We all know the feeling. We spend long hours studying, desperately trying cover everything ahead of exams, only to feel that we’re not making any progress.
Yet there is a better way, which is grounded in neuroscience and psychology research. It’s called Spaced Repetition.
What is spaced repetition?
Spaced repetition involves reviewing content at gradually increasing intervals. Research has shown that it dramatically increases the memory retention and thus efficiency of learning. The first scientist to demonstrate this phenomenon was Ebbinghaus.
Fig 1. Ebbinghaus forgetting curve
A system for incorporating spaced repetition into daily medical life
A practical way to use this in medicine is as follows: when you learn some new information, recall it from memory and review your notes after about one hour, then one day, then one week, then one month, then six months and then one year.
The principle is more important than the exact time spacing and can be adjusted around your life and schedule as required. You can organise this in a number of ways, on the micro (facts and concepts) and macro (topics) levels.
Micro (facts) level
One option for the micro level is to use electronic aids, such as Anki (where you can make your own flashcards) and Memrise (where you can use those created by others). These present you with flashcards and will re-present them at increasing intervals, based on your ease of recollection.
I found Anki most useful for fuelling active recall by having a condition name or an important concept on one ‘side’ of the card and lots of reference information copied from my notes on the back.
For example, Anki presents the card like this:
I would then spend about thirty seconds writing out as much as I can about Mallory-Weiss Syndrome (often using the rough format; aetiology, signs and symptoms, pathophysiology, complications, investigations, treatment).
I would then click ‘show answer’ at which point it would show the reference information, as below, for me to see how much I got and what I missed out.
Based on how easy I found it and how much I was able to recall, I would select the appropriate option at the bottom and would then be re-presented with this card after the relevant period of time.
Macro (topics) level
I created a Review System which is easily organised through a central document as shown below. This is only one way to incorporate Spaced Repetition, but I will explain it to demonstrate the principle.
The system works as follows:
At the end of each day, I spend about an hour recapping things that I have seen, learnt and been taught that day. Anything worth reviewing the next day is added to the ‘Daily Reviews’ column.
At some point during the following day, I will review topics in the ‘Daily Reviews’ column (by recalling content from memory and often doing some further study to clarify important concepts). If I feel the topic is worth reviewing again, I will move the topic into the ‘Weekly Reviews’ column. This means that I will review it again in approximately one week’s time and perform the same process (putting some into the ‘Monthly Reviews’ column and so on). Some smaller topics will be grouped into larger topics as they progress right-wards.
Here’s how this works on a daily basis:
Whenever I have a free moment during the day (such as between teaching sessions, before a clinic, between theatre operations or any other time when no learning opportunities are present), I open up the central document and work through the topics for review in the priority order shown above, from left to right. This usually involves grabbing a piece of paper and recalling as much as I can on the topic before later referring to my notes (which I sync to my phone). If necessary, the recall can be purely mental, such as if bored during a long operation.
I have found using this system a very effective way to make the most of gaps during the day. I can recount numerous occasions where I had a gap of 10-30 minutes, during which previously I would have killed time checking my phone or emails, but instead reviewed some content. I would often get home in the evening having covered the majority of my reviews during the day so I had the option of taking the evening off knowing I’d made good progress.
I would estimate that this system alone enabled me to spend 30-40% less time studying with a noticeable improvement in long-term retention. It also meant I was far less stressed during exam period, particularly finals, as the majority of the content was in my long-term memory thus reducing the need to ‘cram’.
 Melton, “The Situation with Respect to the Spacing of Repetitions and Memory.”
 “Classics in the History of Psychology — Ebbinghaus (1885/1913) Chapter 1.”
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This article is an excerpt from my latest book, The Modern Medical Student Manual, which offers guidance for succeeding at medical school, while finding deeper fulfillment in work and setting yourself up for an impactful medical career. For more information, click here. It is available now on Amazon.
Also published on Medium.