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Introduction: A Humbling Journey Through Surgical Training

_{Hello, I am Dr. Sarath Chandrabhatla, a surgical gastroenterology trainee at AIIMS Bhopal. I want to share how I navigated from a “quick learner” who breezed through undergraduate and postgraduate studies to someone who had to transform his entire way of learning to crack the INI-SS (Institute of National Importance Super-Specialty) entrance exam – on my fourth attempt. It was a 2.5‑year odyssey of repeated failures, a 20‑month hiatus from general surgical practice, and discovering that true mastery demands _much more_ than the methods that once got me by.}

_{In medical school, my knack for fast memorization and superficial overviews worked well enough to pass exams. During my surgical residency, I was fortunate to have inspiring mentors like Dr. Rohan Khandelwal (MS), whose clear teaching style helped me refine core surgical principles, and Dr. Rajamahendran (MS, MCh) and Dr. Santosh Anand (MS, MCh, JIPMER), who sparked my initial fascination with advanced surgical gastroenterology. Their guidance laid a strong foundation—yet I still relied on the same “cramming and quick‑retention” strategies that had served me in the past.}

_{Everything changed when I decided to pursue super‑specialty training. Reading immense textbooks like Shackelford’s and Blumgart’s demanded not just brute‑force memorization but _deep conceptual understanding_—the kind that ties basic science to real clinical applications. My turning point was meeting Dr. Basant Singh (MS, MCh) from AIIMS New Delhi, a remarkable teacher who brought theoretical knowledge to life. His focus on high‑level reasoning—especially for the competitive INI‑SS exam, which filters out only a handful of candidates from a pool of 800–1000 aspiring surgeons—showed me how much deeper I needed to go. Much like Dr. Nishant Yagnik (Neurosurgery) and Dr. Vinitha Nair (CTVS), Dr. Basant Singh was the kind of instructor whose lectures linger in your mind, making you _think_ instead of just memorize.}

_{Around this time, I also took a ten‑day Vipassana meditation course taught by S. N. Goenka, just before starting my preparation for the fourth attempt. This profoundly reframed my understanding of how the mind operates—offering a clear, experiential look at the patterns of awareness, concentration, and reactivity that drive our learning. Observing my own mental processes at such depth gave me new tools to focus and reflect—key skills in any rigorous study routine.}

_{Yet it wasn’t only surgical gurus or meditation that shaped my journey. Dr. Justin Sung from “I Can Study” had a profound influence on my approach to learning itself—teaching me principles of “PhD‑level” study habits, such as meta‑learning, deep questioning, and structured review. I began integrating non‑linear note‑taking, spaced repetition, and AI‑assisted questioning—completely abandoning my superficial, rapid‑fire style of old.}

_{By the time I appeared for my fourth INI‑SS attempt, I was a different learner. Instead of passively reading or relying on flash memorization, I was forming conceptual frameworks, intentionally spacing out revisions, and quizzing myself with increasingly challenging questions. That relentless focus on _how_ to learn—rather than _what_ to learn—ultimately led me to success in the exam and set me on a new trajectory in my clinical life. In this post, I’d like to walk you through that transformative journey—how I failed repeatedly until I realized the limits of my old study methods, and how modern strategies, deeper self-awareness, and a dash of AI finally allowed me to excel at the highest levels of surgical training.}

The “Firehose” Dilemma in Medicine

Whether you’re in surgical training or starting preclinical courses, medical school often feels like “drinking from a fire hose” – a rushing torrent of facts and concepts. You attend back-to-back lectures, highlight entire chapters, and then find that, a week later, much of what you studied has vanished. It’s not just you; it’s how human memory works. In fact, medical knowledge was estimated to double every 73 days as of 2020 – an astounding pace. At the same time, if we make no effort to review or apply what we learn, we forget roughly 75% of new information within a week.

