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today we're talking about the usmle arguably one of the most definitive medical exams that there is i've got hundreds of students in my course that either sitting it or have already said it it's one of the most common requests for me to cover and
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i'm going to be talking about how i would prepare for this in the ideal possible way to get you the highest possible mark we're going to be focusing specifically on the step one and i'll have other videos covering step two and step three this video is also sponsored
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by short form so more on that later in the video before we dive into the techniques let me tell you what this video is not going to cover i'm not going to go into some of the nitty-gritty details around what the step 1 test itself actually is i'm going
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to assume that you either already know that or if you don't then just go read up about it on the usmle website it's accurate it's up to date i'm going to be focusing on the strategies for optimal preparation one of the most important
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things to talk about here is the idea of making sure that the strategy that we are applying is high yield there are a lot of resources out there there's question banks there's books there's guides there's all the stuff that's out there for us mle preparation there's not
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a lack of resources that's for sure however the way these resources are being utilized is really really poor in most cases which is probably the reason why the common strategies for preparing
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for the usmle create a very common result and the common result is that people don't do that well in the usmle step one even though it is actually just basic sciences so why is that well it's
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because of the fact that they're not usually preparing with high yield strategies a high yield strategy is not necessarily just a single strategy or a single technique but it's more a way of thinking about any type of preparation
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strategy and seeing whether it takes the boxes to evaluate whether something is high yield we should actually think about it from the examiner's point of view first long story short examiners have a specific criteria that they are trained on to create questions so your
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step one exam creators are thinking about things in this way and they're trying to test you at different levels of learning and different levels of what's called knowledge mastery so in the lowest
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levels we have simple fact recall so the types of techniques that tend to test you and challenge you and only isolated facts are only going to help you with this form of retrieval these are usually
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the easiest questions that you have in the exam but it shouldn't be the thing that you are expecting is going to get you really really great results there's no research that suggests that strategies that test on individual fact
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recall or isolated pieces of information allow you to problem solve at any higher levels there's no research to support that and there's a lot of people that they sort of say that it will help you in that way but i don't know where they're getting that from it's certainly
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not the case from the experience that i've i've had teaching students to prepare for this exam and it's certainly not what the research says either so the great example of this would be something like anki and flash cards it's only going to test you within the parameters
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of the question that you have created which basically means that you have to create a question for every possible question that you're gonna get asked which is obviously not scalable it's not sustainable and it's not very enjoyable either it's very tedious so the next
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level above this would be about just basic problem solving but basic problem solving is when you have maybe one or two related concepts and you're applying that in a context that may be slightly different to the way that you originally
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learned it so it could be a very very basic clinical presentation that you would be expected to know even if you don't have much clinical knowledge if you look at you know most sort of question banks and quit like challenge questions at the back of a textbook most
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of it is going to be you know this type of basic problem solving this however is still not where most people get called out from i mean you're generally expecting that you're going to be facing these types of problems anyway the problem becomes when we get to the
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higher levels and this is more complex problem solving or just more complex thinking in general and the characteristic feature about problems that are created at this level is that they are very integrative
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and that they are very evaluative so when i say the word evaluative what exactly am i meaning here evaluative learning evaluative thinking evaluative knowledge is when you have information that is connected to each other and
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importantly you know how to navigate and manipulate those relationships and connections between information for example if you imagine that you have a city and this city has lots of roads if you
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had non-evaluative roads in this case those roads are representing the relationships and connections that you form between individual pieces of information like facts or concepts then it would be like
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every single house and building in this place is just connected by like a small street to get from one place to another yes you can technically get there but it can be very time consuming you're likely
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to get lost along the way it's just really hard to navigate because it's just this is so much going on here evaluative learning transforms that type of knowledge schema into something that is much more clearly prioritized much
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more defined we've understood which concepts and which facts are more important or less important in different types of applications and we've understood how we can group these buildings and houses into neighborhoods
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and suburbs or districts that are similar to each other so that's kind of the abstract view of what evaluative learning is it's big picture there's lots of relationships and more than just lots of relationships those relationships are prioritized they're
