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Spaced Repetition and the Forgetting Curve
Full credit for my marks in anatomy during medical school goes to Kurt for showing me the value of spaced repetition in the context of fact based knowledge. The original program I used was Supermemo. It was designed by Steve Wozniak for learning languages and remains one of the most amazing (and complex) algorithms for dealing with this process.
As you probably already know, the whole idea is based around being shown information just before you are expected to lose recall. This timing can be predicted from the “Ebbinghaus Forgetting Curve” which was first proposed in the 1800s.
The programs below take the quality of your answer and present the question to you again at a time based on how hard it is for you. It’s a way of optimising your study for this type of information. It’s best seen in this diagram:
In this way it is possible to target a particular level of retention.
Perhaps the hardest thing to do is writing appropriate questions. This is because it is a bit of a personal thing. There are however some really good general rules. We’re not going to talk about that here, because both the guys at Anki and the Supermemo team have done an amazing job of summarising them.
Programs for Spaced Repetition
Anki is not your only version of this. There are a bunch of other programs which work better for some people that Anki. Our deck is for anki. As time permits we’ll make an effort to convert it across to some of the other formats. Popular versions of flash card programs based on the spaced repetition algorithm include:
Our Cards
Here you have the gold. If you’ve never picked up on spaced repetition as a method for optimising your learning, then a (un)pleasant surprise await. The list below houses the complete physiology syllabus in Anki card format. If you have never heard of Anki before go and check it out over here, set yourself up a free online account and use it anywhere you have 5 mins.
These cards come with the usual caveat that there are likely to be a few errors. You should be able to create an answer to almost any physiology past exam question just by using this deck [link].
Obviously, the sheer size of the syllabus requires a very large number of cards. The original deck is just shy of 2600. But wait, it gets a fair bit worse.
In order to make it a bit more digestible many complex cards have been broken down into multiple smaller more memorisable ones. This seems counter productive as it has increased the total card count to over 4000, however these smaller cards will stick better in your brain. This will eventually sit behind the link “simplified” deck. Yes it’s a lot of cards, no I’m not apologising, you are trying to memorise critical illness physiology for the human body! It’s not a small ask.
Both decks have been divided into syllabus topics for partitioning of the initial review process. If you know about spaced repetition you’ll realise this is not the best way for your brain, but it is good for starting out.
- The original deck – you might as well get started with this one. The simplified deck will take a few months to sort out.
- The “simplified” deck
- The MCQ Deck – This deck is quick to review. It’s just for those who want to see what it feels like to go through the ANZCA MCQ level of detail without all the questions about gasses. There is quite a bit of detail. Many of these cards contain the justification for the answers given.
For Physiology, our advice is:
- Start 1 year out
- Do 15-25 new cards a day only. This should take you only 10 mins. Make sure that you have set anki to show you the new ones first.
- DO NOT DO MORE! If you do more, the load will quickly become unmanageable and you will quit.
- Do them from the same topic.
- Don’t fall behind for any reason.
- Never forget anything
Let’s just emphasise that there is a real risk of attrition using spaced repetition. People always start strong, but after a few missed days, the load gets beyond where they can catch up in a single day. Just take your time, do a few big days and it will sort itself out again.
Pharmacology
You probably noticed that the two monster decks above were just physiology syllabus. Sorry about that. You also have to know the pharmacology. Fortunately, this subject is built for spaced repetition. PC/PK/PD for all drugs just has a structure that is meant for flash cards.
Pharmacokinetics
It is therefore built for Spaced Repetition. Just numbers and names. Just memorise them. You can drag some class specific patterns out of the Pharmacokinetics which you can see in the PK tables below. As with all biology there are also exceptions, but some people prefer to remember a pattern and an exception. Suit yourself.
PK Tables
But you can look at them all, over here.
The fastest way to gain marks in the pharmacology questions is to just spew out the similarities and differences in the PK in a quick table when you are asked. To do that, use the PK deck. This deck doesn’t have any of the mechanism or adverse drug reaction stuff in it, just ADME for everything we could get good data for from the books.
Accordingly, we have also built a “Rapid Pharmacology” deck. This has mechanism, PK, and some interesting thing about the drug, eg administration, product must be shielded from light, the following 6 awful side effects etc etc. This stuff is great for a viva and stands out in a compare and contrast so it’s worth allocating neurones to.
If you’re strapped for time use the PK deck and cruise through on the stuff you already know about the drugs from using them. If you have a bit more time, go with the rapid deck.
Pharmacology is the hardest thing to memorise for my brain, but I have been told by examiners that the emphasis is now on PK. We all know the PD because that is why we are writing the drugs up in the first place, so it doesn’t really differentiate in an exam.
The MCQ deck.
Evidently, as of 2018 there will be MCQs instead of extended matching questions. These have not been done for the primary examination up to this point. The nearest thing we have is the anaesthetics exams and these multiple choice questions have been going for a few years. There is a bit of a history of the type of question and there was a big bank of remembered questions out there. Most of the ICU related questions are included in the deck below.
The MCQ deck has about 1000 MCQ questions which may have some similarities to what you’ll see in the ICU exam (keeping in mind that many examiners span both specialties), but then, no one has sat these in ICU before so maybe just think of this as practice.
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