 What is up guys? Karma Medic here and welcome back to another dose. In today's video I want to talk about how it is that I take my notes as a fourth year medical student studying at King's College London because I've realized this has changed quite a bit as I've progressed through medical school. I'm gonna break up this video into two parts. The first of which is showing you and explaining to you how it is that I take my notes and why I think that my note-taking method is valuable. And then in the second part of the video I'm gonna run through some real-time live examples of me taking these notes so that you can see how it is that I do it. So now as a fourth year medical student I'm currently two years into my clinical rotations, two years of being in the hospital talking to patients, carrying out physical tasks and clinical exams, and so the vast majority of my learning comes from being in that physical environment. So the vast majority of knowledge about diseases, their underlying pathologies, treatments and things like that, I should have already learned and studied in my first three years of medical school. And the evidence for me having learned and studied all of this knowledge is hundreds and hundreds of handwritten notes that I've taken on my iPad, which I've uploaded to Notability and synced across all of my devices, so that the information is readily available to me whenever I need it. Now what I usually do year after year is once my lectures and tutorials start, I listen to or watch them and then start taking handwritten notes again on my iPad. After I write down my lecture notes I would read and study them and then write a condensed version of those notes, read and study the condensed version and then again write down another condensed version of those notes and repeat the process over and over again, until I've distilled my notes down to just the most important facts and pieces of information. Now the good thing about this technique is that one, it reinforces my learning and memory by forcing me to physically write out the information each time. And two, that's pretty much it. The negative things about using this technique is that as I'm sure you know, if you've written lecture notes before, it takes a long, long time. And I've actually already written this material somewhere else in my handwritten notes. If you take any one of the major clinical diseases in medicine, for example, rheumatoid arthritis, COPD, heart failure, diabetes, any of these major topics, I've probably written notes on them at least four or five times in completely different places. And so now if I'm writing down notes on those topics again, I'm just duplicating them. I'm repeating effort that I've already done before. And then the third bad thing about this method of note taking is that it's extremely, extremely passive. It involves very little active learning. You have to really force yourself to think about what it is that you're writing out in order to have that active component of learning. As a result of all of this, when I started my fourth year of medical school, I decided that I was going to take no more handwritten notes, no more rewriting the same topic, disease, pathology, whatever, over and over again. So this brings me on to my active method of learning now in my fourth year of medical school, which is doing past paper questions and reviewing old notes that I've written in notability. So at this point, I'm using information that I gain from past paper questions and from already existing banks of knowledge that are already there on the internet, I'm literally copy pasting them into my own categorized, organized method of notes and learning from there. I've decided that rewriting out all that information for me personally, I think is going to be a waste of time. Now this begs the question of why do I think that past paper questions are the best way for me to learn as a fourth year medical student. First of all, they forced me to actively recall pieces of information that I've already learned before that are stored somewhere deep in my brain. If I read a question and then Google the answer and write it down, that's not going to make me actually think about the question and try and retrieve that information from my brain. Going through that process of trying to dig through the information in your brain is what helps build those strong connections with that fact or with that knowledge or with that explanation, or whatever it is that you're trying to remember. The second thing is that past paper questions are extremely relevant and hyper focused around two things. One, what it is that I need to know in order to pass and excel in my medical school exams. And two, most of the information is directly relevant to what I need to know for clinical practice as a future doctor. The reason certain topics are frequently tested in question banks and in past paper questions is because those are the topics that are going to be most important for clinical practice in the future. Now, I know there's obviously a whole bunch of questions that are purely memorization based factory call, etc. Most of the questions that you'll find in a question bank are actually good, fair questions that get you thinking about different presentations, differential diagnoses, clinical exams, whatever it is. The third thing is that past paper questions or question banks really help you cut through the noise of all the information that exists in medicine. For example, this is a book that's probably quite common within medical circles. It's called Clinical Medicine by Kumar and Clark. This is the big version. It is absolutely massive and huge. Now, I'm sure that all of the information in this book is very interesting, helpful and useful. But in terms of what you actually need to know in order to practice good medicine as a doctor in a hospital, it's not every single thing that's in this book. And so what I find past paper questions really help do is cut through this noise and tell you what are the most important things that you need to focus on. For example, if I realize in past paper questions that the topic of heart failure comes up very often, then I will know that heart failure is an