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ordered they've been really really critically thought through it's not enough just to say these two things are connected we have to actually say these two things are connected so are these two things how are they similar how are
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these connections different which one is more important which one is less important are these two things kind of talking about the same thing is this actually really obvious or is this a new piece of information how is it similar or different to these other sets of
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relationships over here and how can i then represent that so you see the amount of learning the amount of processing that is going on inside our head when we're doing this type of learning is much much higher a higher
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yield strategy would be any type of strategy that promotes that type of thinking and the reason that that is high yield is because when we're operating at these higher levels which is often called higher order learning
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you'll hear me talk about it a lot in other videos when we're operating at these higher orders of learning there's a very interesting thing that happens with our memory and our ability to problem solve the first thing is that
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our memory seems to be enhanced when we use higher order learning so what that means is that we are more likely to remember and hold on to information that was learned through higher order learning than we would if
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we were to learn the exact same thing through a lower order of learning so it means that we can take the same set of let's say 10 facts but if we would try to learn those 10 facts with higher order of learning
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our brain is able to hold on to that information and use that information and manipulate it more efficiently than if we were to cover the exact same 10 facts in a lower order of learning through something like
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flashcards or something like that there is a memory benefit it means that for every hour that you spend on covering a certain amount of information we're actually saving time because we're forgetting less and therefore we're gonna have to repeat the same stuff much
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less and we'll we're gonna have to practice applying it less as well because we're able to apply it more quickly to a higher level so there's a memory benefit of higher order learning and the second thing and this is a
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phenomenon that we don't fully understand why it happens there's theories around it which i'm not going to go into right now but what we have observed is that when you engage with higher order learning processes you are able to actually
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hold on to lower order facts and retrieve at a lower order more efficiently than if you had tried to learn it with lower order learning here's how it works when you
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learn something through lower order learning lower order learning does not translate into being able to retrieve and utilize the information at a high
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order so it means that lower order learning strategies that test you and with isolated pieces of information or just small discrete groups that you've already established that type of learning does not translate into being
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able to answer the more difficult the curvier questions however higher order learning does allow you to handle those types of questions and higher order learning also allows you to tackle the questions that
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are at the lower order as well so higher order learning actually has two birds with one stone you can achieve the more complex problem manipulation type stuff and you can also have individual isolated fact retrieval as well whereas
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with lower order learning you can only get that isolated retrieval and you're not able to access the higher orders it's a really you know triple prong beneficial strategy to take we can actually take
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pretty much any technique and any strategy that we would use and we can make it higher order and i'm going to go through some of the steps now so what we're talking about right now is just upgrading your strategies and the first
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thing that we're going to start with is actually mapping out what the strategies that we're using are right now so we're gonna do a little bit of an audit what that means is that i want you to note down all the strategies that you're using now for the purpose of this video
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i'm gonna actually use uh practice questions as an example because it's a very very common strategy that's used and it is actually you know fairly effective at helping you prepare but i'm going to teach you how we can make it even more
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effective first of all order your current strategies that you're using figure out what the strategy is and i want you to map that against the level of learning or the order of learning that it generally tends to activate now
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you're probably going to be using multiple different strategies so you may want to order each of these separately and then individually upgrade each one one by one that's going to be a lot easier than trying to modify like multiple strategies all at the same time
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that's going to be a little bit overwhelming if you make a mistake it's going to be harder to problem-solve and diagnose for the students going through my course i always recommend that they just stick with one new technique and just swap that out get competency on
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that and then move on trying to fix too many things in a short period of time is is really really challenging once you've mapped out where you're at then we can take it to the next level so for example let's say that you're using practice
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questions and your approach to using practice questions you've got a question bank of some sort you take a question you try to answer it you create your answer and then you check it and then maybe you check it and you may write
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some notes about it you know whatever you got wrong or any pertinent idea that you may have you may write some notes about that that might be the strategy that we're using so we need to think about this at what point are we engaging in higher order learning
