You made it through medical school. You survived residency. And now you are staring down a specialty board exam that feels like a different kind of test entirely — one where the study strategies that got you this far may not be enough.
You are not alone in that feeling, and it is not a reflection of your intelligence or your clinical skills. Specialty board certification exams are high-stakes, content-dense, and unforgiving of inefficient preparation. Many physicians who struggle have strong knowledge in their fields. What they are missing is a system: a plan tailored to their schedule, their learning gaps, and the specific demands of their exam.
That is exactly what an academic coach provides.
Is This You?
It is not unusual for physicians to assume their study skills are sufficient. But consider whether any of these apply to you:
You failed one of the USMLE (United States Medical Licensing Examination) Step exams during medical school.
You scored below the 30th percentile on your specialty in-training exams during residency or fellowship.
You failed your written board certification exam.
You feel overwhelmed by the volume of content and do not know where to start.
You are short on time and struggling to fit board preparation into a demanding clinical schedule.
You feel isolated, as if you are navigating this entirely on your own.
If any of these sound familiar, your current study approach may need to change. The study skills that earned you a seat in medical school or residency are often not sufficient to pass specialty boards. Working with an academic coach can make the difference.
10 Advantages of Working With an Academic Coach
1. A Personalized Study Plan
An academic coach develops a study plan tailored to your specific needs, your learning style, and the content blueprint of your specialty board exam. Rather than working through material in a generic sequence, you study what matters most, in the right order, with a realistic timeline built around your schedule.
2. Identifying Learning Strengths and Weaknesses
An academic coach helps you identify where your knowledge is solid and where the gaps are, then directs your effort accordingly. This prevents you from spending hours reviewing material you already know while neglecting the areas that will cost you points on exam day.
3. Accountability and Support
Preparing for boards over months while managing a clinical workload is genuinely hard. An academic coach provides regular check-ins, structured goals, and consistent encouragement — so that when motivation dips, and it will, you have a system that keeps you moving forward.
4. Test-Taking Strategies
An academic coach teaches you strategies that directly improve exam performance: time management during the test, how to approach complex question stems, guessing strategies, and how to manage stress and anxiety on exam day.
5. Practice Exam Assessment
An academic coach reviews your performance on practice tests and interprets the results — not just what you got wrong, but why, and what to do about it. This transforms practice testing from a passive exercise into a targeted feedback loop.
6. Motivation and Encouragement
Board preparation is a long road. An academic coach provides consistent motivation and helps you reframe discouragement when it comes. Having someone in your corner who understands the process and is tracking your progress makes a measurable difference in how you show up to study each week.
7. Peace of Mind
Working with an academic coach reduces the ambient anxiety of feeling like you might be doing this wrong. When you have a clear plan, a structured process, and an experienced guide, you can focus your mental energy on learning rather than worrying about whether you are on track.
8. Time Savings
An academic coach helps you study more efficiently by cutting through the noise: which resources to use, which topics to prioritize, and which habits are wasting your time. Every hour you spend studying more effectively is time you are not spending on a second or third attempt.
9. Cost-Effectiveness
The cost of academic coaching is modest compared to the cost of a failed exam — financially, professionally, and emotionally. Coaching is an investment in getting it right the first time, or in breaking a pattern that has not been working.
10. Long-Term Benefits
The skills developed through academic coaching — time management, goal setting, metacognitive learning strategies, and test-taking discipline — extend well beyond the boards. They become part of how you approach complex learning challenges throughout your career.
Ready to Stop Preparing Alone?
Academic coaching is well established in sports and business. In medical education, it is newer, and that means most physicians preparing for boards have never had access to this kind of individualized support.
Dr. Linda Carr’s one-on-one coaching program was built specifically for physicians navigating this process. Each 30-45 minute coaching session follows a structured agenda built around your goals, your self-assessment since the last session, and targeted instruction across four areas: how to study for medical boards, time management, test-taking strategies, and test anxiety and stress reduction. Within 24 hours of every session, you receive video and audio recordings, a meeting summary, presentation materials, and written resources to reinforce what was covered.
Dr. Carr works with physicians who are overwhelmed, short on time, frustrated with their current approach, or simply tired of going through this alone. If that describes you, a free consultation is the place to start.
Passing your specialty boards requires more than hard work. It requires the right approach. An academic coach helps you build that approach: a plan that fits your life, targets your actual gaps, and gives you the tools and confidence to walk into exam day prepared.
