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The Key to Success in Medical School (and Life)

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by Alec Palmerton, MD in Plan
Med School Success

The word “success” in medicine is loaded. It invokes the feeling that everything is going well. The student who is at the top of her class; publishing in NEJM; with USMLE scores of 250+. She volunteers in her free time and has started tons of organizations. And she still has a social life.

We’re not sure how to become that uber-successful med student. We have a vague idea that we just need to “work harder.” Or maybe it’s “work smarter.”

Lists of must-use resources and tactics abound. Do UFAP! No, do Zanki! Lean forward! All you need is to repeat UWorld 5x and First Aid 3x! Make a UWorld journal! We accumulate tactics until we’re blue in the face.

The culture of invulnerability in medicine only makes things worse. Everyone projects the image of ultimate success. But behind it, few feel secure in their success. Why else would physician suicide be among the highest of all occupations?

What if I told you that the myth of the uber-successful med student is a myth? And that by pursuing it, your chances of success plummet?

In this article, we’ll discuss:

  • The key to success in med school (and life)
  • What advice a remarkable number of successful people agree on
  • What you should (and shouldn’t) focus on at any stage of med school to maximize success
  • Why you feel so overhwhelmed and unaccomplished (and how to fix it), and
  • Much more!

Table of Contents

What Are Your Two Lists?

There’s a famous story about Warren Buffett, world-famous investor. Someone asks him how to be successful, and so he asks them to make two lists:

  • List #1: the 5 most important things they want to accomplish in their life
  • List #2: the 15 next most essential things they want to accomplish

Warren Buffett’s advice:

Do everything possible to accomplish List #1

What About the Second List?

Now, you’re probably wondering: what about the second list? Buffett explains that the second list is the “avoid at all costs” list.

“But, those things are important to me! I want to do List #2 things, too!”

Exactly, that’s the problem. Buffett’s fundamental insight is this:

It’s not the things you don’t care about that will distract you from success. Instead, it’s the things you care about that will stop you from doing the things that matter most.

As we’ve discussed before, the worst question you can ask is, “can this resource help me?” ANY resource can help you. However, by pursuing everything, you end up taking away time from the best materials. Instead, if you want a top USMLE score, you need to ask:

What is the best way to maximize my USMLE score?

Focus as the Key to Success

Warren Buffett is certainly not the first person to note the power of focus. Here’s a collection of famous people/companies/sayings on the importance of focus:

“Chase One Rabbit, Catch It. Chase Two, Catch Neither.”

A famous saying everyone in my Stanford class knew. It was the life philosophy of the beloved Dr. Oscar Salvaterria.

The ONE Thing

A book on the importance of finding the ONE Thing. The two most famous quotes from the book:

  • “What’s the ONE Thing you can do such that by doing it, everything else will be easier or unnecessary?”
  • “Until my ONE thing is done, everything else is a distraction.”
7 Habits of Highly Effective People

Habit #3: “Put First Things First.” The practice is to focus on the important, not urgent things first. Save the urgent, but not important tasks for later.

OKRs (Objectives and Key Results)

The playbook Google uses to focus the entire company on high-level objectives. For each overarching goal, they define the actions (key results) that will lead to it.

Ray Dalio

The most famous hedge fund manager in the world.

“I learned that if you work hard and creatively, you can have just about anything you want, but not everything you want. Maturity is the ability to reject good alternatives in order to pursue even better ones.”

– Ray Dalio, Principles: Life and Work

Bill Gates

He needs no introduction. To maintain single-minded focus, Gates swore off TV and music for 5 years in his 20s.

What’s On Your Second List?

Focus sounds excellent in theory. However, life happens. You’re probably so busy, you haven’t thought about what is on List #2. Let’s take a minute to consider things that you might put on your second list.

Presentations for School

It seems like every week (or more often) there’s some presentation. You’re assigned to present on some topic, and teach your peers. No one wants to look bad, and so often people spend hours in preparation. However, in my experience, these presentations would never make my first list.

Write-Ups or Special “Opportunities”

In residency, we were bombarded with “opportunities.” Sometimes it was presenting at Grand Rounds. Other times we’d get offers of writing up a case presentation.

