Rethinking Study Guides in Medical Education

Almost every semester, a student asks me if there will be a study guide for the exam. I understand why: a study guide feels grounding when the material is heavy and the pace is fast. It creates a sense of control and clear boundaries. For many students, it’s what they’ve always been given, so it feels like a normal expectation.

But I struggle with the idea of traditional study guides. Over time, I’ve watched them quietly turn into permission slips. If it’s on the list, it gets studied. If it’s not, it gets ignored. The focus shifts from understanding the material to hoping nothing outside the guide shows up. That’s not a character flaw on their part, rather it’s a learned behavior.

When I include something not explicitly listed, even after saying clearly that everything is testable, I often get pushback. Students feel tricked. They feel betrayed. That reaction matters to me, because trust is essential. I never want students to feel like I’m trying to catch them off guard.

At the same time, I hear another familiar response: “Other instructors give study guides.” That comparison is real. Students move through multiple courses at once, each with different expectations. When one class reduces learning to a tightly bounded list, it shapes how they approach all of their courses. It can make my approach feel unfair, especially when the stakes for tthem are so high.

As someone who holds a professional medical degree, my sense of responsibility doesn’t stop at patient care. It extends into how I teach future healthcare providers. In medicine, accountability isn’t to a checklist. It’s to human lives. Protocols and algorithms matter, but they only work when you understand why you’re following them and how to think when something doesn’t fit the script. Clinical judgment doesn’t come from memorizing lists. It comes from reasoning when the guide runs out.

The challenge is real. If I give a very specific study guide, I risk reinforcing memorization and dependence. If I give nothing, I risk leaving students overwhelmed. So instead of asking whether students should get a study guide or not, I’ve started asking a different question: How do I give students structure without breaking trust and without removing their responsibility to think?

This semester, I’m experimenting with what I call “cognitive trainers.” They provide a layered structure, but they aren’t answer lists. They highlight what matters and why. They do give students the study guide, but teach them to build on it. They ask students to solve problems before they feel ready. They normalize discomfort rather than punishing it. They push students to organize information, draw synthesis charts, and show relationships between concepts.

Watching me explain how to solve a problem is not the same as trying to solve it yourself. The learning happens in the attempt. That’s where things start to stick.

One book that helped me frame this is Make It Stick: The Science of Successful Learning by Peter C. Brown. A key idea is that trying to solve a problem before being taught the solution leads to deeper learning, even when mistakes happen. That resonates with what I see in my classroom every semester.

I’m not against supporting students. I’m not trying to make courses harder for the sake of it, or chasing a “tough instructor” reputation. I care about the quality of work that I do and I genuinely care about my students, which is why it’s hard when my intentions are misunderstood. My goal is to prepare them for a time when no one hands them a guide and they still have to think. Better to practice that kind of thinking now—while the stakes are academic, not clinical.