I was a bad student in preclinical. How do I get better from here?

[PathNeuroIMorFM]

Background

My preclinical was P/F, but I was academically not performing at the same level as my peers, which made studying for Step 1 was a nightmare. I was consistently scoring about 72-75% on my exams, with 70% needing to pass. That put me at the 23rd percentile compared to my peers. My excuse was "I prioritize lifestyle over studying" and to a degree that was true. A lot of my efforts in preclinical went to ECs and fun as opposed to academics. I studied maybe 2-4 hours/day inefficiently where many of my peers were studying 4-8 with hyper-efficient study methods. I am very, very lucky I never failed a preclinical exam or Step 1.

The good, the bad, and the ugly

The bad: I've had a lot of self reflection on why I sucked. Despite lifestyle, I had very bad anxiety and depression, which is super well managed now and has led to great improvement. My test anxiety is near zero nowadays, whereas I used to cry the week before exams. I also neglected really fantastic resources like Sketchy to learn bugs and drugs, which I kick myself often about.

The ugly: I never used any QBanks until dedicated (my biggest regret) and my Anki use was never great until the start of 2nd year. This is why my studying was super inefficient.

The good: I've come a long way during my research year with not only publications, but I've also kept up on a great deal of my Step 1 knowledge. I think I'm more knowledgeable now than I ever was during preclinical. I've also started to pre-study for my first rotation (Ob/Gyn) with textbook practice questions and OME. I know rotations require a good personality, and I think I'm pretty agreeable fella. I get along well with almost everyone I meet and try not to be a gunner or rude by any means. I also still love medicine. It doesn't make me jump out of bed in the morning, but I couldn't imagine doing anything else, either.

Where do I go from here?

1. How can I ensure I never come close to failing a Shelf exam and Step ever again? (Unlike my pre-clinical performance)

2. Is there anything else I should address before moving on in clinicals? I have 2 months left to prepare.

Thanks in advance.

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[Billiam95]

Honestly, some of the examples you've provided here highlight my biggest beefs with people who advocate only studying enough to pass in a P/F curriculum. Firstly, studying to barely pass prepares students poorly for step1; furthermore, I'd posit that killing preclinical would set you up for success in clinical, both in foundational knowledge and in work ethic. Secondly, studying to pass puts you at a higher likelihood of failing an exam, a potentially career-altering mistake; when your margin to pass is only a few questions, one bad day or question selection skewed a certain way could be enough to push you into failure. Thirdly, I think studying to pass is doing yourself a disservice by not making the most of the opportunity that is medical school, and you may be doing your future patients a disservice as well. Lastly, free time is, IMO, overrated (past a certain point).
Good on you for acknowledging your short comings in preclinical. On a 30,000 foot overview, you should aim to honor every rotation and every shelf. On a more microscopic level, you should absolutely hammer whatever study methods in clinical you find useful, whether that's OME, B&B, Emma Holiday, Dr. HY, Anking, WCC, etc. What is non-negotiable is at least one pass (preferably more) of uWorld per rotation, with the possible supplementation of Amboss qbank, too. To put it simply, some people study when they're motivated (aka feeling like it) to do so. You should be studying because you are determined to do so (aka studying even when you'd rather not). Over time, the hours of studying when you did not feel like it will add up over a rotation, and you will do better on your shelf & on the wards because of it.
Tldr; studying to pass is bad. In clinicals, you should aim to outwork everyone by working harder and smarter.

