I had mine hole-punched and put in a huge binder. Now, I take out the relevant pages (ex. for a 2-week endocrine block), and put the pages in one of those clear plastic 'sleeves'/dividers (don't know how else to describe it), which itself is 3-hole punched.
I take out the pages to read and put them back in when I'm done... that way, the holes in the FA pages remain intact and I don't leave any pages around
🙂
Regarding annotating, I think if it's not in FA, it's not there for a reason... I just write in explainations of concepts that FA has 2 words for. Plus, I annotate in ultra-short-hand...saves me space, but I doubt if someone else could read it...