This article is adapted from a post in Dr Koshy Jacob's "Building Revise Radiology in Public" series on LinkedIn.

Whenever we talk about what we are building, the temptation is to start with the things themselves, the courses, the subscriptions, the case banks, and to describe their features as though a candidate wakes up wanting features. They do not. They wake up with a problem, and the only useful question we can ask ourselves is whether we have understood that problem well enough to be of real help. So rather than describe what we offer, I want to describe three radiologists, because between them they cover most of the people we exist to serve, and each of them needs something genuinely different from us.

The one who is drowning in material: Core

The first radiologist has no exam booked, or perhaps has one a long way off, and their problem is not a shortage of resources but a flood of them. Every platform, every textbook, every well-meaning senior offers more to read, more to watch, more to get through, and the effect is not preparation but a low, constant anxiety of always being behind on a list that never shrinks. They do not need another library. They need a way to keep their eye sharp, day after day, without the whole enterprise feeling like a second job.

This is the radiologist Core is built for, and the thinking behind it rests on one of the most consistent findings in the science of learning: that actively retrieving knowledge, by answering questions and working through cases, produces far stronger and more durable learning than passively re-reading or watching the same material. Cognitive psychologists call it the testing effect, and the evidence for it is unusually robust. In the landmark studies by Roediger and Karpicke, students who were tested on material retained substantially more of it days and weeks later than students who spent the same time re-studying it, and the re-studiers were also more likely to overestimate how much they knew, because re-reading creates a comfortable illusion of mastery that retrieval ruthlessly exposes. A major review by Dunlosky and colleagues reached a similar verdict on the study habits most of us default to: re-reading and highlighting feel productive and achieve remarkably little, while practice testing sits among the most effective techniques known.

Crucially for us, these findings hold in medicine, not just in the psychology laboratory. In a randomised controlled trial with paediatric and emergency medicine residents, Larsen, Butler and Roediger found that repeated testing on taught material produced markedly better retention at six months than repeated study of the same content, and later work showed the benefit extends beyond written recall to the clinical application of knowledge. Six months is an interesting horizon, because it is roughly the distance at which most radiologists sit from their next exam for most of their careers. A question answered today, in other words, is still working for you in half a year, in a way that a chapter re-read tonight simply is not.

So Core is deliberately built around questions and cases rather than lectures, with the reasoning, references and discussion attached to each one, so that every few minutes spent is a few minutes of genuine retrieval rather than comfortable review. It is low-cost and always-on, because the point is not to cram for a date that may not exist yet but to build the habit of looking, thinking and committing to an answer, which over years is what quietly turns a competent radiologist into an excellent one. Radiology is, at its core, thousands of small acts of retrieval under uncertainty, and a radiologist who practises retrieval daily is training the exact muscle the job demands.

The one with a date on the calendar: Mastery

The second radiologist has the opposite problem. The exam is booked, the months are counting down, and an open-ended library is now precisely the wrong tool. This is made worse by an awkward reality of exam logistics: dates often arrive late, and many candidates find themselves with a far shorter runway than they would have chosen. What they need is not more choice but less, a structured pathway that takes responsibility for coverage so they do not lie awake wondering what they have missed. They need to know that if they work through what is put in front of them, in the order it is put in front of them, they will have seen what they need to see.

This is what the Mastery Courses are built for: a focused run-in to a specific sitting, with the material deliberately curated down rather than padded out. The principle we followed was coverage, not volume. Every diagnosis in the FRCR curriculum should appear somewhere in the set, and nothing should be repeated simply because it happens to come up often. For Part 1 Physics, and for the 2A and 2B question material, that coverage is essentially complete, and the whole experience is designed to mirror the platform candidates will actually face on the day. We are candid about the one exception: anatomy is too vast for any course to honestly claim exhaustive coverage, and we would rather say that plainly than pretend otherwise.

There is learning science underneath this too. The same body of research that supports retrieval practice also warns that learners are poor judges of their own coverage, and that unstructured study gravitates toward the familiar and comfortable rather than the necessary. A curated pathway removes that failure mode. For a candidate with twelve weeks and a family and a clinical job, the most valuable thing we can give is not another thousand cases but the confidence to stop asking whether they are studying the right things and simply study. In the final months before an exam, that certainty is worth more than any quantity of extra material.

