Active studying must replace passive studying, not add to it. Analyze what you are doing and delete all the passive steps. Replace passively "going over your notes" the first time with labeling and supplementing your notes as you review them - yes, this is more work and takes longer, but it saves time in the end. It is much more efficient to review your summaries, rather than working through all your original notes!

The active process is an integrated pattern that emphasizes overall efficiency, but each step depends on having performed the earlier steps. If you decide you don't have time to pre-read, your notes will be poor and you won't track much of the lecture. You just lost one iteration of the details (you'll need to make that up later) and you will need more time to fix your notes. Skipping a 15-minute process which then requires 30 minutes or more to make up for is a bad investment. If you've had a good course as an undergraduate, your pre-reading can probably be limited to memorizing the course outline.

Students usually feel this way if they didn't have grasp of the "big picture" during lecture. Pre-lecture skimming and memorizing the major headings and subheadings eliminate this problem. Reading the introduction and summary in the text reinforces this. As you read through your notes the first time, create your rough draft with the course outline/syllabus and text at hand to help you inserting the organizational headings into the notes. It is more comfortable to go over your notes first, but it isn't time-efficient.

Your notes are the complete rough draft of the information. Your summaries are the final draft with the "necessary" information organized for integration and easy memorization. Don't worry about your notes being pretty, just well labeled and cross-indexed. Use your time to create summaries instead.

I don't recommend skipping lecture, since you are then missing the first chance to hear all of the details (if you don't get lost - and pre-lecture skimming can solve that problem) and review the big picture. Lecture is also the best place to find out what is likely to be on the exam (see FAQ below), which depends a lot on context and emphasis often is not available if you just study from the posted slides, even if you do listen to the podcast. The information flow rate in medical and pharmacy school is a lot higher, and the analysis by the lecturer is a valuable tool you should use, not ignore.

The above answer applies here, too. If you do skip lecture for whatever reason, don't forget you need to replace both the analysis and review the lecture provides and the further studying you need to organize and memorize the material.

Different lecture styles work better for different people, but the bottom line is that lecture is still the best place to find out what the professor thinks is important. If you aren't learning anything in lecture, pre-read more rigorously and memorize the headings and subheadings well enough that you won't get lost if the lecturer rearranges the order somewhat.

Annotate the power-point slides rather than taking completely fresh notes. You still lose the experience of hearing the emphasis and extra explanation. And the only way to improve your note-taking is practice. As a physician, you will be continuing your education (and note taking) the rest of your life, so now is a good time to get better. Re-read the section on note taking for specific suggestions on how to improve it.

Don't save quiz questions or practice questions to test yourself just before the exam!!! It is then too late to modify your studying. You may do well and be complacent, or do poorly and be a nervous wreck. So what? Practice/quiz questions are a guide for studying and the same question can be used multiple times. It's not about knowing the answer - it's about knowing how to analyze the material! Not sure what to know from a lecture after you have created your "rough draft" - look at the practice questions from that lecture. Don't worry about answering them, just think about how what type of material you need to know and how questions might be asked. As soon as you have created the summary for a particular topic — before you have done the active memorization – look at the questions on that topic again. Do you have the information needed to answer them (and any variations you could imagine from the "wrong" answers") in your charts? If not, modify your chart. If you want, try answering them after you have memorized the material in the chart, but do so thoroughly (see question below). Having it all memorized may only happen the night before the exam, and that is too late to be of use.

Used properly, the quizzes and practice questions provided in each course are plenty for preparation — see question below. Also, many of the core textbooks and additional readings recommended by the faculty have end-of-chapter practice questions.

As described above in 'But I need to save...', don't save them to test yourself!! Efficient use of quiz or practice questions requires analysis, not just finding the right answer!

1. Analyze exam question, don't just count up how many you got right. Whether or not you got the question right, analyze it thoroughly.
1. Make sure you understand why EACH possible answer is right or wrong and how each wrong answer could be made correct and what topic it was referring to.
2. If you didn't get it right, go back and memorize the entire chart or summary that contained it.
3. Ask yourself if there are any other examples that could easily be used with the same format.
2. Make sure the information for each question is somewhere in your summaries or charts (not just your rough draft) — if not, add it and any equivalent information to any related categories.
3. Try writing a few possible questions yourself, then answering them (or trade with a friend). This is a very powerful technique to having to analyze the material, know the big picture and know details.

For a variety of reasons, "taking" a practice exam is always easier than taking a real exam - which is yet another reason not to save the quiz and practice questions to test yourself. The actual exam will be a different exam and the time pressure and stress will always make the predictive value of quiz and practice questions marginal. Using quiz and practice questions as described above will be much more effective preparation.

