How I Set the Curve at a Top Medical School

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In the world of study strategies and student optimization, we often focus on acquiring the proper knowledge for high test scores. Spaced repetition, active recall, all that fun stuff. But have you noticed that when you and your study partner study the same material using the same study strategies, one of you can score much higher than the other? This often comes down to test-taking strategies.

As I’ve spoken about in a previous post, there are three domains that determine your student performance: memorization, critical thinking, and test-taking skills. No single factor in isolation will earn you stellar grades in class. But by assessing and addressing your weaknesses across these domains, you’ll be in a much better position. Let’s focus on test-taking skills.

 

Assessing Your Deficits

The first step in improving your test-taking strategies is assessing your strengths and weaknesses academically.

If you find yourself forgetting what you studied on test day, then this likely points to deficits in your study strategies, which we’ve discussed extensively on the blog.

Alternatively, if you find yourself blanking out or freezing during tests, this can point to mismanaged test-taking anxiety. Understand per the stress-response curve, some amount of stress is actually helpful in your performance on the test. However, if your self-talk is not serving you, the elevated sympathetic nervous system response can be interpreted in a limiting rather than empowering frame.

If you find yourself running out of time on tests, then you need to use practice questions to dial in your pacing and become more adept at thinking clearly and decisively with time constraints.

If you’re missing more multiple-choice or essay-based or problem-solving questions, see if you can understand the pattern as to why. Here’s how this helped me. In college, I majored in neuroscience, and in Neuro M145 with Dr. Chandler, we spent the entire course covering all the nuances and forms of action potentials. Nothing else — just action potentials. I had already been accepted into my top choice medical school and senioritis had set in hard, so I barely studied for the test. But to my surprise, I still scored the second highest on our midterm. One of the questions worth several points that most people missed was a question where we had to use our understanding of previous concepts to synthesize principles to a novel situation. I also took Psych 118, Comparative Psychobiology, known to be one of the easiest classes that fulfilled my major requirements, and because of seniorities, again I hadn’t studied much. No worries, it’s supposed to be an easy class. But on my midterm, I got a B! Unlike the neuroscience essay based test, this test was almost purely memorization.

This helped me identify weaknesses and guide my studying moving forward in medical school — I understood that memorization didn’t come naturally to me, and it required a more targeted approach. On the other hand, novel problem solving was something I could spend less time on.

Any time you receive your prior quizzes or tests back, don’t simply focus on what your score is. Rather, go through the test and see what you got wrong and understand why you got it wrong. Are there patterns of what you tend to get correct or incorrect? What about when you miss a question — is it a silly mistake in you not reading the question stem properly? Maybe you missed a key modifier like “except” or “not”. Identify your problem areas related to the content, types of questions, timing, memory, and problem-solving to guide your future studies.

 

How I Attack Tests

When approaching a test, I don’t have a simple-to-learn and easy-to-digest formula that helps me navigate each question. The strategies I employ are the culmination of 2 decades of schooling, and it’s all a bit interconnected and jumbled.

Mindset

First and most fundamentally is my self-talk. If I approach a test with confidence and a positive mindset, believing I’ll do well, then I’m much more likely to score highly. On the other hand, if I have a bad feeling about it and am worried about my performance, my score usually suffers.

If you struggle with your self-talk, there are 3 strategies to consider. First, improve your preparation. If you’re better prepared and know you’ve put in the time and effort, it’s much more natural to transition to positive self-talk. Second, approach the test as a game or a challenge for you to prove yourself. It can be adversarial, meaning you versus the test, or it can be a fun game where you can see how well you do — maybe even a bit of friendly competition with your friends to see who can do best. And third, when you catch yourself in limiting self-talk, challenge it directly, and ask yourself some simple questions. Is this self-talk serving me? Do I believe that I can do well on this test? Does this test even know who I am or what I have in store for it?