I encountered this reality head‑on during my first few attempts at the INI-SS exam. Despite reading huge volumes of text and re‑reading notes over and over, my recall was shaky when I needed it most. Failing thrice taught me that success wasn’t just about _more_ studying; it was about _smarter_ studying. That’s what led me down the path of exploring learning science, adopting a few key strategies, and leveraging technology (including AI) to take my note‑taking and review to the next level.

Below, we’ll first look at why we forget and then dive into the strategies that changed my trajectory: the Socratic method of self‑questioning, non‑linear note‑taking, and spaced, interleaved retrieval. We’ll follow that with a look at personal knowledge management (PKM) systems (your “second brain”) and how AI can be your ever-available study buddy. Finally, I’ll show you how these pieces can fit into a cohesive daily routine – one that turns the firehose of information into a (mostly) manageable stream.

Table of Contents

1. Why We Forget: The Science of Memory (and How to Beat It)
2. A Surgical Trainee’s Journey: From Failure to Smarter Learning
   • i. The Socratic Method: Asking “Why?”
   • ii. Non‑Linear Note‑Taking: Mind Maps and Concept Graphs
   • iii. Spaced, Interleaved Retrieval: Practice That Sticks
3. Building Your Second Brain: Personal Knowledge Management (PKM)
4. AI as Your Study Buddy: Smarter Learning with Technology
5. Bringing It All Together: My Workflow and Next Steps

 1. Why We Forget: The Science of Memory (and How to Beat It)

Think back to a lecture from a month ago – how much can you recall now? Our brains are wired to forget information that isn’t reinforced. Over a century ago, psychologist Hermann Ebbinghaus described the _forgetting curve_, showing that if you never revisit or use a piece of information, you lose most of it within days. That’s why cramming might get you through tomorrow’s quiz, but a week later you feel as if you’re back at square one.

Fortunately, memory science also offers solutions:

But here’s the twist: _even_ these well‑known strategies can fail if we just go through the motions. When I first tried spaced flashcards and question banks, I still struggled – because I was still passively memorizing facts. It was only when I _combined_ memory science with better note‑taking, deeper questioning, and interleaving topics that things truly clicked. The next section details how I overhauled my approach – anchored by lessons in surgical gastroenterology – and discovered the power of these three strategies: Socratic questioning, non‑linear note‑taking, and spaced, interleaved retrieval.

2. A Surgical Trainee’s Journey: From Failure to Smarter Learning

My Humbling Start

After finishing general surgery, I set my sights on surgical gastroenterology. Three times I sat for the INI-SS exam, and three times I fell short. Each disappointment cut deeply; I’d walk out of the exam hall feeling that I had _known_ the material but just couldn’t retrieve it under pressure. Eventually, it dawned on me that I was studying in a way that didn’t leverage how memory and cognition actually work.

I therefore delved into educational research and gleaned insights from top performers. I discovered that they weren’t necessarily studying _more_ than me – they were studying _differently_. They used questioning, made connections between topics, and spaced out their review in a dynamic, “interleaved” way. It sounded tedious at first, but I was desperate to try anything new. Below is an overview of the three techniques that made the biggest difference.

i. The Socratic Method: Asking “Why?”

One change was learning to constantly question myself, in the tradition of the Socratic method. Rather than passively re‑reading, I turned my study sessions into a dialogue:

“Why does this happen? How do we know this? What if…?”

For example, while studying benign biliary strictures, I didn’t just memorize their causes and treatments. I probed deeper:

Why do benign strictures form after a cholecystectomy? How is the pathophysiology different from a malignant stricture? What surgical approaches do we consider if stenting fails?

When reviewing corrosive ingestion, I constantly asked “But why do acids predominantly damage the stomach more than alkalis do?” or “Why might alkaline ingestion predispose to esophageal carcinoma?”

This questioning uncovered gaps in my knowledge and forced me to develop critical thinking rather than just rote recall. Educational research describes this classic Socratic style as teaching by posing pointed questions, pushing learners to deduce answers themselves. In short, you’re not just learning facts; you’re learning reasoning ( [1] ).

