know.

CookbookStudy and examsNo. 10

Board exam notes for medical schoolyour own high-yield notes, system by system

Recipe No. 10Study and exams

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
Works in
know.sh on the web · the iOS app · your AI assistant, through MCP
Keep it
Private. This one never goes 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. 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. 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. 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. 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. 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. 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. 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.

Specimen

  1. You

    I have attached my own notes from the cardiovascular block and the USMLE content outline. Using know.sh, make the document “Cardiovascular” on my “Step 1” shelf and draft a finding per disease or drug from my notes only, with the headings Mechanism, What you see, Easily confused with, Also in and Where I went wrong (leave that one empty). Where my notes are too thin, file a Question finding instead of filling the gap.

  2. Claude

    Your notes cover 21 topics well enough to draft, and three only by name. I will create the document and file them in the order of the outline.

  3. research_createCreated Cardiovascular on the shelf Step 1
  4. finding_addAdded “Aortic stenosis” to Cardiovascular, 7
  5. finding_addAdded 20 more topic findings and 3 Question findings to Cardiovascular
  6. comment_proposeProposed a note on Cardiovascular, 7

  7. Claude

    Filed 24 findings. The drafts use your wording where I could, but they are drafts: I have not checked them against a textbook, and I left every “Where I went wrong” empty for you. Finding 9 lists the manoeuvres for hypertrophic cardiomyopathy, but finding 7 does not say what they do to the aortic stenosis murmur, so I left a proposed note there.

The assistant laying out a system from the student’s own lecture notes, and leaving the parts that must be the student’s empty.

Step 1Cardiovascular

7of 24

Aortic stenosis

Observation, key finding, 2 highlights, 1 note, 360 words

Mechanism. Older patients: a normal three-leaflet valve calcifies with age. Younger patients: a bicuspid valve calcifies decades earlier. The left ventricle pushes against a fixed obstruction and thickens (concentric hypertrophy).

What you see. Crescendo-decrescendo systolic murmur at the right upper sternal border, radiating to the carotids. Weak, delayed carotid pulse (pulsus parvus et tardus). Symptoms on exertion: syncope, angina, shortness of breath.

Easily confused with. Hypertrophic cardiomyopathy, also a systolic murmur; see finding 9 for the manoeuvres that tell them apart.

Also in. Turner syndrome (bicuspid aortic valve).

Where I went wrong. Picked mitral regurgitation twice. Mitral regurgitation is holosystolic at the apex and radiates to the axilla; aortic stenosis is ejection-shaped and goes to the neck.

One topic as a finding, in the student’s own words, rewritten from the assistant’s draft, with a proposed note from the assistant waiting to be accepted or dismissed.

QuizzesCardiovascularQuestion 3 of 8

Which of the following are expected in aortic stenosis? Select all that apply.

  1. aA crescendo-decrescendo systolic murmur at the right upper sternal border
  2. bA weak, delayed carotid pulse
  3. cAn opening snap after the second heart sound
  4. dA murmur that radiates to the carotids
  5. eA wide pulse pressure

Right. The answers are (a), (b) and (d). An opening snap belongs to mitral stenosis, and a wide pulse pressure to aortic regurgitation. See Cardiovascular, 7.

A select-all question written from the student’s own finding. The right options are set in bold, and the answer names the finding to reread.

Prompts to try

  1. 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.

  2. 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.

  3. 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

Indexed under

USMLE Step 1Organ systemsSelect all that applyBoard examsOwn-words notesPatient privacy

See also