Who is in Charge on Your Exam?

Who is in charge when you take you exam?  Do you control you exam, or does the exam control you?

The USMLE is not only testing your content knowledge, but also your ability to problem-solve on your feet. In spite of distractions, are you able to contain your anxiety and focus on the pertinent issues before you? Do you approach each question with a confident curiosity? Or are you hoping that things will be easy; that you have seen the problem before; that you will get lucky and see a question focused on content you recently studied? Do you approach each question with quiet confidence or uneasy hope?

Success on the USMLE depends on identifying issues and thinking clearly. Yes, you must have memorized essential content. But, the exam wants more from you than a demonstration of what you have memorized. The exam wants you to show that you know how to use what you have learned.

To accomplish this you must be more than a recoding and playback device. You must be more than a machine. You must be a person who can assess, think and decide. In short, you are being tested on who you are as much as what you know. The USMLE expects you to be in control of yourself and to demonstrate that by your control of the exam.

Gaining the control you need for the exam begins with your preparation strategy. In the long process of exam preparation it is easy to lose perspective. Over the course of weeks and months it is easy to feel overwhelmed and buried under the material you must master. Once lost, you feel like you are playing catch-up, and you never quite catch up. To avoid playing continual catch-up, take charge of your USMLE preparation from the very beginning.

Begin by making decisions and taking action based on those decisions. Decide what is essential and what is lower yield. Decide what study material resonates with you and helps the content to make coherent sense. And then, plan your study to cover the material you have selected. Avoid the temptation of asking everybody else what you should do. Yes, listen to advice, but then make your own decisions as to what works for you. Be especially skeptical of advice from parents and family members who do not have first-hand knowledge of the USMLE. Family usually advises you to work hard and spend long hours at study, but they rarely can give you the critical insight about what to do with that study time.

You have to live with your exam results, so you need to take responsibility for deciding how you should proceed. Make a study plan that maps our how much time you will study each day, and then follow it! Avoid studying “every waking minute.” Treat study time like a job. Put in your time, mentally clock out at the end of the day and give yourself a chance to rest each evening. Tomorrow you must get up and do it all again. Make sure your strategy is one you can maintain long term, not just over a couple of days.

When your study turns to questions, stay in charge by avoiding excessive focus on you percentage correct. Each question is a chance to test what you know and how you think. If you get a question right, congratulate yourself on your progress. But never forget that it is the questions you get wrong that will really improve your performance on the actual USMLE. When you get a question wrong you have uncovered a deficit. Use this knowledge by taking direct action to resolve the deficit. Diagnose why you missed the question. Was it because you missed something when reading the question or because you did not know the content? If you missed something when reading, pay attention to what you miss and you will discover patterns of errors you can correct. If you did not know the content, go back to your study material and go over it again.

Don’t just react to questions, act on them. Don’t simply feel good or bad about your question results. Make use of the information you have gained and do something about it!

By making decisions all the way though your study preparation, you are not only going to do a better job of learning, you will also be teaching yourself the mental set and the self control the USMLE requires. You know how to take charge because you have learned to take change of yourself. We want doctors who have the self-control and the aplomb to handle whatever patient care issues with which they are confronted. Your final USMLE score is a much a reflection of you control of the exam as it is your memorized knowledge. Take charge of your preparation and you will take charge of your exam.

Steven R. Daugherty, Ph.D.

The Question is the Problem

What we find in life depends on what we are looking for. What we are looking for determines what will grab our attention. Nowhere is this more true than when taking the USMLE.

Many of those who have trouble with the USMLE are obsessed with “getting the right answer”. This focus is misplaced. An excessive focus on the answer misses an essential point. The key to getting the right answer is to be found in the question. The question stem presents the essential problem that you are called upon to solve, and gives you all the necessary information to solve that problem. In short, the question stem, not the options are the key to the exam.

Think of each item on the exam, not as a question to be answered, but as a problem to be solved. You are looking, not so much for an answer, as a solution. The correct mental headset for the exam is not a student trying to please an imagined professor by giving the correct answer, but a physician trying to resolve the problem presented by a patient. Sometimes you can solve the patient’s problem because you have seen it before. More commonly, you will need to think though the information presented to derive a solution that you may never have considered before.

You can look at every option and understand every detail they provide, but unless you have gathered the appropriate clues from the question stem, you will not get the question correct. Trying to answer the question without first collecting the available clues is like shooting at a target without first taking aim.

Learn to recognize your true friends and allies during the exam. The options are the enemy. The question is your friend. The purpose of the options is to fool you, to con you, to trick you into picking the wrong answer. The question stem is your ally. Only the question stem offers the key details you need to separate the wheat from the chaff and bring the best answer into clear focus.

The source of our obsession with the answers stems from our emotional response to the exam situation. Questions are aversive stimuli. We do not like questions and want to get past each one as soon as we can. In our heads our emotions scream for us to pick an answer, to get out, to escape the pain of the question. The problem is that our emotional instincts urging escape cause us to pick an option simply to exit the question, rather than have the patience to figure out the right answer. Questions are pain. Preparing for the USMLE is in part about learning to tolerate the pain of the question long enough to do the mental processes required sort out the best of the presented options.

Success comes from learning to love the question. Dive in and revel in the presented case. Read carefully. Collect the clues. Think about the problem before you. And then select the option that offers the best chance of providing a solution. Mastering this sequence is the ladder that leads to a great score and a successful exam performance.

The real challenge on the USMLE is not coming up with the correct answer, but understanding what the issues presented in the question. USMLE questions do not just ask you something, they also give you the clues you need to come converge on the best answer. Success goes, not to those who can guess the best, but to those who have the patience and mental discipline to collect the presented clues, identify the essential problem, and then reason though to the best possible solution. Look to the question and the answer will come to you. Once you fully understand the problem presented by the question stem, choosing the best answer is the easy part.

Steven R. Daugherty, Ph.D.