How I Used Roam Research to Study for Medical School Board Exams

Akiff Premjee
July 14, 2020

I feel like it would be unjust of me to write a productivity newsletter in 2020 and not talk about Roam Research in one of the first five issues.

For those of you living under a rock, Roam Research is the new darling of the productivity and note-taking space. It came on the scene in full force towards the end of 2019 and brought with it the key features of back-linking (linking a concept both to an empty page and the page where it came from) and block references (being able to reference something you wrote in a different note).

Here is a visual from their website to put a little bit of context to that word vomit above:

And if you're still lost, don't worry. Here is a primer from Nat Eliason on how why he loves Roam and how he uses it.

Most people I know today use Roam for personal knowledge management - basically storing ideas and concepts that they discover to create a personal wiki of their own knowledge that grows over time. I think this is a great use case for Roam and one that I also subscribe to. You continuously add content to Roam and as your database grows larger and larger, you see connections form between different pieces of content that share similar ideas. Roam actually creates a nice visual of your connections for you that is completely useless right now but makes for a nice picture to post on Twitter.

Here's what it look like:

How to use Roam Research: a tool for metacognition - Ness Labs

However, this isn't the only way to use Roam. Recently, I was studying for the biggest board exam I was going to take in medical school, Step 1. I found that I could use some of the features of Roam to keep track of all the content I needed to learn. I wanted to use today's post to walk through that workflow.

The Framework

A little context: Step 1 is the exam you take after the first two years of medical school and is the culmination of the pre-clinical years. It includes physiology, pathology, and pharmacology for every body system. Basically, you have to know everything about everything.

I broke down my system into two major lists: Step 1 List of of Topics to Review and Step 1 Review Notes.

Step 1 List of Topics to Review

This was a simple to-do list of topics that I had encountered in practice problems that I needed to spend more time going over. I've included a screenshot below but I broke everything down by body system (immunology, renal, etc.) and had specific topics tied to each system.

See how some of the items in that screenshot have dates attached to them? Towards the end of my studying, I started planning out my weeks by tagging specific concepts with the date I wanted to review them. By default, Roam creates a blank page for every new day and when you log in you see the page for that day. This was great because I would plan my week and then each day Roam would automatically tell me what 4-5 concepts I had planned to go over that day. It took away the friction of deciding what I should be doing in a given day so that I could focus on just getting my work done.

Step 1 Review Notes

This was the meat and potatoes document. It was where I listed each individual topic I wanted to cover (from the Step 1 List of Topics to Review document or from missed questions in practice tests) and did a deep dive on that topic. Here is a screenshot from a portion of that document:

A few things to note:

The Holy Grail: Page Links

The ability to create page links (or back links or page references depending on who you are talking to) is where Roam truly gave me value. The idea is that you can put any idea in double brackets and it creates a link to a page for that idea. As you keep adding content, that idea may come up again and so you link to it again. The great thing about this is that when you go to the specific page of that idea, you see all the places that it was linked.

Let's take a look at an example of this:

Above is my page on "hypercalcemia" (elevated levels of calcium). You can see that I mentioned hypercalcemia in multiple different places, while going over an NBME practice exam and also in my Step 1 Review Notes. But if you look closely, you'll see that each bullet point is a different time I mentioned hypercalcemia. There is hypercalcemia in multiple myeloma (which apparently I went over twice - showing that I really needed to review this) and also in sarcoidosis.

This is amazing! I've basically created a repository for myself of medical information that I need to keep track of and learn. Because I made these references, there is no clutter of information that I already know well - it's just the stuff that I want to go over, review, and learn more about. In one click, I can see all the places I've mentioned hypercalcemia and dive deeper into each of them for more context. This kind of learning was huge for me when studying for the boards because it allowed me to connect concepts rather than learn about things in isolation.

Page links were also useful when tagging specific body systems. For instance, when I look up my "cardio" tag, I can see everything related to cardiology that I have ever put in my database. This leads to great rabbit holes to go down and review concepts that I've found worth it to document. I'm essentially creating a personally curated medical wiki for myself that I hope to grow as I continue into my clinical years of medical school. Here's a snapshot of my "cardio" page:

Reviewing My Notes

I want to quickly note that using Roam in this way wasn't my primary method of reviewing notes. For that I still relied on Anki + spaced repetition. However, notes in Roam would lead me to either create Anki cards for myself or find pre-made decks so that I could ensure I was repeatedly going over this content. Writing this out in Roam was my way of making sure that I understood the concepts to begin with so that I could then add them to Anki for review.

As I go into my clinical years of medical school, the hope is to keep this up and build on this database. I'm already starting to document interesting clinical cases I see in the hospital. It will be great to see connections build between foundational concepts from the classroom and what I see in the real world with patients.

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