The Question is the Problem

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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.

9 thoughts on “The Question is the Problem

  1. Another 1 of paradigm shifts for me… thanks dr. daugherty for your time that you spare to help us change our thought process through writing such insightful blogs. So, its like a chess a game i guess, where every time u play, u play a unique game. but u use your previous knowledge and experience to solve the situation. and u dont know the exact perfect move, u have to go with the best one available…

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  2. Elena

    The problem here is the test banks we have. Truly the majority of them aimed at starter level and do not have the complexity of USMLE so the actual problem is that many people get startled when they see the real questions. if you trained your memory all the way through and then asked to think – as simple as that you are not used to. Even NMBEs are retired USMLE questions as they lack the requiered complexity otherwise they would not be retired.

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  3. Ali

    Dear Dr. Daugherty
    Have you written anything on the various methods by which we get questions wrong on USMLE, I mean not reading well, lack of knowledge etc. This I am asking so that I can make an assessment as to improve along doing Q banks.

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  4. Nesie160

    Thanks Dr Daugherty, I have been having problems with nbme’s and uworld because I lacked the skills I am learning from you right now. I however am most comfortable looking at the last sentence of the question first, especially for the long questions, before reading through the entire stem because, in doing qbanks n nbme’s I have found that the questions asked may have been answered without going through the whole vignette. In your opinion, Is it ok to do this?

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    • NO, thisi s not OK. All USMLE questions go thoguht several screening processes before they go on the actual exam. One is to see if you can answer the question without reading the vingette. If you can, it does not make it onto the exam. Remember that NBME questions are availale for NBME exams because they do not meet current USMLE standards. NBMEs can be predicitve, but all the students I talk to say that they USMLE questions are a level up!

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