From Step 1 Failure to Emergency Medicine Residency | Dr. Alyssa Makowski on Clinical Reasoning, Aphantasia, and Medical School

Why Smart Medical Students Struggle (And How Doctors Actually Think)

In this episode of Dr. Tisdall Unfiltered, I sit down to discuss one of the biggest problems in modern medical education: why so many intelligent, hardworking medical students continue to struggle despite putting in enormous amounts of time and effort. As a pathologist, medical educator, and author of Clinical Pathophysiology, I've spent decades teaching students, residents, and physicians how to think through clinical problems rather than simply memorize facts. In this conversation, I explain why memorization often fails, how experienced clinicians approach diagnosis, why pathophysiology should serve as the foundation of medical education, and what students can do to develop stronger clinical reasoning skills. We also discuss the most common mistakes I see medical students make, why traditional textbooks often fall short, how doctors build differential diagnoses, and why understanding disease mechanisms is more valuable than memorizing isolated facts. Whether you're preparing for medical school exams, the USMLE, clinical rotations, residency, or simply want to become a more effective learner, this episode provides a framework for understanding medicine the way practicing physicians do. If you're a medical student, resident, healthcare professional, or educator looking to improve your understanding of clinical reasoning, pathophysiology, diagnostic thinking, and medical education, this episode is for you. Be sure to follow Dr. Tisdall Unfiltered for more conversations on medical education, clinical reasoning, pathophysiology, physician training, and expert insights into how medicine is actually practiced and taught. Get my free 6 week clinical reasoning series (12 high-yield multiple choice questions with MD-written answers): https://www.drphiliptisdall.com/mcq-email-series [https://www.drphiliptisdall.com/mcq-email-series] Clinical Pathophysiology (Edition 2) is now available for purchase! http://drphiliptisdall.com/textbook [http://drphiliptisdall.com/textbook] I’m building out our community where I will be teaching live online. For more information, head over to http://drphiliptisdall.com [http://drphiliptisdall.com] Watch the full video episode on YouTube: https://youtu.be/dJMSCfV71m4 [https://youtu.be/dJMSCfV71m4]

Why Medical Students Feel Lost | Dr. Tisdall Unfiltered

I’m building out our community where I will be teaching live online. For more information, head over to ⁠drphiliptisdall.com⁠ [HTTP://drphiliptisdall.com] In this episode of Dr. Tisdall Unfiltered, I sit down to discuss one of the biggest problems in modern medical education: why so many intelligent, hardworking medical students still struggle to truly understand medicine. We dive into the growing disconnect between learning objectives, compliance-driven testing, and real clinical reasoning — and why memorization alone is failing students. I explain why patient-centered learning matters, why students forget material even after studying for hours, and how fragmented teaching methods prevent learners from building a complete understanding of disease from patient presentation all the way down to molecular mechanisms. We also discuss the difference between apprenticeship and observership in medicine, why cadaver-based anatomy often fails to create clinically usable understanding, and how anxiety and poor learning systems contribute to medical school burnout. Throughout the conversation, I share stories from teaching medical students directly, including helping struggling students rebuild their approach to learning after failing major exams. If you are a medical student, premed, resident, educator, or healthcare professional trying to understand how doctors actually think through disease, this episode will challenge the way you think about medical education. We unpack many of the frustrations students expressed after one of our viral short-form clips discussing why medical school feels harder today than it did for previous generations. Topics include: * Why medical education feels overwhelming * Learning objectives vs clinical mastery * Why students struggle with retention * The problem with compliance-driven testing * Clinical reasoning and patient-centered learning * Cadavers vs clinical anatomy * Anxiety and performance in medical school * How to build a real learning system * Why medicine must be learned as a connected story Be sure to follow Dr. Tisdall Unfiltered for more in-depth conversations on clinical reasoning, pathophysiology, medical education, and how to think like a doctor. Get my free 6 week clinical reasoning series (12 high-yield multiple choice questions with MD-written answers): https://www.drphiliptisdall.com/mcq-email-series [https://www.drphiliptisdall.com/mcq-email-series] Clinical Pathophysiology (Edition 2) is now available for purchase! http://drphiliptisdall.com/textbook [http://drphiliptisdall.com/textbook] Watch the full video episode on YouTube: https://youtu.be/PpBmgiKQxXE [https://youtu.be/PpBmgiKQxXE]