 

[DarkBluMage]

Honestly, some of the examples you've provided here highlight my biggest beefs with people who advocate only studying enough to pass in a P/F curriculum. Firstly, studying to barely pass prepares students poorly for step1; furthermore, I'd posit that killing preclinical would set you up for success in clinical, both in foundational knowledge and in work ethic. Secondly, studying to pass puts you at a higher likelihood of failing an exam, a potentially career-altering mistake; when your margin to pass is only a few questions, one bad day or question selection skewed a certain way could be enough to push you into failure. Thirdly, I think studying to pass is doing yourself a disservice by not making the most of the opportunity that is medical school, and you may be doing your future patients a disservice as well. Lastly, free time is, IMO, overrated (past a certain point).
Good on you for acknowledging your short comings in preclinical. On a 30,000 foot overview, you should aim to honor every rotation and every shelf. On a more microscopic level, you should absolutely hammer whatever study methods in clinical you find useful, whether that's OME, B&B, Emma Holiday, Dr. HY, Anking, WCC, etc. What is non-negotiable is at least one pass (preferably more) of uWorld per rotation, with the possible supplementation of Amboss qbank, too. To put it simply, some people study when they're motivated (aka feeling like it) to do so. You should be studying because you are determined to do so (aka studying even when you'd rather not). Over time, the hours of studying when you did not feel like it will add up over a rotation, and you will do better on your shelf & on the wards because of it.
Tldr; studying to pass is bad. In clinicals, you should aim to outwork everyone by working harder and smarter.

How is free time overrated when med students lack it to an extreme degree?

 

[DarkBluMage]

Background

My preclinical was P/F, but I was academically not performing at the same level as my peers, which made studying for Step 1 was a nightmare. I was consistently scoring about 72-75% on my exams, with 70% needing to pass. That put me at the 23rd percentile compared to my peers. My excuse was "I prioritize lifestyle over studying" and to a degree that was true. A lot of my efforts in preclinical went to ECs and fun as opposed to academics. I studied maybe 2-4 hours/day inefficiently where many of my peers were studying 4-8 with hyper-efficient study methods. I am very, very lucky I never failed a preclinical exam or Step 1.

The good, the bad, and the ugly

The bad: I've had a lot of self reflection on why I sucked. Despite lifestyle, I had very bad anxiety and depression, which is super well managed now and has led to great improvement. My test anxiety is near zero nowadays, whereas I used to cry the week before exams. I also neglected really fantastic resources like Sketchy to learn bugs and drugs, which I kick myself often about.

The ugly: I never used any QBanks until dedicated (my biggest regret) and my Anki use was never great until the start of 2nd year. This is why my studying was super inefficient.

The good: I've come a long way during my research year with not only publications, but I've also kept up on a great deal of my Step 1 knowledge. I think I'm more knowledgeable now than I ever was during preclinical. I've also started to pre-study for my first rotation (Ob/Gyn) with textbook practice questions and OME. I know rotations require a good personality, and I think I'm pretty agreeable fella. I get along well with almost everyone I meet and try not to be a gunner or rude by any means. I also still love medicine. It doesn't make me jump out of bed in the morning, but I couldn't imagine doing anything else, either.

Where do I go from here?

1. How can I ensure I never come close to failing a Shelf exam and Step ever again? (Unlike my pre-clinical performance)

2. Is there anything else I should address before moving on in clinicals? I have 2 months left to prepare.

Thanks in advance.

Lots of practice questions and use first aid to reference when reviewing them! It might be a good idea to try and put yourself on a schedule to review the subjects or organ systems that you’re a bit unsteady on before clerkships start.

 

[PathNeuroIMorFM]

Lots of practice questions and use first aid to reference when reviewing them! It might be a good idea to try and put yourself on a schedule to review the subjects or organ systems that you’re a bit unsteady on before clerkships start.

Thank you!

I have been reviewing a good amount, but I'll definitely be sure to double down on my cardio studying. It was my worst subject, but I have zero doubts that will be helpful for just about every rotation.

 

[PathNeuroIMorFM]

To put it simply, some people study when they're motivated (aka feeling like it) to do so. You should be studying because you are determined to do so (aka studying even when you'd rather not).

Could you explain more about how I could tap into this potential or make the process easier?

Many of my peers on clinicals right now often have a hard time studying after a long day on the wards/travelling. I, myself, have difficulty sitting down and doing more chart reviews or going over flashcards after an 8-10 hour day in research. I'm pretty productive when I'm in lab, but it's so difficult not to veg out when I get home for the day, especially on top of cooking, laundry, exercise, etc...

