How to perform better in medical school exams by revising less

Good news! Most of what you’re learning is a waste of your time! Hooray. Pareto advocates (like yours truly), would remind you that >80% of your exam performance will come from <20% of everything that you study at medical school. So how can you identify the core material to know in depth so you can revise less?

Lets jump into it!

🥜Article in a nutshell

• In both MedEd resources and in real life you’ll regularly see only a handful of presentations in a given specialty.
• Each presentation has a handful of associated conditions.
• Each condition has a handful of key learning points
• Each condition has a very small handful of niche trivia.
• Being aware of all the above will put you in good stead for your exams for a given topic and will save you from wasting your time reading too widely.
• You can identify the common stuff using the steps outlined in this blog!

In case you didn’t know, this blog is a part of my Study Hacks series – my top tips on HOW to study at medical school to study smarter and unlock your time.

As MedEd is turning more and more digital, there are probably plenty of online resources you didn’t know about – I’ve collated all my top recommendations on WHAT to study in the MedEd Vault. Sign up below to access!

🤔What Is The Pareto Principle?

The Pareto Principle. The 80:20 principle. The rule of the vital few – call it what you like, but make sure you add it to your repertoire of life hacks

The late, great, Vilfredo Pareto was an Italian economist, who outlined an interesting observation in 1906. He found that >80% of land in Italy belonged to <20% of individuals. Later, it was found that this 80:20 rule reappeared as an observation in a wide variety of contexts, from economics, to business, to biology.

An you guessed it, it also applies to medical school education too.

The Pareto principle states that oftentimes, 80% of output comes from 20% of input.

Heres some examples in real life;

• 80% of wealth in the world is owned by much less than 20% of its inhabitants
• You’ll habitually occupy <20% of the space in your house >80% of the time
• 80% of Ali Abdaal revenue will come from <20% of his Youtube videos
• <20% of drivers account for >80% of road traffic accidents
• <20% of Amazon customers account for >80% of Amazons revenue
• 80% of closed sales will come from <20% of a sales team
• It was thought that <20% of the population were super spreaders of COVID-19, resulting in >80% of recorded cases.

Its important to not that this is an observation, not a law. The numbers 80 and 20 are fairly arbitrary (though were close to the numbers reported by Pareto). Depending on the context, you may find that 90% of the output comes from 10% of the input, or 1% of the input results in 99% of the output. the bottom line is that the input and output are NOT proportional.

👊Why Apply The Pareto Principle In Medical School ?

The good news is, more revision does not equate to more marks! You don’t need to continually seek to learn more facts and figures to do very well at medial school.

The vast majority of your marks will come from core principles rather than the minutiae.

So what does this mean. Well, if you revise as widely as possible you’ll likely notice that:

• Most of what you revise won’t come up in exams
• You’ll find most of your understanding comes from only a few books/websites/resources
• Only a few of your lectures will be high yield
• Only a few of your days in placement will be highly valuable

Only a small amount of differentiator questions on the niche and rogue facts and principles will set apart the very high performing students. There is a degree of luck in having come across and retained the answers to niche topics, or you may even pick them up through lucky guesses in MCQ papers – there is a method here that I used to consistently rank top of the year that I’ll be writing about in my guide.

👏How to Apply the Pareto Principle in Medical School

Step 1: Know the topics that will be covered in your exam

• Identify the core components of your upcoming exam. What is the main focus? What specialty will be covered? Does your university publish learning objectives or a syllabus to focus on?

Step 2: Go 80/20 on the key presentations.

Have an idea of the key presentations for each specilaty. For example in a cardiology module you’ll likely find that there’s an emphasis on:

• Chest pain
• Heart failure
• Symptomatic murmurs
• Palpitations/arrhythmias

These are the areas you should know very well as they’re presentations seen very commonly on a cardiology ward (and I can back this up having completed a cardiology job for my first post after medical school).

Step 3: Go 80/20 on the conditions associated with each presentation:

• e.g. arrythmias are most commonly associated with
  • Atrial fibrialltion
  • SVT
  • VF/VT
  • Simple ectopicsIts a good place to focus your understanding.

Step 4: Go 80/20 on the facts of each condition:

• What are the areas that come up time and time again when you read around these particular conditions? This is where skimming across several different sources will serve you well.
• E.g. On the topic of atrial fibrillation, you’re likely to be able to condense the key learning points to diagnosis (absence of p-waves; fibrillation waves; irregularly irregular on ECG), aetiology (e.g. PIRATES mnemonic), management (acute vs long term; conservative vs medical vs surgical) and clinical scoring (e.g. CHAs-VASc and HASBLED scores).

If you read around all these components and apply them to your revision schedule, then great, its likely that you’ll be ready for the majority of questions. Of course you can read more, but you’ll get to a point where you’re wasting your valuable time on things that are highly unlikely to come up.

Step 5: Go 80/20 on the niches

• You’ll find that a lot of conditions have a few niche facts when it comes to associated conditions, signs on examination or aetiology. I advocate reading about conditions from multiple sources as youll quickly spot when the trivia knowledge is being repeated between sources – this is a marker that the fact is trivia fodder and is possible (yet still unlikely) to come into your exams from your exam writers.
• For example:
  • Klebsiella pneumonia being closely associated with alcoholics
  • Endocarditis being associated with HACEK organisms
  • Legionnaires disease being associated with faulty air conditioning
• These are brief examples of the sort of facts that could be used for differentiator questions

👐How many resources should I use?

You don’t have to delve into everything out there. I’d recommend sticking to several key resources… but if you want to perform the best you can, you should also get into the habit of exploring for extra layers of knowledge. I call this the Core & Explore Technique which I talk about in my guide!

The right resources for you will depend on your learning style, your strengths and weaknesses and those that are accessible to you. Everyone is different.

Ive made a big bank of online meded resources to help you identify and focus on those that are best for you to you! You can open the MedEd Vault here!

🙌Conclusion

The Pareto Principle is a great one to remember. When you find yourself revising too hard, too widely, or feeling stressed that you haven’t revised enough… just remember: you can always keep studying more, but you dont need to. You’ll have a better ride on the rollercoaster of medical school if you focus your time on the core principles, so that ultimately you can revise less and create more free time to invest elsewhere.

I hope this helps! 💪