critical decisions in peoples’ lives and prevent them from, or allow
them to, take on challenges. But they are not immutable. These
beliefs are habitual ways of thinking that can be changed with a
little thought—consistently applied. It is important to realize that a
growth mindset is possible and that choosing it helps you achieve
the big (and little) goals in your life.

3. Solution-oriented behaviors focus on problem solving and

getting things done, rather than attributing your lack of
productivity to another person or thing. Example: “I don’t have
enough time.” Hey, don’t even think that, much less dwell on it.
Simply figure out what you must do to get the necessary time,
given that you’ve committed to the task.

4. Outlook: Keep a positive outlook. Remember that you are an

awesome, future expert doc with amazing grit. At least, starting
now you are!

Vary your surroundings while studying

Don’t think that because you are in a new environment or because
there are a few distractions around that you can’t learn effectively.
It’s just the opposite!

It has been a surprising and counterintuitive finding from the

learning research that encoding improves when studying in varying
surroundings and with mild distractions. We can make sense of

18 ©2022 MedStudy
this when we consider what is prioritized in the encoding of an
episodic memory.

As we’ve covered previously, episodic memory, which is the source

of all semantic memory, is event-based. We more strongly encode
information that is considered more important, and that allows the
processing to be very efficient. The importance attached to elements
of an event is derived from previous experience and from hard-coded,
brain-based processing. The brain tends to attach more importance to
differences in our surroundings than to the surroundings themselves.
Our brains habituate to elements in our surroundings that don’t change
with time and essentially cancel them out. In novel environments, we
have much stronger event-related memories. Remember the first time
you went to a foreign country, the first time you camped out in the
mountains, or the first time aliens probed you in that weird room? (Just
making sure you’re paying attention!) The point is, unique experiences
stand out.

On the other hand, studying day-after-day in a bland, small, white room

with no distractions adds no importance to the memories generated
there; it decreases encoding strength because you’re bored to death
with the place!

During your study sessions, focus solely on the study material. You will
find that the differences in the environment and the mild distractions
are perfectly ignorable. The point of these factors is to enrich the
encoding, not to actually distract you!

Add interesting stories to your study material

We love stories. Stories are a series of events, and our episodic
memory mechanisms are most at home cataloging and encoding
events. Again, the “who, what, where, why, and when” of an event is
encoded along with its importance. Memory experts often use stories
to give themselves seemingly amazing powers of recall. They can take
a very long list of items and make up a funny story that has these items
in the same sequence as they appear in the list. They can then repeat
the items forward or backward or start from any item on the list.

What We Know: My ths and Truths 19

 Here are a couple of examples showing how we can use stories
during studying:

1. When doing spaced retrieval practice with Q&As: A board‑style

Q&A is already telling a story. It helps with the encoding if you
put yourself in this story and “experience” the scenario. For
example, you can imagine the patient in the question stem is
one of your patients or, perhaps, a close relative. If you choose
the wrong answer, play out in your mind how this story ends
(tragically—with weeping and with friends and colleagues
looking out of the corner of their eyes at you), but then, after
learning the correct answer, reimagine it with the correct
ending (happy—with all friends and colleagues dang proud to
know you). Perhaps you then imagine explaining the reasoning
of the correct answer to one of your amazed colleagues. Make
it an interesting story with an ultimately happy ending.

2. When drawing a concept map: Concept maps are great

for breaking down difficult concepts and processes into
manageable pieces. These maps show relationships between
associated facts that make up the concept and even other
concepts. We can think of it as a representation of our semantic
network for that concept. One thing studies have shown about
concept maps is that they must be generated by you. You can’t
copy one off the Internet and find it very useful. Concept maps
can look like anything. They are often a funny picture or items
with lines drawn between them. Most of the power of the
concept map is the thought that goes into creating it. You are
clarifying associations and comparing and contrasting similar
items. However, because the way we learn is with our episodic
memory, it is very difficult to remember a static concept map
(even if you made it yourself!). Instead, bring a story into the
concept map, turning the concept map into an event—hacking
the brain to remember it better.

20 ©2022 MedStudy
Concept Map

Learn more about concept maps at medstudy.com/method/concept-maps.

Put some emotion into your studies!