important topic. Of course, having been to the hospital, I know that there are a lot of patients with heart failure. And so what I can do is I can go to the heart failure part of this book and I can read it in intense detail. But a lot of the other things in this book, like pori, ferria, cutaneous, tarda, I don't need to know in this much detail. I need to know very simple facts and pieces of information about which question banks will do very well for me. So yeah, past paper questions really help you narrow down and focus on what the most important, what the most common topics and diagnoses and diseases are. And then the fourth thing is that question banks have a lot of metadata that no other type of studying provides for you. What I mean by metadata is, for example, how well you're performing against the average student who's taking the exact same questions as you, how well you're performing in different sections or systems of the body, rest, cardio, endocrinology, whatever. You can even see your progress over time and it sort of helps you identify what your weaknesses and your strengths are. If you find that you're scoring nineteen, ninety-five percent in the cardiology section, but maybe 60 or 70 percent in rest, then you know that you need to read up more and study more on the respiratory section. And then some question banks, like the one that I use, even has a comment section. And the great thing about a comment section is that it is a collection of students going through the exact same thing as you. If you found that question hard to answer, then chances are a bunch of other people did too. And then people who didn't find it so hard to answer will comment letting you know what their methods of memorization or what their learning and understanding is of that topic. And I usually find that the comment section is very, very helpful. It also has some great banter, which I'm sure we'll see later on in the video. I've always known this as a student, but as I enter my eighth year, oh God, eighth year of education across two different universities, I realize this more than ever, which is that studying lecture notes, tutorials, talking to your friends, watching YouTube videos, whatever it is, is about half of the work. It's half of the studying that you need to do. The other half is actually putting all of that work and studying into practice by doing practice questions or past paper exams. And quite simply, for me, the single biggest regret I have for when I wrote my U.S. only step one earlier this year in the summer is that I didn't do more practice questions because I know for a fact that if I had done more practice questions, I would have scored better than I did. All right, so that's the end of my ramble about why it is that I think past paper questions are an excellent way to study for medical school exams. Now let me show you exactly how it is that I do this. All right, so this is my note-taking method as a fourth year medical student. I've got past medicine, which is a question bank on the left half of my screen, and Notion, which is where I harbor all my notes on the different conditions that I need to know in medical school on the right half. And a big thank you to Notion for sponsoring this video. If you don't know, Notion is a completely free app that you can use to organize pretty much anything in your life, whether that's your projects, your school work, your to-do lists, literally anything. I personally use it to manage my entire YouTube workflow from coming up with ideas, scripting them, writing down notes from my podcasts. I also use it for everything to do with my medical school, keeping track of lecture notes, to-do lists, bigger projects, essays, research work, etc. And also my daily to-do lists, my larger life to-do lists and bigger projects. I use the app every single day and find it extremely useful. If you want to try out Notion for yourself, I'll leave links in the description down below where you can download it and try it out for free. Thanks again to Notion and back to the video. One of the best things about this question bank is that they have a textbook. Within this textbook, you can click this button over here, and it will actually sort pieces of information based on how important they are or how often they show up on exams. Now a lot of you might be thinking, yeah Nasser, these do show up less often on exams, but they're also important for clinical practice and you should know them as a doctor. And I completely agree with you. However at the same time, the things that show up more often on exams are the things that are more important or relevant for clinical practice because they are more common or important in clinical practice. So if you're pressed for time for an upcoming exam or you need to be as efficient as possible in your studying, sorting out the information that you want to review like this is a good way of doing that. So as you can see here on the right, I have all the different topics or systems that I need to know for medicine organized quite neatly into these different pages and within each of them I have subheadings and more pages with more information on each of these specific topics. Now all the information that you see here, pretty much everything that has been put into these different categories, has been directly copy pasted from the past medicine question bank and the review textbook. So within each one of these pages, I'll read through the information, try to understand it and figure out what's actually going on, highlight different pieces of information, put things in bold that use different colors, whatever it is I need to do to sort of help refresh my memory on this topic or learn it from scratch. And then usually at the top as well I'll write things in my own words what I think was most important that I took away from this information and this way the vast majority of the studying that I do is active. It's reading questions, thinking about information, trying to fit different pieces of the puzzle together and then the note taking aspect is a much smaller percentage of my time. I think this will probably be a lot easier if I just show you so let's get started with that. See this first