In the challenging world of medical education, where stress and information overload are common, one big question remains: Why do some students succeed while others struggle? The answer often isn’t about natural talent, but the strategy used. This Q&A dives into Dr. Palmerton’s story, a story of turning his own academic struggles from failing the SAT to mastering Step 1 into a unique way of learning.
Drawing from his time at Stanford, noticing flaws in traditional lectures, and using real-life clinical stories, Dr. Palmerton changed how students should study. His methods, focused on understanding concepts, using spaced repetition, and building a growth mindset, have helped students improve from poor scores to top marks.
Whether you’re dealing with test stress, feeling buried by Anki cards, or doubting your ability to improve, this interview offers practical steps to turn challenges into success. Let’s look at the key principles that have helped countless students and could help you too.
To keep things clear and easy to follow, the interview is presented in a Q&A format.
Q: How did you get started helping medical students learn better?
A: I’ve always loved teaching. My mom was a college professor, so education was something I grew up around. But when I got to Stanford for medical school, I was surprised by how ineffective the lectures were. It wasn’t that the professors weren’t smart. They were brilliant. But the system didn’t reward great teaching. Professors were promoted for research and clinical work, not for how well they taught. I realized that if I wanted to improve medical education, I’d have to work outside the system.
Q: What made you decide to create a new approach to med school studying?
A: When I was a biochem TA at Stanford, I saw that students hated the course. And that was despite the fact that the professors really cared. What stuck with me the most were the small clinical stories they’d mention during lectures. So when I got the chance to teach, I built my lessons around those stories. I’d start with a real-life example, then explain the biochemistry behind it. The sessions became so popular that the department ended up flipping the course and using that approach going forward.
Q: How did you go from struggling with standardized tests to scoring in the top 1 percent on Step 1?
A: In high school, I didn’t even know you were supposed to study for standardized tests. I wanted to go to Princeton, but my SAT scores were too low. That rejection motivated me. I didn’t want test scores to hold me back ever again. So I worked hard for the MCAT and eventually scored in the 99th percentile. Then I took that same mindset into Step 1 and scored a 270. I’m not naturally good at these exams. I just figured out what worked, and once I did, I realized I could teach it to others too.
Q: What’s the best way for medical students to study for the USMLE?
A: It comes down to three things. First, you have to learn the material well. That means truly understanding the concepts, not just memorizing. Second, you need a system for remembering what you learn over time. That’s where spaced repetition comes in. Third, you have to be able to apply that knowledge under pressure, whether in clinical situations or exams. If you do all three, there is no limit to how much you can retain and use.
Q: How can I remember everything I study in med school?
A: The key is spaced repetition. It’s based on reviewing information right before you’re about to forget it. I use Anki for that. It spaces out the cards so that each review strengthens your memory. As long as you do your cards every day, it’s possible to retain huge amounts of information with surprising consistency. It’s not about reviewing everything all the time. It’s about reviewing the right things at the right time.
Q: Is there a better way to use Anki for med school?
A: Definitely. Most people use Anki to memorize facts. I use it to think through concepts. Instead of simple Q&A, my cards ask deeper questions. For example, “Why would a fasting person who drinks alcohol become hypoglycemic?” That kind of question forces you to walk through the reasoning, not just recall a detail. It’s harder, but much more effective.
Q: I’m overwhelmed with all the content. Where should I start?
A: Start small. Don’t try to master everything at once. I usually recommend picking one topic, like coronary artery disease, and learning it deeply. Once you understand one system really well, it builds confidence. From there, it gets easier to expand into other areas. It’s like a video game. You start on level one. You get a win. Then you move up to the next challenge.
Q: Why am I not improving even though I study all the time?
A: A lot of students spend hours memorizing facts without really understanding what they mean. That’s one part of the problem. The other is mindset. Some students start to believe they’re just not good at exams. But I’ve seen over and over that this isn’t true. When you focus on learning concepts, using spaced repetition, and applying knowledge, you can absolutely improve. You just need to shift how you study.
Q: How can I develop a growth mindset when I’m close to failing?
A: Most people come to me when things aren’t going well. They’re feeling desperate. Maybe they failed an exam or are weeks away from a big test. That’s often the best time to change, because the pain pushes them to try something different. I’m always honest about what’s possible. Some students improve dramatically in a short time, but for others, it takes longer. The first step is being willing to approach things differently.
Q: Why do some students succeed using the same resources I use?
A: That’s a great question, and it’s one I hear a lot. Everyone uses the same tools. UWorld, First Aid, Pathoma, you name it. What matters is how you use them. One student might go through UWorld just trying to memorize facts. Another might use it to identify patterns, build reasoning skills, and create Anki cards that reinforce concepts. The materials aren’t the difference. The method is.
Q: Can students really go from failing to scoring in the 260s?
A: Yes. I’ve seen it happen many times. One student failed Step 1 four times, then scored a 272. Another started with a 202 on Step 2 and got up to a 262 in about three months. They weren’t using different books or programs. They were just approaching the same material in a new way. It’s proof that how you study matters far more than what you study.
Q: How do I learn medical concepts instead of just memorizing facts?
A: Start by asking yourself why things happen, not just what happens. I often start students with something simple but high-yield, like coronary artery disease. It doesn’t require knowing every part of medicine to understand it. Once you can fully explain one concept, you can repeat that same process with other topics. Learning concepts is a habit, and once it clicks, it changes everything.
Q: What surprised you most after working with so many med students?
A: What surprised me most is just how powerful this approach can be. I always believed people could improve with the right tools, but I didn’t expect the transformations to be this dramatic. People who thought they weren’t cut out for medicine are now scoring in the top percentiles, matching into competitive residencies, and feeling confident on rounds. It’s more than just getting through an exam. It’s about building a completely different mindset that they can take into the rest of their careers.
Conclusion
The journey from feeling lost as a student to becoming a confident doctor isn’t about memorizing more facts or studying longer hours. It’s about changing how you learn. As this Q&A shows, real progress happens when you shift from just memorizing what to study to understanding how to study—focusing on understanding concepts, using spaced repetition, and staying resilient instead of giving up.
The examples shared, students dramatically improving their Step 1 scores, courses redesigned with clinical stories, and Anki cards that teach reasoning, prove that change is possible. But the biggest lesson is that success isn’t just about exams. It’s about creating a mindset that turns challenges into opportunities for growth, a mindset that will help you throughout medical school, residency, and your career.
As you move forward, remember this: The difference between staying stuck and achieving success is often one simple choice. Will you keep using the same methods, or will you try a system that works with your brain, not against it? The tools are available. The results are proven. Now it’s your turn to take your learning to the next level.
