Askdoc's USMLE Newsletter

Understanding How We Learn

Understanding How We Learn

Hey there! Mike here. Welcome to the next edition of Askdoc's newsletter.


Today we will be discussing "How We Learn." The best student can learn, memorize recall and analyze information up to 10 x faster and more effectively than the worse students. And the reason is they they have great study skills.

You may know and already have some of these study skills and they are second nature to you already. But definitely, in my 7 years of teaching them to over 400 students, I have yet to see anyone who knows all of them. Even those who eventually aced the exam.

In order to understand what these study skills are and how they work, you need to understand first how we learn. These study skills enhances the learning process, making learning faster and more effective. It's a very big topic actually and occupies about a third of my book and over a quarter of my online lecture seminar.

In this newsletter, we will just provide a short summary of the learning process and some tips on how to increase your learning speed and capabilities.

How We Learn

First, we learn by repetition.

Have you ever wondered why we need to repeat something before we can learn and remember it? Well, everyday, our senses are bombarded with thousands of stimulus that are useful for the moment, but are not required for long term survival. Most of these stimuli are recorded, used and immediately forgotten by our brains. Trying to record them all in memory will fill our brains up pretty fast.

How then does the brain decide what stimulus to remember? Yep, when it is repeated. And the more times it is repeated, the stronger your brain will retain that memory. That includes both declarative memory (information) and non-declarative memory (experience and skills)

That is why we recite repeatedly to learn information (e.g. the periodic table). And practice makes perfect (also repetition) applies to skill (golf, driving, etc.) This encoding is done at the level of the neural synapse through a feature called synaptic plasticity.

Repeated firing of the synapse will trigger synaptic plasticity, encoding the information primarily on the synapse. Further repetition after synaptic changes reach maximum will trigger long-term potentiation which is needed for more permanent storage of memory. If you want to know about the neurophysiology of learning and memory and how to use the principles to increase your learning speed and efficiency from 100 to 500%, please see my online seminar workshop. (Askdoc's How to Master the USMLE Step 1 Seminar Workshop)

You can't just say to your brain "Now hear this brain, I want you to memorize the next 30 pages I am going to read since I need it for the exam." The only signal your brain will accept is to repeat the material over and over again.

But, but… Repetition is boring! Yes!

Isn't there anything I can do to make learning less boring? The answer is again yes.

Once you have finished the module on neurophysiology of learning and memory in my seminar, you will understand that repetition is just the beginning. By applying certain methodologies in learning and memorization you can increase learning efficiency up to five-fold.

The topic is too large to be discussed fully here, so I picked 4 learning principles that will increase the efficiency of learning beyond mere repetition. For really detailed discussions of these principles and more, refer to the seminar workshop.

Second, we learn best by spaced repetition.

The components involved in synaptic plasticity involves neurotransmitters, synaptic vesicles that store them and the receptors that they bind to. Normally, only a fraction of these structures are used in neurosynaptic firing with a significant amount held in reserves.

When a synapse fires, the synaptic vesicles release the neurotransmitter and the neurotransmitter binds to the receptors. Given time, the components will be recycled for reuse. However, if the synapse fire repeatedly, it will recruit components from its reserve and causes the signal to become stronger. This is called synaptic plasticity.,

Once all the reserve components have been recruited, increase firing rate will not strengthen the signal further. Once synaptic plasticity has reached maximum, the only way to increase the signal is for kinases to be activated and gene expression commence to produce more synaptic vesicles, neurotransmitter and receptors for the synapse. Activation of genetic expression is called long-term potentiation. This is how long term memories are formed.

Long-term potentiation requires time to work since it involves genetic expression. Therefore, it may make sense to space repetition once long term potentiation is triggered, to give time for genetic transcription and translation to occur and the appropriate proteins to be produced.

Spaced repetition is implemented in various ways in USMLE prep, including dividing the learning process into phases and doing multiple revisions. Using flashcards on various phases of your review can help retention tremendously. For more details refer either to my book or my online seminar workshop.

Repetition is the mother of all learning, the father of action, which makes it the architect of accomplishment.

Zig Ziglar
Author and Motivational Speaker

Third, we can increase pace of learning by association.

Have you ever wondered how the brains of people with photographic memory work?

The latest scientific studies shows that there is no neurophysiological basis for photographic memory. People do however show "photographic memory like" abilities on specific fields or topics on which they have vast experience or expertise.

