Preclinical
How to Study in Medical School
Apr 11, 202610 min read
By Mike
By MikeBy MikeDisclaimer: StrudelMed / Strudel Academy LLC is an independent medical education resource. The content below is not medical or clinical advice and is intended for educational purposes and general guidance only. Curricula, grading structures, and resource availability vary by institution.
The preclinical years (M1 and M2) serve two purposes: passing your courses and building a foundation for Step 1 and clinical rotations. These goals are not in conflict if you study efficiently. The students who struggle most are those who study passively or wait until dedicated to learn high-yield material for the first time.
The core principle is simple: prioritize active learning over passive review. Reading and re-reading notes feels productive but produces weak retention. Doing questions, making and reviewing flashcards, and teaching concepts back to yourself are consistently more effective.
If your school is lecture-heavy, you need to decide early whether attending lecture is a good use of your time. This varies by school and by professor. Some lectures are excellent and irreplaceable. Others cover material you can learn faster from outside resources.
A common approach is to watch recorded lectures at 1.5x to 2x speed and supplement with board-relevant resources. If your school requires attendance, use that time actively: annotate slides, make flashcards during lecture, or work through the material with a question in mind rather than passively watching.
Do not fall into the trap of spending all your time on lecture material at the expense of board-relevant learning. Your school's exams matter, but the overlap with Step 1 content is where your long-term investment pays off.
If your school uses PBL, TBL, or a flipped classroom model, your independent study time is even more important. Use the structure of your curriculum to guide which topics to study, but rely on high-yield resources to learn the material at board depth.
Stay current. Falling behind in medical school compounds quickly. A week of unreviewed material becomes two weeks of catch-up. Build a study schedule that keeps you within a few days of the current material at all times.
Study in blocks. Focused study sessions of 45 to 90 minutes with short breaks are more effective than marathon sessions. The Pomodoro technique (25 minutes on, 5 minutes off) works well for many students.
Study actively. Every study session should involve doing something: answering questions, making cards, drawing pathways, explaining concepts out loud, or working through practice problems. If you are only reading or highlighting, you are not studying efficiently.
You do not need every resource available. Pick a focused set and use them consistently. Below are the most widely used and highest-yield resources for preclinical coursework and Step 1 preparation.
See our Preclinical Resources Review for my full recommendations, but here is a brief synopsis.
A strong core setup looks like:
Anki is a flashcard application that uses spaced repetition to optimize long-term retention. It is the single most effective tool for memorizing and retaining the large volume of information required for medical school and boards. The tradeoff is that it requires daily consistency.
Anki shows you cards at increasing intervals based on how well you remember them. Cards you get wrong appear more frequently. Cards you know well appear less often. Over time, this moves information into long-term memory with minimal total review time.
Use a pre-made deck. Building cards from scratch is time-consuming and often lower quality than established decks. The most widely used deck is the AnKing deck, which consolidates and tags cards from multiple sources (Pathoma, Sketchy, Boards and Beyond, First Aid, Costanzo, etc.). Cards are tagged by resource, organ system, and topic, allowing you to unsuspend cards as you cover material in class.
Unsuspend cards as you go. Start with all cards suspended. As you cover a topic in lecture or with a resource, unsuspend the corresponding cards. This keeps your daily review load aligned with what you have actually studied.
Do your reviews every day. This is non-negotiable if you are going to use Anki. Skipping days causes reviews to pile up exponentially. Even on busy days, doing your reviews (even if you skip new cards) maintains your retention.
Keep new cards manageable. Adding too many new cards per day leads to an unsustainable review burden within weeks. Most students find 20 to 40 new cards per day sustainable long-term. Adjust based on your review load and schedule.
Adding too many new cards. Starting with 100 new cards per day feels manageable for the first week, then becomes overwhelming. Start conservatively.
Skipping review days. Missing even one or two days creates a backlog that can take days to recover from. Consistency is more important than volume.
Not using tags. The AnKing deck is organized by tags. Use them to unsuspend cards by topic, resource, or organ system rather than unsuspending randomly.
Making all your own cards. Unless a concept is not covered in existing decks, use the pre-made cards. Your time is better spent reviewing than card-building.
Spending too long on each card. Anki reviews should be quick. If you are spending more than 15 to 20 seconds per card on average, your cards may be too complex or you may need to review the underlying material before continuing.
A typical daily study schedule during preclinical years might look like:
Morning: Anki reviews (30 to 60 minutes depending on load) Midday: Attend or watch lectures. Supplement with board resources (Pathoma, Boards and Beyond, Sketchy) for the corresponding topics. Afternoon/Evening: Practice questions from Amboss or Rx aligned with current material. Unsuspend new Anki cards for topics covered that day. Before exams: Shift focus to course-specific material 3 to 5 days before the exam. Continue Anki reviews but reduce or pause new cards.
