Why I Took 0 Notes In Medical School

In this article I'm going to show you exactly how and why I take no notes when studying and how after I started taking no notes I was able to study less and get better grades. I'll be walking you through step-by-step the ways that I actively learn during lectures and classes and how I can remember all the content without wasting any time making loads and loads of notes. While I used these techniques during medical school and when training as a surgeon the tips in this video can be applied to anything and help you perform better in whatever you are studying.

You don't need to have read any of my previous articles but I'll touch on topics like active recall, spaced repetition and the Pomodoro and Feynman techniques which I cover in detail in other articles. So let's get into it, what is the strategy I use to take no notes and first why did I even stop taking notes?

Why I stopped taking notes

Well in my first year at medical school I sat in lectures taking down notes from the slides and then reading back and highlighting these to prepare for exams. Unfortunately this method didn't work great for me as I failed an exam as nobody had taught me how to actually study and learn. I would usually turn up to lectures without any preparation and then find it a bit boring sitting and listening for anything from 30-60 minutes. I would just copy everything from the powerpoint slides and note down word-for-word what the lecturer said without really trying to understanding anything. I'd then try to make sense of my notes, condense them and re-read them before an exam. This wasted loads of time and these study methods of re-reading and summarising information were shown to be inefficient and ineffective in a 2013 study by Dunlosky et al. which I later read and which I cover in my article on active recall.

Despite all this overwhelming evidence all of us still default to note taking and rereading and there's a simple reason it's because it's easy, it's passive and it's what we were taught in school. While copying down the slides might help you stay awake during lectures and it might make you feel like you have accomplished something and been productive in reality the fastest way to learn and retain information is by making our brains work by testing ourselves and recalling information which is an active process. We all have this misconception that, in order to study, we have to put stuff into our brains, but actually it's flipped on its head if you look at the evidence, the actual way to remember anything and to make anything stick, is by retrieving information from our brains rather than trying to put it back in. After realising all of this and spurred on by failing an exam I experimented with a few methods and researched lots more and came up with a strategy that saved me loads of time and helped me come 1st in medical and surgical exams. So let's take a deeper look at the strategy I used and where it came from.

My Active No-Notes Study Strategy

The core of the strategy is based around active recall, practice testing and spaced repetition. I avoid highlighting, rereading, or summarize at all costs. In one sentence, the strategy is plan, create questions, review and then repeat. This is a simplified version of a reading comprehension framework known as SQR3 named for its five steps: survey, question, read, recite and review. This method was introduced by Francis P. Robinson, a prominent American education philosopher in his 1946 book Effective Study. I experimented with the SQR3 method but as I'm obsessed with efficiency and productivity I simplified it to plan, questions, review and repeat so let's look at the planning phase first.

Plan

As I used to just rock up to lectures I rarely had any context for what was being taught and I definitely didn't read the course syllabus in any great detail. So every week before lectures I'll plan out what lectures are coming up, where they fit into the course syllabus and what might be tested on an exam and what I'm going to study. I'll block out time the day before a lecture to go over the lecture notes and make sure I know the learning outcomes and what is going to be covered and I'll also skim through to see if there are any terms or concepts that I don't know. Most lectures will have aims and outcomes highlighted at the start and by making sure you understand these as a minimum it will give you better insight into what is important and allow you to be more focused in your learning when in a lecture. If you don't have any lecture notes ahead of a lecture dive into the recommended textbook for that subject and match the lecture to the relevant chapter. You can then use this to help you to scope out any key concepts and learning outcomes.

Planning and preparing before the lecture will also help you to learn some top-level concepts ahead of the lecture and spot anything that you find difficult as you make questions in the next section. This then allows you to test yourself in the lecture using active recall when the lecturer mentions topics or poses questions. Equally if you planned ahead and know the course syllabus and the learning outcomes if a lecturer goes off-topic you immediately know if it isn't relevant or useful and you can remain focused on the key high-yield concepts.

Planning doesn't need to take long just a single Pomodoro of 25-minutes or less the day before a lecture. Now when I was starting off I found it tricky to stick to planning every lecture the day before and so I'll give you a regression you can use which is to just grab the first 5-10 minutes of the lecture while other people are still joining or the lecturer is giving an intro and review the syllabus on your phone and skim through the lecture notes and learning outcomes which is fairly low effort to get you into the planning habit.

Create Questions

Now in the planning phase when going through the notes or recommended textbook rather than just reading ahead of the lectures I'll actively create questions just like in my video on how I practically use active recall. I'll try and do this ahead of the lecture if I have the lecture notes or if not I'll make questions from the relevant section of the recommended textbook or course notes. Ideally creating questions ahead of the lecture is the best way to learn as you can then test yourself and review your knowledge in the lecture which we'll touch on in the next section.

As I go through the lecture notes I'll have my Evernote or a Word document on one side of my screen and then the lecture notes on the other. I'll group questions under headings that match the structure of the lecture and I'll just convert anything in the lecture slides or notes into questions. I won't note down any answers, I won't take any notes I'll just write questions. I'll usually do this in my Pomodoro time ahead of the lecture when I'm doing my first pass over the lecture notes. You don't need to go crazy here just 1-2 active recall questions per slide covering key high-yield topics, remember you can always come back and create more questions later, so look at the learning outcomes know what's important and what to prioritize and make questions only on the things that you want to focus your practice sessions on which are useful and relevant to you.

