I started teaching fifteen years ago, as a graduate student at the University of Oklahoma in the spring of 1998. This document is a summary of everything I’ve learned about how students learn from then up until now. I’m setting it down in print because I found myself giving the same advice over and over again to students in one-on-one sessions—and at least for some of them, it’s made a difference.

Here’s the summary. The rationale for each point is explained in more detail below.

1. Learn how you learn.
2. Use your solo study time to build things.
3. Use your group study time to explain things to other people, and to have them explain things to you.
4. Focus on the stuff that scares you; use your fear as an ignorance-detector.
5. Review everything on a regular basis—for a given exam, daily if possible.
6. Spread out your study time so you don’t study past the point of diminishing returns.
7. Spend as much time in lab as possible.
8. Learn to ask for help.

1. Learn how you learn.

All of the rest of this advice will be many times more effective once you learn how you learn. Some people are visual learners, some verbal, some more narrative, some more spatial. I myself am visual all the way. I can really struggle with written descriptions, but if I draw something a couple of times, it will be in my head forever. I have a colleague who is just the opposite, and her preferred study method is to organize everything into giant tables. Now, I don’t know a ton about all the different learning modes, but other people do, and most schools have some kind of education, counseling, or student services office with people who can help you figure this out. If you don’t have access to resources like that, fear not: you can probably diagnose your strongest learning mode on your own, by straightforward experimentation. Observe your information consumption—what kinds of things do you gravitate toward, and what kinds of explanations do you struggle with?

2. Build things.

When you study, don’t just read your notes or watch videos. Build things. My very first question when students come to me about studying is, “What are you building when you study?” I don’t care if it is sketches or tables or flashcards or posters or interpretive dance—that’s for you to figure out (see point [1]). But whatever your preferred avenue of expression, if you spend at least part of your study time making things, you will engage your motor neurons, which is a way of coercing your interneurons into actually thinking about the output. And that will help fix the information in your brain. In short, active learning beats passive learning. And as a bonus, you’ll have your own customized notes that you can return to later (for example, when you’re studying for boards).

3. Study with a group, and explain things to each other.

In all of my time teaching anatomy at four different universities, it has always been true that the students who did the best were part of effective study groups. It’s not just autocorrelation, because struggling students improve when they join effective study groups. I think that this is because people in effective study groups spend their time asking each other questions, not just to quiz each other, but primarily in the vein of, “I don’t understand this, can you please explain it to me.” (Hint: if you don’t do that in your study group, maybe your group is not effective. The fix is obvious.) And when you try to explain something to someone else, you will rapidly find out what you actually understand versus what you only thought you understood. And when other people explain things to you, at best you are getting tutored, and at worst they are finding their own weaknesses, although ideally both things go on at once, and both parties benefit.

I reckon that about half of what I learned in graduate school, I learned from my fellow grad students. I am pretty sure that my advisors understood and anticipated that, and deliberately fostered environments in which peer-to-peer teaching could flourish. In small group work you can get more focused, individual attention than you can in a lecture hall with dozens or hundreds of other people. Don’t only study in groups—some solo study is necessary to firm things up for yourself, and to build your own tools (see point [2])—but don’t only study on your own, either.

4. Study what you’re afraid of.

Use fear and anxiety to your advantage: let them direct you to study what you’re afraid of. Think of your study time as a bug hunt, in which you systematically identify your weaknesses and deal with them. If  you know the lungs cold but the thought of cardiac autonomics causes your pulse to spike, then you already know where you need to put the time in. Use confusion and fear as diagnostics for areas you need to work on.

5. Review everything regularly.

Repetition beats cramming, for at least a couple of reasons. One is that anatomy, like most subjects dealing with nature, is a continuum. But you tend to get it delivered in 50-minute chunks, with the inherent continuity broken up into more-or-less arbitrary bins (“hip”, “thigh”, “knee”, etc.). One of your primary jobs, then, is to take this string of chunks and mentally turn it back into a continuum: to find the joins between adjacent lectures, and the overarching  principles that unite them all. The best way I know to do this is to review everything on a regular basis—daily, if possible. If you have two hours blocked out to study, spend the first 30 minutes going over your notes* from all of the previous lectures, then get on to the day’s topic. Next time, whatever you studied today will be another link in the chain. In time, you will see how today’s material links back to previous lectures, and forward to later ones.

