Transcription
I still can't believe I'm a physician at the world's top hospital, but my performance in medical school that made all of this possible was centered on a simple study system that you can use to ace every exam that you take, stay ahead of your peers, and actually remember everything that you learn.
A little over 2 years ago, I walked up to my medical school dean with my San Carri to get an envelope that was holding the answer to where I would be working for the next 5 years of my life. A countdown started over the loudspeaker. 5 4 >> 3 2 1 >> Surrounded by family and loved ones, I ripped the envelope open. >> Mayo Clinic, Department of Orthopedic Surgery. The number one orthopedic program in the world. And everything that led to that moment, every exam, every rotation, every early morning that I didn't feel like studying, this was all built on a system, a specific, repeatable, evidence-backed system. You know here, my name is J.R. Smith, and that system is what I want to show you today.
Now, it's important to start by saying that I didn't always have it like that. The version of me who showed up to his first pre-med lectures studied exactly the way that most students do. Go to class, do whatever work is required in the moment, and a few days before the exam, pull out the PowerPoints and cram until something sticks. That approach felt like studying, and that's actually the dangerous part. A cognitive psychologist named Nate Kornell published research in 2009 documenting something that he called the fluency illusion. He found that 72% of students who crammed for an exam genuinely believed that cramming was more effective than distributing their studying over time. But when their actual test scores were compared, cramming lost consistently. What cramming created wasn't retention, it was familiarity. And familiarity and retention are not the same thing.
Herman Ebbinghaus put numbers to this in 1885. His forgetting curve shows that without any deliberate effort to revisit new information, we forget roughly 70% of what we learn within 24 hours, literally one day, not a week, just one day, 70% gone. And I ignored all of this because I didn't know that it existed. So, when I started preparing for the MCAT, I treated it like any other test. I'd get through my pre-med courses, start a dedicated prep, and then just review everything then. What I was actually signing up for was relearning years of material from scratch during the most high-stakes study period of my life to that point, just using the same broken approach that I'd always used. And I scored a 506 and had to retake it. That was tough, but what hit harder was eventually understanding why. It wasn't intelligence, it wasn't the difficulty of the material, it was that I built my entire approach to learning on a foundation with no long-term memory built into it. I wasn't studying, I was short-term memorizing and calling it studying. The system I'm about to walk you through is what I replaced it with. In medical school, using this system, I scored a 265 on Step 2, which puts me near the 99th percentile, and then I achieved my dream of matching at the Mayo Clinic.
The system has three phases: learn, retain, and apply. The goal of the learn phase is efficient, high-quality first exposure to new material. For me in medical school, that meant video-based resources instead of long lectures. I leaned heavily on Sketchy and Boards and Beyond. A video took me 10 to 30 minutes, and a lecture covering the same content took two to three hours. That's not a preference, it's a real structural advantage. A researcher named Richard Mayer spent decades studying how people process different types of learning media. His cognitive theory of multimedia learning is built on one key finding: the human brain has a separate processing channels for visual information and auditory information. When a learning resource uses both simultaneously, like a well-designed video that pairs spoken narration with animated visuals, the brain can absorb more without overwhelming either channel. Mayer's research found that this format improved learning outcomes significantly. Now, you don't have to use the same resources that I used. The point is that the learn phase should just be built around whatever format gives you the highest quality first exposure in the least amount of time. And that looks different for different people. Once you identify it, you build the rest of your system around it.
Now, it's important to know whatever your learn resource is, the first exposure is never enough. That's not a flaw in the system, that's just how memory works. Phase two is what turns a first exposure into something permanent. Phase two is retain. This is where most people's approach completely breaks down. They learn something, feel good about it, and then move on. And then Ebbinghaus's forgetting curve does exactly what it always does. The retain phase solves this with spaced repetition. I used Anki, specifically a pre-built card set called the AnKing deck, which was designed around the same resources that I was already using to learn. There were cards built specifically around Sketchy and Boards and Beyond and a ton of other resources, and this made the pathway almost frictionless. I'd watch a video on the topic, and there were already flashcards waiting for exactly what I just watched. That same evening, I'd unsuspend those cards and do them. Here is exactly what the daily flow looked like for me. Every morning before class or before any clinical responsibility started, I'd do my Anki review cards. These were cards I'd already seen before, shown to me again at expanding intervals designed for long-term retention. The reason I started my day like this and woke up early to study before anything else is because I came across Brian Tracy's book Eat That Frog, which is built around doing the most important or most difficult thing first. And for me, that was Anki. Not because I loved it, cuz I didn't, but because I understood what it was doing for me. Then during the day, I'd go wherever I needed to go, class or the hospital, and in the evening, I'd watch a video on the next topic, then I'd unsuspend the cards for that material. And what this did was that it created a system where I saw material three times before it ever showed up in class. Once during the initial video, again that same evening when I reviewed the new cards, and a third time the next morning during my morning review.
