This is a really hot topic - always! Whenever there are new students, this will be topical.

Study has four parts, and for you to function at a high level, you need to undertake all 4 regularly and systematically. The four parts are:

  1. Understanding
  2. Summarising
  3. Revising
  4. Applying


It is a modern trend to see education as something that provides everything for the learner and makes the teacher responsible for the learner's outcomes. If you don't understand its the the personality clash with the teacher, the teacher doesn't know how to explain, yada, yada. Sorry to tell you that learning is the responsibility of the learner. So do your best impression of a vacuum cleaner, and suck it up! Learning is hard. Learning has to be worked on. Learning is intellectually stimulating. Is learning fun? Sorry, wrong question! Occasionally learning is fun, learning was always interesting, learning was mostly a slog. But the preposition that it must be fun to allow learning to occur is just erroneous and unhelpful in the extreme.

I submit to the BOTS philosophy of study. B.O.T.S. = Bum On The Seat! There is no substitute for regular contact between the gluteus maximus and top of the chair to provide the necessary connection between neurons.


This part is perhaps the only area where the excellence of your teacher might - might - make a difference. expert presentation of new knowledge in clear formats with a good structure will help you greatly. It is however not the whole story for two reasons.

  1. understanding imparted from a senior is never complete and never yours. You still have to do the work to fill in the framework. There are many details present within an understanding, it's not just 'big picture' statements. You have to know about the bricks as well as the shape viewed from a distance.
  2. this is not all there is to learn, so you need to be a "deep" learner and follow your nose to discover other things. I have always been amazed how the additional things I have learnt have always been so useful around exam time. even reading a specialist Pathology journal while waiting to go into a fellowship Pathology examination.


This process is the act of taking your understanding and committing it to paper in bit size chunks. I used to write headings and then commit my understanding to a single page. More than one page and I knew it should be cut in half. I used lots of white space (good for notes later) and colours (draws attention quickly) and indentations (nature organisation quickly evident).

At the end of a block, the pages were bound into a book.

Overall, this process is not hard. It is somewhat time consuming and does take a lot of time at the desk. But understanding and a lovely set of notes is still not what is needed.


This process is perhaps the most important and the worst done of all three. The problem is that few people have worked out what revision is and therefore how to make it easy and beneficial. Revision is NOT rote learning! Rote learning is bad. It is largely meaningless and devoid of understanding.

I would ask that you recall what happened to the first long message from your first love. What you did was to read it over and over again. Not to memorise it, but to see it repeatedly and bathe in the glow of understanding and emotion. Now I am not suggesting that you will get emotional about Physics study! BUT, when you read and re-read that letter, you came to understand the meaning. You also came to recognise the turn of phrase that perhaps betrayed a hidden thought. And lastly, if you discussed the letter with the loved one, you were able to almost quote the phrases verbatim. All this without rote learning.

Actually this sounds like the kind of learning outcome that would be good for your study doesn't it. Able to provide your learning back to someone interested (examiner??) with a deep understanding of how it fits into the area of discussion. The key to having this occur is to do what you did with that letter - read it repeatedly, read it often, and read it. But don't read it to rote learn it.

So what you do is to understand an area, then tonight summarise it. Tomorrow morning you rise 30 minutes early and take 30 minutes while having breakfast to read all of the 1 page summaries that you did last night. Tomorrow it is all the summaries (yesterday and the day before), the next day the same. So every day you read all the summaries. Towards the end of the month you will have read the first 1 page summaries 30 times. You will now find that these summaries take no more than a glance for you to look at headings and notes to say "I know that", and move on. But with that thought you just did revision!

Once your 30 minutes is full of page turning , retire the oldest pages to a nearby storage box. Every Saturday morning, revise everything including what is in the storage box. Once you have finished a block of work, take out all the 1 page summaries and reorganise them to suit your perception of the flow of material and get them bound into a book. Revise one book a week. When you go traveling, take a book and get your loved one (you are now in a permanent relationship!) to ask you questions as you drive.

Before the exams, up this revision rate to a book a day. By the end of the year the first 1 page summary will have been read about 100 times. You will know what is on the page because you have seen it so often. You will know what is coming on the next page.

Make no mistake, this step is the most rewarding (it has the biggest payback), but not the most work - that honour goes to getting the understanding nailed and the summary page produced. This step is just a relentlessly repetitive process that takes a small amount of time every day. So it takes discipline and has no immediate payback to encourage you. Understanding gives a thrill. Application gives a twinge of meaningfulness. Summarising even has a page to show for it. But revision seems to be a small repetitive unrewarded daily process that is easy to jettison. But think of it like skydiving, when you reach the point of applicability for previous knowledge (much like the time for pulling that ripcord), you want to see the chute open and have some knowledge come out to catch your fall and direct you off to a landing site (much like opening your mouth to see some sense come out!)

Stack the odds in your favour, do the revision early and consistently so that when you are required to pull the ripcord of your knowledge parachute, you can demonstrate that you packed the silk and lines of your understanding using the safety procedure of your revision. (Gee, I am having a visual night tonight!)


This is the purpose of the whole learning process in medicine - to apply the knowledge. But the preceding steps demonstrate clearly that you have to remember what you understand so that you can apply it. You can't go back to first principle with everything you know. This is where lists are important, and why relying on lists alone is a problem. This learning thing is an integrated whole. A list without understanding is pointless and misguided (unapplicable??), while an understanding without a memory is unfocussed and inaccessible (unapplicable??).

Of all the steps, this one can be left to itself and catered for by going into the clinical environment.

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