In every case, I would say no. Why? Because they were on my second list. But my co-residents would usually agree to do them. When I saw them stressing over their Grand Rounds presentation, I’d ask them why they said yes. Their answer was a variant of “because it will help me in the future.”

Again, the question isn’t what will be helpful. The key is: what are your goals, and what is the best way to achieve them?


Every school calls this something different. At Stanford, we would have quarterly evaluations of our supposedly burgeoning clinical skills.

I almost failed my first one. So I spent every afternoon for a couple weeks preparing for my next one. I ended up getting an excellent evaluation, which boosted my mood for 5 minutes. However, in retrospect, was that a good use of my time?

School Exams/Quizzes

The next time you spend hours cramming for your school exams, remember this:

Residencies rarely if ever consider your preclinical grades.

Why? Because they are usually pass-fail. And for the schools that somehow do have grades, they still don’t count for much.

An exception is AOA. However, even then, you have to ask what list you’d put it on.


No one wants to feel bad about themselves. Like in my clinical exam skills test at Stanford, I didn’t want to be someone who almost failed.

The beauty of the two-list strategy is that there are important things. But then some things are most critical. Getting high grades on my med school exams, or shining on a clinical evaluation might be helpful. But they would never make my first list.


Research is important. For competitive specialties, it is virtually necessary. However, of the two, your USMLE scores are (usually) more important than research. So if you find yourself struggling to do both, focus on one. You can always take a research year later.


If you ask anyone, “is it good to shadow?” most people will say yes. However, that’s the wrong question. Instead, you should ask what activity you would give up to shadow?

Don’t define the value of something without considering the opportunity cost. Doing so is to live your life by your second list.

Other Extracurriculars

Lots of students try to be the head of their desired specialty’s interest group. They do so because they think it’ll look good on an application. It also allows you to network with decision-makers.

These Things Are All Good – That’s the Problem

Are these things good? Of course, they are. But the fact that they are useful is what gets us into trouble. It’s like being at an expensive all-you-can-eat buffet. There are so many wonderful options. However, quickly we find that we can only handle so much.

Med school and life are the same. We are not wanting for “useful” or good things. The key, however, is to ask whether they be on your first list or your second?

Med School Success

A common med student mistake is to assume that more of a good thing must be better. However, like a delicious buffet, for every good thing on our plate, we take space away from another good thing.

What’s On Your First List?

The beauty of the two-list strategy is that the lists will differ for different people. What you prioritize will depend on your values.

What you need to do is clear. You need to think about what is most important to you.

It’s ok to want to:

  • Lead an organization
  • Do well in your classes
  • Ace your OSCEs
  • Get top USMLE scores and keep your options open
  • Attain a top residency

However, you can’t prioritize all of them.

First List Recommendations for Top USMLE Scores

As we discussed, not everyone has the same goals. However, if your goals include having broader choices in residency, USMLE scores are critical. These are the top things you need to focus on, for top USMLE scores for every level.

(To read What 250+ on Step 1 or Step 2 CK Means, and How to Do It, click here).

Preclinical Student: Master – Not Memorize – the Day’s Material, and Remember the Old

Preclinical students need to master the curriculum. I’ve discussed this at length previously. The approach is simple, though:

  • For every day in class, learn that day’s material
  • Make Anki cards, so you never forget it
  • Do your Anki cards
  • For things you didn’t master by the end of the week, save it for the weekend

If making cards takes too long, use the Yousmle Step 1 Deck. You’ll make high-quality connections, the kinds of things that Step 1 tests. You will also learn how to make better cards faster.

Don’t use Zanki.

Dedicated Study: Mastery, Retention, and Application

The focus during dedicated studying is similar to your class focus. The critical difference is you are no longer in classes. Instead, you need to focus on identifying your weaknesses by doing QBank questions. Then master the relevant material, and make/do cards, so you don’t waste time re-learning it.

Are you struggling with mastering material in enough time? Try the Yousmle Online Course. There you will master content in the shortest time – and get pre-made Anki cards, so you never forget it. Stop watching videos and forgetting them immediately. Instead, master relevant Boards material and learn how to apply it to maximize your score.

Clerkships: Mastery of Each Clerkship’s Content + Question Interpretation

To score 250+ on Step 1, you need to master a large volume of information. For Step 2 CK, the amount you need to know is less. However, your ability to use it becomes critical.