Multiple Choice Questions

When approaching a multiple-choice question, there are a few strategies to consider. First, if it’s a long question stem, such as what you’d find on USMLE Step 1, I’ll go to the last sentence of the question stem and then read the answer choices. This helps guide me with regards to what to focus on and buzzwords to be on the lookout for.

After reading the question and answer choices, I cross out answers that I know are wrong — it’s important here to only cross out choices I can truly rule out.

When I get stuck between two answer choices, and I acknowledge either can be correct, I ask myself which one is more true. Which answer choice has a stronger case for it, and which can I imagine the professor explaining to be the right answer? I will also ask myself, “for this answer choice to be true, what else must be true?” For any given answer choice to be true, a series of assumptions must be made that are congruent with that answer choice. This helps me narrow down the correct choice based on the plausibility of its associated assumptions.

Another useful tactic is to extrapolate the extremes. This strategy is usually most appropriate for science questions, such as math, physics, cardiology, and the like. Let’s say I’m between two answer choices, with one answer choice saying Factor X causes a 10% increase in cardiac output, and the other saying Factor X causes a 10% decrease in cardiac output. If the relationship between Factor X and cardiac output isn’t readily apparent, I’ll extrapolate the extremes — in other words, if Factor X was blown up in magnitude, would it be more likely to cause a 1,000% increase or decrease in cardiac output? This helps me more clearly identify the directional relationship.

Science Problem & Essay Questions

For your science tests, the professor will often give you at least partial credit when you show your work. In these instances, err on the side of showing too much work rather than not enough.

If you see a question that was similar to a practice question — let’s say you’re using the same equation in projectile motion in physics, then think back to what mistakes or traps you have fallen for. Maybe you forgot to convert units in the past — don’t make that same mistake now on test day. In fact, you may even find it helpful to write out a reminder on your piece of paper saying “Do not forget to convert units!”

Changing Your Answer

Some say to always go with your gut and never change answers unless you are 100% sure that the new answer choice is the correct one. I don’t necessarily agree with this. If I come back to a question and I remember something new or have a different way of thinking about the problem, then I’ll reassess my answer choices and go with what I feel is the best choice at that moment, regardless of what I had chosen previously. More often than not, this results in me changing to the correct answer.

What you should not do, however, is change your answer without having a good reason to change it. This often results in you choosing an incorrect response.

Standardized Exams (SAT, MCAT, USMLE)

For standardized exams, you should have done hundreds if not thousands of practice problems before test day. This will give you an idea of what the key concepts are on the test, the way the test makers will ask you questions, and the possible ways that they can trap you. Sometimes students get too trigger happy in calling something a trap — sure, their professor may have used that tactic as a trap on a class exam, but it would be incredibly unlikely to occur on the MCAT. Being able to accurately assess this will come from experience, most readily through a high volume of practice questions and practice tests.

A simple yet shockingly effective tactic I used was to try to think like the test maker. I’d ask myself, “If I made this test, what would I be testing here?”. This helped me align with the mindset of the test and more clearly see what I was being tested on and what was expected of me. This tactic alone propelled my standardized test scores dramatically.

 

Distilling the various test-taking strategies I’ve used over the years for this post was surprisingly difficult, and the result wasn’t as cleanly cut and organized as my other posts. Part of it is because we don’t explicitly talk about or describe these strategies, and part of it is we aren’t taught these things — we learn them over time through intuition, experimentation, and feel. What I’ve found most helpful in teaching effective test-taking strategies is to work with my students 1-on-1 with individualized tutoring. That way, we can go over questions together, and we can go through their thought process, step-by-step, and I can precisely point to where they went astray and how their thought process could be tightened up. If you want to work with me or another top-scoring physician who crushed the MCAT, USMLE, and other tests, visit Our Services page to find the area of Tutoring that’s right for you.

If you enjoyed this post, you should also check out my post on the good, bad, and useless of study strategies. Much love to you all!

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