Using AI for Self‑Interrogation

Interestingly, I found AI chatbots like ChatGPT helped me stay accountable. I’d feed in a brief summary of, say, EHPVO (Extrahepatic Portal Venous Obstruction) pathophysiology, then ask the AI to quiz me with Socratic‑style questions. It might prompt: “Explain the pathogenesis of variceal bleeding in EHPVO – but start with the role of portal pressure.” This forced me to articulate an answer in my own words. Each question that stumped me was an instant opportunity to go back and study more deeply. Over time, questioning (by me or by AI) became a second nature – and I found it served me beautifully in the exam hall, where clinical vignettes often hinge on “why” and “how” rather than raw memorization.

ii. Non-Linear Note-Taking: Mind Maps and Concept Graphs

Another major shift was how I took notes. I used to create long, linear notes – bullet points for each topic, all tucked away in separate sections of a notebook or digital file. The problem? Important links between topics were invisible, and my memory compartments stayed isolated.

Enter Concept Maps and Links

I switched to concept mapping and diagrammatic note‑taking. For example, while reviewing corrosive injury, I drew a web of connections:

– Central node: “Corrosive Ingestion (Acids vs. Alkalis)”

– Branches: acute injury patterns, endoscopic evaluation timelines, complications (strictures, perforation), management steps, risk of malignancy, etc.

– Sub-branches: “Acid ingestion → Coagulation necrosis (stomach) → potential pyloric stricture → need for surgical bypass.”  

    “Alkali ingestion → Liquefactive necrosis (esophagus) → high esophageal stricture risk → possibility of esophageal carcinoma.”

By laying out these connections in a single visual, I made the content memorable. Each piece of data had a “home” in my map, and it linked to other ideas. Numerous studies in medical education confirm that concept mapping fosters deeper comprehension and better recall than linear note‑taking ([2,3]).

On my tablet, I also created hyperlinked notes: e.g., “Benign Biliary Strictures” → link to “Pathophysiology of Bile Duct Injury” → link to “Portal Hypertension” if relevant, etc. This mimics the Zettelkasten or “slip-box” approach that great thinkers historically used (just in digital form). The result was a personal knowledge network – a “second brain” that reflected how these diseases interrelate. When you view your notes as a web of ideas (instead of countless separate pages), you’re more likely to recall them as an integrated whole.

iii. Spaced, Interleaved Retrieval: Practice That Sticks

The final piece of my puzzle was how I reviewed. Before, I would tackle one subject (say, pancreatitis) exhaustively for a week, then move on to another (say, biliary surgery) with minimal overlap. I’d cram near the exam, rereading entire chapters in huge chunks. The result? A short‑lived sense of “I got this!” that vanished under exam pressure.

• Spacing: Reviewing Over Time

Instead of big, one‑off study marathons, I started spacing out my revision in shorter, more frequent bursts. For example:

– Monday morning: 15 minutes reviewing “EHPVO” notes + 10 quiz questions

– Wednesday morning: Another quick pass + 5 new quiz questions on EHPVO

– The next week: A short spaced review again

This consistent re‑exposure over days and weeks interrupts the forgetting curve right when you’d normally lose the information. Studies show that spaced practice significantly outperforms cramming for long‑term retention ([4]).

• Interleaving: Mixing Topics

I also mixed different topics during each study block – a method known as interleaving. Rather than reading 50 questions on corrosive ingestion all in one go, I’d do 10 questions each on corrosives, biliary strictures, EHPVO, hepatic tumors, and pancreatitis, all jumbled. This initially felt harder (“Wait, we’re jumping to variceal bleeding now?”), but that very challenge cements the learning. Medical education research suggests that interleaving improves your ability to distinguish similar concepts and adapt to exam scenarios, boosting retention by 25‑30% over blocked practice ([4]).