Now I'll again give you some regressions if you're just getting started with this method as it can be hard to consistently block out time to do this before lectures. Firstly if you don't have any notes ahead of the lecture it's fine to create questions in the lecture itself. If the lecture is live-streaming or you're watching a recorded lecture you can again pop it up next to your Word document or note taking app on your screen. If you do create the questions when live in class or a lecture this actually forces you to concentrate and really think about the topic rather than just passively transcribing what is being said. The second regression is that it's also fine to bulk create questions at the beginning or end of the week of lectures if you find creating questions in bulk is easier to manage. If this is the case simply reading over the lecture notes ahead of the lecture is fine and better than doing nothing at all but I'd still suggest creating some questions during the lecture if you can.

Review

Now that I have planned and understand the context of the lecture and how it fits into the exam syllabus and I have actively read through the lecture by creating a couple of questions on each slide I will now head to the lecture itself. In the lecture I know what to expect and so I'm paying attention and thinking about the questions I wrote down and self-testing in my head to see if the explanations from the lecturer can improve my understanding. I might also add in some extra questions if relevant and useful or if I've been a bit lazy I might use the question creation regression and create my questions during the lecture. I'm also more engaged with the material being taught as I know it's relevance and I'm actively looking for answers to questions.

After the lecture and in the run up to the exam I'll then test myself using these questions. If I don't know the answer I won't sweat it and I'll jump back into the lecture notes or the recommended textbook or read-around the topic by watching a YouTube video or using another resource. This process helps provide further context to the information you are looking up and also helps you to more deeply understand concepts and refine the initial questions that you made as you start to identify your knowledge gaps through self-testing.

I'll initially think about the answer in my head and will then try and write down an answer in more detail to test the extent of my knowledge. For each of the questions I'm thinking about the Feynman Technique and asking myself "do I know this well enough that I can explain it to a child?".  For example if I've attended a lecture on Hypertension in a Cardiology lecture series and I've written a question like "what are the treatment options for hypertension?" I'm making sure I understand what the lifestyle changes and medical interventions are but I'm also making sure I understand why they work by diving deeper into the source material or I'm writing new recall questions. The process of converting learning content into questions is a form of studying and you're deepening your understanding of the topic and you're being intentional about what you have to learn and what you don't have to learn and by improving these questions you're just making it easier for your future self to active recall them and actually learn effectively as the exam approaches so that in the weeks before the exam you can quickly run through lots of questions.

Repeat

Now that we've reviewed and self-tested and identified any knowledge gaps I'll add these questions into my spaced study timetable. I covered this in my videos on spaced repetition and how to study for exams and I'll also add the link to the timetable in the description below too.

This then reminds me when to come back to a topic and set of questions using spacing intervals which reduces the effects of the forgetting curve and helps you to remember information for longer.

When testing yourself there are really three repeatable steps:

• Try to answer the question as best you can
• Fill in your knowledge gaps
• Practise again at spaced intervals

It's this repetition of practicing, understanding, filling in the knowledge gaps and then practicing again that makes for a good revision session. A typical day might therefore look like:

1. Wake up
2. Repeat: Do active recall questions from a previous lecture
3. Review: Attend a lecture I've planned and created questions for
4. Take a Break
5. Plan + Create: Create questions for a future lecture.
6. Go to bed

What About Flashcards?

Now the best study technique is the one that works best for you and helps you to learn as efficiently and effectively as possible. And if you love using flashcard apps like Anki or Shiken then go for it. A modification for flashcard lovers is to add your questions into a flashcard app and to build out decks relevant to what you are studying and use the automated spacing intervals. If you enjoy flashcards when creating questions, you can just directly enter them into Anki or a flashcard app rather than into a Word document of Evernote equivalent first to save time.

Now it's worth noting that creating flashcards takes a little bit longer as you'll need to add in answers and ensure those answers are robust compared to the standard question creation system where you go to your source notes to review anything you're not sure about. Most lectures and textbooks are well-structured and will likely be more robust than a 2-line bullet point answer added to a flashcard.

If you like creating flashcard decks and using pre-made decks from others then you just want to get into the habit of creating and reviewing information in as efficient way as possible. Remember rather than just learning short facts on the reverse of flashcards you should still go to the source material to ensure you deeply understand the concept and it's also important to check that if you are spending time entering questions and answers that they don't already exist in a pre-made deck as this is just duplication of work.

If you've not used Anki here is a quick example of what that might look like. It's pretty quick to add a question, copy over an example from some source material and then add it to your study deck.

Shiken is pretty similar, you can choose from multiple question types and then add your question and answer to your flashcard and then you can interact with it and test yourself and rate how well you know it. Both will then space out your learning for you.

Summary

So in summary the no notes strategy I use is: plan, create questions, review the questions and notes through self-testing and then repeat this using spaced repetition.

• Plan - plan out what you'll be studying and understand the context of the lecture
• Create - create questions before the lecture from notes or textbooks or during the lecture if this works better for you
• Review - in the lecture you can test yourself and add more questions. After the lecture review your questions, self-test and fill in your knowledge gaps by going back to the lecture notes or read around the subject
• Repeat - use a spacing schedule to repeat the questions again and again before your exam

Remember to experiment with this method to find the way that works best for you. This is the system I used because it optimised for time and efficiency when studying for exams around my day job as a surgeon and when running a business.