Along with expanding your knowledge as you prepare for your exam, you should also take some time to improve you question-answering skills. The basic skills for answering multiple-choice questions are not difficult to describe, but require practice to master.  When confronting an exam question your main tasks are: read the question accurately, think as you are reading the question, and force yourself to make a choice among the options provided.  Of these tasks, learning to think as you read the question requires the most practice.

Each test question is composed of two parts: the Question Stem and the Answer Options.  Most students feel the urge to get to the answer options as soon as possible.  This is understandable. Questions are “aversive stimuli.” They invoke negative emotional reactions such as uncertainty and anxiety.  To avoid these emotions most people want to get rid of each question as soon as possible.  Answer options represent escape, and thus the route to feeling better.  The problem is, in your haste to get rid of the question, you may settle for any option rather than searching for the best option.

The answer to each question is to be found in the question stem, not in the options.  For the USMLE, every option seems reasonable.  Looking at the options is often more a source of confusion than clarity.  There are few clues in the options to help you choose among them.  The information you need to make a choice is in the question stem, and that is where the majority of your time and attention should be spent.

Every question on any USMLE is answerable by an expert in the field with no options presented.  So first, try answering the question without reference to the options at all.  To train yourself to do this, take a piece of paper and cover the options so you cannot see them.  Then read through the question.  Start at the first line, paying careful attention to the important demographic information it will often contain.  When you come to the end of the first sentence, stop briefly, and tell yourself what you think is going on. Call to mind pertinent knowledge.  Tell yourself where you think the question is going.  And then, with these thoughts in hand, read the next sentence of the question.  Continue this process until you have read the whole question stem, stopping at every period to tell yourself what is happening in the question.

This technique prods you to think and not merely to read without comprehension.  When you get to the end of the question stem you will find the actual question you are to answer.  If you have read the information provided for you in the question stem, you should now have a reasonable guess as to what the answer should be.  Now, and only now, take a look at the options provided.  By first focusing on the question stem, you should now be fully equipped to select an option that has a high probability of being the best of those presented.

USMLE items are not so much questions to be answered as problems to be solved.  The correct process for handling each question is not Read, then Answer, but Read, Think, Answer.  Training yourself to focus on the question is really a process of training yourself to think.  Your best score will come from practicing this simple sequence until your cognitive desire for the best answer can overcome your emotion desire to escape.

Steven R. Daugherty, Ph.D.

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