In essence, spaced, interleaved retrieval gave me repeated exposure to a wide range of surgical gastroenterology topics, forcing me to retrieve details from memory over and over in unpredictable orders. Eventually, I found myself confidently recalling info on benign biliary strictures or corrosive strictures even weeks after first learning them – precisely the outcome I needed to tackle an exam that leapt between topics.

3. Building Your Second Brain: Personal Knowledge Management (PKM)

Once you’ve embraced deeper questioning and smarter review, you still need a system to keep track of all the information. Enter Personal Knowledge Management (PKM) – an approach to organizing and curating your notes so that they form a “second brain” you can rely on.

_{Example of an old-school PKM approach: the Zettelkasten index-card system, famously used by Niklas Luhmann. Today, digital tools (Notion, Obsidian, Roam, etc.) let you do this seamlessly.}

Why PKM?

• Centralized, searchable notes: Instead of scattershot lecture slides, you build a knowledge base you can search and cross‑reference.
• Connections, not silos: Linking notes and tagging topics encourages you to see how concepts interrelate – crucial in a field like medicine.
• Easier to maintain and review: When you discover new insights (e.g., a new treatment approach for corrosive strictures), you plug it into your existing structure, keeping your “second brain” fresh.

In my own routine, PKM meant I never had to start from scratch when revising. My notes weren’t mere transcripts; they were dynamic, interconnected summaries that I could update at will. That synergy of note‑taking and note‑linking made spaced review far more efficient: everything had a place, everything was accessible.

Over time, a well‑curated PKM system becomes invaluable. You reduce the mental load of remembering _where_ you wrote something down and instead focus on actual _learning_. And in the real world of clinical medicine, PKM can store protocols, guidelines, even interesting case discussions, so you have them at your fingertips later.

4. AI as Your Study Buddy: Smarter Learning with Technology

In the last couple of years, AI tools (like ChatGPT and others) have exploded onto the scene, offering on‑demand tutoring, question generation, and even semantic search of your personal notes. Rather than seeing AI as a threat to genuine learning, I treat it as a coach – guiding me toward more active engagement.

Practical Uses of AI in Studying:

1. Instant Q&A: Stuck on a concept? Ask your AI chat assistant for a simplified explanation or for analogies. While you still must verify correctness, AI can speed up the initial “explain it to me” phase.

2. Generating Practice Questions: For self-testing, you can feed your notes (on, say, “EHPVO”) into the chatbot and ask, “Create 5 clinically oriented questions with answer explanations.” That’s a quick way to practice retrieval on the exact material you just studied.

3. Semantic Linking: Some emerging tools can automatically suggest connections in your notes. For example, if you wrote about “portal vein thrombosis,” AI might suggest linking it to your note on “variceal bleeding.” Over time, it helps you build a more robust knowledge graph.

4. Personalized Spacing: Although Anki’s algorithm is already powerful, some AI-driven platforms claim to tailor your spaced review schedule based on your performance trends – for instance, pushing more review of those dreaded topics you keep missing.

It’s crucial to remember that AI is fallible. It can occasionally produce errors or oversimplifications. However, that’s not necessarily a downside: learning to critically evaluate an AI’s answer is yet another form of active engagement. As you cross-check the AI’s responses against trusted references, you reinforce your own knowledge.

Moreover, recent research has shown that AI language models can answer many USMLE-style questions at near‑passing (or even surpassing) levels. This suggests they’re robust at processing medical knowledge – so why not use them as a 24/7 “study partner”? The point, of course, is to amplify your own reasoning, not outsource it.

5. Bringing It All Together: My Workflow and Next Steps

Let’s recap how these elements combine into a routine you can implement right now:

1. Capture & Organize

    After a lecture or reading session, distill the key points into concise notes (digital or paper). Use a PKM tool (Notion, Obsidian, etc.) to link related topics.

2. Question & Discuss(Socratic Method)

    Regularly ask yourself “why, how, what if?” about the material. Or let an AI chatbot pose Socratic questions. Don’t skip over holes in your reasoning; investigate them.