For physicians who have struggled, who are short on time, or who simply want to maximize their chances of success, coaching is one of the most effective investments you can make.
What separates physicians who pass their specialty boards on the first attempt from those who struggle — despite putting in equal hours? It often is not the volume of studying. It is the quality of it. High-scoring physicians have learned to study in ways that produce retention, not just familiarity. The skill behind that approach is called metacognition, and it is one of the most underused tools in medical board preparation.
What Is Metacognition?
Metacognition is the awareness and regulation of one’s own thinking and learning processes. In practical terms, it means knowing what you know, recognizing what you do not, and adjusting your approach accordingly.
Metacognitive skills include three core activities: planning your learning before you begin, monitoring your comprehension as you study, and evaluating the results afterward. Research consistently links stronger metacognitive skills to higher academic performance across medical and professional education settings.
Struggling learners tend to have underdeveloped metacognitive skills. They may highlight a passage in a review book and assume the highlighting means they have learned it. They overestimate their understanding and underestimate their knowledge gaps. Strong learners, by contrast, are more self-aware. They recognize when something has not clicked, return to it, and engage with it through multiple strategies until it does.
How Most Physicians Study for Boards — and Why It Falls Short
Most physicians preparing for boards rely on one of two approaches: reading or question banks.
Reading is the default. The assumption is that reviewing material enough times will produce retention. Repetition does help, but it is one of the least efficient learning strategies available. It creates familiarity, not recall.
Question banks are more effective because they force the learner to retrieve information rather than passively recognize it. They also identify knowledge gaps quickly. The problem is that many physicians use question banks reactively — answering questions without a systematic process for addressing what they get wrong.
The most efficient approach combines both, in a specific order: test first, then study the gaps. Start with a practice test or question bank session on a topic before reviewing it. Note what you missed. Then study those gaps directly. This feels counterintuitive, but it is faster and produces stronger retention than reading first and testing later.
10 Metacognitive Learning Strategies for Board Preparation
Learning science has identified specific strategies that develop metacognitive awareness. These are the methods that move information from short-term familiarity to long-term recall.
1. Self-Questioning
Before studying a topic, ask yourself what you already know about it, what questions you have, and what you need to learn. This creates a framework for new information and primes your brain to absorb it more efficiently. Pause periodically throughout your study session to check your comprehension consciously.
2. Retrieval Practice
Self-testing requires more mental effort than re-reading, which is precisely why it works. Testing yourself moves knowledge from short-term to long-term memory and can improve retention by up to 50% compared to re-reading alone. Practice tests, question banks, and flashcards all qualify.
3. Reflection
After a study session, take a few minutes to ask what you understood well, what remains unclear, and what you will do differently next time. Research shows that brief, structured reflection reduces anxiety and improves performance in subsequent sessions.
4. Thinking Aloud
Talk through material out loud as you study. This forces you to articulate your reasoning, which quickly reveals gaps you might miss when simply reading. If you cannot explain a concept clearly out loud, you do not know it well enough yet. Use your smart phone to create a voice memo that you can listen to when you’re exercising or driving–this is an excellent approach to master the content.
5. Notes From Memory
After reading a section, close the book and write down everything you can recall. Then check your notes against the source material. This active engagement strengthens recall and makes gaps immediately visible.
6. Graphic Organizers
Build concept maps or visual diagrams that show how topics connect. Using words and images together — a technique known as dual coding — strengthens neural connections and improves long-term retention.
7. Active Reading
Approach reading material by making connections to what you already know, asking questions as you go, and making predictions before you read the answer. Passive reading produces passive learning which doesn’t ‘stick’.
8. Spaced Repetition
Without reinforcement, studied information decays exponentially. A study plan that spaces out review over days and weeks (rather than concentrating it in a single session) locks information into long-term memory. Self-test a few days after initial study using flashcards or practice questions.
9. Interleaving
Rather than studying one topic until you have exhausted it, mix related topics together regularly. Shuffle your flashcards, alternate question bank topics, and group related concepts into clusters. Interleaving forces your brain to discriminate between similar concepts, which produces stronger retention than blocked practice.
10. Working With a Coach
Understanding which strategies work best for your learning style is not always obvious. A board preparation coach can help you reflect on what you have been doing, identify what is working and what is not, and build a targeted approach based on your specific gaps and schedule.