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well in this particular process we're not really at any point or at least it's very dependent on the question that we're being asked so for example if we get a question that asks us on a really really challenging set of concepts which
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by the way there are just less of those than there are the easier ones so we're not going to encounter these questions like every single time you know they're going to be like one every once every fifth or once every you know 10th question is going to
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be a really really integrated and challenging one we want to increase that ratio a little bit more we may see that we are not challenging our evaluative higher order learning very much at all when we're answering the question we're sort of just thinking about how to
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answer that question we're playing with a few different concepts against each other in the scope of just what that question is asking we're producing an answer and outputting something so we're activating some good cognitive learning effects there specifically that's a
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generation effect we're checking it here and that's useful to just make sure and give yourself some feedback so there's evidence to suggest that that's going to help with your learning and then if there's anything that we want to consolidate we're just chucking some notes in it but we're not really doing
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that really really deep evaluative thinking at any point so what we can what can we do here we can actually remove this part here and we can actually interject this with an additional step so instead of just
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answering the question and then checking it straight away we can use something that is a little bit more difficult it's a little bit more effortful and more challenging but it's going to stimulate more effective learning so again that's
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more bang for buck if you're spending a certain amount of time to answer a question anyway we're going to get more learning extracted from that single session and the way that we're going to do this is instead of just checking the answer
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we're actually going to make a decision for ourselves on how difficult we found this question to answer and how confident we are with the answer that we produced so we can say that we have a high level of confidence we're shaky on
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it or we have a low level of confidence if we have a higher level of confidence on this that's fine we can move on to the next question if we have a low level of confidence or we are shaky on it then what this is indicating is that the
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pattern of thinking that was involved in answering that question is a pattern that we are not too familiar with or we don't have that level of confidence on there is a gap or a weakness there the important thing is that when you are
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practicing and when you are studying your goal is to find these weaknesses because you don't want the weaknesses to come out in the actual exam so what's most important is not whether you got it right or wrong what's most important is
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how confident you are in that you got it right or wrong to begin with before checking the answers if you are shaking or you're not confident it means regardless of whether you manage to get it right or wrong this particular pattern of thinking is
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something that you are weaker on that is a cue for us to dive into it a little bit more so what we do here is anything that we were a little bit shaky on anything that we thought we had a low level of confidence we're going to go
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through and review our notes we're going to look it up a little bit more and use whatever other resources that we have available and we're going to create a model answer and what this is going to do is it's going to open up that question a little bit more instead of
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thinking just in the parameters of it we're actually now exploring the concepts more fully which means we're protecting ourselves against multiple other variations of how this question might have been asked if you've
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ever answered a question gotten it right the same or very similar question has come up in an exam and you still got it wrong or you struggled with it that is a perfect example of how you can get one question right but if you don't fully
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explore the concepts there a small variation of it can still trip you up a characteristic feature of high yield learning strategies is that for each one unit of work you're putting in you're getting more than that one unit of
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learning out of it so for each question you're doing we want to be able to answer 10 other variations of that same question and just going one for one question answer check does not achieve that we're going to go through our
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resources and we're going to create this model answer until we're at a point where we have a higher level of confidence about our model answer when we are confident about our model answer we might realize that our initial answer was actually wrong or we may realize
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that it was originally correct it's kind of irrelevant actually at that point as long as we've got a model answer that we've worked through and we're really really happy with we can then take that and we can compare that against the real answer to see whether our model answer
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was right and that gives us two additional steps one we have the learning that's generated from exploring the information to create the model answer and number two we have the learning that comes from actually checking that with the real answer as
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well so it's almost like for every question we're doing we're doing another set of questions like a hidden set of questions the hidden questions that only the top students are able to see you know open their third eye of studying
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when we check our answer if that was wrong that indicates that there is usually a much larger conceptual misunderstanding because it basically means even when we turned this into an open book setting where you could fully
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explore all the concepts in the relationships and how to answer this we still were not able to come up with an answer that was very comprehensive and we still got it wrong that means that there is likely to be other conceptual