Intense emotion can powerfully enhance encoding, sometimes making
an event unforgettable. This can be good, but in the case of mental
or physical trauma, it can be debilitating. We are probably familiar
with using the sheer terror of not passing a test to cram better. But
we really don’t want to make this our go-to study method! Moderate
emotion also enhances encoding, and we can use this effect to enrich
the stories we create while studying (as under the previous heading
“Add interesting stories to your study material” on page 19). The more
personal the emotion you experience with your stories, the better you
will encode the event.

Interleave the content

Interleaving is combining multiple topics into the same study session.
For example, you can have a Pulmonary Preview | Review Question
spaced retrieval session combined with initial reading of topics in
Cardiology and Infectious Disease.

What We Know: My ths and Truths 21

 Now, this study technique is pretty dang nonintuitive and may sound a
bit crazy. And even when you do it, it may feel like you are not getting
much learning done. But! ...this has been proven to enhance not only
the encoding but also the cognitive processing involved with learning.

Why does interleaving work?

• Increased attention: Once you start studying this way, you will
see that you remain fresher and have better focus throughout
the study session.
• Practicing recall: Bouncing back and forth between topics can
be thought of as a mini retrieval practice. The more often you
recall knowledge, the better your grasp of it and the stronger
your memory of it.
• Contrast and compare: Mixing concepts forces you to contrast
and compare similar information in different topics, thereby
building new and stronger connections to and between
concepts and developing a more robust understanding of each.
You don’t get this benefit from studying one topic at a time.
• Active learning: Interleaving is active learning—as opposed to
traditional, passive learning; you are actively engaged in the
learning process rather than merely being a passive receptacle.
You are constantly thinking about what you are doing and are
directing all your own efforts. This helps you maintain focus
and deepens your learning. As you might guess, active learning
meshes very well with growth mindset.

Whew! There certainly are many factors that help optimize your study
sessions!

Let’s see how combining the elements from the 2 Learning Truths and
what is now known about how memories are made works with the
MedStudy Method.

22 ©2022 MedStudy
The MedStudy Method
The MedStudy Method adds a little method to the madness of solidly
learning all the medical knowledge you need to know. Your immediate
need may be to study for the boards, with an ultimate goal of gaining
expert-level fluidity of the facts, concepts, and processes.

Take a serious look at your current state of medical knowledge

through the looking glass of your brain’s semantic network nodes
(of tightly related information). Most of us have some pretty big and
shiny (durable and accessible) nodes and some pretty big, wide-open
interconnections between these larger nodes. These are areas we are
very familiar with. But when we consider the level of knowledge we
wish we had, the picture gets dreary and we see many small, tarnished
nodes with few interconnections and many we don’t have access to
(we just know we learned that info previously). By simply using the
MedStudy Method in your studies, you’ll soon have these nodes bright
and shiny with big, strong connectors—and keep them that way.

Many of us go into high-stress, freak-out mode when we study

because we focus on the terrible need to pass this or that exam.
The MedStudy Method allows you to put a calm, high-intensity
focus on the processes that are sure to achieve this same goal and,
in addition, put that information into your long-term, immediately
accessible knowledge bank. So, no need to worry; trust the method,
and you can put your valuable energy into the optimum learning
processes rather than wasting it on freakouts, procrastinations, and
brain paralysis.

Let’s assume you are preparing to start the journey of studying for the
boards. To plan a long journey over land you consider many factors,
such as how much time you have available for travel, means of travel,

The MedStudy Method 23

 route of travel, and what luggage to take. Similarly, for this journey for
knowledge, you don’t just jump right in; you need to plan:

1. How to study most effectively

2. What to study
3. How to sequence and execute your journey

So, I’ll present the MedStudy Method in these same 3 steps. Let’s go
through them one by one.

 ow to Study — PSSr, the Optimal Learning

1. H
Sequence
In the previous chapters, we went through the brain science of memory and
the best evidence-based study techniques. Here, we combine and distill
all of this into the best universal study method. This works no matter what
it is you are learning and attempting to transfer into long-term memory.
PSSr stands for the 3 phases of learning used in the MedStudy method:
Preview, Study, and Spaced retrieval (PSSr). Below, I cover the very specific
techniques used in each phase. This PSSr approach is an optimization of the
way we naturally learn and works with any study material.

