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Public HealthHow I Built Ridiculously Good Medical School Notes
I want to help reframe your perspective from memorisation to mastery. To build a process that primes your mind to spot patterns, form connections and resurface exactly what you need, when you need it.
Sound fair enough? Let’s get into it.
The Issue with Other Notes
Issue: too much information, not enough structure. Pages upon pages of signs, symptoms, risk factors, epidemiology, investigations, management, complications…it’s simply too much.
As I scoured online articles for other Doctors’ insights into Finals revision, a common theme emerged:
The crucial point is not to expect yourself to learn everything…get know the common clinical cases in each organ system well.
This is precisely true. But most of the resources recommended to you don’t reflect this advice. I set out to create a resource that provided the essential information: the 20% of knowledge that allows you to answer 80% of the questions. That’s what I did, and here’s how I did it.
The DF*F Blueprinting Framework
To illustrate the process, allow me to guide you through the process of creating the DF*F Nephrology Blueprint. At DF*F, we rely on Notion for our workflow, but these steps are adaptable to any note-taking app or style you prefer.
Step 1: Birds Eye View
This is the starting point, and it's one of the most critical stages because it forms the bedrock of the blueprint. Every subsequent step relies on this.
How do you determine the best way to categorise the system? Google it. Have a look through the diagrams and mind-maps online to see how others have chosen to segment the speciality. I then divide the topics with the following considerations:
- Anatomy
- Physiology
- Key diseases / conditions
Following my Nephrology Google search, I found loads of confusing diagrams, like the one on the right. But also some valuable ones, like the one on the left.
Here’s the nephrology birds eye view: We begin with anatomy, then delve into the key conditions you're likely to encounter in exams, and conclude with the intricacies of nephrology that will earn you those top marks.
Step 2: Understanding the Territory
Next, we dive into the essential anatomy and physiology of the system in question. It's here that we'll unravel physiological intricacies, ensuring you don't mix up which arteriole constricts or dilates with NSAIDs or ACE inhibitors (classic exam question). This is the time to visualise the anatomy that the subsequent topics will be referring to, like differentiating between the renal interstitium and tubules.
In this stage, it's vital to focus on building a strong foundation; trying to grasp intricate renal pathophysiology before understanding the basics is a recipe for confusion. These fundamentals will allow you to spot patterns and form connections quicker.
Step 3: Understanding the Disease
“Understand. Don't memorise. Learn principles, not formulas.” – Prof. Richard Feynman
Now, we need to cover what happens when these functions falter. This will differ depending on the speciality, but understanding the pathophysiology will help you when you’re faced with interpreting investigations and determining management steps.
By structuring your notes by anatomy & physiology, when you’re asked ‘how would you manage CKD?’ by that terrifying consultant, you’ll know what to do. You won’t just blurt out the first thing that pops into your head, but instead, run through your structure:
‘Okay well I know the kidney produces EPO so we’ll want to do an FBC and iron studies to see if they’re anaemic, then we could give them some iron or darbepoietin to manage anaemia. I also know it produces 1-ɑ-hydroxylase so we could look at their calcium…etc.’
Step 4: Understanding the Clinical Context
While it might be tempting to rote learn every presentation, investigation and management step, it can be much simpler to add more clinical context to your revision.
These are the questions I like to ask:
- How would this person present?
- What differentials would I have for that presentation?
- How would I rule in / out each of those differentials?
- Would the initial management differ between these diseases?
- Is there a more tailored management approach when we specify the diagnosis?
By grouping differentials, investigations and management, it helped me feel less overwhelmed with the amount I needed to learn and it’s invaluable when managing patients as a Foundation Doctor.
Dumb revision:
Presentation → Disease
Presentation → Disease
Presentation → Disease
Smart revision:
Presentation → Disease / Disease / Disease
Example: Diseases of the Glomerulus
The glomerulus can be a very confusing and overwhelming topic. I want to show you that it isn’t if we apply the DF*F Framework to it.
When considering diseases of the glomerulus, rather than trying to learn all of the diseases individually, let’s chunk them together. The first step is differentiating between nephrotic and nephritic syndrome. Is there blood on the urine dip? Once we’ve made that differentiation, we’ve already ruled out half our differentials, and worked out the further investigations & management (as these patients will all need the same tests and initial management before we’ve worked out which specific pathology they have).
Top: Overwhelming number of conditions to consider. Bottom: Conditions, classified. A far less overwhelming way of approaching glomerular disease.
On placement in fourth year, my friend and I were getting grilled by a gynaecology consultant. He was us asking about the causes of PV bleeding. We had two completely different approaches.
Jacques had a mnemonic that he reeled off: PALM-COEIN. Polyps, adenomyosis, leiomyosis, malignancy, coagulopathy…etc.
I had a completely different approach. I used the anatomy to go through each structure that could’ve been affected. Vagina: trauma / foreign bodies. Cervix: erosions / inflammation. Uterus: adenomyosis, polyps, contraceptive-related.
Mnemonics can be valuable tools for recalling differentials and management steps, but they might not always resonate with everyone. I personally find logical reasoning to be much more useful. Ultimately, a combination is probably the best approach.
Recap: The 4 Steps
These four steps have helped me to build blueprints for every speciality covered in Finals. It’s a simple process, but who said Finals revision needed to be complex? There’s lots to learn, but with the right tools, it doesn’t need to be overwhelming.
Stick to these 4 steps when approaching a speciality and you’ll be grand:
- Birds Eye View
- Understanding the Territory
- Understanding the Disease
- Understanding the Clinical Context
The Cost of Revision: Money vs Time
This framework walks you through the secrets behind the DF*F Blueprints, but the not-so-secret cost of this is time. It’s taken me hundreds of hours to build these blueprints, working with consultants and registrars to build them.
I want you to fulfil your Finals potential, but to do that, you have to decide if you want to spend your time or money. Either way I hope the DF*F Framework provides you with knowledge and tools to allow you to reach your potential in Finals.
Pricing
Get access today! We’re only accepting 30 new users per week to make sure we help each individual to get the most from our systems. Finals are approaching, for every day you don’t have DF*F, you’re missing out on the disproportionate gains that you could get with our systems!
Essential Blueprint
£14.99 / year
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✗ The Finals Playbook (£14.99 value)
Entire Blueprint
£22.99 / year
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✗ The Finals Playbook (£14.99 value)
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£29.99 / year
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✓ The Finals Playbook (£14.99 value)
Our Guarantee
If worse comes to worst, and you F*ck Finals, we’ll refund you the full payment and give you free access to the blueprints and playbook for your resit exams and—if it comes to it—resit year. In addition, we’ll have a call to review your revision process and help you work out how best to improve your process.
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