Three Steps for Applying Metacognition in Board Review
Research in medical education identifies three phases for applying metacognition effectively: planning, monitoring, and assessing. Here is how each one works in practice.
Planning
Before beginning to study a topic, ask:
What do I already know about this?
How will I approach studying it?
How much time will it require?
Set specific learning goals with a timeline. Use the board exam blueprint and content outline as your guide rather than the table of contents of a review book. Start with a quiz or question bank set to establish your baseline: what you already know and where your gaps are. Review the questions you missed, make flashcards or a concept map for those concepts, and retest yourself on those questions two to three days later.
Monitoring
While studying, stop frequently and ask:
Am I actually understanding this, or just recognizing it?
Can I explain this concept in detail from memory, without looking at the page?
Reading content repeatedly creates the illusion of understanding. Self-testing is the only reliable way to confirm you have actually learned something. Thinking aloud is particularly useful here — if you cannot articulate a concept clearly, you know exactly what needs more work.
Assessing
At the end of each study session, take five minutes to evaluate:
How confident am I in the material I just covered?
What went well?
What obstacles came up, and how did I handle them?
What was hardest to learn, and why?
What will I do differently in the next session?
This brief assessment closes the loop on each session and directly informs how you approach the next one. Over time, it builds a clearer picture of your patterns: where you are consistently strong, where gaps keep reappearing, and which strategies are actually working for you.
Why Metacognition Matters for Medical Boards
Board exams are cognitive marathons. Success requires more than knowing the content — it requires managing your thinking throughout months of preparation and during the exam itself.
Research in medical education shows that metacognitive skill levels vary widely among medical learners, and that few are ever explicitly taught these strategies. That is a significant gap, because the evidence is clear: learners who develop metacognitive skills perform better academically, retain more over time, and adapt more effectively when they encounter unfamiliar material.
The good news is that metacognition is a learnable skill. It does not require more hours of studying. It requires more intentional ones.
Medicine is embracing AI in a wide-ranging way, with applications that touch nearly every aspect of healthcare.
Here are some of the key areas where AI is making a difference:
improved diagnoses,
drug development,
personalized treatment,
and remote patient care.
In practical terms, a doctor using an AI assistant can analyze a patient’s medical history, identify potential risks, and suggest treatment options. The doctor can then use this information to make a more informed diagnosis.
Benefits of AI
Artificial intelligence (AI) is making computers good at things that usually require human intelligence.
Here’s a breakdown:
Learning and problem-solving
AI systems can analyze data, identify patterns, and use that knowledge to tackle new problems. For example, an AI system analyzing medical scans might be able to detect abnormalities with higher accuracy than a human radiologist.
Automation
AI can automate tasks that are repetitive or require processing large amounts of information. Think of chatbots answering customer service questions or recommendation algorithms suggesting products you might like.
Decision-making
AI can be trained to make decisions based on complex data sets. For instance, an AI system might be used to assess loan applications or predict fraud risk.
The Role of AI in Board Exam Preparation
AI isn’t about robots taking over the world. It’s about using computer power to enhance human capabilities in various fields.
Here are a few examples of the ways AI can assist physicians during board preparation:
Knowledge Access and Organization
• Search and summarize: AI can quickly trawl through vast amounts of medical literature and educational resources to find relevant information on specific topics or answer focused questions.
• Compile study guides: Tell AI the specific board you’re studying for, and it can help compile a study guide by summarizing key concepts, highlighting high-yield topics, and providing links to credible sources.
Practice and Assessment
• Generate practice questions: AI can create multiple-choice, short-answer, and case-based questions similar to those found on board exams. It can tailor the difficulty level to your needs.
• Provide explanations: After answering practice questions, AI can explain the correct answers and the reasoning behind them, highlighting common mistakes to avoid.
• Identify knowledge gaps: By analyzing your performance on practice questions, AI can pinpoint areas where you might need to focus your studying.
Additional Benefits
• Time management: AI can help you create a personalized study schedule that optimizes your time and ensures you cover all the necessary material.
• Stay up-to-date: AI can inform you of recent medical advancements and guideline changes relevant to your board exam.
An AI app that I frequently use is Google Gemini (released on February 8), the new umbrella name for all of Google’s AI tools. Head over to the Gemini website and use the AI there in the typical way you interact with an online chatbot. You’ll be amazed!