3. Create Concept Maps (Non‑Linear Notes)

    Sketch or digitally map important topics. Show how they connect to related concepts (e.g., linking “Benign Biliary Stricture” → “Portal Hypertension” if relevant). Make your notes visually reflect the “bigger picture.”

4. Spaced, Interleaved Practice

    Use a flashcard or question‑bank system that schedules short, recurring reviews of old material. Mix topics in your quizzes (e.g., 3 GI questions, then 3 biliary questions, then 3 about pancreatitis) rather than doing one block at a time.

5. Leverage AI

    Ask the AI for clarifications, analogies, or quick quizzes. Generate targeted Q&A based on your personal notes. Use it as a helpful coach, _not_ a crutch.

6. Reflect & Iterate

    Track which concepts repeatedly trip you up. Update your concept maps or notes to fill those gaps. If a particular approach or schedule isn’t working, adjust.

My Personal Takeaways

By integrating these practices, I went from repeated disappointment to confidently passing my surgical specialty exam. These principles don’t just help pass one test; they build a lifelong learning framework – crucial in medicine’s ever‑evolving landscape.

• Stay humble: If you’re struggling, it likely means your method needs rethinking, not necessarily that you need more hours at the books.
• Trust cognitive science: Techniques like spacing, interleaving, and concept mapping feel harder in the short run but yield dramatic improvements in retention.
• Make it your own: Everyone’s workflow can differ. Experiment with tools, question styles, and note‑taking apps until you find a rhythm that suits you.

What’s Next??

As I continue my surgical gastroenterology journey, I’m building Nucleux Academy – an integrated platform that combines these evidence-based methods and AI enhancements under one roof. Think of it as a place where your notes, flashcards, and an AI tutor all live in a single ecosystem. While that project takes shape, there’s no reason you can’t start applying these strategies with freely available tools right now.

Conclusion & Call to Action

Medicine is a lifelong learning journey. The volume of knowledge only grows, and the stakes are high. But take heart: by systematically adopting Socratic questioning, non‑linear note‑taking, and spaced, interleaved retrieval, you can transform the way you learn. Add in a well‑structured personal knowledge system (PKM) and the judicious use of AI, and you’ll stay ahead of the curve.

Try one tactic this week – whether it’s creating a single concept map on a tricky topic, or quizzing yourself with five interleaved questions each day. Notice how your recall and understanding improve. Then layer on more methods over time. As you refine your process, you’ll notice greater confidence, sharper clinical reasoning, and far less stress when exams loom.

Remember: Success is not final, failure is not fatal; it is the courage to continue that counts – and, I would add, the courage to _learn differently_ when what you’re doing isn’t working. Happy learning!

References

1. O’Dell D.V. _et al._ (2016). Would Socrates Have Actually Used the “Socratic Method” for Clinical Teaching? _Journal of General Internal Medicine, 31_(9), 1092-1096.

    – PMC Article Link

2. Baliga S.S. _et al._ (2021). Concept map as a teaching and learning tool for medical students. _Journal of Education and Health Promotion, 10_(35), 35.

    – PMC ArticleLink

3. Maroufi S.S. _et al._ (2023). Mind mapping in recalling and retrieving core contents in anesthesia technology students. _Journal of Education and Health Promotion, 12_(1), 108.

    – PMC Article Link

4. Birnbaum M.S. _et al._ (2013). Why interleaving enhances inductive learning: The roles of discrimination and retrieval. _Memory & Cognition, 41_(3), 392–402.

    – Cited in: Using Evidence-Based Learning Strategies to Improve Medical Education – PMC

Additional reading on memory and learning science:

– Durable Learning | Lecturio Medical

– Performance of ChatGPT on USMLE: Potential for AI-assisted medical education using large language models – PMC

© 2025 – Dr. Sarath Chandrabhatla & Nucleux Academy. All rights reserved.