PHASE 1: PREVIEW
Relax and see what you can remember. At this stage, you’re only getting
ready for the study unit(s) (explained on next page) you will do the
following day. This is a low-stress exercise in which you simply look at
the topics and attempt to recall everything you know about them; you’re
not trying to learn new information.

Because this is a preview exercise, you do not seek the answers. You
only go over the questions and you only see what you can dredge up with
a little pondering (i.e., effortful recall). Be careful! You might interpret
this exercise as a serious “assessment of knowledge” and judge yourself
harshly if you don’t know much at this point. Rather, welcome this for
what it really is—a low-stress, simple process proven to make your brain
“sticky” for what you’re about to learn the next day.

24 ©2022 MedStudy
 PREVIEW
The day before you dig into the study material, recall everything
you can about it using the Preview | Review questions as prompts.

STUDY
Read through your study units carefully, seeking understanding.
Don’t memorize!

SPACED RETRIEVAL
Using the Preview | Review questions, Q&As, and flashcards
as prompts, practice recall of the same study material over
progressively longer intervals. This moves your study material
into easily accessible long-term memory!

REFRESH

Go back through the study material only as needed
to refresh your understanding.

The MedStudy Method 25

 PHASE 2: STUDY
Seek understanding. This is where you actually study the material in
a textbook, attend the lecture, or watch the video. Make this a low-
stress exercise also. You are not supposed to know the material yet nor
are you supposed to “know” it at the end of this study period. During
this phase, you are satisfying your curiosity and simply aiming for an
understanding of the facts, concepts, and processes.

If you are using a study unit with no Q&As, make your own Q&As,
flashcards, and concept maps that cover key information and help you
understand it. You can then use these same study aids during all future
review sessions of that material.

PHASE 3: SPACED RETRIEVAL (RECALL, RECALL,

RECALL)
Okay, now we get serious about moving the study unit material into
long-term memory. This phase is all about putting Learning Truth 1 to
work (recall, recall, recall).

After the initial study session, go over the same study unit in 2 days,
10 days, 6 weeks, and 6 months (or whatever progressively longer

The Study Unit

In the MedStudy Method, a “study unit” is the study material you plan
to address during one study session or set of sessions. Generally, a study
unit should not be more than you can cover in a day or two and should be
tightly related material—so use the major topics as your study units. The
best place to source your study units from is the table of contents of a book
or the subtitles in a video product. For example, in the MedStudy Core,
source your study units from the major topics in the table of contents.
In memory terms, a study unit can be thought of as a node (or set of nodes)
in the semantic network of the brain. What you do in the study sessions
devoted to a particular study unit is to strengthen that nodal area and
improve accessibility to it. Similarly, when you contrast and compare similar
information in different nodal areas you are strengthening the connections
between these nodal areas.

26 ©2022 MedStudy
 spacing best fits your schedule). As always, continually practice recall
and dredge up all you can remember after reading a question but before
reading the answer or explanation. As you move through each session
on a particular study unit, you’ll find that the time spent becomes less.
Eventually, you fly through the spaced retrieval sessions of the earlier
material. Be very dedicated with this phase of learning! Spaced retrieval
using this very particular way of practicing recall is the only way to reliably
shuttle this information into long-term memory.

Each of these progressive review sessions of the study unit must be set
up with structured content that reliably quizzes you about the same
need-to-know information. Use Q&As, review questions, and/or flashcards
that are already part of the study unit, or the ones you make on your own.
And include any concept maps you made on that study unit.

Remember that these sessions are about practicing recall of the

information. Be careful! Don’t get trapped into rereading and rehighlighting
the study unit (no matter how badly you want to! [Fluency illusion!]).

Refresh
During your recall sessions, go back to the study unit material as needed
to maintain your understanding of the material.