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issues that are there we need to go and explore that a lot more fully we need to dive into that topic again what does this mean from a practical sense it means that number one each question your answer is going to provide you more learning but number two it's going to
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take a lot longer to get through questions and it's going to take a lot more effort per question again i'm not going to bore you with the research here but it's really really clear what the research says is that students often
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don't use the right learning strategy because they react negatively to effort in fact it even is so well demonstrated that it has its own name it's called the misinterpreted effort hypothesis it says
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that students tend to see a learning strategy feel that it is more effortful more challenging and as a result they will veer away from that because they feel that that effort means that they're either doing it wrong or that the
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technique is bad they consider more effortful learning with being a bad thing and this is really really really prevalent especially with learners that are very very heavy with their note taking and have a long history or very
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passive learning strategies they're very uncomfortable with the idea that learning is actually more effortful also the research is very clear that that effort usually correlates with good encoding practices good level of cognitive load which increases our
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learning efficiency if it feels more effortful that's actually a good thing if you're studying and it doesn't feel effortful and cognitively challenging you're actually wasting time because you're spending time studying but that information is not going to stay in your
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head and you're not going to be able to use it in the exam what's the point of learning it and spending the time studying if you're not even going to be able to get the result that you wanted at the end of it anyway a lot of people will think about that and think well all of my friends are doing it but again
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common things create common results the common result is usually not that great and with regards to the first point we're not actually covering the information more slowly let's say that we have
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three different questions using a passive learning strategy it would take you normally five minutes to cover each individual question and each question is testing you on let's say three different concepts
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and the relationship that these concepts have with each other so that means that after 15 minutes you have covered nine concepts and the relationships that they have with each other however you're only testing yourself on the relationships
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that are tested in that particular question stem in that particular sequence in that particular order and we know that just testing yourself in that isolated parameter does not equate to you being able to
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then answer all the other variations of these nine concepts so for example if the question is testing you in a way that's like this it doesn't mean that you're then going to be able to answer a question that asks you on
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this because it's a different network it's a different pathway so even if it's the same concept you still may not be able to answer a question with this variation so it means that actually we've got nine concepts but we only have
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three possible patterns that we were tested on let's say now that we spend instead 15 minutes per question using this approach instead going through and exploring everything and really building it up more by doing this
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we are able to test on the same three concepts but also multiple other variations between them so instead of let's say just there being the one set one pattern we're now able to see three different patterns so now we're testing
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on the same nine concepts but where we've got now nine different patterns as well to get the same number of patterns that we are covering for the exact same nine concepts we would have to do this
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three times so it would still take us 45 minutes right so this takes us 45 minutes and this takes us 45 minutes to achieve the same level of
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knowledge mastery and actual real ability to perform during the exam doing this allows us to evaluate the ideas more deeply because we're trying to create the perfect model answer we're not relying on having another answer
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there and in fact we can even go in tangents we can even think about other ways that the question might have tested us that would have made it more challenging so that our model answer isn't just the model answer for this one question it's the model answer for any
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type of question that tests on any variation of these few concepts and if we're able to do that we are now evaluating the relationships we're evaluating the concepts with each other we're activating higher order learning which is activating the memory benefits
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that higher order learning has which means that you can retain this information for longer as well so if we are using this method of learning we may forget half of this stuff after two or three weeks which
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means that every two to three weeks we actually have to repeat the same patterns and the same concepts to hold on to that knowledge whereas we may only need to repeat it in this form once
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every four to six weeks this approach is more efficient as time goes on the more you learn the more relationships there are and the more patterns and ways that you can get tested the more efficient it
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is usmle step one is the perfect example of where the scales like crazy because there is a lot of stuff to be covered and there are a lot of ways that they can test you on that stuff finding a method that scales that allows you to
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leverage one question to access a lot more learning than that single question would normally provide is gonna be the like the key that unlocks a much more time efficient pathway so i know there are people out there that have like