Test-taking strategies can always be improved and can help the student display what he or she really does know, but usually most of the problem is due to passive studying strategies.

1. In many cases, the student understood general concepts but did not memorize enough facts clearly enough to analyze and answer the questions. Medical and pharmacy school requires a much greater level of clarity of information than undergraduate classes. Definitions must be precise and equations must be correct. Knowing how much detail to learn is difficult, and varies with each class; quiz and practice questions can be helpful (another reason to use them early) as well as listening to the professor's emphasis during lecture (this often takes attention and practice, since each lecturer's style differs).
2. In many cases, the student doesn't realize the difference between "familiarity" with the logic provided by someone else and synthesizing the material well enough to apply it to new situations. "Going over notes" only helps with "familiarity". Organizing the material in charts or diagrams requires synthesis and integration and helps identify connections in the material that will allow you to quickly and accurately eliminate incorrect answers or identify the correct answer.
3. More difficult exam questions often require working through multiple equations or multiple steps in a complex pathway. This type of analysis is difficult to do rapidly for the first time, especially under the pressure of an exam. Quiz and practice questions can provide examples, and should be used to work out methodical approaches that allow you to answer that style of question. Such methodic approaches need to be worked out ahead! Yet another reason to use quiz and practice questions during studying, not saving them for the night before the exam.

This is a real phenomenon, and not just your imagination. At least two different processes seem to contribute to consistently doing this:

1. People, including students, unconsciously equate effort with accuracy. So if it takes 3 minutes to justify one answer and only 30 seconds to justify another, the 3 minute answer is often picked. Of course this usually means that it took more assumptions and tortuous reasoning to justify the 3 minute answer, which makes it less likely to be true. (Perhaps part of the reason for picking the more tortuous answer is fear one won't be able to recreate the logic again!)
2. Students also frequently give more validity to impressions of "what your body wants to do" or "what the cell wants to do" than to actual known relationships or equations that describe reality. Often, a student will say something like, "Well, I knew that stroke volume times heart rate equals cardiac output, and answer 'b' fit that equation, but I though that stroke volume should be really important in determining cardiac oxygen consumption because the heart wants to move all that blood, so I chose answer 'c'." Notice the difference between "knew" and "should". How can I keep from doing this? Few, if any, of us can prevent this entirely, but you can decrease the frequency by actually writing a "truth score" next to the letter of the answer. Have faith in your score - if you've never heard of it, don't assume it's right (because you're sure you miss things) and don't assume it's wrong.
   
   Use a 5-point scoring system (e.g. "++, +, +/-, -, --" or TT, T, ?, F, FF) to assign a "truth" value to each answer as you first read it — before you agonize over any of them. For example:
   
   
1. TT is definitely true (you can write an equation or fact that demonstrates it).
2. T is probably true (you can't think of a definite proof, but you have a hunch).
3. ? is one you are really not sure of (don't assume it's true or false if you just don't know)
4. F is probably false.
5. FF is definitely false.

Think about each answer you aren't sure of, but don't change the original "truth" value unless you have a revelation of an equation or relationship you can actually write out.

If the one you are agonizing over gets a +/- or ?, but the original has a + or T, go with the original.

Most "trick" questions aren't. Well-written multiple choice questions (MCQ) ask for discrimination between similar conditions or possibilities (as will differential diagnosis) and definitely require careful reading. This is why those precise definitions are important, and where compare-contrast charts between topics or conditions are so useful. This isn't to say that differential diagnosis requires discrimination between molecular processes, of course, but the thinking needed to eliminate or include answers in well-written molecular or detailed MCQ and on clinical MCQ is very similar. Common problems in this category include:

1. Choosing the first correct statement, even though it is not the best answer to the question.
2. Choosing a familiar association between two factors, even though that association does not work in the described scenario or the factors are related inversely instead of directly.
3. Choosing an answer based on an imprecise definition of a critical word in the question.
4. Reading the first half of an answer and choosing it, without reading the second half and realizing that the second half makes the answer false.
   

Techniques that can help reduce mistakes made during the exam:

1. For each answer, read the stem and that answer as one continuous statement.
1. Make sure the statement answers the question asked and is true under the conditions listed.
2. While reading each answer, make sure the entire statement is correct, not just half.
2. Slow yourself down by underlining, boxing or circling relevant information in the question and jot down any useful equations or quick lists in the margin as a reminder.
1. Try to have a "back-up" alternative logic to verify your answer; emphasizing organization and connections during studying helps this technique this a lot.