The AMA ChangeMedEd initiative and the University of Michigan DATA-MD team have developed a seven-part online learning series that introduces learners to foundational principles in artificial intelligence (AI) and machine learning.
Artificial intelligence is having a major impact on the world, the field of medicine, and medical education. While AI can be a valuable tool for many things, it’s crucial to remember that it cannot replace traditional study methods or guarantee success on the boards. For comprehensive exam preparation, you should utilize a variety of resources.
Looking For Board Preparation Support?
Has preparing for your medical specialty boards left you feeling overwhelmed, frustrated, or alone? Do you feel lost, not knowing how to study to maximize your learning and retention? Have you done everything right and failed your board exams?
I’m Dr. Linda Carr, a medical educator and learning coach, and I provide expert one-to-one coaching for medical specialty boards. I understand the struggles of board prep, and my tutoring can guide you toward becoming board-certified.
But don’t just take my word for it. My coaching program is loved by physicians like you.
“I had failed my pediatrics boards 6 times! I did everything – but what I was missing was Dr. Carr. The year I got her assistance, not only did I pass but my score jumped up 20 points!” PEDIATRICIAN IN CALIFORNIA
Ready to regain your confidence with customized medical board exam preparation?
It is not unusual for medical learners—at all levels of the learning spectrum—to spend all their time studying, mostly reading and testing, without recalling what they learned, resulting in little retention. This is a mistake that you can easily rectify.
Two Ways to Make Reflection a Part of Your Daily Board Preparation Make reflection a regular part of your daily study regimen by making it a habit to reflect on your learning as you study, especially:
(1) At the end of the day, ask yourself: What were the key things I learned? What went well? What challenges did I encounter? How can I improve my study tomorrow?
Take a few minutes to record a voice memo on your smart phone explaining key concepts or answering practice questions (especially ones you struggle with). Then, listen to these recordings while commuting, exercising, or doing other activities—essentially creating your own personalized audio study guide. This process forces you to articulate your knowledge and identify areas that need improvement.
(2)At the end of the week, solidify your learning and boost long-term memory by going beyond a simple skim. Dive deeper by revisiting key learning points, re-examining missed questions,and even those you guessed correctly. Analyze these questions to identify areas for improvement and solidify understanding. Most importantly, actively seek connections between the different topics you covered throughout the week. This process of weaving knowledge together strengthens your grasp of the material and unlocks its broader applications. Make this reflection and consolidation activity a consistent part of your weekly preparation; it’s an investment that will pay off in the long run!
Why Reflection Aids Learning and Retention Many benefits result from reflection. In truth, reflection encourages a better learning experience because:
(1) it encourages learners to take charge of their learning; reflection invites them to become more engaged in their learning accomplishments and struggles;
(2) it builds stronger connections between learning experiences; reflective learning fosters learning-by-thinking, which can help learners develop critical thinking skills and improve their future performance.
John Dewey, an American philosopher, psychologist, and educational reformer, was a highly influential figure in the field of education, particularly for his emphasis on learning by doing and experiential learning.
Dewey’s quote: “We do not learn from experience. We learn from reflecting on the experience” highlights the importance of reflecting on experiences to gain true learning. Just going through something isn’t enough. We need to take time to analyze, understand, and draw meaning from those experiences to solidify our learning and apply it to future situations.
Dewey believed this reflection was a crucial part of the learning process. By actively thinking about our experiences, we can identify patterns, solve problems, and develop new knowledge. This reflective approach is still a cornerstone of many educational philosophies today.
In his research, Chang (2019) found that reflection-in-learning is necessary for learners to revisit what they have learned for improvement and for in-depth learning. It gives students an opportunity to document their learning journey and provide references and suggestions for future student
Through reflection, learners become accomplished at recognizing that they are learning and building skills continuously” (Helyer, 2015, p. 23).
Make reflection a high priority in your board preparation to encourage a superior learning experience.
“No one is born with skill. It is developed through exercise, repetition, and a blend of learning and reflection that’s both painful and rewarding. And it takes time.”–Twyla Tharp
Visualization is a powerful tool for learning, engaging your brain in a way that can spark deeper understanding and memory retention. But visualization isn’t just about seeing–it’s about engaging all your senses. Visualization offers a multisensory feast, engaging not just the eyes but also the mind and body.