Three authors, Peter Brown, Henry Roediger, and Mark McDaniel, published a book called Make It Stick in 2014 that synthesizes decades of cognitive research into a clear finding. Spacing out study sessions, even when it feels slower and less efficient, forces the brain to consolidate memories and strengthens the neural pathways that connect new information to what you already know. Cramming creates familiarity. Spaced repetition creates retention. Now, this is how Phase Two works at the deepest level. When I finished any block, I kept doing those cards. So, when my biochemistry course was finished, I was still doing biochemistry Anki cards every day through cardiology, through immunology, through every course that followed until I took Step One, since I knew that that material was going to be on the exam. Not because biochemistry was directly relevant to what I was studying on those days, but because it would be relevant for when I sat down for Step One. The version of me going into dedicated Step One prep didn't have to relearn biochemistry from scratch because the version of me in the middle of immunology kept reviewing a few cards every morning. That's what it means to be studying for your future self instead of your current self. And it's the principle that separates the people who cruise through and crush exams from the people who have to spend months relearning what they should have retained the first time. Also, there's something that happens when you've seen a piece of material 50 times that just doesn't happen during the first few. It stops being something that you're trying to remember or recall, and it just becomes something that you know. In a clinical setting, that difference is not small.
Running Division One Track and Field at Duke University shaped how I think about this more than almost anything else. As a short sprinter and a long jumper, improvements were measured at the hundredths of a seconds and the centimeter. You could put in weeks of disciplined training, and your time might drop by a hundredth of a second. It could feel like nothing was happening, but you learn to trust the process because you understood that those hundredths compounded. Learning works the exact same way. Reviewing three biochemistry cards on a Tuesday afternoon may feel completely meaningless, but if you do it for 200 Tuesdays, it suddenly becomes the reason that you don't have to cram before the most important exam of your life. And this brings me to the key of the retain phase, simplicity. BJ Fogg, the founder of the Stanford Behavior Design Lab, built a model around one idea. A behavior happens when motivation, ability, and a prompt converge at the same moment. The problem with complicated study systems is that they require high motivation to execute. And motivation is the most volatile variable in the equation. A system that only works when you feel like using it isn't a system, it's a dream. James Clear makes the same point in Atomic Habits. Consistency matters more than intensity. And complexity kills consistency. My morning routine was identical every day. Review cards, that's it. The bar to start was so low that skipping it would have felt stranger than doing it. Simplicity is the mechanism that makes consistency possible. And consistency is the only thing that produces results.
Now, phase three is about applying that knowledge. Knowing material and performing on a test are two different skills. I learned this the hard way. I went through stretches in medical school where I was showing up in class, performing well in small groups, and feeling genuinely confident about what I was learning. And then I would sit down for an exam and my scores didn't reflect any of it. The issue wasn't that I didn't know the material, the issue was that I hadn't practiced applying it under test conditions. Test-taking is a skill. It's not a talent, it's not something that you're born good or bad at, it's a trainable skill. And I really want you to sit with that. And the only way to train it is to practice taking tests. It's no different than training any other skill. You can't get good at playing basketball by watching it, regardless of how much you learn about the sport or how many Michael Jordan highlights you watch. You have to actually pick up a basketball. To develop the skill of test-taking, you have to practice taking tests and doing practice questions. It's truly that simple. When I was in medical school, I used UWorld, which I still recommend to anyone preparing for the MCAT or the USMLE exams. And I actually have a discount link in the description below as a special gift for making it this far in the video. But John Dunlosky and his colleagues published a comprehensive review rating 10 of the most common study techniques. Practice testing earned one of only two high utility ratings. Rereading, the most widely used study strategy, earned a low utility rating. The difference is what happens cognitively. Rereading produces passive familiarity. Practice questions, on the other hand, forces active retrieval. They require you to pull information from memory and apply it to something that you've never seen before. That process is itself a form of learning.
Henry Roediger and Jeffrey Karpicke published research confirming what's now called the testing effect. The act of retrieving information from memory strengthens the memory itself. What's important is that when retrieval fails, when you get that question wrong, you actually learn something that you couldn't have learned any other way. You find a gap. And finding the gap before the exam finds it is the entire point. Here's how the apply phase connects to the rest of the system. The route of blocker course, I try to get slightly ahead of the curriculum every day. Watch videos on upcoming topics, unsuspend cards, build a small daily buffer. When I reach the final 1 to 2 weeks before an exam, I no longer had any new material to learn. I could take all the time that I'd been spending on videos and new Anki cards and replace it with practice questions. And by exam day, I wasn't cramming, I was just refining.
Now, regardless of if you're in medical school or not, these principles can apply to any situation you find yourself in when learning is a part of your job. Specific tools in this system, Sketchy, Boards and Beyond, Anki, UWorld, these are just what worked for me in my situation. But what I'm handing you is a process. It's not a product list. So, find the most efficient medium for your first exposure to new material, then build a system for revisiting what you learn at expanding intervals, and then test yourself before the exam tests you. That process works whether you're a medical student, a law student, an engineer, or someone trying to master a skill over a long period of time. The brain doesn't care what field you're in. Ebbinghaus's forgetting curve runs on the same schedule for everyone. I want you to think about one thing before you close this video. What does your current study system actually look like? Not the version that you describe to other people, the version that actually runs. Is it building retention over time or is it producing short-term familiarity that disappears before it can serve you?
Now, if you want a structured framework to build this system, including a custom Notion workspace, daily habit trackers, space for your notes, and a 30-day challenge that walks you through implementing all three of these phases, I built exactly that in the Evolving Student Challenge. The link is in the description. And if you want to see a system that I've developed that basically takes notes for me on autopilot, you would love this video here. I'm admittedly not a great manual note-taker, but thankfully I don't have to be. Keep evolving, and I'll see you in the next one.