Most physicians recognize the importance of mastering multiple-choice questions for board exam success. These questions are a cornerstone of medical board exams and offer a reliable way to gauge your specialty knowledge.
Taking multiple-choice tests is a preferred study approach because it simulates the exam format, helps physicians identify their knowledge gaps, and improves their test-taking skills. Even more, success on practice tests can boost confidence and reduce test-day anxiety.
While multiple-choice tests are a valuable tool for preparation, it’s important to supplement them with other study methods, such as reviewing high-yield topics in current, comprehensive board review books, online resources, medical podcasts, and practicing clinical scenarios.
In a 2022 study, an Error Reflection Method (ERM) was developed to help medical students focus on ‘why’ they got an MCQ wrong rather than ‘what’ they got wrong, thereby promoting self-reflection and learning that focused on assessment.
FOCUS on ‘Why’, not just ‘What’
It’s typical to look for WHAT you missed on practice tests. However, figuring out WHY you missed it requires more self-reflection and analysis. Recall your reasoning: why did you choose the incorrect answer? Did you make any biases or assumptions? Did you use effective strategies to eliminate incorrect options?
The ideal approach is to relearn the information in such a way as to make it meaningful and memorable–to make it “stick” in long-term memory.
Five Strategies to Turn Your Errors into Triumphs
(1) Test first. Find out what you know and don’t know. While you may not feel ready to test yourself, do it anyway. It’s actually a more efficient way to learn. Focus on high-yield topics from the exam blueprint and prioritize your study efforts accordingly.
(2) Identify your knowledge gaps. Determine the topic–what subject matter was the question related to? Assess your understanding–do you have a firm grasp of the concepts involved? Identify missing information–was there any key detail you overlooked?
(3) Self-reflect and learn ‘what’ was missed and ‘why’ you missed it. Figure out what in the answer options led you astray. Re-read the question carefully. Examine the correct answer–why was it the correct choice? Analyze the incorrect options–what made them seem plausible.
(4) Retest using active recall. Test yourself regularly by using flashcards or quizzes to reinforce your understanding of the material. Avoid passive learning strategies like re-reading or highlighting, which are leas effective for long-term retention.
(5) Identify the types of errors you are making using the ERM Framework (below). Are you making test-taking errors and/or learning behavior errors? Periodically assess your testing errors so that you can take the appropriate action.
USE the ERM framework to Enhance Your Learning
The table (below) was developed as part of the ERM that medical students used to improve their self-reflection on learning-behavior deficits. Physician learners at all levels can use this to aid their learning.
Error Reflection Method
In this study of nearly 4,000 M1 and M2 students, the majority of errors were Learning-behavior errors (Types 5-9)–with the largest percentage (30%) represented by Type 7 Error, followed by Type 8 Error (< 20%).
As a result of using the ERM method, students were surprised at the number of test-taking errors they made, and their anxiety about making errors diminished.
So, how can this information be helpful to those preparing for medical specialty boards?
When you review your missed questions, use the ERM framework to analyze ‘why’ you missed the questions.
Use the ERM with daily testing or more extended monthly practice tests to assess and inform your preparation. For questions you repeatedly miss, create a flash card or a question card to record specific data about the question, the distractors and why they’re incorrect, and the answer and why it is correct.
Multiple Choice Questions Help You Prepare for Your Medical Boards
Don’t leave your board exam preparation to chance. Like many of your colleagues, dedicate a substantial portion of your study time to honing your skills with multiple-choice questions.
Remember, learning ‘what’ you missed is important but going a step further and reflecting on ‘why’ you missed it, can help prevent your making these mistakes in the future and boost your board score.
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High-stakes exams in medicine can be daunting, but there are several things you can do to improve your chances of success.
One of the best ways to prepare for medical boards is to practice on questions from online question banks (e.g., TrueLearn, UWorld, MedStudy, BoardVitals), specialty Q-banks, and specialty practice exams.
Don’t wait until you feel ready to do questions. Start testing when you begin preparing for your boards–this is the most efficient and effective approach.
Learn from your testing errors by asking two questions: (1) WHAT was my error? and (2) WHY you made the error? Both questions are necessary to ensure that you know the material and will not repeat the error in the future.
Since question banks are the most effective and efficient method of study, maximize your testing strategy by using these four steps:
(1) TEST yourself on a block of questions (topic-based or random),
(2) IDENTIFY your learning gap(s)—ask WHAT and WHY,
(3) LEARN the content that you need to understand, preferably from a current review book,
(4) RETEST—Periodically retest the questions that you miss.
The tips below provide specific guidelines on avoiding reading and interpretation errors, how to narrow the options, ten best practices for guessing, and when it’s acceptable to change answers.
1. AVOID READING & INTERPRETATION ERRORS
Short-term memory’s limited capacity and duration can lead to numerous errors when reading, interpreting, and answering test questions. Selecting a wrong answer may be due to (1) mental mistakes, (2) reading errors, or (3) cognitive biases.
MENTAL MISTAKES … long questions are more daunting to understand and process … they tax stored knowledge in long-term memory and the limits of our short-term memory capacity.
READING ERRORS … tend to occur when you try to read too quickly, skim the question, lack focus, or overlook details. Don’t assume you “get it” before you’ve read the entire question stem. Identify critical information. Pay attention to the essential content information and important parts of speech (verbs, adverbs, conjunctions, prepositions, and adjectives). Look for words that qualify or add specificity to factual statements. Search for thought-shifting words such as but, however, despite, and except.
Questions on standardized exams do not contain “filler information;” the details arenot there to mislead you. When information in the question stem seems misleading, it is because you have misunderstood it or have a superficial understanding of the concepts being tested.