Here are 3 learning strategies based on visualization:
1. CONCEPT MAPPING: This strategy involves creating a visual representation of relationships between ideas or concepts. You can use diagrams, flowcharts, or mind maps to show how things connect to each other. This can be helpful for understanding complex topics and identifying key relationships.
2. VISUAL NOTE-TAKING: Instead of taking traditional linear notes, try drawing what you’re learning. This could include using diagrams, sketches, or even doodles to represent key ideas. Visual note-taking can help you to focus on the most important information and remember it better than traditional note-taking methods.
3. MENTAL IMAGERY: This strategy involves using your imagination to create mental pictures of what you’re learning. This can be helpful for remembering details, understanding processes, and making connections between different ideas. For example, if you’re trying to learn about the water cycle, you might imagine water evaporating from the ocean, rising into the clouds, and then falling back to earth as rain.
There are many other ways to use visual aids to improve your learning. Experiment with different techniques to find what works best for you.
Here are some additional tips for using visualization for learning:
Use colors and shapes to highlight important information.
Keep your visuals simple and clear.
Label your visuals so that you can easily understand them later.
Review your visuals regularly to reinforce your learning.
Overall, visualization can be a valuable tool for many learners, but it’s not a universal magic bullet. The effectiveness depends on individual learning styles, the complexity of the material, and the quality of the visualization itself.
Here are some additional tips for using visualization effectively:
START SIMPLE: Begin with basic visualizations and gradually increase complexity as you get comfortable.
MAKE IT PERSONAL: Use imagery that is meaningful and relevant to you.
ENGAGE MULTIPLE SENSES: Combine visual imagery with other sensory details, such as sounds or textures.
PRACTICE REGULARLY: The more you use visualization, the better you’ll become at it.
Visualization as a learning tool has its strengths and limitations, and its effectiveness can vary depending on individual learning styles and preferences. Here’s a breakdown:
Strengths:
Enhances understanding: Visualizing concepts can make them more concrete and easier to grasp, especially for abstract or complex topics.
Improves memory: Creating mental imagery can strengthen neural connections, leading to better recall and retention of information.
Boosts engagement: Visualization can make learning more active and immersive, increasing motivation and focus.
Limitations:
Individual differences: Not everyone learns best visually. Some learners may prefer auditory, kinesthetic, or other learning modalities.
Requires effort: Effective visualization takes practice and concentration. It’s not a passive learning strategy.
Dependence on prior knowledge: Building mental models requires some understanding of the underlying concepts first.
Remember, the best learning approach is often a combination of different strategies. Experiment with different techniques and find what works best for you!
Visualization isn’t a magic wand, but it’s a powerful tool in your successful learning arsenal. It clarifies your vision, ignites your motivation, and trains your mind for victory. So, close your eyes, paint your dream onto the canvas of your imagination, and step into the future you desire. Remember, seeing is believing, and believing is achieving.
Start visualizing your goals today and watch your journey to success unfold with newfound clarity, motivation, and an unshakeable belief in yourself. Remember, the future is yours to craft, and the first step is seeing it vividly before your mind’s eye. So, see it, believe it, and achieve it!
__________
Linda L. Carr, Ph.D., Founder/Principal at Coaching for Medical Specialty Boards, is a medical educator and learning specialist who coaches physicians preparing for specialty boards through virtual, one-on-one coaching. Visit www.DrLindaCarr.org to learn more about Linda and her program, her clients’ success, and download her FREE Study Guide.
You can do several things before you begin to read a journal article or a textbook that can increase your reading comprehension. Using this strategic approach for reading may take a little longer, but it will be well worth your time. Here are ten suggestions to optimize your learning while you read:
1. Look at the objectives and/or the headings and ask yourself what you know about that content.
2. Reflect on your prior knowledge … what do you already know about these topics? What do you not know? Spend time here … don’t rush.
3. Look at the tables … what does each tell you? Read the captions. What questions do you have?
4. Look at the figures… what do they tell you?
5. Connect the informationbetween the tables, figures, and diagrams. What do they tell you? Tie the tables, figures, and diagrams back to the text.
6. Go to the end of the article (or textbook) and answer the quiz questions (if there are any). Cover the answers, guess what the distractors might be. Identify your learning issues.