Everything in Medicine Is NOT Equally Important | Dr. Tisdall Unfiltered

Most medical students are overwhelmed because they’re trying to learn medicine as if every fact carries the same weight. In this episode of Dr. Tisdall Unfiltered, I break down why that approach fails and explain how I teach students to organize medicine in a clinically meaningful way. I discuss the difference between foundational diseases, major diseases, and minor diseases, and why understanding pathophysiology matters far more than memorizing isolated facts for exams. Drawing from decades in pathology and medical education, I walk through real examples including cancer biology, HPV, lymphoma, cystic fibrosis, lupus, rheumatoid arthritis, apoptosis, molecular medicine, and clinical reasoning. I explain how foundational diseases teach the principles underlying clinical medicine, why modern medicine is increasingly molecular, and how students can stop cramming and start actually understanding what they’re learning. This episode is especially important for medical students preparing for exams like the USMLE, students struggling with information overload, and anyone interested in learning how experienced physicians think through disease mechanisms and patient care. I also discuss why I believe current medical education often emphasizes memorization over mastery, and why I’m building a new educational community centered around clinical reasoning and deep understanding. If you enjoy these discussions on medical education, pathophysiology, and clinical reasoning, be sure to follow Dr. Tisdall Unfiltered on Spotify and Apple Podcasts for more expert discussions and long-form teaching episodes. Get my free 6 week clinical reasoning series (12 high-yield multiple choice questions with MD-written answers): https://www.drphiliptisdall.com/mcq-email-series [https://www.drphiliptisdall.com/mcq-email-series] Clinical Pathophysiology (Edition 2) is now available for purchase! ⁠http://drphiliptisdall.com/textbook⁠ [http://drphiliptisdall.com/textbook] I’m building out our community where I will be teaching live online. For more information, head over to drphiliptisdall.com [http://drphiliptisdall.com] Watch the full video episode on YouTube:: https://youtu.be/yKC4iHyRG74 [https://youtu.be/yKC4iHyRG74]

From Step 1 Failure to Emergency Medicine Residency | Dr. Alyssa Makowski on Clinical Reasoning, Aphantasia, and Medical School

In this episode of Dr. Tisdall Unfiltered, I sit down with Dr. Alyssa Makowski, a newly matched emergency medicine resident whose journey through medical school was anything but straightforward.  Alyssa was one of the strongest students I had ever worked with, yet she repeatedly struggled to cross the exam threshold required to move forward toward Step 1. What followed became one of the most remarkable transformations I’ve witnessed. We discuss medical school failure, STEP 1 preparation, clinical reasoning, learning styles, mentorship, burnout, impostor syndrome, and what actually separates memorization from true understanding in medicine. Alyssa also opens up about discovering she has aphantasia — the inability to form mental images — and how that fundamentally changed the way she had to approach learning medicine, anatomy, and pathophysiology. This conversation is especially important for medical students, pre-med students, residents, educators, and anyone struggling with standardized exams despite being highly capable clinically. We explore why some intelligent students continue to underperform on medical board-style exams, how confidence and resentment affect learning, and why medicine ultimately forces every student to confront their weaknesses honestly. If you enjoy long-form discussions on medical education, clinical reasoning, pathophysiology, and physician training, make sure to follow Dr. Tisdall Unfiltered for more expert interviews and conversations. Get my free 6 week clinical reasoning series (12 high-yield multiple choice questions with MD-written answers): https://www.drphiliptisdall.com/mcq-email-series [https://www.drphiliptisdall.com/mcq-email-series] Clinical Pathophysiology (Edition 2) is now available for purchase! ⁠http://drphiliptisdall.com/textbook⁠ [http://drphiliptisdall.com/textbook] I’m building out our community where Dr. Tisdall will be teaching live online. For more information, head over to drphiliptisdall.com [http://drphiliptisdall.com] Watch the full video episode on YouTube: https://youtu.be/sJldsWiPBTY

Why Medical Students Struggle: Clinical Reasoning vs Memorization (with Dr. Nancy Selfridge & Dr. Eric Neilson)

In this episode of Dr. Tisdall Unfiltered, I sit down with Dr. Nancy Selfridge and Dr. Eric Neilson to have an honest conversation about what’s really happening in medical education—and why so many capable students struggle when it comes time to apply what they’ve learned. Together, Dr. Selfridge, Dr. Neilson and I worked to build and implement a new approach to teaching medicine—one that moves beyond memorization and focuses on clinical reasoning, structure-function relationships, and how physicians actually think in practice. In this discussion, we break down what happens when students encounter board-style exams for the first time, why “knowing the material” often isn’t enough, and how small-group, patient-centered learning reveals the real gaps in understanding. We also explore how remediation, tutoring, and teaching others can transform struggling students into some of the strongest clinical thinkers—and why the future of medical education depends on training both better learners and better teachers. If you’re a medical student, pre-med, or educator, this episode will challenge how you think about learning medicine—and give you a clearer framework for what actually matters. Be sure to follow Dr. Tisdall Unfiltered for more in-depth conversations on medical education, clinical reasoning, and how to truly think like a doctor. Clinical Pathophysiology (Edition 2) is now available for purchase! ⁠http://drphiliptisdall.com/textbook⁠ [http://drphiliptisdall.com/textbook] Watch the full video episode on YouTube: https://youtu.be/owK2izhSwLQ [https://youtu.be/owK2izhSwLQ] Follow me on social @drphiliptisdall