BMJ 2019;365:k663 doi: 10.1136/bmj.
k663 (Published 11 April 2019)
Student
LIFE
Study tips for medical students
Examples of evidence based revision strategies
Anna Richmond PhD student in medical education and specialist trainee year 4, obstetrics and
1 1
gynaecology , Thomas Cranfield second year medical student , Nicola Cooper honorary clinical
2
associate professor
1
University of Nottingham, UK; 2Derby Teaching Hospitals NHS Foundation Trust, UK
Studying and revising for exams is a major part of medical
school success, yet students do not always receive coaching in
how best to learn or revise. Many students begin by using the
same techniques that worked for them at school, such as
revisiting material and making notes. Research has shown,
however, that these techniques alone have a limited impact on
long term knowledge retention and academic success.1-4
Successful students use a variety of learning strategies, which
include5:
• Retrieval practice
• Elaboration
• Concrete examples
• Concept maps and dual coding
• Interleaving.
Retrieval and spaced practice
Successful performance in exams relies on being able to retrieve
information from your long term memory. Accessing your long
term memory is like rediscovering a path—if you have been
down it many times before, the neurological connections are
stronger and information is easier to remember.
Retrieval practice helps to build these connections, giving you
practice at remembering. The three main ways to build retrieval
practice into your study are:
• Spacing your revision of topics
• Practising recall before you revisit your notes
• Using practice questions and preparing flashcards to test
your recall.
People tend to study a topic in one block before moving on to
the next topic, and this is often how students revise. However,
spacing out the revision of a large topic over several weeks can
benefit your performance and ability to recall information in
the long term.6-9 This is because you have to start each session
anna.richmond@nottingham.ac.uk
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STUDENT
by retrieving knowledge from the last one. To use this strategy
effectively, it is important to plan a revision schedule so you
don’t run out of time.
Before starting to revise a topic, try to recall as much as you
can about it. Only read through your notes and any course
material after you have attempted to recall as much as you can.
Having to actively think about what you already know can help
to identify gaps in your knowledge or understanding, which
indicate where you need to focus your revision.
Preparing your own flashcards from memory and then using
them to revise is another good method of retrieval practice. You
can also use practice questions, papers, or quizzes, checking
that your answers are correct. This is also an effective way to
incorporate retrieval practice into your revision.10 11
Elaboration, concrete examples, and dual
coding
Elaboration involves taking a subject or concept and describing
it in as much detail as you can. Asking questions such as “why?”
and “how?” helps you to draw out detailed knowledge.
Coming up with concrete examples to demonstrate abstract
ideas will also help to make information easier to recall.12
Examples help with the understanding of concepts, rather than
factual recall.
Creating concept maps (fig 1) can be a useful way to combine
elaboration and concrete examples, as well as link ideas. This
helps to develop clinical reasoning and problem solving
skills.13 14
Presenting words in a visual format, such as in a concept map,
also enhances learning14 through a strategy called dual coding,
where you present the same information in two formats —visual
and verbal. This strategy is particularly useful when learning
medical topics such as anatomy, which require visual diagrams
or illustrations as well as words.14
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BMJ 2019;365:k663 doi: 10.1136/bmj.k663 (Published 11 April 2019)
Mixing things up
Interleaving —also known as “mixing things up”—can be
another powerful learning strategy to aid recall of related but
separate topics.
A common approach many students take is to revise topics by
subject, because this is usually the way they are taught or
presented in textbooks. For example, within a cardiology module
a student might revise heart failure, followed by ischaemic heart
disease. However, with interleaving, your revision strategy
would entail switching between study of different subject areas
that are related in some way. You could revise different
conditions that cause breathlessness: heart failure, asthma, and
pulmonary embolism. This makes it easier to identify different,
but similar, conditions.
Studies have found that interleaving aids long term recall and
discrimination between concepts.15 In one study designed to
teach students electrocardiogram interpretation, participants in
the group who practised interpreting a mixed series of
electrocardiograms scored higher than the group who practised
interpreting electrocardiograms that showed similar
abnormalities.16
Interleaving topics can feel awkward compared with studying
one topic thoroughly before moving on to another. However,
studies have shown that interleaving is better than other
techniques in helping people retain knowledge in the long
term.4 6 15-17
Box 1: Study tips: Thomas Cranfield, second year medical
student, University of Nottingham
Before medical school my approach to studying consisted of cramming during
the weeks before exams and coursework deadlines. When I started medical
school, I was similarly chaotic: I would write lots of notes during lectures, but
I didn’t know how to use them. My first formative exam results reflected my
poor study habits.
After researching a range of learning techniques, I changed the way I revised.
I created and used flashcards, as well as doing practice multiple choice
questions and explaining concepts using concrete examples. I also used
elaboration and dual coding techniques to help visualise complex ideas and
systems of the body.
When I prepare for lectures, I start by looking at the learning objectives and
coming up with a list of questions I would like to find answers to during the
lecture. I use these answers and additional information from textbooks to form
the basis of my revision flashcards.