* The whole point of notes (by which I mean sketches, flashcards, etc.—whatever it is that you are building during your study time) is to serve as a funnel between the course material and your brain. So useful notes have to package things so they are easier to understand. If the map is as complicated as the territory, it’s not really a map. It’s okay if your first set of notes is overly long and ugly, because your first set of notes should not be your only set. As your understanding improves, build new tools (i.e., make new notes) that reflect that.

6. Don’t study past the point of diminishing returns.

This is the other reason why repetition beats cramming. You need to revisit the material multiple times because the amount you can learn in one session is finite. There is a real biological basis for this: the neurotransmitters and receptors involved in shifting information from short-term memory to long-term memory need a certain amount of time to recharge, and that time is measured in hours, not minutes. Somewhere around the three hour mark, your brain will have absorbed as much as it can for that session. You can keep putting more stuff into short-term memory, but it won’t get copied to long-term memory. Get up and do something else, and come back to it that evening, or the next day. (“Do something else” can mean “do useful work for your other classes”, especially if the work for other classes is different in kind, like practicing techniques.) The more times you revisit the material, the more opportunities you have to successfully copy it into long-term memory, the more you actually learn.

This may sound crazy, because we have all had episodes of sustained effort lasting more than three hours, like a day at work. The difference is that at work, you’re not trying to remember everything, and when you study, that is precisely what you are trying to do. I have had students tell me that they are studying for six to eight hours at a time and they’re still not getting it. This is heartbreaking—such long uninterrupted sessions guarantee that at least half of that time is simply wasted. You absolutely can study effectively for six or eight hours a day, you just need to break up the time: two hours in the morning, three in the afternoon, another three in the evening, so your neurotransmitters can recharge in between. You will hear people say things like, “Study smarter, not harder.” Mostly this boils down to, “Study actively and more frequently, not passively or for too long at a stretch.”

7. Spend as much time as you can in the lab.

Spend as much time as you can in lab, not just on dissecting days, but anytime the lab is open. We have a saying, that you learn concepts in the lecture hall but you learn anatomy in the lab. The time with the cadavers is a gift, the only opportunity you will have for the rest of your career to spend dozens of hours getting tactile experience cutting on patients who don’t bleed and can’t code. Use it. “But what about my friends, family, pets, hobbies—my life?” Your life extends ahead of you for decades. Your time in the anatomy lab lasts for a few weeks at most.

8. Learn to ask for help.

The last thing I have to say is the most important: learn to ask for help. I am on one of the student performance committees at WesternU, where students end up when they fail courses. There are a constellation of things that may cause a student to fail a course, but one of the big ones is trying to bull through alone. I get it—you were hot stuff in high school, maybe college too, the big fish in the small pond, and you’re used to being the smartest person in the room. Well, now you’re in med school, and your previous specialness is now the default for everyone here. It is very likely that college did not prepare you to work anywhere near as hard as you will have to now. The good news is that you are therefore untested, so even you don’t know how much you are capable of. In the next few years, you will find reserves of strength that you did not know you possess—but you will not do it alone. Asking for help is not a sign of weakness. It means that you are strong enough to be honest about your limitations, which is the first step to overcoming them. In my experience, more people fail out of pride than from lack of ability.

Whom should you ask for help? It depends on your situation, but a short list includes peers, TAs, professors, student services, counselors, and the school administration. If you don’t know whom to ask, just ask someone, and they’ll probably point you in the right direction. Usually knowing whom to ask is not the hurdle—it’s being willing to ask in the first place. If you are struggling in a course and you haven’t been to talk to the instructor, then you’re not trying as hard as you could be. You have committed years of your life to this. Isn’t succeeding more important than polishing your pride while the ship sinks? Learn to ask for help.