How to Study in Medical School: What the Evidence Says Works

Medical school gives you more content than you can reread, and most students start with the methods that got them through undergrad: highlighting, rereading, copying notes. If you are trying to work out how to study in medical school, the research is fairly consistent that those methods are not the best use of your hours. This guide pulls together what three published sources say about what works, and turns it into a weekly routine you can test yourself.

The sources: a 2023 overview of evidence-based learning strategies in medical education by Christopher Madan, a 2023 systematic review of spaced and retrieval practice in health professions education by Trumble and colleagues, and a BMJ Student Life article on study tips by Richmond, Cranfield and Cooper (2019). We could read the full text of the first two. The BMJ piece is paywalled, so we only used the part visible without a subscription. Links are at the end.

The problem with rereading

The BMJ article opens with the point that many students begin medical school using techniques from school, such as revisiting material and making notes. It says research shows these techniques alone have limited impact on long-term retention and academic success.

Madan makes a similar observation: without explicit instruction, students tend to use basic strategies like rereading and paraphrasing notes. When students were taught more evidence-based strategies, he reports, they found them more satisfying, had more confidence in their studying habits and performed better.

Six strategies with the best evidence

Madan lists six strategies from the psychology literature, and the BMJ article names a similar set (retrieval practice, elaboration, concrete examples, concept maps and dual coding, interleaving):

1. Spaced practice: spread studying over time.
2. Interleaved practice: alternate between topics.
3. Retrieval practice: test yourself instead of reviewing passively.
4. Elaboration: connect new material to what you already know.
5. Dual coding: combine words and visuals.
6. Concrete examples: use specific cases to understand abstract principles.

Each is easy to describe and harder to do, because the best strategies feel harder while you use them.

Does it actually work in medicine? A systematic review

Trumble and colleagues searched seven databases in November 2022 for studies on spaced (“distributed”) practice and retrieval practice in health professions education. They found 56 eligible studies containing 63 experiments. According to the abstract, 43 demonstrated significant benefits of distributed practice and/or retrieval practice compared with control groups. The authors conclude that both strategies are effective at improving academic grades.

Two caveats from the same abstract: study designs varied a lot (different interventions, comparison groups and assessments), and the authors say study quality could be improved. So this is good support for the strategies, not a precise promise of how much your grades will move.

Spacing: one worked example from the literature

Madan gives an example of a student, Jamie, with an internal medicine exam in two months and eight hours available. Three options:

• Four hours each on the coming Saturday and Sunday, soon after the material is taught.
• Four hours a day on the weekend right before the exam.
• Two hours per weekend across four weekends before the exam.

He says spaced practice studies suggest the third option would give the best results, especially over a longer period. This matters in medicine because content builds on itself and cumulative exams are common.

Interleaving: mix your topics

In the same example, Madan says that if Jamie has twenty common presentations to learn (abdominal pain, cough, headache), alternating between them each session would improve learning compared with finishing one before the next. Alternating also tends to build deeper understanding of how concepts relate. If you study by system, try mixing questions from different systems in the same session.

Retrieval practice: test first, review second

Madan’s advice is direct: re-reading and note-taking are options, but retrieval practice, where being tested is the priority, is better. That can mean flashcards or practice multiple-choice questions. The BMJ article lists three ways to build it in: space your revision, practice recall before you revisit your notes, and use practice questions and flashcards to test yourself.

Two details worth using. Madan notes that flashcards made by the student are more effective than pre-made ones, and that making them also pushes you to elaborate. And the BMJ article says spacing a large topic over several weeks helps, because each session begins by retrieving what you learned in the last one.

Elaboration, dual coding and concrete examples

These three are about understanding, not timing:

• Elaboration: Madan suggests wider reading beyond the assessed level to connect core content with further knowledge.
• Dual coding: for abstract topics such as how sodium-potassium pumps maintain membrane potential, pair a diagram with a written explanation.
• Concrete examples: for pharmacokinetics, work through a real drug such as acetaminophen and how it is absorbed, distributed, metabolized and eliminated, to see the general principles.

A weekly routine to test

This is our suggestion built on the sources, not a protocol from them.

1. Sunday, 20 minutes: list the topics you studied this week and the topics from two to three weeks ago.
2. Each study day: start with 15 to 20 minutes of questions or flashcards on older topics before opening new material.
3. New material: read once, then close the book and write what you remember. Then check.
4. Make your own cards for what you got wrong, with a diagram where it helps.
5. Mixed question blocks twice a week, drawing from several systems.
6. Review misses and add the underlying concept, not just the answer.

Hypothetical example (not a real case): you study cardiac physiology on Monday. On Thursday you open with ten questions on it, then start renal. The next Monday, you mix five cardiac and five renal questions. The same topic has now come back three times.

Why it feels worse and still works

Madan points out that these strategies are often perceived as harder and as giving worse results on immediate tests, even though learning is far better on the final assessment. That is why they are called desirable difficulties. If a retrieval session leaves you feeling less confident than rereading, that does not mean it is failing.

Madan also notes that retrieval practice takes more effort than restudying, so it depends on your own motivation and habit. Group sessions can help here: quizzing each other gives you a reason to show up and a reason to answer without notes.

Common mistakes

• Relying on rereading and notes alone, which the BMJ article says has limited impact.
• Crammed weekend blocks instead of spaced sessions.
• Studying one system to the end before touching another, with no review of the old ones.
• Using only pre-made cards and skipping the effort of making your own.
• Believing in learning styles. Madan notes the learning styles myth has been mixed in with evidence-based practice in medical education.

Keeping the routine going

A routine is easy to plan and hard to start. If you work better with company, Refocus lets you study at the same time as other people, each on their own material, which can make the first retrieval block easier to begin.

Summary

1. Rereading and notes alone are weak. Test yourself.
2. Space topics over weeks and mix them within sessions.
3. Make your own cards, add diagrams for abstract topics, use real examples.
4. Expect it to feel harder. That is normal.

Want company for your next study block? Try Refocus: study alongside others, free to start. Join at refocus.co.in.

Sources: Madan, Using Evidence-Based Learning Strategies to Improve Medical Education (2023), Trumble et al., Systematic review of distributed practice and retrieval practice in health professions education, Richmond, Cranfield and Cooper, Study tips for medical students, BMJ 2019 (paywalled; only the visible portion used). This is general study advice, not tied to a specific exam or curriculum.

Cover photo: Unsplash.