7. Ask yourself what’s missing – what is NOT in the material? Then, read the article (or book).
8. Close the article (or book).
9. Make a mind-map (or concept map) of all you remember. DO NOT REFER TO THE ARTICLE. Keep forcing yourself to use alternative memory techniques (visualization, photos, graphs, personal associations).
10. Checkthrough the material and fill in important information that you missed (use a different color of ink). Then, do another mind-map, from memory.
You can improve your reading comprehension by experimenting with these ten suggestions. If you practice reading in this step-by-step manner and make it a habit, your learning will be more meaningful and remembered longer. This method can definitely help make the content “stick”, and that’s the result we need.
________
Linda L. Carr, Ph.D., Founder/Principal at Coaching for Medical Specialty Boards, is a medical educator and learning specialist who coaches physicians preparing for specialty boards through virtual, one-on-one coaching. Visit www.DrLindaCarr.org to learn more about her program and download her FREE Study Guide.
Have you ever wondered what physicians with the highest board scores do differently when they study?
Physicians with high-pass scores have developed effective ways of learning and have mastered a skill called metacognition–learn what it is and how you can use it to your advantage on medical board exams.
Many physicians spend most of their time reading to prepare for their medical boards. The assumption is that they can pass their boards if they read the material enough times. While repetitively reviewing content does help us learn, there are deeper learning strategies that help us remember content when we study.
Other physicians rely on question banks to prepare for their boards. With this method, you can more easily discover what you know and don’t know. You can also learn a lot by studying the question item distractors, and testing helps identify learning gaps, which call for further study.
A more desirable approach to preparing for medical boards is to use a combination of self-testing and reading. However, the order in which you do these tasks is important. You should test first, then study your learning gaps (questions you missed or don’t thoroughly understand). This may be counterintuitive, but it saves time and energy and is more efficient and effective.
But what else can physicians do to maximize their learning and retention when high-stakes exams are in the future?
METACOGNITION MAKES LEARNING VISIBLE
As stated, metacognition is understanding your own thinking and learning processes. Metacognitive skills include planning your learning, monitoring whether your current learning strategies are successful, and evaluating the results of your learning. Both content knowledge and metacognitive skills are essential for effective learning. Research shows that improving your metacognitive skills is associated with increased academic performance.
Weak learners tend to have underdeveloped metacognitive skills, leading to overconfidence in understanding the material. Weak learners may passively highlight a passage of a review book and believe that the highlighting means they will remember the content. They may also need to pay more attention to their time to study and review complex concepts.
On the other hand, stronger learners are more self-aware and recognize when they don’t know the material. They ensure they return to it and review it in various ways, using effective learning strategies.
Over the last three decades, learning science has identified specific strategies to help learners develop an awareness of their thinking processes as they learn. These techniques allow them to focus with greater intention, reflect on their existing knowledge versus information they still need to know, recognize errors in their thinking, and develop practices for effective learning. These strategies are called METACOGITIVE LEARNING STRATEGIES—practically speaking, it’s how people learn.
WHAT LEARNING STRATEGIES ARE INVOLVED IN METACOGNITION?
Metacognitive strategies help learners analyze the material they’re studying, reflect on their learning, and direct their work. Examples include:
Self-questioning –before you study a specific topic, ask yourself what you know about it already, what questions you have, and what you hope to learn—this provides a context and a framework for new knowledge; it also involves pausing throughout a task to check your thoughts and actions consciously; self-questioning is critical to effective learning.
Testing yourself (or retrieval practice) –self-testing requires more mental effort than rereading. It helps move knowledge from short-term to long-term memory and helps you remember up to 50% more than you would with re-reading alone; other methods include practice tests and flashcards—methods that ask you to assess your knowledge and check if it’s correct.
Reflection – research has shown that reflecting on what we do (and do not) know, what we need to learn, and the most appropriate learning approach to use; can occur during or following a task; it can reduce anxiety and stress levels while boosting our results.
Thinking Aloud – talk through your material; this encourages learners to reflect on what they are doing, think about how well they are doing it, and identify any areas that could be improved; learners can be proactive about identifying problems and correcting them.
Taking Notes from Memory – engage actively with the reading material by pausing periodically to summarize what you read from memory; this strengthens your recall, which increases your chances of remembering and understanding the material.
Graphic Organizers – create concept maps or graphic organizers to visualize material and see the connections between various concepts; words and images constitute dual coding, which strengthens neural connections in the brain.
