# Board exam notes for medical school — your own high-yield notes, system by system Recipe No. 10, Study and exams. From The know.sh Cookbook: https://know.sh/cookbook/medical-boards - For: a second-year medical student preparing for USMLE Step 1 - You bring: your lecture notes from the preclinical blocks, your school’s learning objectives, the USMLE content outline, and what you learn from each block of practice questions - You get: a set of Step 1 notes with a document per organ system, a finding per topic in your own words, and select-all quizzes built from them - Time: a weekend per system during the preclinical blocks, then an hour a day in your dedicated study period - Keep it: private; never on a public link Step 1 preparation comes with more resources than anyone can finish: a review book, a question bank, video series, the school's own lectures, and a deck of cards someone else made. What most students lack is one place where their own understanding is written down, in their words, in the order of the body rather than the order of the resources. This recipe builds that place, and lets your AI assistant do the bulk of the filing. Give Claude, ChatGPT or whichever assistant you use your lecture notes from the preclinical blocks; it lays them out as a document per organ system and a finding per disease, drug or mechanism, with the same headings every time. You go through it in the editor and make it yours, ending each finding with the mistake you made the first time. Then the assistant writes select-all-that-apply quizzes from your findings, and Look up shows you where amyloidosis or sarcoidosis turns up in four different systems. The review books and question banks stay where they are, under their own licences, and never go to your assistant. No patient ever goes into this library. ## What you will use - **Your AI assistant**: Claude, ChatGPT or a local model, connected to know.sh: it drafts a finding per topic from your own lecture notes, writes select-all quizzes, and flags contradictions. - **The editor**: Where you rewrite each draft finding into your own words, split the long ones, fill in *Where I went wrong* and mark **Key**. - **Research document**: One document per organ system in the USMLE content outline, *Cardiovascular* to *Endocrine*. - **Finding**: One finding per disease, drug or mechanism, with the same five headings; the ones you keep missing marked **Key**. - **Quiz**: Select-all-that-apply quizzes your assistant writes from your findings, each question citing where its answer lives. - **Highlights**: One highlighted sentence per mistake, so those findings print in bold wherever the index lists them. - **Proposed notes**: Proposed notes from your assistant when two of your findings contradict each other or describe the same sign. - **The iOS app**: The iOS app, in TestFlight beta, for a quiz between lectures or on the train. ## Method ### 1. Give your assistant your notes and the outline Collect your own lecture notes from the preclinical blocks and the USMLE content outline, and give them to your assistant: attach the files in Claude or ChatGPT, or point a local client at the folder. Ask it to make a shelf called *Step 1* in know.sh, a document per system in the outline (*Cardiovascular*, *Respiratory*, *Renal and urinary*, *Gastrointestinal*, *Endocrine*, *Nervous system* and the rest), plus *Biostatistics and epidemiology* and *Pharmacology principles*, because questions draw on them from every system. Give it only what is yours to give: your notes, and your school's materials if its policy allows. Never the review book or a question bank. ### 2. Have it draft a finding per topic, with the same headings Ask for one finding per topic, titled by the name the exam uses: "Aortic stenosis", "Nephritic syndrome", "Beta blockers". Under each, the same five headings: *Mechanism*, *What you see*, *Easily confused with*, *Also in* (the other systems where it appears) and *Where I went wrong*, left empty. Tell it to draw only on your notes and to file a *Question* finding wherever your notes are too thin to say anything. A block's worth of notes becomes forty or fifty draft findings in one sitting. That is the point: the assistant does the laying out, so your hours go into the next step. ### 3. Make every finding yours in the editor Open each system and press **Edit**. Read each draft against your notes and rewrite it until it sounds like you: a sentence you would not have written is a sentence you will not remember. Correct what is wrong, split any finding longer than a page, and drag them into the order you want to study them. After each block of practice questions, close the question bank, open the finding and write under *Where I went wrong* what you learned, in your own words. Mark the topics you have missed more than once as **Key**. Do not paste a review book's text or a question bank's questions and explanations; copyright and the banks' terms of use forbid it, and a copied paragraph will not stick. ### 4. Ask for select-all quizzes Ask your assistant for a quiz: "Using know.sh, make a quiz of eight select-all-that-apply questions from *Cardiovascular* on my Step 1 shelf." It writes them with know.sh's quiz tools, each citing the findings it came from, and you take it in know.sh or the iOS app. Step 1 itself asks for