I'm worried I'll fall into the same attitudes as my peers, or worse, fall into my old mindset in preclinical of "I'm tired. I'm going to do the bare minimum and relax".

 

[Billiam95]

How is free time overrated when med students lack it to an extreme degree?

Maybe free time is the wrong way to put it. I see the sentiment more commonly on Reddit where med students will brag about putting forth the minimum effort under guise of 'P=MD' either to justify prior poor performance or make sandbagging more acceptable. A large percentage of those types of posters are still preclinical and haven't yet taken step1 or been on the wards, so they really have no idea if that strategy works in the long term. So, yes, free time is obviously important, and you should be as efficient as possible to maximize your free time, but it shouldn't come at the expense of being a borderline student.

Could you explain more about how I could tap into this potential or make the process easier?

Many of my peers on clinicals right now often have a hard time studying after a long day on the wards/travelling. I, myself, have difficulty sitting down and doing more chart reviews or going over flashcards after an 8-10 hour day in research. I'm pretty productive when I'm in lab, but it's so difficult not to veg out when I get home for the day, especially on top of cooking, laundry, exercise, etc...

I'm worried I'll fall into the same attitudes as my peers, or worse, fall into my old mindset in preclinical of "I'm tired. I'm going to do the bare minimum and relax".

Repetition to a large degree - if you make yourself get out of bed when the alarm clock first goes off, it gets progressively easier over time once its habitual. Similarly, the more often you force yourself to study after a long day (or whenever you don't want to, weekends, etc.), the easier it gets over time as it transitions from a conscious choice to a habit.
Not to say that you should aspire to be a machine and always be productive, but instead of veging out all afternoon, veg out for just an hour or so. In your down time, you could also make a conscious choice as to what is most restorative to you (ie, gym vs. watching tv) to maximize your off-time benefit.

 

[Zen Arcade]

If you want to prioritize high shelf and Step 2 performance, I would stick with Anki and UWorld/AMBOSS questions. Do a block of questions EVERY day during clinicals (could be 20-40 questions per day). This will prevent you from cramming right before the shelf. Unsuspend a chunk of new Anki cards every day so that you slowly work through the whole subject deck. Unsuspend cards of concepts you encounter in Uworld so when you learn a new concept its constantly in your memory. Here's the most important thing: when you finish a rotation you have to keep doing the Anki cards for that rotation. I know it sucks studying for a Peds shelf during Psych, but this will make you so prepared for both Step 2 and future shelf exams. There is a lot of overlap between shelf exams - particularly with IM/Surgery/FM. If you keep up with Anki from all your shelf exams by the end your knowledge base will be huge, setting you up for success in Step and the shelf exams at the end of clinical year. Most of the people in my class who say they don't like Anki stop doing decks as soon as a shelf is over. That completely defeats the purpose of the tool. The purpose of Anki is that once you learn that c-ANCA is associated with GPA for the IM shelf you don't need to restudy that topic for the FM shelf and Step 2. It saves time in the long run but can feel like a burden in the moment. It really is fool proof and I know a lot of my classmates who improved immensely after learning how to implement Anki correctly.

 

[AlbinoHawk DO]

Sounds like you already know everything you were doing wrong, and everything people that were successful were doing well. It sounds like really you just don't want to accept and do what needs to be done

 

[PathNeuroIMorFM]