1-2
Table of Contents
P O S T E R I O R P I T U I TA R Y G L A N D
ENDOCRINOLOGY

GENERAL PRINCIPLES� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-1 HORMONES OF REPRODUCTION � � � � � � � � � � � � � � � � � � � � � 1-27

FEMALES� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-27
PRIMARY, SECONDARY, AND TERTIARY
GLANDULAR DISEASES� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-1 ANTERIOR
Normal Physiology � PITUITARY � � � � � � � � � � � � � � � � � � � � � � � GLAND
� � � � � � � � � � � � 1-27
Amenorrhea � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-28
HYPOTHALAMUS � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-1 Hirsutism � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-29
PREVIEW
MALES � � � � � � � � �REVIEW
| � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-30
POSTERIOR PITUITARY GLAND � � � � � � � � � � � � � � � � � � � � � � � � � 1-2
• What MELLITUS
DIABETES are the hormones � � � � � � � � � � � of
� � � �the
� � � � � anterior
� � � � � � � � � � � �pituitary?
� � � � � � 1-31
ANTERIOR PITUITARY GLAND � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-2
OVERVIEW � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-2 OVERVIEW � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-31
• What are typical signs and symptoms of a
PITUITARY TUMORS � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-3 CLASSIFICATION � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-31
pituitary tumor?
DIAGNOSIS AND SCREENING � � � � � � � � � � � � � � � � � � � � � � � � 1-32
Overview� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-3
Hyperprolactinemia and Prolactinomas � � � � � � � � � � � 1-4 •PREDIABETES
What is the �workup � � � � � � � � � � �for
� � � � �a� �pituitary
� � � � � � � � � � � � tumor?
� � � � � � � � � � � � � 1-33
Acromegaly � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-5 Overview� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-33
• Aside from
Goals and Typesa prolactinoma,
of Treatmentwhat � � � � � � � are
� � � � � the
� � � � � �other
� � � � 1-33
Other Pituitary Tumors� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-6
Acquired Hypopituitarism � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-6 TYPE 1 DM
causes of� �hyperprolactinemia?
� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-33
Overview� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-33
DIABETES INSIPIDUS � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-7 • What is the
Treatment ofbest T1DM initial
� � � � � � �medical
� � � � � � � � � � �therapy
� � � � � � � � � � � for
� � � � � � 1-33
hyperprolactinemia?
Notes for T1DM � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-34
SIADH� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-8
TYPE 2 DM � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-35
THYROID GLAND� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-8 • How do you test for acromegaly?
Etiology� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-35
NORMAL PHYSIOLOGY � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-9 • Which cancers
Treatment of T2DM most � � � �commonly
� � � � � � � � � � � � � � �metastasize
� � � � � � � � � � � � � � � � to
1-35
THYROID FUNCTION TESTS� � � � � � � � � � � � � � � � � � � � � � � � � � � 1-9 GLYCEMIC TREATMENT GOALS � � � � � � � � � � � � � � � � � � � � � 1-38
the pituitary?
OTHER THYROID TESTS � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-9 DIABETIC COMPLICATIONS � � � � � � � � � � � � � � � � � � � � � � � � � � 1-38
Example: How to identify a “study unit” from the major topics in the
Uptake and Scan � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-9
Ultrasound � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-10
• What is the
Overview � � � � �clinical
� � � � � � � � � �presentation
� � � � � � � � � � � � � � � � � �of
� � � �pituitary
� � � � � � � � � � � 1-38
apoplexy? �The
Monitoring � � � � � �treatment?
� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-39
Table of Contents—look for bold entries that aren’t indented.
Biopsy � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-10
HYPOTHYROIDISM � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-11
ANCILLARY MANAGEMENT � � � � � � � � � � � � � � � � � � � � � � � � � � 1-39
Hypertension� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-39
Findings � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-11 OVERVIEW
Dyslipidemia � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-39
Diagnosis of Hypothyroidism � � � � � � � � � � � � � � � � � � � � � � � 1-11 Aspirin � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-40
Treatment of Hypothyroidism � � � � � � � � � � � � � � � � � � � � � � 1-11 The anterior pituitary produces 6 hormones (a handy
HYPERGLYCEMIC EMERGENCIES � � � � � � � � � � � � � � � � � � � 1-40
Myxedema Coma � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-12 mnemonic is FLAT-PiG):
Ketoacidosis � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-40
TheHYPERTHYROIDISM
MedStudy Method � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-12
Etiology� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-12
Hyperglycemic Hyperosmolar
1) Follicle-stimulating hormoneState (FSH)(HHS) � � � � � � � 1-41 27
DIABETES IN PREGNANCY � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-41
Findings � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-13 2) Luteinizing hormone (LH)
Graves Disease� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-13 OBESITY � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1-41
3) OVERVIEW � � � � � � � � � � � � � � �hormone
Adrenocorticotropic � � � � � � � � � � � � � (ACTH)
� � � � � � � � � � � � � � � � � � � � 1-41
 2. W
 hat to Study
The PSSr technique can be applied to any study material. To optimize
study time, use study materials that are focused as much as possible
on your goal. This can be difficult to find because learning material is
often produced with more than one goal in mind. I’ll introduce you to
the MedStudy learning resources and use them for examples of how to
study medicine. These learning tools are 100% focused on the medical
knowledge you need to know to be a competent specialist—exactly what
the boards test for. Our physician contributors are dedicated specialty and
subspecialty teachers who take the board blueprints, many years of user
feedback, and their own experience (teaching, writing board questions,
etc.) to hash out between them what is expected of a competent specialist
and use only that material as MedStudy content. Below is a description
of the MedStudy learning resources presented kinda generically with the
resource in bold and the main function underlined.

