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Chapter 9 Revision

OVERVIEW

This chapter will assist you in making realistic revision plans and will suggest some
techniques for revising knowledge and skills. We also gathered general experiences
and tips from medical students to share here. As is customary, we conclude with
frequently asked questions.

What exactly is revision?

Revision, at its most basic, is a systematic method of reminding yourself of
what you have learned in preparation for a written or practical exam. There
has been so much written in the last decade about the best ways to revise
and the most efficient techniques for committing things to memory that
choosing a personal revision path can be confusing with so many options.
Remember that you are already skilled at passing exams because you have
completed GCSEs, A-levels, and possibly a degree. As you already know,
revision isn't rocket science, but it is an important part of your learning
arsenal, and like anything else, revision skills can be improved.
We have previously discussed the importance of revising early in the
course rather than waiting until the last minute. This way, you can gradually
and methodically increase your knowledge, understanding, and skills, which
will boost your confidence. You are already halfway there if you have
managed to review and organize your notes, lecture handouts, articles, and
so on each week into a logical filing system. You'll have been revising as you
went, so it'll just be a matter of refreshing your understanding and possibly
getting some practice in for any practical exams.
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An important thought to keep in mind while revising is to imagine

yourself as the examiner posing a question on this topic

● What understanding would you like to put to the test?

● What question would you ask to put it to the test?

Keeping this overview in mind at all times will allow you to see the
knowledge and skills you've acquired from an assessment standpoint, as well
as visualize the questions and tasks you might be asked in an exam.

What are the techniques?

So, what revision techniques will work best for you? Do you find that books
help you learn? Is it preferable for you to discuss what you learn in a group
setting? Are you a visual learner who prefers diagrams or graphic
representations of information? As with all learning, we are all unique and
do things in different ways, but research has revealed:
We recall only 20% of what we read
We recall only 30% of what we hear
We recall only 40% of what we see
We recall 50% of what we say
We recall 60% of what we do
We recall 90% of what we read, see, hear, say and do
(Turner, 2007)
As a result, a combination of revision methods may be beneficial

Make a plan
It is critical to spend a few hours at the start developing a comprehensive
revision plan. Have a timetable for each week, decide on the focus for that
week, and then break it down for each day, scheduling how much time you
will spend revising each topic. Remember to schedule time to eat, relax, and
exercise each day to compensate for periods of inactivity - a long walk or a
swim. Divide your revision time into 1.5-hour blocks, with 30-minute breaks
in between to stretch your legs and get a drink. So, each revision block is
two hours long, and you could aim to complete three or four blocks for each
full day, or perhaps one if it is an evening session. Include at least two times
per week when you will revise with others in a group.
You can stop worrying about whether everything will be covered if you
create a comprehensive plan that covers the subjects to be revised and stick
to it (Table 9.1)
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Table 9.1 A typical revision schedule for a third-year student revising the heart

Day/date AM PM Evening

Monday 18 Jan Anatomy of heart Physiology of heart 5.00 –7.00 gym

and supper
7.00 –9.00 draw
rough anatomy,
create consolidate
diagrams, self-
testing

Tuesday 19 Jan Heart failure: main Heart failure: 5.00 – 6.30 supper
presentation treatment and and walk
management 6.30 – 8.30
consolidation,
self-testing

Wednesday 20 Jan Myocardial Myocardial 6.00 –7.00 supper

infarction: main infarction: Revising heart failure
presentation treatment and and myocardial
management infarction with Chris

Thursday 21 Jan Group revision on Revise topics 6.00 – 8.00 supper and
whole topic identified in group gym
revision Prepare for practical
session tomorrow

Friday 22 Jan Group work Reflect on group Epidemiology of

practising history practise: identify heart disease
of chest pain, gaps and
examining the weaknesses
chest, feedback

Saturday 23 Jan Day off Day off Day off

Sunday 24 Jan Lie in Consolidate all Plan for next week’s

topics from this revision. Get out
week. Fine tune, notes, appropriate
finishing touches to books, etc.
notes. Put away files
and books not
needed any longer