If you want to prioritize high shelf and Step 2 performance, I would stick with Anki and UWorld/AMBOSS questions. Do a block of questions EVERY day during clinicals (could be 20-40 questions per day). This will prevent you from cramming right before the shelf. Unsuspend a chunk of new Anki cards every day so that you slowly work through the whole subject deck. Unsuspend cards of concepts you encounter in Uworld so when you learn a new concept its constantly in your memory. Here's the most important thing: when you finish a rotation you have to keep doing the Anki cards for that rotation. I know it sucks studying for a Peds shelf during Psych, but this will make you so prepared for both Step 2 and future shelf exams. There is a lot of overlap between shelf exams - particularly with IM/Surgery/FM. If you keep up with Anki from all your shelf exams by the end your knowledge base will be huge, setting you up for success in Step and the shelf exams at the end of clinical year. Most of the people in my class who say they don't like Anki stop doing decks as soon as a shelf is over. That completely defeats the purpose of the tool. The purpose of Anki is that once you learn that c-ANCA is associated with GPA for the IM shelf you don't need to restudy that topic for the FM shelf and Step 2. It saves time in the long run but can feel like a burden in the moment. It really is fool proof and I know a lot of my classmates who improved immensely after learning how to implement Anki correctly.

Yeah, my biggest mistake in preclinical was suspending old Anki cards after the block was over. Absolutely decked me during Step 1 dedicated.

Thankfully I set up my schedule to be relatively easy in terms of accumulating knowledge. Not looking forward to surg and EM tho.

OB/GYN - > Peds -> Surg + EM ->IM -> neuro -> FM -> psych

Do you think it will be worth going over old UWorld (go over some OB during IM) or just keep up with the Anki cards?

Sounds like you already know everything you were doing wrong, and everything people that were successful were doing well. It sounds like really you just don't want to accept and do what needs to be done

Yeah. Probably.

But me in preclinical did none of these things and sucked, so hopefully this will help a little lol

 

[Zen Arcade]

Do you think it will be worth going over old UWorld (go over some OB during IM) or just keep up with the Anki cards?

Nope! Just do the UWorld questions for that rotation. Try to get through as many NBME exams as possible as well. There usually are at least a couple NBME questions from those exams that show up again on the actual shelf. They like to repeat ideas/questions.

 

[deleted1079620]

Could you explain more about how I could tap into this potential or make the process easier?

Many of my peers on clinicals right now often have a hard time studying after a long day on the wards/travelling. I, myself, have difficulty sitting down and doing more chart reviews or going over flashcards after an 8-10 hour day in research. I'm pretty productive when I'm in lab, but it's so difficult not to veg out when I get home for the day, especially on top of cooking, laundry, exercise, etc...

I'm worried I'll fall into the same attitudes as my peers, or worse, fall into my old mindset in preclinical of "I'm tired. I'm going to do the bare minimum and relax".

I’ve heard of students getting up super early to get their cards & questions done before rotations. Then you can rest in the evenings.

 

[and 99 others]

Yeah, my biggest mistake in preclinical was suspending old Anki cards after the block was over. Absolutely decked me during Step 1 dedicated.

Thankfully I set up my schedule to be relatively easy in terms of accumulating knowledge. Not looking forward to surg and EM tho.

OB/GYN - > Peds -> Surg + EM ->IM -> neuro -> FM -> psych

Do you think it will be worth going over old UWorld (go over some OB during IM) or just keep up with the Anki cards?

Yeah. Probably.

But me in preclinical did none of these things and sucked, so hopefully this will help a little lol

I don't understand how people are continuing with their Anki reviews from prior blocks when a new block starts. For me, and I'm assuming most others, that's around 1000 cards per day right off the bat day one of the new block. I struggle to dip into new material when I have even 500 reviews from the SAME block. Can someone please explain to me how people are using Anki so longitudinally across blocks? It seems so infeasible to me, I must be missing something.

 

[voxveritatisetlucis]

I don't understand how people are continuing with their Anki reviews from prior blocks when a new block starts. For me, and I'm assuming most others, that's around 1000 cards per day right off the bat day one of the new block. I struggle to dip into new material when I have even 500 reviews from the SAME block. Can someone please explain to me how people are using Anki so longitudinally across blocks? It seems so infeasible to me, I must be missing something.