Active Reading Strategies – good readers make connections to prior knowledge and make inferences and predictions, which require constant attention and a questioning mindset.
Figuring out how you learn – to better understand what learning strategies work best for you, make an appointment with an academic coach to reflect on what you have been doing and figuring out what works best for you.
Spaced repetition – an effective study plan spaces out your information strategically to secure knowledge into your long-term memory; without reinforcement, studied information will decay exponentially; follow-up your study by self-testing a few days later using practice tests or flashcards.
Interleaving practice – mix up related topics as opposed to studying them in a blocked fashion; mix up your flashcards, question bank exercises, and review topics by grouping things into clusters of topics; commonalities and differences across topics will appear through interleaving practice.
3 WAYS TO INTEGRATE METACOGNITION IN BOARD REVIEW
Changing one’s approach to board preparation is not easy. Still, the effort can be worth it when you realize the benefits—greater comprehension and retention of material and improved medical board scores.
Metacognition is gaining attention in the medical education research community. However, studies show that the use of metacognition among medical learners varies greatly and that few learners are explicitly taught metacognitive skills. Put simply, there are three steps for applying metacognition: planning, monitoring, and assessing.
PLANNING
Planning sets the stage for effective learning. Ask yourself: “What do I already know about this topic?” “How will I prepare to study it—what learning strategies will I use?” “How much time will I need?” Set learning goals with a timeline. The online board exam blueprint and the content outline can serve as a guide. Rather than start reading a review book, take a quiz to determine what you know/don’t know about this topic. Review the missed questions—make flashcards or a concept map to aid your learning. Retest on questions you missed in two to three days. Continue to review your learning gaps using a variety of learning strategies (listed above).
MONITORING
As you study, frequently stop and ask yourself: “Am I on the right track?” “Do I understand the material (i.e., can I explain it in detail from memory)? Reading content repeatedly gives the illusion that we know the material, but only when we test ourselves do we know for sure. Thinking aloud can help identify your learning gaps.
ASSESSING
At the end of your study, ask: “How confident am I that I understand the material?” “What went well?” “What obstacles did I encounter, and how did I/can I work through them?” “What was easiest for me to learn?” Why?” “What was most challenging for me to learn?” “Why?” “What will I do differently tomorrow?”
Medical boards are cognitive marathons. Achievement on board exams extends beyond cognitive skills; it also requires managing one’s thinking. Metacognition fosters excellence in learning because active learning strategies are robust, easily accessible, and broadly applicable. As medical knowledge continues to expand, metacognition is increasingly recognized as an essential skill for doctors to develop to enable them to identify their own learning needs and expand their academic potential.
__________
Linda L. Carr, Ph.D., Founder/Principal at Coaching for Medical Specialty Boards, is a medical educator and learning specialist who coaches physicians preparing for specialty boards through virtual, one-on-one coaching. Visit www.DrLindaCarr.org to learn more about her program and download her FREE Study Guide.
Learning is a multi-step process of increasing cognitive complexity.
This information is useful to know because questions used on national boards generally require higher-level reasoning. Bloom’s Taxonomy of the Cognitive Domain, revised by Anderson and Krathwohl in 2001, includes six categories. It begins with the simplest level (REMEMBER) and concludes with the sixth, and most complex, level (CREATE).
As you study for your boards, stretch your learning to include higher level thinking (i.e., analyzing, evaluating, and creating).
Here’s what you need to know about the six levels of learning:
Level 1 – REMEMBER
Learners are able to recall a wide range of previously learned material from specific facts to complete theories. But, this level merely requires bringing to mind the appropriate information.
Learners apply their knowledge by using it in another familiar situation from the one in which it was learned. The application may include rules, methods, concepts, principles, laws, and theories.
Learners analyze when they break information into parts to explore understandings and relationships in an attempt to identify evidence for a conclusion.
Applying the Six Levels of Learning to Your Board Exam Preparation
Because questions used on national boards rely on critical thinking, make sure that you include the full spectrum of learning that includes taxonomy levels 4 through 6.
When you think actively about the material (using critical thinking), you process the ideas more thoroughly and construct extensive cognitive networks connecting new ideas together and linking them to what you already know.
Remember that you do not learn much just by reading, memorizing, and recalling material. You must “activate” your learning by talking about it, writing about it, relating it to past experiences, applying it to your daily life—in short, making it part of yourself.
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