Three student revision comments

At the end of each week, I like to go over all of my (fairly extensive) notes
and handouts and file them into module files. In the weeks leading up to an
exam, I then revise one module at a time. Each module takes me about 4
weeks to complete.
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I don't make special revision notes because it would be redundant. Because I

make every set of notes work for me, it's important to get them right from
the start. I prefer revising alone, but I occasionally get together with others
to practice clinical skills. When I don't understand something, I enjoy
collaborating with others. I also enjoy reading a variety of textbooks to
ensure that I understand everything. I revise about 5 nights a week before
exams, but I save weekends for other activities.
Hortense, third-year graduate student
We formed a 'learning objectives' revision group to go over the learning
objectives for all of our PBLs [problem-based learning] and clinical
placements and ensure that we have covered everything so that there are no
surprises in exams. Our revision group functions similarly to a PBL group in
that we all decide which aspects of a subject to investigate and then share our
findings as a group. We have a scribe who takes notes and draws diagrams,
which I then condense into a final revision summary. I usually begin revising
eight weeks before an exam and don't do much else. Most days, I revise and
put my life on hold.
Christopher, second-year student
It's difficult for me to establish a revision routine because I have two young
children. I try to keep my notes organized so that the course doesn't get out of
hand, and everything is kept in a filing cabinet out of the way of the kids. I
frequently get up at 5.00 a.m. to go to work because I am a morning person. My
husband has the kids all day on Saturday, so I have plenty of time to study - I
always go to the library because it's quiet. I find that I can revise in a very
focused manner in relatively short periods of time (20 minutes), and I do so
throughout the day. I believe having children has taught me not to waste time.
Chloe, second-year graduate student

Organize your living space

In Chapter 8, we discuss organizing your desk or learning space. However,
for the sake of revision, we recommend a more radical reorganization of
your life! The goal is to eliminate all distractions so that you can focus solely
on revising. So, before getting started, some preparation is required:

● Clean your apartment or room

● Sort and store your belongings
● Change bed
● Organize your workspace
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● Stock up on healthy snacks and foods

● Do your laundry
● Inform everyone that you are about to begin revising
● Make a 'do not disturb' sign for your front door

Consider 'known distracters': are there certain things that always seem to
distract you? Perhaps phone calls, instant messaging on your computer, or
turning on the TV for a second during a break, only to find yourself sitting in
front of it 2 hours later? Plan how to avoid them; perhaps turn off your
phone, unplug from the Internet, or cover the TV with a towel.
If you live in an area where it is impossible to study in a quiet environment
without interruption, you will need to revise in the college library or another
room. Tutors can assist you in organizing this.
During A levels I was always able to revise everything really quickly just
before exams but this didn’t work for me at med school. I had to retake my
second year because I failed exams on two occasions and had to learn a
different way of studying for deep understanding. I think I was a late
starter!
Joel, fourth year student

Refreshing memory
It is critical that you understand and remember that simply copying
notes from a book or handout will not help you understand or
remember them. You must interpret and translate them into your own
words, perhaps by paraphrasing or converting them into a MindMap or
flow chart (see Chapter 2). This is the distinction between taking notes
or recording the factual content of, say, a lecture and taking notes that
include your analysis and interpretation of the information (Evans, 2004).
Exams are designed to assess your understanding of a topic rather than
your ability to memorize it, though there may be some information that
you must memorize. Turn over your notes after paraphrasing them and see
what you can remember and write out again. You can now see how valuable
the advice in Chapter 2 is. This process will be much easier for you if you use
Cornell notes or some of the other techniques we discussed, such as writing
questions as you go along. Try going over your notes again in a week to see
how much you remember. Consider recording your notes and listening to
them as you walk around. Assume you're giving a lecture on this subject;
what would you say and how would you structure it?
You've probably used revision cards, Post-it notes, colored highlighter
pens, and mnemonics like:
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● site
● onset
● character

● radiation

● afflicted symptoms

● timing

● exacerbating and relieving factors

● severity,
a simple mnemonic for asking a patient about pain All of these are beneficial
tools
I made a batch of revision cards which I carried about with me and looked
at when I had slack time, like on the train. I find it easier to revise in short
bursts rather than a long session
Alice, first-year student
It is frequently stated that the best way to learn something is to teach it,
and you may wish to do so in a learning group, with everyone taking turns
teaching a topic. This works on two levels: first, it shares some of the
revision work, but it also allows you to compare your level of understanding
of a topic to that of your peers. Are you on the same level as the others, or
are you going over a topic too thoroughly? Are you revising a topic with a
good breadth or overview but not understanding enough of the detail?
Learning alongside others will provide you with a good sense of breadth and
depth.
You might want to look at previous papers to see what has come before and
how questions are written and presented. Try your hand at some of these
papers and time yourself. Familiarize yourself with the following types of
questions:
● extended matching problems
● multiple choice questions (MCQ)
● questions with short answers

