Annotation Nation

By Tim Durso

One of the greatest challenges in studying for Step 1 is deciding what information is worth trying to remember. In an ideal world, you’d be able to memorize every bit of information you come across the first two years of med school, but if you could do that you’d be playing blackjack in Las Vegas with Tom Cruise instead of cramming your brain full of lysosomal storage diseases (that’s a Rain Man reference for those less movie-inclined). One of the best ways to machete your way through the thicket of medical knowledge out there is to annotate your handy-dandy version of First Aid (see here for the latest and greatest version).

While everyone agrees that annotation is an essential part of the sacred rite that is Step 1 studying, everyone seems to have a different approach. I’m going to try to help analyze some of these different approaches, and hopefully you’ll come away with a better understanding of what might work for you in your preparation. To accomplish this, I’m going to borrow elements from the famous children’s tale of “Goldilocks and the Three Bears.” If you haven’t heard of this story, call your parents and ask them why, and then Google it before reading further.

Papa Bear a.k.a. The Novelist
This annotator takes note writing to the next level. They’ll make sure that an obscure fact from a 1958 article on pancreaticoduodenectomy finds it way somewhere onto their page because, hey, there could be a question on it! This approach, while the most thorough, makes for an incomprehensible amount of information that you can’t possibly review in any timely way. If I were you, I’d leave the essays to the people who get paid to write.

Mama Bear a.k.a. The Minimalist
Did you write your name in your copy of First Aid? If so, this annotator may not invite you to their study session for the crime of violating the pages of the hallowed text that ought to remain untouched. This strategy is admirable, as First Aid contains the most relevant board-specific topics. At the same time, I think it’s pretty short-sighted, as a book that’s intended for review is bound to contain topics that need a little more explanation, especially if you didn’t cover them in class. Not writing anything is just not a reasonable option.

Baby Bear a.k.a. Just Right
So what are we left with then? In my opinion, the perfect amount of annotation is writing just enough to make sure you fully grasp a topic in First Aid without adding novel or obscure information that’s unlikely to appear on Step 1. I know it’s hard for med students to let go and (*gasp*) trust other people, but believe me when I say that if you know First Aid cold, you’ll crush the boards. This means adding whatever notes you need to understand the content therein, no more, no less. One last quick tip from my med school’s study advisers that I found useful: when you first start annotating, write on post-it notes instead of on the actual book itself. You may find later on that your understanding of a concept will improve after learning about a related topic in a different section. Once you feel more comfortable with the concepts, feel free to start putting pen to actual paper. This way you avoid cluttering your book with misguided or less-than-useful initial thoughts.

Have any other questions about annotating First Aid? How do you annotate? Let me know in the comments. But keep it short 😉