question, what blood results would be in keeping with your suspected diagnosis? You suspect you may have hemochromatosis and take some bloods. Alright so hemochromatosis is what? It is a condition where you have excess levels of iron in the body. You have too much iron in the body and you can't store it properly and so it leaks into places where it shouldn't be. For example the testicles or the liver and I think in the brain as well so it can cause some neurological problems. What blood results would I expect with this? So transferrin is used to transfer iron around the body. If we have tons and tons of iron in the body we have an overload of iron then I'm going to say that transferrin is going to be high. Ferritin. Ferritin is the storage of iron in the body. If we have an overload of iron I'm going to expect ferritin to be high as well. TIBC refers to how much the body is looking for iron. So if we're iron deficient then TIBC will be high. That's what I remember. So now it must be low. So transferrin high, ferritin high and TIBC low. Nice. That way I've sort of worked through the question. I've managed to arrive at the right answer which is great especially since I'm doing this live on camera. So the first important thing that happened there is I had to think really long and hard about a whole bunch of different aspects of medicine in order to arrive at the right question. If I was simply taking notes on hemochromatosis okay hemochromatosis is a lot of iron. A lot of iron means you'll get these blood levels then I won't be actively thinking about the information. I won't be trying to suck it in and absorb it and learn it and remember it. Now that I've learned this very valuable piece of information I know that we're talking about hemochromatosis. So I'm going to go back to my conditions and I'm going to put in hemochromatosis. Hemochromatosis is what kind of fits in a lot of different places but let's go with metabolism. So the first thing that I do is I copy paste all this information that the question bank provides me with on hemochromatosis. All right. As you saw when I was answering this question I already know a decent amount about hemochromatosis and enough in order to answer that question correctly. So all these notes here I'm going to read through but I'm going to scan through them. I'm not going to read them in super intense detail. I'm not going to try and like understand every single aspect of it. If I read something that's new that's different that I haven't heard of before or that I think is important I will write it up over here in caps lock. At the same time I'm going to highlight pieces of information here that I think are important. So let's do just that. So what was the main learning point about this? Okay. Investigations will show. So those are the main lab results that I'm going to see and I'll highlight them in I don't want to do green. I want to do red or yellow actually for investigations. So I know that this is the important information that I took away from this question. So now I'm going to read through the information and look for other important things that I need to know. Sort of iron absorption and metabolism. I guess I put it in the right place. Cosmine inheritance HFE on chromosome 6. So anything that I highlight in yellow has to do with investigations. Anything I highlight in green has to do with treatment or management. Anything in red is something very important and anything written in caps lock or bold is obviously something very important as well. Now you'll see as I go through my notes I try and do this color coding as often as possible but I'm not going to lie. Some of the times I'm just really not bothered. I'll highlight a piece of information and color it something whatever the color is just so that I can have it colored and know that it's important in the future. So that's just a quick example of how I would take the information that I learned or that I already knew from a pass paper question and put it into my notes. The last thing I do before I move on to the next question is I check the comment section but there's no comment section on this question. So on to the next one. Alright so again starting with the final sentence of the question. Given the likely diagnosis which imaging is likely to be diagnostic. I can't answer based on the sentence so I need to read this first. What's going to be diagnostic? So sensory neural hearing loss means it's not conductive. It's something to do with the nerves. Anything that sort of doesn't show me soft tissue connective tissue type things is not going to be very useful for me. Autoscopy you're not going to be able to see anything to do with sensory neural hearing loss. Doppler ultrasound is going to be for blood flow unless there's not enough blood flow to a nerve. Not sure that's going to help me too much. X-ray of the head is going to show me physical structure so don't think that'll help either. I think it's either CT head or MRI of the CPA. I know that this piece of anatomy is involved in hearing loss but I'm trying to remember why it's for a schwannoma. So a brain tumor that grows at this specific place can affect hearing loss or can affect hearing rather. The only thing is I would expect this stem to be showing me or leading me towards something that shows that this patient might have like neurological symptoms because of a mass growing in her brain that would lead me to a tumor. Going to go with this. Great. Happy I knew that. And there we go. The main important learning point here is that acoustic neuromas I think otherwise known as schwannomas are best visualized by an MRI of the CPA. So I got to the thing that they were trying to get me to look at or think about in this question. And again I had to actively recall that piece of information from something that I did while I was studying for my step one exam. So let's see if I can find that neurology. So somewhere in these notes I will have written about the cerebellar pontine angle a schwannoma in the brain. Schwannoma classically at the cerebellar pontine angle. So I have these notes somewhere. I've written them down before and I don't want to go and keep writing it down a hundred times. Here we