● best responses to questions

Knowing the format of the question will allow you to practice
and will improve your performance Getting a group of people to sit a past
paper together is a really useful exercise. Compare the results and select a
model response for each question. How did the other members of the group
approach the question style? Chapters 10 and 11 delve deeper into common
question styles and approaches to dealing with them.

Refreshing clinical and communication abilities

You may be familiar with a variety of written exam formats from previous
study, but clinical and communication skills are primarily tested at
medical school in an Objective Structured Clinical Examination (OSCE),
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a less familiar practical examination An OSCE divides a large room into a

number of'stations,' each of which focuses on a different task. Each station
may contain a model, image, simulated patient, or real patient, as well as an
examiner, and you will be given 5-10 minutes to complete a task before a
bell rings and you move on to the next station. The examiner will grade you
on a variety of task-related items. The great thing about OSCEs is that, while
they can be nerve-racking, you get a wide range of opinions about your
competency because, say, there are 17 stations in the OSCE, so 17
examiners evaluate you.
Clinical and communication skills, in contrast to knowledge, must be
actively revised in pairs or groups with feedback. You've probably already
covered the main skills that will need to be reviewed during your course, but
they must be practiced, practiced, practiced!
We suggested earlier that, like any other type of revision, clinical and
communication skills should be practiced informally with your peers on a
weekly basis, but keep in mind that revision cannot replace real
experiences, and we hope that message was clear in Chapters 3 and 4. It
would also be beneficial if this revision was incorporated. The following
exercise suggests ways to organize this:

EXERCISE: AN INTEGRATED APPROACH TO CLINICAL AND

COMMUNICATION SKILL REVIEW

● Choose a topic as a learning group, asthma for instance

● The entire group reviews the asthma knowledge base, makes notes, dia-grams,
collects articles, and so on
● One group member creates a 'patient scenario' or role play that combines clinical
details of asthma with relevant psychosocial issues the patient may be
experiencing
● One person acts as the 'patient,' and the rest of the group takes turns interviewing
them about their asthma - don't forget to give each other feedback on the
interview, possibly dividing it into 'content' (the information gathered) and
'process' (the communication skills used to elicit the information). Use the
communication skills checklist (Chapter 4)
● The group has also looked at skills books and skill handouts on examining the
chest, and you have agreed on a "gold standard" for doing so and created a
checklist
● A group member agrees to have their chest examined, and you take turns
examining each other using your gold standard checklist while providing feedback
● Remember to wear your 'examiner's' hat! What items would you test and give
marks for if you were writing an OSCE station about asthma? In Chapter 11, we go
over OSCEs in greater detail
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It was difficult to apply what we had learned in lectures and PBLs [problem-
based learning] to skills. I tried to learn everything from books because I'm
good at it, but in the end I realized it was more about practicing with real
people. I got the hang of things once I started doing that.

Arfa, first-year student

Of course, working with real patients is the best way to revise clinical and
communication skills, but you may not have reached that point in the course
yet, so working in a group with colleagues and any simulation models/
equipment your medical school may have is a good substitute.

The link between smell and memory

This link has long been known, but research at the University of
Northumbria discovered that smelling rosemary oil 'produced a significant
enhancement of performance for overall quality of memory' (Moss et al.,
2003) in healthy adults. This connection can be useful in revision. Consider
this:

● Purchase an aromatherapy oil burner and rosemary oil (do not use
rosemary oil if pregnant)
● Whenever you are revising, but never otherwise, burn the oil
● Put a few drops of rosemary oil on a tissue (never directly on your skin)
just before the exam and smell it at regular intervals throughout

In contrast, the same study discovered that lavender oil significantly

reduced memory and performance, so if you're having trouble switching off
after revision and sleep, try putting lavender on your pillow!

