High-stakes exams in medicine can be daunting, but there are specific strategies that can meaningfully improve your performance. This article covers four areas: how to avoid reading and interpretation errors, how to narrow your options, the 10 best practices for guessing, and when it is acceptable to change an answer.
But first, a word on question banks.
Start With Questions, Not Reading
One of the most effective ways to prepare for medical boards is to practice with questions from online question banks — such as TrueLearn, UWorld, MedStudy, and BoardVitals — specialty Q-banks, and specialty practice exams.
Do not wait until you feel ready to start doing questions. Begin testing as soon as you begin preparing. It is the most efficient and effective approach available.
When you get something wrong, ask two questions:
- What was my error?
- Why did I make it?
Both questions are necessary to confirm that you understand the material and will not repeat the mistake.
Maximize your question bank strategy with this four-step cycle:
- Test yourself on a block of questions (topic-based or random).
- Identify your learning gap: ask what and why.
- Learn the content you need to understand, preferably from a current review book.
- Retest: periodically return to the questions you missed.
1. Avoid Reading and Interpretation Errors
Short-term memory’s limited capacity and duration can produce numerous errors when reading, interpreting, and answering test questions. Selecting a wrong answer is typically the result of one of three causes: mental mistakes, reading errors, or cognitive biases.
Mental Mistakes
Long question stems are more demanding to process. They tax stored knowledge in long-term memory while simultaneously pushing the limits of short-term memory capacity.
Reading Errors
Reading errors tend to occur when you read too quickly, skim the question, lose focus, or overlook details. Do not assume you understand a question before you have read the entire stem.
Identify the critical information. Pay close attention to important parts of speech: verbs, adverbs, conjunctions, prepositions, and adjectives. Look for words that qualify or add specificity to factual statements. Watch for thought-shifting words such as “but,” “however,” “despite,” and “except.”
Questions on standardized exams do not contain filler information. The details are there for a reason. When information in the question stem seems misleading, it typically means you have misunderstood it or have a superficial grasp of the concept being tested.
Analyze the information as it is presented and make predictions as you go. Faulty reasoning occurs when your conclusion does not follow from the facts as presented. The most common types include circular reasoning, overgeneralization, false causality, oversimplification, and unjustified assumptions.
Cognitive Biases
Be aware of how the placement of information within a question can distort your judgment:
- Serial position effect: Each portion of the question — beginning, middle, and 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 tends to be favored.
- Premature closure: You draw a conclusion before reading and analyzing all available information. Make sure the answer you select is not just a correct answer — make sure it is the best answer.
2. Narrow the Options
When you are uncertain, treat each answer option as a true-or-false statement. Work through them individually, marking each as clearly true or clearly false. This forces deliberate evaluation of every choice and reduces the risk of anchoring on the first plausible-sounding option.
3. Ten Best Practices When You Have to Guess
Use these guessing strategies when you have exhausted your knowledge and reasoning:
- Choose the general option. Select the more general answer. If more than one option is similarly general, make a random guess.
- Avoid absolutes. Correct responses typically do not include absolute language such as “always,” “never,” “must,” “none,” or “only.”
- Select the middle of the range. When options are numerical, the correct answer is often in the middle of the range, not at either extreme.
- Use the deductive approach. If each option represents a set of variables, identify all variables first. Count how many times each variable appears across all options, then select the option containing the variables that appeared most frequently.
- Look for the clang association. If a word or phrase in the question stem is repeated exactly or very similarly in one of the options, favor that option.
- Look for similar and opposite alternatives. If two options mean essentially the same thing, the correct answer is likely neither of them. The correct response is often one of two opposite alternatives.
- Select the longest alternative. Exam writers frequently include more information in the correct response.
- Avoid question-answer grammar mismatches. The question and the correct option should be grammatically consistent. A singular question stem should not be answered with a plural option, and vice versa.
- Make a random guess when necessary. After ruling out as many options as possible, select the first remaining one. If you have not ruled out any, pick A. If you have ruled out A, pick B, and so on.
- Guess only as a last resort. It is always preferable to use knowledge and reasoning to select the best answer and eliminate as many options as possible before guessing.
4. When to Change Answers
Each time you change an answer, one of three outcomes is possible: wrong to right, right to wrong, or wrong to wrong.
Research shows that approximately 55% of answer changes go from wrong to right — the preferred direction. The remaining 45% is roughly evenly split between right to wrong and wrong to wrong (Sefcik, Bice, & Prerost, 2013).
Only change an answer if you have a clear, specific reason: you now realize your first answer was wrong and you know what the correct answer is, or you misread the question the first time. Do not change an answer based on doubt or anxiety alone.
Practice Until It’s Second Nature
These test-taking strategies work best when they are practiced until they become automatic. That takes deliberate repetition over the course of your board preparation — not a single read-through the night before the exam.
One important caveat: these strategies are tools, not substitutes for preparation. They work only when you already have sufficient core knowledge of your specialty. No guessing strategy compensates for a genuine knowledge gap, but when you are close, these techniques can make the difference.
Reference: Sefcik, D. J., Bice, G., & Prerost, F. (2013). How to Study for Standardized Tests. Burlington, MA: Jones & Bartlett Learning.