The key is integrating board-relevant studying into your daily routine rather than treating it as a separate task. If you are watching Pathoma as you learn pathology in class and doing the corresponding Anki cards, you are preparing for both your course exam and Step 1 simultaneously.
If your curriculum is organized by organ system, align your outside resources with the current block. When you start the cardiology block, watch the corresponding Boards and Beyond and Pathoma chapters, unsuspend cardiology Anki cards, and do Amboss questions filtered to cardiology. This keeps everything reinforced from multiple angles.
Protect at least one day (or a half day) per weekend for rest. Burnout during preclinical years is real and undermines long-term retention. A sustainable schedule maintained over two years beats an intense schedule that leads to exhaustion and inconsistency.
You are preparing for Step 1 from day one if you are using board-relevant resources alongside your coursework. Formal "Step 1 prep" typically begins during a dedicated study period (usually 4 to 8 weeks, depending on your school and comfort level).
Focus on building a strong foundation in the basic sciences: physiology, biochemistry, anatomy, immunology, and early pathology. Start Anki early. Use Boards and Beyond or Pathoma as supplemental resources. You do not need to be doing UWorld or practice exams at this stage.
This is when Step 1 preparation intensifies. Continue Anki. Begin or continue working through Pathoma, Sketchy (micro and pharm), and Boards and Beyond systematically. Start using a question bank (Amboss or Rx) alongside your coursework. As you approach dedicated, you should have seen most of the high-yield material at least once.
This is when you do UWorld, take practice exams (NBMEs and the free 120), review First Aid intensively, and fill in knowledge gaps. The work you put in during preclinical years determines how much of dedicated is review versus learning material for the first time. Students who have been consistent with Anki and board resources throughout preclinical years typically find dedicated to be more manageable.
Passive studying. Re-reading notes, re-watching lectures without active engagement, and highlighting without self-testing produce poor retention. Always be answering questions, making cards, or explaining concepts.
Not doing questions early enough. Questions are a learning tool, not just an assessment tool. Start doing practice questions during M1, even if you get many of them wrong. The process of working through a question and reading the explanation teaches you more than passive review.
Trying to use every resource. Pick a core set of 3 to 4 resources and use them well. Jumping between 8 different resources leads to shallow coverage and wasted time. Depth with fewer resources beats breadth with many.
Ignoring Anki reviews. If you commit to Anki, you commit to daily reviews. If you are not willing to do reviews daily, Anki may not be the right tool for you, and that is okay. But starting and stopping repeatedly is the worst approach.
Neglecting physiology. Pathology and pharmacology are high-yield for boards, but understanding physiology is what makes those subjects click. A strong grasp of normal physiology makes learning pathophysiology significantly easier.
Cramming before exams and forgetting after. Medical school requires long-term retention. If you are cramming for each exam and losing the material afterward, you are creating a much harder workload for yourself during dedicated and clinical years. Spaced repetition addresses this directly.
Not taking care of yourself. Sleep, exercise, nutrition, and social connections are not luxuries. They are prerequisites for sustainable performance. Students who sacrifice wellness for study hours consistently burn out and underperform relative to students who maintain balance.
Medical school is a multi-year endeavor. Your study habits need to be sustainable, not just effective in the short term.
Sleep. Aim for 7 to 8 hours. Sleep is when memory consolidation happens. Cutting sleep to study more is counterproductive beyond the very short term.
Exercise. Regular physical activity improves focus, mood, and energy. Even 20 to 30 minutes most days makes a measurable difference.
Breaks and rest days. Build rest into your schedule intentionally. One full rest day per week or at minimum a half day is important for long-term sustainability.
Social connection. Maintain friendships inside and outside of medical school. Study groups can be effective if they involve active discussion rather than passive co-reading.
Mental health. If you are feeling overwhelmed, anxious, or depressed, reach out to your school's counseling services or a trusted mentor. These feelings are common in medical school and there is no benefit to managing them alone.
Daily habits:
Core resources: First Aid, Pathoma, Sketchy (micro and pharm), Boards and Beyond, Anki (AnKing deck), Amboss or Rx question bank
Weekly goals: Stay current with coursework, maintain Anki streak, protect rest time
Before each block exam: Shift focus to course-specific material 3 to 5 days out, continue Anki reviews, review practice questions on the relevant organ system
Before Step 1 dedicated: Complete Pathoma, Sketchy micro and pharm, and majority of Anki cards. Have seen most high-yield material at least once. Save UWorld for dedicated.
Best of luck!
— Mike