Some people in my class do anki for 8 hours per day not even joking

 

[Zen Arcade]

I don't understand how people are continuing with their Anki reviews from prior blocks when a new block starts. For me, and I'm assuming most others, that's around 1000 cards per day right off the bat day one of the new block. I struggle to dip into new material when I have even 500 reviews from the SAME block. Can someone please explain to me how people are using Anki so longitudinally across blocks? It seems so infeasible to me, I must be missing something.

Clinicals generally involve less specific material than preclinicals (less cards needed) and the amount of time between exams is a lot longer. As long as you start new cards every day and dont wait until the last couple weeks to start them, its pretty doable. I never had to do much more than 500-600 cards a day during clinicals, and that was at its worst. Usually only 300-400 cards per day.

 

[Billiam95]

I don't understand how people are continuing with their Anki reviews from prior blocks when a new block starts. For me, and I'm assuming most others, that's around 1000 cards per day right off the bat day one of the new block. I struggle to dip into new material when I have even 500 reviews from the SAME block. Can someone please explain to me how people are using Anki so longitudinally across blocks? It seems so infeasible to me, I must be missing something.

I matured about 28k cards of Anking during preclinical - which worked out (most days) to about 600-700 reviews per day, or 1.5-2 hours review old cards/day. Difficult, but very doable if you are committed. In comparison, keeping up with Anking is much easier in clinical years - I usually have somewhere in the neighborhood of 120-180 reviews per day, which is much more doable.

As for making it easier to get through the cards - I bought the app on my phone and would go through cards at the gym, in elevators, etc. You can get through a surprising amount of cards that way. Generally too, the step1 cards, in reflection of step1 material, are largely memorization and do not require much critical thinking, meaning you can get through the cards themselves pretty quickly. I don't know how long you've been trying anki, but you also get more efficient the more you do it - slower when you first start, then blazing through cards several months later.

Keeping up with Anking is absolutely a commitment and is difficult, but I can see now in my 3rd year that it was absolutely worth it. I went into step1 dedicated passing practice exams by a healthy margin and was spared the super stressful 'will I pass' dedicated that some of my classmates had. I have also noticed that while I do not use a lot of the nitty gritty details in clinical day-to-day, that fundamental knowledge is necessary for doing well on shelf exams and on the wards. There have been numerous times on exams this year where I've gotten a shelf question right only because of some step1 Anking card I (vaguely) remember that did not come up in the UW/Amboss/Anking cards for that shelf.

tldr; hard but worth it.

 

[MateoGM416]

Since when is scoring 72-75% is bad?

 

[operaman]

I don’t think things are as dire as they seem. Yes you have a large foundational knowledge deficit but I don’t think there’s much chance of fixing that in 2 months. Thankfully there’s a LOT of repetition so you’ll get many refreshers on the key concepts you need to master. You will probably have to do more sporadic remedial study from time to time compared to someone with stronger foundations, but that’s not too bad.

Key thing for rotations is practice questions. My approach was doing 100% of the questions for two difference sources for each rotation. This ensures you’re covering the entirety of high yield concepts for each rotation. The key is getting through all of the questions. UWorld is wonderful but some rotations have a massive amount of questions and the stems are long. It’s not easy to cover everything.

Back in my day 8-10 years ago I used PreTest and Lange Q&A because they had short stems and nice apps plus there was a bug that kept giving me the full paid version for each rotation free of charge. Not sure what’s comparable now, so ask around. Again, the key is breadth rather than depth.

Nowadays there are also lots of videos that cover key clinical concepts, so watch those as well. I always found videos easier to do when tired because I could crash and watch something for 30 minutes before even if I was too tired to bang out more questions.

I’m skeptical of the anki spaced reps for rotations for many reasons. So much of clinical medicine is not just factoids. Rotations are pretty short so you don’t get as much benefit from the spaced repetition thing compared to preclinical and maturing a step One deck over a year or two. 4-6 weeks is not much time to reap the benefits from Anki.

If there are good focused decks that’s just hit high yield factoids for each rotation then that may be worth doing - things like milestones and vaccine schedules for peds for Instance- but beyond that I think time is better spent honing the concepts of clinical medicine through videos and practice questions.