MedStudy Core: This is a 5-volume, 900+ page comprehensive review

of the IM or Peds specialty and the “source of truth” for all the content
in the other MedStudy learning resources. The Core is casually written,
clearly presented, and reads like a series of great talks about the
must-know topics in your specialty. A special feature is the Preview |
Review questions with the answers highlighted in the text, which
were written to work very well with the “P” and “Sr” phases of PSSr.
Other tools tightly integrated with the Core are the Flashcards and
the board-style Q&As. Study units (i.e., main topics) in the digital core
are interlinked with their board-style Q&As.

Live (or video) board review course: Comprehensive review of the

specialty (IM or Peds). This is 5–6 days of talks—8 hours per day—given
by great and engaging teachers. These talks review the content in the
Core. They contain many spot-on, board-focused audience response
questions. The entire talk with all the content from the slides including
the audience response questions (with answers) is in a gigantic
full-color syllabus.

28 ©2022 MedStudy
Online Q&As: These are a semi-comprehensive review of your
specialty and can be used either after the comprehensive review or in
parallel with it (i.e., doing the same specialty at the same time). These
are board-style, highly board-focused questions with answers and full
explanations. Additionally, these Q&As are interlinked with the same
topic heading in the Core so you can refresh yourself on the material
easily.

Flashcards: Preview phase and spaced retrieval phase learning booster.

Use these and/or make your own. Flashcards are great for practicing
recall. Read the front of the card, recall what you can, then flip it over
and see the answer.

Audio Pearls: Study phase learning booster. This is a series of

recordings made by expert specialty and subspecialty speakers
synthesizing and summarizing the what you must know from the Core
with their own emphasis added. During study, it is good to come at
the same study unit material from different paths. Because the Audio
Pearls follow the same title sequence as that in the Core, they are
easily adapted to reinforce the Study phase of your study units.

3. H
 ow to Sequence and Execute Your
Journey—Introducing Your Personal Trainer.
We found that it would be a full-time job to keep up with all the
complex calendaring of many study units when you fully implement a
system that first requires that you preview the study unit, then study
it, and then move the study unit into long-term memory using spaced
retrieval sessions with progressively longer times between sessions.
Whew! So we decided to do that for you!

We basically took all of the PSSr learning phases and what we know
of how the brain processes memory—everything we’ve talked about
in this StudyWise guide—added the latest in learning engineering best
practices, and funneled all of it, in the form of many elegant algorithms,
into the digital brain of the all-new Personal Trainer.

