The Annotation Trinity

Your textbooks should become prized possessions. It is amazing how many current medical students and residents do not own a textbook. The ubiquity of cellphones, tablets, and laptops make lugging around a one-thousand-page textbook seem archaic. Even though the medium is antiquated, I can assure you that learning how to annotate a textbook is a valuable skill that can improve your performance on standardized exams. If you are looking for every possible advantage on your next big test, consider these annotation suggestions.

#1 Highlighter Frugality: Your goal, when reading a page of text, should be to identify 3 to 5 key points worth highlighting. Many medical students obsessively highlight way too much. A page that is almost entirely highlighted is of no use when you reference this material later. If you are highlighting more than 5 key point per page you are not being critical enough as you read.

If you just can’t decide which 3 to 5 points are important, this is a clear sign: you do not have mastery of the subject. Rather than marking everything, a more practical strategy would be to read about the same topic in a different text. Reading about the same material presented in a different way will help you identify the key points.  (More about this concept HERE) Hold back from highlighting too much. It might feel good to highlight liberally, but it will not help with long-term retention.

#2 Key Question (Top): At the top of every page try to write the best question you can create from the page below. I recommend doing this with a thick permanent marker; this assures you will not write too much. An example, from my specialty: Number of lymph nodes needed for rectal cancer resection? This is a real top of the page question from my reading. The answer (12) has shown up on many of my standardized exams. The process of putting a high-yield question at the top of the page forces you to think like a test writer. Additionally, if you have a 1,000+ page textbook you are forcing yourself to generate 1,000+ test questions. This process turned my surgical textbooks into a repository of test questions. The process of reviewing these top page questions also creates an ultra-efficient way to review a textbook in the days immediately preceding an exam.

#3 Definitions (Bottom): When you read a primary medical text you should understand every word. This may sound obvious, but it is amazing how many times standardized test questions can become confusing simply by using an obscure term. As described previously (HERE), test writers need to create a distribution which requires approximately half of the examinees to get each question wrong. One way for medical exams to create confusion is by using terms that are in the textbooks (fair game) but not commonly used during casual conversations on the wards. Do not skip over terms or words you do not understand. I use the bottom of the page of my textbooks to define every word I cannot define from memory. While such definitions are not required on every page, it is surprising how many times a word, term, or abbreviation will come up that is confusing.

Annotating your book can turn an intimidating surgical textbook into a standardized testing “life hack”. While you may scoff at the idea purchasing a textbook, I encourage you to consider annotating a physical book as described above.  If these suggestions sound too simple, I will close with a quote from the man (Charlie Munger) commonly described as “Warren Buffett’s Brain”: “take a simple idea and take it seriously”.


JAY on TWITTER @JayMacGregorMD






2 responses to “The Annotation Trinity”

  1. Jameel Ahmad Brown, M.D. Avatar
    Jameel Ahmad Brown, M.D.

    Dr. MacGregor, this advice is a brilliant distillation of impactful studying skills! Thank you for your gifts to the field, they could change so many lives and careers!

    Liked by 1 person

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