Also be sure to take advantage of whatever didactics are offered by your school. Those tended to be very high yield for me back in the day. Also be sure to read about whatever you see on the wards - that kind of knowledge sticks much better anyhow.

As for what to do now, I’d start doing practice questions for your first rotation. This is less about meaningful study than it is about recalibrating your brain for clinical vignettes rather than basic science vignettes. They may look alike, but they’re very different. You will need to learn to pay attention to different parts of the story and read with a different mindset than step 1. In my first rotation, I went from averaging 90% correct on UWorld blocks to 30% correct my first shelf practice block. Obviously I got better, but I had to reset my approach a bit. Now would be a great time for you to do that as well if you aren’t already.

 

[and 99 others]

Clinicals generally involve less specific material than preclinicals (less cards needed) and the amount of time between exams is a lot longer. As long as you start new cards every day and dont wait until the last couple weeks to start them, its pretty doable. I never had to do much more than 500-600 cards a day during clinicals, and that was at its worst. Usually only 300-400 cards per day.

I can see it being fine for clinical but I was thinking more for preclinical. I was just SWAMPED with cards such that I just suspended everything after the second block we just finished up it would have been simply impossible to keep up with it.

I matured about 28k cards of Anking during preclinical - which worked out (most days) to about 600-700 reviews per day, or 1.5-2 hours review old cards/day. Difficult, but very doable if you are committed. In comparison, keeping up with Anking is much easier in clinical years - I usually have somewhere in the neighborhood of 120-180 reviews per day, which is much more doable.

As for making it easier to get through the cards - I bought the app on my phone and would go through cards at the gym, in elevators, etc. You can get through a surprising amount of cards that way. Generally too, the step1 cards, in reflection of step1 material, are largely memorization and do not require much critical thinking, meaning you can get through the cards themselves pretty quickly. I don't know how long you've been trying anki, but you also get more efficient the more you do it - slower when you first start, then blazing through cards several months later.

Keeping up with Anking is absolutely a commitment and is difficult, but I can see now in my 3rd year that it was absolutely worth it. I went into step1 dedicated passing practice exams by a healthy margin and was spared the super stressful 'will I pass' dedicated that some of my classmates had. I have also noticed that while I do not use a lot of the nitty gritty details in clinical day-to-day, that fundamental knowledge is necessary for doing well on shelf exams and on the wards. There have been numerous times on exams this year where I've gotten a shelf question right only because of some step1 Anking card I (vaguely) remember that did not come up in the UW/Amboss/Anking cards for that shelf.

tldr; hard but worth it.

This is good advice, thank you! My other worry here is using Anking versus cards made by other students for in-house stuff. I currently use a deck that is a hybrid of Anking relevant to the material we're learning as well as cards made specifically for our own lectures to capture the details to help pass in-house exams. The problem with that is that I don't know what remaining boards material I am missing out on since I am not using every single Anking card for a given topic. Any thoughts or experience?

 

[PathNeuroIMorFM]

Since when is scoring 72-75% is bad?

It's not necessarily "bad". A pass is a pass. But the class average was much higher and I hated the feeling of cutting it so close to failing. There was a time or two when I was just 3-5 questions on my 150 Q exam away from failing the entire block. It was very anxiety inducing. I don't want to go through that again.

 

[PathNeuroIMorFM]

As I'm thinking about this and reading more and more about other students stories, I realize that Cardiology was hands down my worst subject in medical school. It was also one of my first subjects, so its been a long time.

If anyone has good resources to learn cardio for clinicals, I'd greatly appreciate it. If UWorld is enough, please let me know. I imagine that cardio is going to be pretty important from day 1 and I don't want to be behind.

 

[deleted1079620]

Go through the online med ed lectures for cardiology, they’ll give you a decent foundation to start clinical rotations. Other than that, know how to do a focused history & exam, write a note & present.

If you want more EKG practice then life in the fast lane is good for that.