General hints and suggestions

These were gathered from a variety of people and sources, but especially
from medical students who found them useful.
● Make a 'do not disturb' sign for your front door. Inform your friends and
family that you are revising and solicit their assistance. Put your revision
schedule on the outside of your door so that everyone can see what
you're up to.
● Turn off your phone at regular intervals while revising. Inform people
that you intend to do so
● Eat and drink frequently. There is a well-known link between eating
healthy food at regular intervals and improved learning performance.
Consume breakfast and
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snacks such as bananas, sesame seeds, tuna fish, dried fruit, avocados,
nuts, and so on are recommended. Consume plenty of water.
● Exercise on a daily basis to combat stress and inactivity. It will aid your sleep.
● Gentle music can help some people revise, and you can even buy specially
designed CDs in music stores if you want to. Turning off the television, on the
other hand, never helps.
● Cross off each topic that you revise from your revision timetable; this is
extremely satisfying and helps you track your progress.
● Get enough sleep and go to bed at a reasonable time. Revising late at night can
be detrimental.
● Visualize yourself entering the exam feeling calm, happy, and in command. Try
to imagine the room and yourself calmly writing or performing a task in an OSCE
station during the exam. Keep this positive image in mind.

What if I don't succeed?

Most of us fail something in our lives, and as painful as it may be, failing an
exam will almost certainly make you a better doctor. Why? Because you will
devise strategies to overcome failure and pass retake exams, and you will
have gained valuable experience and insight into what it is like to fail, which
will help you develop your empathic skills.
Even if it feels like it at the time, failing an exam is not the end of the
world, and most medical schools will be able to assist you in preparing for a
re-take exam or repeating a portion of the course. Get as much feedback as
possible about why you failed so that you can identify your strengths and
weaknesses, and then get together with anyone else who has failed to
develop a plan and form a learning group to prepare for what comes next.
Talk to students from previous years about their revision techniques and
tips; they will often have developed sophisticated strategies, and there is no
point in reinventing the wheel! However, no single strategy will work for
everyone, and you will need to tailor revision to your specific strengths and
weaknesses as well as learning style.

Summary
We have discussed the practical implications of creating a good revision
plan and managing your revision space, and I've seen examples of
revision strategies from three students, as well as some suggestions for
group integrated revision.
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● Examine the subject you're revising through the eyes of an examiner.

● Exams assess understanding rather than memory.
● Revise from the start of the course.
● Create a good revision strategy and stick to it.
● People revise in various effective ways.
● Spend some time revising in a group setting.

Further reading and references

Evans, M. (2004). How To Pass Exams Every Time. Oxford, How To Books Ltd.
Moss, M., Cook, J., Wesnes, K., Duckett, P. et al. (2003). Aromas of rosemary and
lavender essential oils differentially affect cognition and mood in healthy
adults. International Journal of Neuroscience 113: 15–38.
Turner, L.K. (2007). Revision techniques, Business Studies. Woodside High
School, Wood Green, London.

Further reading and references

Q: I spend hours revising but can't recall anything from the exam.

A: A common issue that could be caused by poor revision technique. You could spend
hours revising, but is it good revision? Have you created a timetable, assigned topics
to time blocks, paraphrased your notes, and collaborated on revision with a group? It
is truly about the quality of the revision rather than the quantity. Starting your
revision early will boost your confidence because you will know you have covered
everything.

Q: I always seem to panic right before an exam.

A: Exams can be very stressful, and most people feel a little nervous at first.
Remember that this panic will result in a 'fight or flight' response. Examine the
breathing and relaxation techniques suggested in Chapter 8 and consider a longer-
term solution, such as yoga. If this becomes a major issue for you, you should seek
help from a counselling service, which may be able to assist you in developing
individual strategies to combat your panic.

Q: I misplaced a bunch of my revision notes on the bus.

A: You can turn your bad luck into a great revision tool! Request to borrow other
people's notes, examine the books for content, and paraphrase them into something
that makes sense to you. Compare revision notes for depth and breadth, and present
your findings in a group setting. By doing so, you are actively revising and may even be
revising more effectively!
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Q: I'm never sure when to start revising for an exam.

A: I hope we've persuaded you that revision should be done on a weekly basis, and
that the final few weeks before an exam should be used for fine-tuning and
consolidation, because you won't be able to cram a year of learning into 5 weeks!
Make a revision schedule a few weeks before the exam so that you can review and
remind yourself of what you have learned. Allow plenty of time so that nothing is
rushed and so that everything can be covered thoroughly.