The MedStudy Method 29

 THE VALUE OF BOARD-STYLE Q&As
Board-style Q&As obviously help get you ready for the questions
you’ll see on the boards but they are also a powerful study tool that
helps you learn the finer details of important concepts. Consider the
following about board-style Q&As:

• Q&As cover must-know information. The concepts and

processes quizzed by Q&A writers are picked because
they are the most essential and most board-relevant. No
wasted time here!
• The topic is presented as a story—a patient scenario. A
scenario is a depiction of an event, so our minds much more
readily remember it (memory of events = episodic memory,
the initial coding of all memories). You can emotionalize the
event—you are the doctor and the patient is your patient—for
stronger encoding.
• Distractors are valuable! The way multiple-choice distractors
(the incorrect answers) are written make them a study tool
in themselves. There is usually one distractor that is easily
confused with the correct answer. The other distractors are
feasible (but wrong) answers. So, in each Q&A, you get to
contrast and compare potentially confusing info about the
correct answer with info about the distractors (any one of which
could be what the question is about the next time you see it!).
As always, practice recall on the distractors and then imagine
a scenario or condition in which each distractor would be the
correct answer. This expands your learning across topics—
hence, achieving an interleaving effect, which strengthens the
connections between nodal areas. Whew! All this is within a
board-style Q&A.

30 ©2022 MedStudy
You essentially get your very own friendly and encouraging Personal
Trainer. It takes you through the topics in the Core, using both the
topic’s Preview | Review questions—along with the extracted answers—
and the associated Q&As.

If you have the Core, Personal Trainer follows you throughout the
journey toward your goal, setting up weekly assignments based on
your goals and timeline. As your study pace changes, the calendaring is
instantly recalculated. Your Personal Trainer also keeps real-time track
of all the work you’ve done no matter if your study pace has changed.
Once a study unit goes into spaced retrieval phase, it will stay there
and keep reappearing despite other schedule changes—ensuring the
steady transfer of that info into your long-term memory. If you forget
something, the Personal Trainer will bring that study unit up more
often a few times and then return it to spaced retrieval phase once you
indicate that you’ve relearned it.

Personal Trainer uses the Study Board to set up your weekly

assignments, to follow your progress, and to communicate with you.
You use the Study Board as a portal with a selective viewing of your
study products—only showing what you need to complete that week.
You can do all of your studying from this board! The Personal Trainer
will give you access to the digital Core and the Q&As (if purchased) as
needed.

The Study Board has 3 main areas—each presenting the study material
for 1 of the 3 PSSr phases of learning. There is the Study area on the
left, the Spaced retrieval area in the center, and the area on the right
is where you Preview the next day’s study units. There are free trials
available at medstudy.com.

Quick Tips for Staying Motivated

Getting prepared for a board exam and just keeping up with your ever-
changing specialty takes an investment of time and attention. The theory
of operant conditioning says that when a certain behavior is followed by a
pleasant outcome, we are more likely to repeat the behavior.

The MedStudy Method 31

 You can use this effect to help maintain your commitment and focus on
your studies. When you have achieved a significant goal or milestone,
give yourself a reward. It should be something that you find very
pleasant. Maybe eating at your favorite restaurant, an afternoon off, a
movie night, or a morning sleeping in. You know what external rewards
motivate you best.

Don’t ignore the good feelings (internal rewards) generated by your

study efforts. In the long run, internal rewards have been shown
to be even more motivating than external rewards. These internal
rewards might include a feeling of satisfaction with finally learning a
tough topic, the feeling of absorption with your studies, and the sense
of accomplishment that you are progressing well along a long path.
Persist with your studies and you will find that you can keep up with
them simply because it feels good to keep up with them!

And be sure to have a celebration when you complete your exam,

and when you get the notification that you passed! You, along with
everyone who has supported you along the way, deserve it!

The End
(or, maybe a fresh start)

Go to
medstudy.com/studystrong
to learn more about
how MedStudy is making
learning medicine
easier

32 ©2022 MedStudy
All research-based content for this guide is comprehensively discussed with detailed
references in the following books:

Brown, P. C., Roediger, H. L., & McDaniel, M. A. (2014). Make It Stick: The Science of
Successful Learning. Belknap Press: An Imprint of Harvard University Press.

Carey, B. (2014). How We Learn: The Surprising Truth About When, Where, and Why
It Happens. Random House.

Ericsson, A., & Pool, R. (2016). Peak: Secrets from the New Science of Expertise.
Houghton Mifflin Harcourt.

Ambrose, S. A., Bridges, M. W., DiPietro, M., Lovett, M. C., & Norman, M. K. (2023).
How Learning Works: Eight Research-Based Principles for Smart Teaching 2nd Ed.
Jossey-Bass.

The MedStudy Method 33