How to study

Even though she claims she hates studying, consultant anaesthetist Leyla Sanai has passed all her many exams at the first sitting. In this article she shares her tips for success

Studying for exams is a nightmare. There is no easy way of doing it--it is a relentless grind. Two of the worst things about medical school are the frequency and enormity of the exams. No sooner have you finished one and had a breather for a couple of months when another looms forebodingly on the horizon, with its whispered threats of doom in the form of resits, or being "booted" out should you fail.

When I was a student there seemed to be people who could breeze effortlessly through all their exams with minimal effort. Some of these people boasted about how they had barely picked up a textbook, and bragged about nights spent in the pub instead of studying. These individuals were telling huge porkies. It's impossible to make it through medical school without working hard--the sheer volume of facts to be learnt mitigates against luck or brains as passports to exam success. Any successful medical student who pretends that they have never studied in their life deserves an Oscar. I think that their motivation for spinning these webs of fiction is, firstly, a wish to be seen as a genius who never needs to study; secondly, a wish to be viewed as a life and soul type who rarely stops partying, and, thirdly, it is a desperate insurance scheme. So if they fail, despite their secretive hours of cramming, they can swagger in and drawl that it is no surprise they failed since they did no work, and exclaim about what miserable swots everyone else is.

Once you have accepted that, sadly, your desk is not just somewhere to park your butt when looking out the window, and the library is not just a place to meet your pals before the midweek night out at the union, it is essential to devise a method of study which is effective for you.

Make a timetable
Plan your study carefully. There is no point in flicking through your anatomy book with such lack of enthusiasm and boredom that you get through only one chapter in three months. On the other hand, do not be ridiculously overambitious in your aims: setting yourself two hours to learn the entire physiology of the respiratory and cardiovascular systems is a trifle optimistic. Once you have made your plan, try and stick to it--if you keep taking a week longer for each chapter than you had intended you will have a huge panic at the end. Remember, it is better to know everything moderately well than to be an expert in only 1% of the syllabus. It is futile knowing the anatomy of the dorsum of the upper limb digits like the, er, back of your hand, if you would not recognise a lower limb if you fell over one

Think in terms of amount learnt, not hours
As a student, I wasted many, many months sitting staring at the same page of some vast volume, daydreaming about what I would buy from the supermarket, or where I would go that weekend. I equated being miserable and torturing myself with virtuous study, surmising that if I was having a hideously dull time then it must be doing me some good. Sadly, the adage "no pain, no gain" is not necessarily true in reverse--that is, pain does not automatically lead to gain. I was also envious of my best mate who could sit and study intensively for hours at a time, then pack her books up and go and have fun. My method involved self punishment. When I caught myself daydreaming, I would forgo little treats like the late night drink in a pub or the movie at the weekend and spend these times staring at the same page. Again. This was not constructive.

Give yourself rewards
If you have something to aim for it is far easier to motivate yourself. Tell yourself that if you learn the chapter really well, then you will allow yourself a treat. Whether this is a night out, some new clothes, a day off at the weekend, or whatever, is up to you. But be strict with yourself. If you spend the day skiving off instead of studying then you must forgo your treat. No cheating.

Don't be tempted to try faddy methods
I found studying so immensely painful that I always believed there was some secret trick that would suddenly render it all easy. This was not the case then, nor tragically, is it now. My flatmate and I amassed many different systems that would miraculously change our lives, making studying a doddle. Highlighter pens were one--the idea was that you would go through your notes or the textbook, highlighting salient points so that they would lodge themselves stubbornly in your memory.

Unfortunately, my highlighter pen did not stop me from daydreaming, and I ended up with many textbooks in which every second word would be religiously highlighted, whether it was a key word or just "and" or "a." My flatmate fared no better. She spent hours poring over filing cards on which she wrote important facts, but ended up with a floor littered with hundreds of little cards and little else.

Relate facts to function
The best way of remembering something is to understand it. Okay, so this is not always possible as some things need to be memorised parrot fashion--the Krebb's cycle, for instance. The friendly biochemist will not wave you through the viva just because you understand its concept, he still wants the mind numbing details of the numbers of adenosine triphosphates, etc. However, in many other areas, facts are far more easily remembered if they are understood. Anatomy is one example. In my experience ploughing through Cunningham's Anatomy (a manual for dissection) was like the worst form of self flagellation. Never has a book been written before or since that was so dull, verbose, opaque, difficult to plough through, unimaginative, unenlightening, tedious, and unrelated to function. Some of the sentences would drone on for what seemed like days, veiling any potentially memorable facts in a surfeit of heavy medical terminology and Latin. It was a great cure for insomnia but carried the risk of inducing narcolepsy. Far, far better are the books which explain things in as simple a way as possible, and, better still, relate dry fact to function. It is much easier to remember the effects of different muscle groups if you have visualised the results of their malfunction. Similarly, textbooks that show pictures of patients with particular medical conditions make it far easier to recall the sequelae of these conditions. A picture is worth a thousand words, especially if they are cloaked in pompous medical terminology.

Do not compare yourself with others
People who claim that they have done no work will try and convince you that the clavicle will come up, the first rib is a "dead cert." Do not listen. Others will work but for a fraction of the time you need to. They may have partially photographic memories. They may have far better concentration. Their neurones may be more supple and adept. However, you cannot hone your brain by sending it to the gym. You are stuck with your grey cells. They may be greyer and more dingy than your best mate's, but deal with it.

Categorise and compartmentalise
When a chapter is fresh in your mind, 10 minutes after reading it for the 67th time, it may seem as if all the facts contained within it will spring forth effortlessly the next time you summon them. However, three months down the line, your only memories of it may be that it was a large and fact filled chapter of which you have no recollection. Because of this, it is a good idea to categorise and compartmentalise whenever you can. If the chapter gives you a load of different drugs that can be used in a particular disorder, categorise them into their different methods of action. Then, if you just understand these different modes, you will be able to recollect the categories at a later date and give an example of a drug in each group. Similarly, if a particular disease has effects on many different parts of the body try and compartmentalise these into different organ systems. If you remember the headings the small print will follow. And the headings are much easier to recall if they are filed away in some logical order.

Test yourself
As studying is so unpleasant, it is tempting to just cram facts into your cerebrum without testing whether they can be retrieved. My motives for not testing recall were an ostrich like reluctance to face the possibility of retrieval failure. This is not a good approach. You want to make sure the traffic is two way. Trying to extract stringy bits of knowledge from your brain for the first time in the exam is stressful and doomed to failure.

Practice the relevant form
If the exam will include multiple choice questions (MCQs)/essays/short answers/vivas/spot dissections make sure you practise these endlessly. When I started swotting for my part 1 MRCP, I read and learnt Kumar and Clarke, my favourite textbook, three times. Then I attempted an MCQ and got about 20%. For the next few months, I abandoned the textbooks and practised MCQs endlessly. It was the right thing to do.

As a final word of encouragement, despite my loathing of study, I have passed all parts of the MRCP and the FRCA (fellowhip of the Royal College of Anaesthetists) the first time simply by sticking to the rules above, in particular the last one--that is practising the relevant type of questions over and over. The only test I have ever failed is my driving test. I did not practise the format I was tested on--that is driving!

Leyla Sanai, consultant anaesthetist, Western Infirmary, Glasgow
Email: leyla.sanai@virgin.net


studentBMJ 2001;09:357-398 October ISSN 0966-6494