When you are learning a topic, being able to understand and contextualise the information and correctly store it in your memory is essential. Many revision strategies overlook the importance of understanding. If you only use question banks, flashcards or study tools such as Anki, you run the risk of learning specific facts without understanding the context and bigger picture.
I remember for one exam during medical school, I decided I would try to be ultra-efficient and effective and get a really high grade. I worked harder for this exam than I did for any other exam in medical school. My process was to mind map facts and commit every one of them to memory. What I forgot to do was look at the big picture and on my understanding. I was blinded by simply looking at the facts.
In the end, I did disappointingly badly in the exam, below average for my year despite working extremely hard. I became disheartened and lazy for the next set of exams. I decided working hard was not worth the hassle and spent a minimum of time focusing on simply understanding the overall picture of the syllabus, getting a broad knowledge and learning some core key facts to aid my understanding of the overall topic areas. I ended up doing well in the exam, well above average for my year, despite much less effort.
I had a similar experience when sitting the DRCOG exam as a postgraduate. I decided I would only use a question bank to revise, do the questions and read the explanation. I finished all the questions with a good average score and thought I was ready for the exam. When I sat the exam, I struggled with choosing the correct answer, as the questions did not match the questions and explanations in the question bank I used. I knew lots of key facts, but I didn’t have the broader context and bigger picture that comes with really understanding the topic.
Later, I wrote the Zero to Finals obstetrics and gynaecology book. This involved hundreds of hours of reading around the topic, understanding the pathophysiology, reading guidelines and research papers and trying to make sense of everything I was reading. I had to zoom right out and understand the bigger picture, then zoom in on the specific facts, understanding their relevance and context. Once I had finished the obstetrics and gynaecology book, I resat the DRCOG exam. Without using any question banks or fact-learning strategies such as Anki, I easily passed the exam with a good score.
If you learn the facts and do not have the understanding (as you would if you simply used question banks), then you end up in a situation where when a question is asked that does not exactly match the fact you have learned, you cannot work out the right answer using your understanding and context. Medical exams are designed to test not only your factual knowledge but also your deeper conceptual understanding as well.
This deeper knowledge is not only important for exams. Conceptual knowledge allows you to respond to new information by thinking through clinical symptoms and signs and explaining presentations that you have not previously seen. It allows you to respond to novel situations and problems, which is what you will face on a daily basis as a doctor.
The conclusion here is that you need to have an overall understanding and framework for the facts you are learning. This will allow you to do well in exams as well as in life as a doctor. Once you have an overall understanding, it then becomes easier to plug new facts into your memory.
For this reason, I recommend including active reading as part of your study and revision strategy. Don’t just rely on spaced repetition and testing to prepare for exams.