Analyze the information as it is presented and make predictions as you go. Faulty reasoning occurs when the facts do not support your conclusion as they’ve been presented. The main types of faulty reasoning are circular reasoning, overgeneralization, false causality, oversimplification, and making assumptions that are not true.
COGNITIVE BIASES:
“Serial position effect” … each portion of the question (beginning, middle, end) has the potential to unduly influence your decision.
“Primacy effect” … information at the beginning of the question is better recalled.
“Recency effect” … information toward the end of the question is favored.
“Premature closure” … draw your conclusion before reading and analyzing available information. Make sure the answer you’ve selected is not just the correct answer, make sure it’s the best answer.
2. NARROW THE OPTIONS
Check each option by treating it like a true-false statement and see which options are true and false.
3. TEN BEST PRACTICES WHEN GUESSING
The GENERAL alternative … select the more GENERAL option; if more than one option is relatively general, make a random guess.
Avoid ABSOLUTES … Identify the ADJECTIVES each option includes correct responses typically do NOT include absolute statements (always, never, must, none, only).
MIDDLE of the Range … when presented with a series of numerical options, the correct response is often in the MIDDLE of the range, not at either extreme.
The DEDUCTIVE Approach … If each option represents a set of variables, FIRST identify all the variables. Next, count the # of times each variable is included in any of the options; then select as your final answer the ONE option that contains the set of variables that were included the greatest # of times in all the options.
The CLANG Association … If a word or phrase in the question stem is repeated exactly or very similarly to one of the options, select that option.
Similar and Opposite ALTERNATIVES … examine the options for the same or the opposite. If two options mean essentially the same thing, then the correct response is not likely to be one of them. The correct response is often one of two opposite alternatives.
Select the LONGEST Alternative … often, exam writers include more info in the correct response.
Avoid Question-Answer GRAMMAR DISAGREEMENT … the question and options should be in grammatical agreement. If the interrogatory is singular, the option should be singular. If an interrogatory is plural, it should not be completed with a singular option.
Make a RANDOM GUESS … select the first option after trying to rule out as many as possible. If you haven’t ruled out any options, pick A. If you’ve ruled out A, pick B. If you’ve ruled out A and B, pick C, and so on.
GUESS ONLY AS A LAST RESORT … it’s always best to use knowledge and reasoning to select the best answer and to rule out as many as possible.
4. WHEN TO CHANGE ANSWERS
Each time you change an answer, there are three possible outcomes:
-Wrong to Right;
-Right to Wrong; or
-Wrong to Wrong.
Studies show that approximately 55% of answers were changed from WRONG TO RIGHT – the preferred direction, with the remainder relatively evenly divided between the other two possibilities. WRONG TO RIGHT is about 55%, and 45% is evenly divided between RIGHT TO WRONG and WRONG TO WRONG.
Only CHANGE ANSWERS if you have an epiphany during the test and … (1) If you now realize your first guess was wrong, and you now know what the correct answer is, or (2) If you misread the question the first time.
In conclusion, practice, practice, practice until these tips are second nature and you’ve stopped any bad habits. These test-taking tips, while important, only work when you already have sufficient core knowledge of your specialty.
Reference:
Sefcik, D. J., Bice, G., & Prerost, F. (2013). How to Study for Standardized Tests. Burlington, MA: Jones & Bartlett Learning.
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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.
If you’d like to boost your performance on multiple choice questions (MCQs), here is a method to help you understand what you might be doing wrong and help you take corrective action. You’ll need some uninterrupted time to work, preferably in a quiet location, and a sheet of paper with three columns (i.e., Question #, Answers, Notation) to record all your answers and make some notations.
1. Select a set of 60 random questions from a good source(questions you have never seen before). Set a pace of one question per minute on average or 60 questions in one hour.
2. Set a timer for one hour. Practicing in a timed environment will help you develop reading fluency and reading accuracy.
3. Use an “active” reading process, not a passive one, to answer the MCQs. Try to answer the MCQs without reading the distractors–predict what the best response might be. Record your answers on the numbered sheet and make a notation next to each indicate either: I know this (KNOW), I think I know this (THINK), or this is an absolute guess (GUESS).
4. When the hour is up, do NOT score the questions. Read the explanations without knowing if you got them right or wrong.
5. Repeat the exercise taking as much time as you need–linger and reflect.
6. After repeating the exercise, look at the answers and score yourself. Do NOT determine how many questions you got correct until you’ve read the explanations. If you selected the wrong answer, you are more likely to be defensive and try to come up with excuses as to why you got it wrong. It’s better to read the explanation with an open mind.
7. Compare your scores (timed with untimed).
8. Determine how many, as well as which questions you got right and wrong within each of three categories: Know, Think, Guess. This is the point of this exercise. You need to gauge the accuracy of your metacognitive knowledge meter–when you are sure you know the answer, you want to get it right. If you guessed and you got it wrong, it’s ok. But, when you get a question wrong that you thought you knew, then you need to figure out why.
9. Note what these mistakes are, then think about what to do so you can correct this problem. Whether you got something right or wrong when you only thought you knew the answer or you guessed means that YOU NEED TO DO some focused studying in that area. It points to a weakness in your CONTENT KNOWLEDGE. Getting something wrong that you were fairly confident you knew, on the other hand, presents a bigger challenge. You need to determine exactly why you missed the question you thought you knew.
IF you were familiar with the information but had difficulty recalling specific details or make the proper associations–your challenge likely lies with the method you used to commit the content to memory (review memory techniques and study skills).
IF you misread the stem of the question, you need to enhance your reading skills.
IF you selected a correct answer, but not the best answer, you need to work on your test-taking skills.
IF you knew the correct answer but wrote down an incorrect response, you need to focus on minimizing errors during the test.
Use this procedure to identify why you are missing MCQs and learn how you can improve your test-taking skills.
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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.