go. Hearing loss, tinnitus, and ataxia. The stem mentioned hearing loss and tinnitus and I said that I wish the stem had told me something else some other neurological sign that would indicate a tumor in the brain which is ataxia. So I know this information. I've written it down before. I've learned it. I've studied it. And so I don't want to go ahead and keep writing it over and over again. Now what I'm going to do is take away this very important information. So a vestibular schwannoma is a tumor but I wouldn't necessarily put it under my categories of oncology because that's more for like cancers, cancer cancers. So instead I'm going to put this in neuro under tumors and I don't think I have a page for tumors. So I'm going to make a new one. Like I said, I know almost all this information already. So now I'm just going to read it. I'm going to scan through it and see what I think is most important. So 90 percent of cerebellar pontine angle tumors. Very important because that's how I arrived at the answer to the question. Classical history is vertigo, hearing loss tinnitus, and an absent corneal reflex. So that's part of the triad from my previous notes that I didn't have. Now this is quite important, which I hadn't remembered properly. So it can affect these cranial nerves 8, 5, and 7. So again, since this is important I am going to highlight it and I'm going to read it and try and understand it and remember it. So now another piece of information that I know is important because I've studied this before is this here. So I'm going to highlight it. I know it's going to come up on exam at some point. This is quite good management, urgent referral to ENT. It's likely to come up on my exam, so I'm going to highlight it as well. So like I said, last thing that I do is I check the comment section because either there's going to be something really funny, which is going to make me laugh and make studying this a little bit funner, or there's going to be some useful piece of information there written by other students that I can use in my own notes. So can someone explain why this can't just be Meniere's disease? I didn't even consider Meniere's disease as a differential diagnosis. Maybe I should have because 14 other people also considered this to be Meniere's disease. So let me read about why it might be that differential. You expect to get all other symptoms Meniere's, oral fullness, episodic in nature, Disney's vertigo sphere, and the patient count function. Okay, so probably the reason I didn't consider it as a differential is because it was missing all these things. However, now I can go to my Meniere's disease note. Where is it? Ear, nose, and throat. Ear, Meniere's disease. Put the information here. And so now I have written more notes and added more notes to some other topic that I hadn't even considered before. Alright, and then you usually also get a couple salty comments from people who think that the question wasn't good. Honestly, I don't care if the question is good or not. If it's in a question bank, if it's a piece of information that I need to know, there's no point being salty or not. I either know it or I don't. I learn and I move on. Now that we've seen the comment section, we can move on to the next question. I think I'll do one more question on camera and then we'll call it for this video because it's been getting quite long. Okay, since this question is very similar to the first one, it might be something different, but since it's similar, I'll do a different one. Alright, so I see a picture. What's the most likely diagnosis? Kind of need to read this then. I'll be honest with you, I have absolutely no idea. Polymorphic eruption of pregnancy. Never heard that before. Pumphalix. Never heard that before. Herpes gestatianus. Never heard that before. It sounds made up, but usually when something sounds made up, it turns out to be the right answer. Anyway, lichenplanis I think is more of a vaginal disease, not around the umbilicus. I'm guessing either way, so let's just go with this word that I've never heard of before. Okay, it was wrong. 72% got it right. Here's a good example of a question I've gotten wrong, where I knew absolutely nothing about what this was. So I'm going to go down to the bottom. What is this topic? Skin disorders associated with pregnancy. So I'm going to go to my albs and gynae. I'm going to go under albs, and I'm going to write page skin conditions. Alright, associated with pregnancy. So now I'm going to copy paste this information, and I'm going to read through it and try and learn it and understand it. Eight topic, eruption of pregnancy. 72% of people who answer this question got it right. So clearly it's more common knowledge than I would have expected that I thought. So I'm going to put it in bold and I'm going to highlight it, because clearly it's important. Management is usually asked about, so I won't put this here. And I guess this is an example of what it looks like. The important thing is that I've learned a new piece of information. Okay, I've highlighted or made in bold whatever I think is important. And so now next time pregnancy skin condition comes up, I will hopefully have some information about it to help me answer the question. So that's everything that I wanted to talk about in this video. Hopefully I've explained why it is that I like to use question banks and notion as a note-taking method in my fourth year of medical school and why I find it valuable. And hopefully you've also seen how it is that I read an interpreted question, extract important information, and take notes from them. If you've got any comments or feedback or there's anything you'd like to let me know, please do in a comment down below. Otherwise, I'll catch you in the next one. Pace. Let's wait for the ambulance to pass. It's warm enough. This is what happens when you don't record a video for a couple of weeks. No emails. Go away. Go away. I'm explaining things now. Go away. I don't need you right now. Progressive Cerebellar HV in first year of life. Telangiectasia, skin, lesions, dilated blood vessels and ears, nose, face, neck. I see immunocompromised to increased infection. All right, so I can still read these.