Step 2 CK involves questions from all of the core rotations. Thus, each rotation is your best opportunity to learn the related content.

On pediatrics, make sure you have mastered all of the UWorld pediatrics content. Use question interpretation techniques to learn how to apply it.

(To read USMLE 240+: How to Improve Your USMLE Score Without Cramming More Facts, click here).

(To read The Secret to Scoring 250/260+ You Can Learn Right Now: Question Interpretation, click here).

Step 2 CK: Question Interpretation

As I alluded to previously, Step 2 CK depends on question interpretation. You need to know what every single sentence means. The more you do so, the higher the likelihood of getting that question right.

If you want to improve your score without cramming more, check out the Online Course. There, we will teach you how to approach any question so you can maximize your score. You’ll not only master the relevant material, but you’ll also use it to get more items right.

How to Accomplish List #1: Put First Things First

We’ve defined the critical foci for every step if your goal is to match well. But how do we actually align our actions with our values?

  1. Put first things first
  2. Follow Parkinson’s Law: work expands so as to fill the time available for its completion
Put First Things First

This is the phrase used in the 7 Habits of Highly Effective People. It states that you have to make time for your most important activity. So if you’re a first-year, you need to master material first, before anything else. Every day.

(To read Step 1 Study Schedule for 250+ and Top Preclinical Grades, click here).

Parkinson’s Rule: Cram the Unimportant/Urgent Tasks

But what would the other things that need to get done? What do we do about those urgent, but unimportant tasks that can get in the way? Stuff like random assignments? Or poorly-written quizzes/tests?

It’s simple. Follow Parkinson’s Rule.

Credited to Cyril Northcote Parkinson, the rule states “work expands so as to fill the time available for its completion.” In other words, if I give myself all week to study for a clinical skills test, it will take all week. However, what if I only had an hour to prepare? The fantastic thing is, I’d still get it done.

Once you’ve defined your values, be sure to schedule a time for them, every day. Then use Parkinson’s Rule to cram the urgent, but not important tasks.

Concluding Thoughts: Focus as the Key to Success

Do you find yourself accumulating tricks and tactics to solve your problems? You see someone who appears successful, and you try to do what they’re doing? If students are cramming UWorld and First Aid, and you decide to add that to your routine. Your friends are getting research positions, so you do the same thing. A professor recommends shadowing, so you add it to the pile.

If so, do you also feel overwhelmed? Does your day end with a deep feeling of not accomplishing much? Do you feel dissatisfied? If so, you likely lack focus.

Remember, none of the tactics you learn will matter without focus. Like the Ray Dalio quote above:

“You can have just about anything you want, but not everything you want. Maturity is the ability to reject good alternatives in order to pursue even better ones.”

What good alternatives will you reject, to pursue the better ones?

What do you think? How has focus/its lack affected your training thus far? Let us know in the comments!

Photo by Tim Cooper

  1. Jonathan says:

    Hi Alec,

    I’m a MS-1 and I have purchased your Anki card but for some classes I need extra info for my block exam. What should I do? How can I master the contents of my classes without falling behind, doing your deck and study the new material?

    Kind regards,


    1. Yousmle says:

      Hi Jonathan,

      Thanks for your question. As chance has it, I actually JUST wrote an article on this exact topic:

      You can also see previous articles relating to it here:

      Hope this helps!

  2. sana iqbal says:

    I wanted to ask you I have friend in carribean medical school and he did not pass basic comprehensive exam that you have to take before step he took it 6 times and now he got dismissed he applied to other carribean school and got it there. Now that person is asking if he applies to residency how will they look at his application due to dismissal from first school and lets say he gets a 250 on steps now. I thought you might be better person to ask this question because you are the expert in your field. This guy got tons of publications also.


    1. Yousmle says:

      A good USMLE score will help, definitely, although he will have to have a good explanation for why he failed out of his first school. Look at the “black box” discussion in these articles:


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Want FREE Cardiology Flashcards?

Cardiology is key for impressive USMLE scores. Master cardiology from a Harvard-trained anesthesiologist who scored USMLE 270 with these 130+ high-yield flash cards. You’ll be begging for cardio questions - even if vitals make you queasy.