They take advantage of a property of synaptic plasticity called associativity. When you associate two pieces of data, the brain will try to wire the neurons that contain those information together. There is a saying that "neurons that are wired together, fire together". The detailed explanation of how this work is complex. But in short, if you associate two things together, when you remember one, you will remember both.

So if you associate what you don't know to what you already know, you will tend to retain and be able to recall that new information, better and faster. Once you have successfully linked the new info to the old, your brain will take care of doing the repetitive firing needed to initiate long term potentiation and put that data into long term memory.

There are many ways to implement this principle in USMLE prep. We will just discuss two ways briefly.

One is to organize topics into headings and subheadings and memorize them. That is how my study and outline notes are organized. By grouping related topics together under a heading and subheading, you relate them to each other and so tend to recall them together because of associativity.

Remember, every question is about one topic. And the correct answer is within that topic. By recalling all the various information about one topic together rather than separately, it will be easier to answer that specific question or have the information needed to answer the question.

Two is by integrating topics together. When you integrate topics together, you tend to recall them together even if they come from different subjects. Remember some questions are based on integrated topics and recalling all the information together can make it easier to answer the question and find the right answer.

If you want to know how to implement the above methods in detail and other methods of implementing this principle refer to my book or my online seminar workshop.

Fourth, multi-modal learning can increase retention and recall of information.

Some people learn better visually, so they prefer illustrations, diagrams and animations. Some people learn better conceptually so they like written descriptions. Some prefer having an audio component to learning, while others in operate motor memory like writing,

However, the best way to learn is multi-modal, using at least two modes to learn something. People learn better if diagram are accompanied by descriptive texts and vice versa. Songs and lyrics together makes it easier to remember both. I remember in high school, I needed to memorize a poem in mandarin. I wrote down the poem aside from reciting it out loud to remember it verbatim.

The reason multi-modal learning is very effective because in effect you have two copies of the same or almost similar information linked to each other. As you remember one part of it, you remember the other thus making the information retention stronger.

However, for the USMLE, you always need to use conceptual learning as one of the modalities as it uses description of concepts in the exam even if an illustration or video or audio would have been better. You get a description of heart sounds rather than actual heart sounds. A description of an ECG reading than an actual ECG.

Fifth, sleep can speed up learning and retention.

Have you ever wondered why infants and children sleeps a lot? Have you ever experience having a hard time learning something, then realizing you suddenly got it after sleeping?

This is because of the way the brain works once it knows it has to remember something. Remember, the brain has to repeatedly fire the correct synapse in order to remember it long term. Normally when you repeat something, you not only signal your brain to remember it, you also start the process of synaptic plasticity and long term potentiation to put the information in long term memory. But it takes a long time to consciously memorize things. Fortunately the brain has a more efficient way to process the information.

Once you signaled your brain to remember something, the brain will repeatedly fire that neuron subconsciously while you are asleep. Often at speeds in milliseconds or hundreds of times per second. Declarative memory or information is usually stored during stage 3 and 4 sleep, while non-declarative memory like skills are stored during REM sleep.

Training coaches knows this that is why they require athletes to sleep 8-10 hours during training days. That is also why your brain shuts down the body during REM sleep. Imagine the neural circuit for perfecting that golf swing firing hundreds of times per second and that circuit is still connected to the body. Lol.

Infants need long periods of sleep so all those new information can be encoded to the developing brain. They need to learn everything almost from scratch. Interpreting sounds, what they see, how to control their motor movement, etc. so they need significant amount of sleep to do that.

It takes a minimum 2 hour nap to reach stage 3 and 4 sleep, while a minimum of 4 - 5 hours to reach REM sleep. That is why naps are so effective in knowledge work while relatively useless in physical training.

So remember, adequate sleep is important if you want to speed up learning and make it more efficient.

We have just touch on some of the more important aspects of how we learn. If you want to learn more details and tons of other methods and techniques to speed up and increase the efficiency of how you learn and remember things, refer to my online seminar workshop.

Til next time,


P.S. Next issue, we will discuss why the USMLE is a hard exam and some steps you can take to make it "easier".

Better Prep.

Easier Exam.

Higher Scores.

How to Master the USMLE Step 1 Book

Better Prep.

Easier Exam.

Higher Scores.

How to Master the USMLE Step 1 Seminar

Score HIgher. Read the Book.

An in-depth written guide on how to prep better and score higher for the USMLE Step 1. Read the book. Better Prep. Easier Exam. Higher Scores,

Score Higher. Listen to the Lecture

A 48-module lecture seminar on how to prep better and score higher for the USMLE Step 1. Listen to the Lecture. Better Prep. Easier Exam. Higher Scores.