The one who needs the room: live courses

The third radiologist has, ideally, been through both of the above. They have built fluency with Core and covered the curriculum with Mastery, and they have hit the ceiling of what solitary work can do. They can reason through a case alone at a desk, but the exam is not taken alone at a desk. It is taken under pressure, out loud, in front of an examiner, and there is a readiness that only comes from rehearsing in those conditions.

The evidence here comes from a different corner of the literature but points the same way. A twenty-year meta-analysis by McGaghie and colleagues found that simulation-based medical education with deliberate practice was clearly superior to traditional clinical education for acquiring specific clinical skills, with a large pooled effect. The principle transfers directly to exam preparation: the closer the practice conditions sit to the performance conditions, the better the performance holds up when it counts. Kromann and colleagues showed the same thing for skills more broadly, and every viva candidate knows it instinctively. There is a particular kind of composure that cannot be read into existence. It has to be rehearsed.

So our live courses are built to be intensive enough to genuinely simulate the exam. Candidates are actively on the hot seat, seeing cases, being examined and cross-examined by expert examiners who question the way real examiners question and who can identify a candidate's specific weak points within a handful of cases. Some of this pressure exists in the Mastery Courses too, through the live viva sessions and study groups that run alongside the material, and those sessions are valuable. But they are, by design, more peer-led and more forgiving. The live courses are the full-dress rehearsal: the same intensity, the same scrutiny, the same feeling in the chest, so that the first time a candidate experiences the real pressure of the exam is not in the exam.

Why three, and not one

It would be simpler, commercially and operationally, to build one thing and insist it suits everyone. We have chosen not to, because the three radiologists above are not three market segments to be captured. They are three moments in a single career, and most radiologists will pass through all of them: the long stretch of keeping sharp without a date, the compressed run-in to a specific sitting, and the need to feel the pressure of the room before the real thing. At each moment the pain is different, so the tool must be different, and the evidence for what actually works at each stage, retrieval practice for durable learning, curated coverage for a compressed timeline, and realistic simulation for performance under pressure, is what shaped what we built.

That is the only test we try to hold ourselves to. Not whether a product is impressive, or complete, or clever, but whether it answers a real difficulty that a real radiologist is facing right now, in a way the science of learning would recognise as sound. The radiologist remains the hero of this story, working through something genuinely hard. Our job is to make sure that whichever of these three moments they are living through, there is something built specifically for it, waiting for them when they need it.

References

Roediger HL, Karpicke JD. Test-enhanced learning: taking memory tests improves long-term retention. Psychological Science 2006;17(3):249-255.

Roediger HL, Karpicke JD. The power of testing memory: basic research and implications for educational practice. Perspectives on Psychological Science 2006;1(3):181-210.

Dunlosky J, Rawson KA, Marsh EJ, Nathan MJ, Willingham DT. Improving students' learning with effective learning techniques. Psychological Science in the Public Interest 2013;14(1):4-58.

Karpicke JD, Blunt JR. Retrieval practice produces more learning than elaborative studying with concept mapping. Science 2011;331(6018):772-775.

Larsen DP, Butler AC, Roediger HL. Test-enhanced learning in medical education. Medical Education 2008;42(10):959-966.

Larsen DP, Butler AC, Roediger HL. Repeated testing improves long-term retention relative to repeated study: a randomised controlled trial. Medical Education 2009;43(12):1174-1181.

Larsen DP, Butler AC, Lawson AL, Roediger HL. The importance of seeing the patient: test-enhanced learning with standardized patients and written tests improves clinical application of knowledge. Advances in Health Sciences Education 2013;18(3):409-425.

Kromann CB, Jensen ML, Ringsted C. The effect of testing on skills learning. Medical Education 2009;43(1):21-27.

McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB. Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. Academic Medicine 2011;86(6):706-711.

Originally shared by Dr Koshy Jacob on LinkedIn. Follow the series there