One of the hardest but most fruitful techniques I added to my studying was
interleaving. I use a timer to limit studying a single topic to 25 minutes before
taking a 5 minute break. I then move on to a different topic—for example,
going from cardiovascular to respiratory medicine. Initially, this was difficult
but I found that the more I did it the more connections I could see between
topics, which helped to reinforce my learning.
As a result of changing my approach to revision, my formative marks almost
doubled.
Effective learning requires effort and
organisation
Educational studies show the advantages that taking a strategic,
organised approach to learning has over cramming facts in a
short space of time.3 Brown and colleagues, in their book Make
It Stick: the science of successful learning, write: “We are poor
judges of when we are learning well and when we’re not. When
the going is harder and slower and it doesn’t feel productive,
we are drawn to strategies that feel more fruitful, unaware that
the gains from these strategies are often temporary.”6
The strategies described in this article might seem challenging,
but diversifying your learning strategies and spreading out your
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revision will benefit you not only in your exams but also in your
future role as a doctor and lifelong learner.
BMJ: first published as 10.1136/bmj.k663 on 11 April 2019. Downloaded from http://www.bmj.com/ on 15 April 2019 by Abid Khan. Protected by copyright.
Box 2: Learning strategies
• To learn effectively, practise retrieving information by:
• Spacing things out: revisit topics after you have had time to forget them
a little
• Preparing your own flashcards and using them for revision
• Using self testing, quizzes, and practice questions
• To learn better, elaborate and use concrete examples:
• Describe an idea with as much detail as possible in your own words
• Use examples to describe abstract concepts. These examples could
be clinical examples or links to patients
• Use concept maps to make connections within and between topics
• Use words and pictures together
• Mix things up to improve long term recall:
• Studying in blocks is effective for short term recall but less effective
than interleaving topics for longer term recall.
Box 3: Further information
Brown PC, Roediger HL III, McDaniel MA. Make it stick: the science of
successful learning. Harvard University Press, 2014
The Learning Scientists: www.learningscientists.org
ANKI—a website and app that can help you make your own flashcards:
https://apps.ankiweb.net/
Kahoot!—create your own quizzes: https://kahoot.com/
Competing interests: None declared.
Provenance and peer review: Not commissioned; externally peer reviewed.
1 Paschler H, McDaniel M, Rohrer D, Bjork R. Learning styles: concepts and evidence.
Psychol Sci Public Interest 2010;9:105-19.
2 Reiner C, Willingham D. The myth of learning styles. Change: The magazine of higher
learning. 2010. 10.1080/00091383.2010.503139.
3 Dunlosky J, Rawson KA, Marsh EJ, Nathan MT, Willingham DT. Improving students’
learning with effective learning techniques: promising directions from cognitive and
educational psychology. Psychol Sci Public Interest 2013;14:4-58.
4 Bickerdike A, O’Deasmhunaigh C, O’Flynn SO, O’Tuathaigh C. Learning strategies, study
habits and social networking activity of undergraduate medical students. Int J Med Educ
2016;7:230-6.
5 Shin H-I, Jeon WT, Yang EB. Relationship between learning strategies and academic
achievement in medical college and graduate medical school students. Korean J Med
Educ 2010;22:197-204.
6 Brown PC, Roediger HLIII, McDaniel MA. Mix up your practice. In: Make it stick: the
science of successful learning. Harvard University Press, 2014.
7 Didau D. What if everything you knew about education was wrong? Crown House
Publishing, 2016.
8 Benjamin AS, Tullis J. What makes distributed practice effective?Cognit Psychol
2010;61:228-47.
9 Moulton C-AE, Dubrowski A, MacRae B, etal . Teaching surgical skills: what kind of
practice makes perfect?Ann Surg 2006;244:400-9.
10 Larsen DP, Butler AC, Roediger HL. Repeated testing improves long-term retention
relative to repeated study: a randomised controlled trial. Med Educ 2009;43:1174-81.
11 Deng F, Gluckstein JA, Larsen DP. Student-directed retrieval practice is a predictor of
medical licensing examination performance. Perspect Med Educ 2015;4:308-13.
12 Rawson KA, Thomas RC, Jacoby LL. The power of examples: illustrative examples
enhance conceptual learning of declarative concepts. Educ Psychol Rev 2015;27:483-504.
13 Daley BJ, Torre DM. Concept maps in medical education: analytical literature review.
Med Educ 2010;44:440-8.
14 Mayer RE, Anderson RB. The instructive animation: Helping students build connections
between words and pictures in multimedia learning. J Educ Psychol 1992;84:444-52.
15 Rohrer D. Interleaving helps students distinguish among similar concepts. Educ Psychol
Rev 2012;24:355-67.
16 Hatala RM, Brooks LR, Norman GR. Practice makes perfect: the critical role of mixed
practice in the acquisition of ECG interpretation skills. Adv Health Sci Educ Theory Pract
2003;8:17-26.
17 Gaglani S, Haynes R. Five study techniques every medical and health professions student
should know. 2016. www.youtube.com/watch?v=DM9yEcznq0s.
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Figure

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Fig 1 Potential causes and types of seizure, showing how they are related to each other

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