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entire you know massive question banks of like literally thousands of questions and they will go through all of the questions that are at their disposal like you know they'll go through like 10 000 questions and they still won't actually do that well or they do
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decently but they've spent like every waking moment of their life on just cramming through these questions that is completely not necessary and i have a lot of students again that have either set the usmle in
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the past or are sending it right now that are achieving the same results if not better but spending a lot less time and it is actually more enjoyable as well because you're actually exploring the information you're engaging your
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brain in a more authentic natural learning process rather than trying to fit it artificially through a method of learning that your brain doesn't actually enjoy in the first place now what i've talked about and what i've outlined here is just a single specific
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way that you can start upgrading your strategies it's a general principle that you can apply you can map out the exact learning process that you're using at the moment and you can think about how you can upgrade it by swapping out components and trying to
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increase the order of learning that you're using however i do know that it's not a simple or straightforward process and also this is not the single strategy that's going to change everything for you it is an important one that i
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encourage you to apply however you do need to have other things in place as well for example an effective note-taking strategy an effective way of encoding information when you learn it during lectures an effective way of reading through multiple resources and putting it together all of these things
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come together to build an entire system and i'm not able to cover that entire system in a single video because you know my video is long enough as it is and that's the reason why i have a entire program a sequential program that's designed to teach you all of
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these things step by step to build the entire system but i also know that it's not viable some people aren't ready some people just simply don't want to or some people just can't afford to join the program and that's totally fair i still
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want to be able to help you work through this because i think it is very important what i would encourage you to do is jump on over to my instagram at dr justin sung and you'll see a post on my instagram asking about what your
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experience is trying to apply these techniques and what questions you may have youtube is not a great place to have kind of more back and forth discussion but i'm going to try to hold instagram live sessions where i actually have the opportunity to directly
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communicate with you answer some of the questions that you have when you give these a go and you've got the questions we can actually discuss them i can help you work through these a little bit more and then finally there is a question that commonly is asked which is how do i
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even know the stuff to begin with where did i get this from i have read a lot of research articles and i have taught a lot of students and done a lot of trial and error to figure out the system
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however a great place to start is through just reading books but who's got the time for that when you've got all the studying to do and that's where the sponsor of this video short form comes into play short form is a method of
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essentially consolidating the information that you have from other readings and other books that you may have one example of this would be hyperfocus a book that talks about the difference between intentional hyper
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focus and intentional distraction to activate different pathways of thinking what they do is not just cover the main points but they actually also synthesize it against other books that are talking about the relevant same topic if there's
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a concept that's talked about in for example hyperfocus for example about engaging creativity they will actually add in comments and notes from other books that also talk about creativity and compare and contrast how accurate
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the ideas are that are talked about in this book with what's talked about in other books which means that you're really getting like four birds with one stone type of deal the other benefit is that it also gives you these kind of practice guidelines and
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exercises that you can apply which means that you can actually take a certain book and then action on it it's a really really good way of consolidating information and it's a perfect book companion it's a lot more useful than my experience with blinkist
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it's really really good if you've got audible as well because you can buy the book on audible you can listen to it and you can consolidate that with short form as well so if you check the link in the comments and the description below you'll see an affiliate link if you use that link you'll get five days of
00:25:54
unlimited access and an additional 20 discount on the annual subscription and i do recommend the annual subscription because of the fact that they're releasing stuff very regularly they have new books or articles that are put out every single week which means that even
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if they don't have a book that you wanted right now if you give it a month or so they may actually have it and you can even request for it yourself so i hope you found that useful i'm looking forward to answering your questions in the instagram so make sure to check that
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out and we'll continue the conversation over there on ig live if you've already tried something like this before and you found that it's been effective then leave a comment below as well to show other people that it is worth the time and the effort and the energy to
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sometimes make learning a little bit more challenging for you because it's more worth your time than just sitting there studying passively and wasting your time if you like this type of content then as usual i would really appreciate a subscribe and click the
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notification bell as well leave a like for the algorithm and i'll see you on the next one [Music]
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