Memorization Is Not Enough

One of the most common questions I hear when advising people preparing for the USMLE is how to memorize and remember all the details required for their exam.  The short answer is that if you are at the level of memorizing, you are simply not ready to take any of the Steps of the USMLE. Yes, the USMLE requires you to know essential medical knowledge. But, doing well on the exam comes from being able to apply that knowledge, not from the mastery of rote memorization.

Let me repeat, the USMLE is not about memorization. The examiners assume that you already know the required medical content. Your medical school success certifies that you have the basic knowledge already. The USMLE is not testing you on what you know, but problem-solving, whether you know what to do with what you know.

Focused repetition is the key to memorization. Anything that you read two or three time, if you are really paying attention, is recorded in the cortical regions of your brain. Your brain functions to retain what recurs. But, the USMLE requires more than this. You have to be able to recall and use the information within the time constraints of the exam. Remember, the USMLE is not seeing if you are a good student and able to digest all of the necessary information. Rather, the exams are checking whether you have a practical grasp of that information and understand the implication it has for medical practice.

You do not get to this level of mastery required for medical practice all at once, but by increasing levels of involvement and understanding over time. These levels can be conceptualized as pyramid in which one learning task supports the next. Recognition, being familiar enough with material to know it when you see it, is the bottom level of the pyramid. Next comes Memorization, being able to call content to mind when needed. Problem-solving, the third level, is achieved when you can combine remembered content and apply it to find the best response to presented situations. At the top of the pyramid comes Innovation, being able to create a new knowledge, new understanding, and new responses.

In medical school you are tested primarily on Recognition and Memorization. The USMLE test you primarily on Problem-solving. The amount of problem-solving required increases as you move from Step 1 to Step 3. The Clinical Case Simulations of Step 3 push problem-solving right up to the border of Innovative thought.

All of which means that at some point your preparation for the USMLE must move beyond brute memory and accelerate to the level of application and problem-solving. Sitting by yourself, reading and re-reading your study material simply will not get you to this higher level. You need to do something with the material. Outlines help. So does making diagrams. But, nothing speeds up the process like talking about the material. Interacting with peers and professors is the quickest way to boost your mastery beyond the level to recall, to being able to use the material you have learned.

The bottom line is that there are a lot of good sources of study material out there, but none of it will get you where you need to be unless you use it the right way.  Before you take your USMLE, you must move beyond memorization to application and problem-solving. The USMLE does not want to see what you know, but whether you can use that knowledge like a physician.

Steven R. Daugherty, Ph.D.

RE-READING AGAIN AND AGAIN IS REDUNDANT AGAIN AND AGAIN.

So, you have completely read through all of your study material to get yourself ready for the USMLE. Now what?

The most common advice I hear students giving each other about what to do after they have completed reading their study material is, “Read over the material again.” But, is this really the best way to get ready for the USMLE? What is the added benefit of going over the same material repeatedly? Once the farmer has plowed the field, is there really much benefit in plowing it again, and again, and again?

The fact is, students re-read and re-read study material because they want to put the effort in to get ready for their exams and they do not know what else to do. The effort is admirable. The results, however, do not justify the efforts. Most of you will have noticed that no matter how many times you re-read the material, you still find you cannot remember crucial information when you need it on an exam. Each re-reading does refresh your memory, but then the memory gets lost again as you move on to other things.

Getting ready for your exam is not about doing the same things over and over. Rather, you need to change what you do as you gain more familiarity with the material and your level of understanding increases. Think about this as a two step process:

Step 1: Getting the information into your head. Reading the material gives you familiarity. You know you have seen it before; you can recognize it. At this stage you need to read over the content and think about what you are reading. The key here is attention, to actually focus on what you are reading rather than simply going through the motions.

Step 2: Being able to recall, and use the material when you need it. Getting the material into your head is one thing. Being able to get it out when you need it is another. The key here is to do something active with the material, and doing practice questions seems to provide an excellent means making this happen.

The difference between re-reading and following up reading with practice questions has been convincingly demonstrated by the  work of the psychologists Henry Roediger, Mark McDaniel and Kathleen McDermott. In a series of research studies they had some students spend extra study time re-reading material over again. At the same time they had other students spent their extra study time doing practice questions and getting feedback on how well they performed on those questions. When both groups of student given exams to test their retention days and weeks later, the student who spent time on practice questions after their initial time studying did significantly better. This trend of better retention, if anything, increased over time.

This important research confirms what the best students already know from personal experience. Re-reading the same material over and over produces nothing but diminishing returns for the time invested. Adding practice questions to your study routine after initial concentrated study over the material helps to increase both comprehension and retention. Questions are not magic, but they do guide you to move beyond rote re-reading to the focus on recall which is essential to produce top exam scores. Questions should make you THINK and move you beyond the rut of memorization.

Steven R. Daugherty, Ph.D.