a single best answer, but select-all makes you judge every option on its own, and there is no guessing your way through five independent calls. When you miss one, open the finding, add a line under *Where I went wrong*, and highlight it. The quiz comes back under *Revisit* after 3, 7 or 21 days, depending on your score. ### 5. Let Look up connect the systems Boards reward the student who knows that one disease shows up in several places. Amyloidosis is a restrictive cardiomyopathy, a cause of nephrotic syndrome and a cause of peripheral neuropathy. Write the *Also in* line, then press ⌘K and type the condition: Look up lists every finding that mentions it. The index itself holds the names and acronyms that recur, such as Turner, HCM or ECG, and prints in bold the findings where you highlighted a mistake. Ask your assistant to link findings that describe the same condition from different systems, so a hover takes you across. ### 6. Accept or dismiss what your assistant notices Ask your assistant to read a system for contradictions between your own findings. It can leave a proposed note in the margin, set apart with a dashed rule, with **Accept** and **Dismiss**: "Finding 9 says this murmur gets louder with Valsalva; this one says it softens." Contradictions like that are exactly the errors that survive to exam day. **Accept** turns the proposal into an ordinary note; **Dismiss** removes it. Check the point against your course materials before you change anything, because an assistant can be wrong about medicine too. ### 7. Work the weak systems in your dedicated period Once you are in dedicated study, **Star** the three systems your practice scores say are weakest, and open *Contents → Starred* each morning. Ask your assistant for one mixed quiz across the starred systems every day, and take whatever *Revisit* brings back: a quiz you scored under 60 per cent returns in three days. The iOS app holds the same library and takes the same quizzes, which turns the gap between two lectures into a quiz on renal tubules. ## Prompts to try Your assistant, connected to know.sh (Claude, ChatGPT or a local model): > Using know.sh, make a quiz of eight select-all-that-apply questions from the document “Cardiovascular” on my “Step 1” shelf. Each question should have five options, with two to four correct, and the wrong options should be findings of conditions that are easily confused with the right one. Cite the finding for each option. Your assistant, connected to know.sh (Claude, ChatGPT or a local model): > Using know.sh, read every finding on my “Step 1” shelf and list the conditions named under “Also in” that do not yet have a finding of their own, grouped by system. Do not write the findings; I will write them from my notes. Your assistant, connected to know.sh (Claude, ChatGPT or a local model): > Using know.sh, look through the document “Renal and urinary” on my “Step 1” shelf for any two findings that contradict each other or describe the same sign differently. Leave a proposed note on each pair, quoting both lines, and change nothing. ## Variations - Use the same shelf through clinical rotations: add a document per clerkship, with findings for the topics each shelf exam covered, in your own words and with no patients in them. - Nursing or pharmacy students can follow the same shape for their own licensing exams, with documents per body system or drug class drawn from the exam’s published content outline. - Keep a document called *Test-day plan*: timing per block, breaks, what to eat, and what to do when a question throws you. ## Where it falls short - There is no image or file upload, so histology, gross pathology, imaging and ECGs stay in your other resources. Describe the key feature in words in the finding. - Quizzes only cover what you have written. They are not a question bank and cannot tell you what the exam weights; practise with official and licensed materials too. - If you use a flashcard deck, keep it. Quizzes return on a 3, 7 or 21-day rule by score; they are not spaced repetition, and they track quizzes, not individual facts. - Any assistant can be wrong about medicine, and quietly so. When a draft finding or a quiz answer disagrees with your course materials, your course materials win until you have checked. A smaller local model may also misfile topics; Revisions shows every change it made. ## A note on patients, review books and exam content No patient information goes into this library, ever: no names, dates, record numbers, photographs or stories from clinical sessions, even with details changed. Write about conditions, not people. Do not copy commercial review text, including First Aid, UWorld or any other book or question bank, into your notes; summarise what you learned in your own words. Never write down or share questions recalled from the USMLE or an NBME exam; the USMLE treats disclosing exam content as irregular behaviour, with consequences that can follow you into residency applications. Check your school's policy on AI in coursework and disclose AI use where it asks. These are study notes for an exam, not medical advice or clinical guidance, and nothing your assistant writes should be used to care for a patient. Indexed under: USMLE Step 1, Organ systems, Select all that apply, Board exams, Own-words notes, Patient privacy.