You have been taking high-stakes exams your whole life, and here you are studying for the boards in preparation for the Board Certification or Maintenance of Certification exam, just as nervous as ever. That’s natural! Failing the exam can have repercussions, and you don’t want to have to retake it.
Unfortunately, many learners, at all levels, have misconceptions about learning and do not prepare effectively. Most of us don’t know which learning methods are most effective, and we often prepare for exams using inefficient learning strategies.
Mistaken Beliefs About Learning When Studying for the Boards
Many people have a poor understanding about what leads to success in learning and remembering knowledge and skills. These beliefs are not harmless; faith in them can lead to failure.
1. Believing that being good at a subject is a matter of inborn talent rather than hard work
Have you always been strong in certain topics? Do you tell yourself that your success is a result of your inborn intelligence and natural skill? Conversely, have you told yourself you’re just “bad” at something and no matter what you do, it will always be hard for you? Well, this line of thought is hurting your ability to learn and improve your performance. Studies show that people who think that ability is innate tend not to work hard or persevere. In fact, a growth mindset (the belief that intelligence is not fixed and can be developed) is a comparably strong predictor of achievement.
2. Assuming that learning is fast
With the limited time you have around clinical and personal obligations, it would be nice if learning new things (and reminding yourself of things you once knew by heart) were a quick process. However, if you want to understand the learning material and remember it, you need to be prepared to spend some time on it — and go back to it again and again.
In one of our interviews with Ulrik Christensen, founder and CEO of Area9 Learning, our adaptive-learning technology partner, we asked, “Does NEJM Knowledge+ enable physicians to spend less time preparing for their medical board review exams?” He answered:
No, adaptive learning is not magic, and this is a very important thing to understand.
Broadly speaking, people need to study much more than they think they do. To a physician who is under pressure because of an upcoming board exam, an adaptive learning system may feel like more work than a traditional study method because the system will be better than they are at identifying what they don’t know and need to study more. But, if adaptive systems don’t make people study harder than they otherwise would, I don’t think they would work very well.
3. Thinking that knowledge is composed of isolated facts
Weaker learners try to memorize items independent of their relationships with interrelated concepts. Reading through a textbook underlining important nuggets may make you feel like you’re learning, but looking over those terms later will not help you synthesize information coherently — and will not be useful in retrieving knowledge in the real world.
Robert Bjork, PhD, a well-known expert on learning and memory, wrote that “it is important to remind ourselves of some of the ways that humans differ from man-made recording devices. We do not, for example, store information in our long-term memories by making any kind of literal recording of that information, but, rather, by relating that new information to what we already know…and the retrieval of stored information is a fallible, probabilistic process that is more inferential and reconstructive than literal.”
4. Believing that multitasking is easy, especially during class or studying
Focusing on two or more tasks at a time is a fact of life, but believing that you can do more than one thing at a time effectively is a myth. You may convince yourself you have both read up on the contraindications for a new medication and listened to your mom berate you for not calling often enough at the same time, but neuroscience studies show that your brain was in fact switching back and forth between these two tasks, and you are likely to have missed important information in the meantime. Nancy K. Napier, PhD, in Psychology Today says, “That start/stop/start process is rough on us: rather than saving time, it costs time (even very small micro seconds), it’s less efficient, we make more mistakes, and over time it can be energy sapping.”
Sadly, believing in the multitasking myth has even led to medical errors.
Bad Decisions in Prepping for the Exam
The reality is that you have a limited amount of time to prepare for your exam, so it makes sense to have a plan of attack. Don’t fall into the following traps, and you’ll have a better chance of success when studying for the boards.
5. Relying too much on your instructors to prepare you
Our brains acquire and retain knowledge best under certain conditions: when we need the knowledge at that moment in time and when the new information has context. The majority of learners who are taking courses to prepare for the boards and residents taking their assigned roster of courses assume that if they attend class, listen and take notes, look over the study guides instructors have handed out, and so on, they will be ready. Textbooks, handouts, study guides, and slide decks can be a great starting place, but just being present and reading over the materials is not enough to guarantee that you will do well on the exam. If you are committed to succeeding, you need to take responsibility for ensuring that you truly understand the material.
6. Not leaving enough time to study
It may seem like the best strategy for success would be some concentrated cramming sessions close to exam time, but with the scope of knowledge you need to commit to memory so large, it is likely you will underestimate the amount of time it will take to review all the material. Given that you’re a busy person, you’re going to want to hold at least some of that knowledge in your long-term memory, and that means not forgetting what you learned at the beginning of your study sessions. Repeated studies have shown that spaced repetition is the most effective method for retaining learning over the long term.
7. Studying in an arbitrary, rather than priority, order
You can’t know exactly what’s going to be on the exam, but the boards do publish blueprints showing what portion of the exam will be on the various topics (e.g., cardiology 14%, primary ethics 2%, etc.) as well as (for the Internal Medicine board exam) which tasks (diagnosis vs. treatment) are more likely to be tested on for a given topic. So it would be better not go down the list of topics alphabetically but to use study materials that are proportional to what’s covered on the exam — and to focus your attention on the highest priority items.
8. Wasting time reinforcing your strengths
It is a common error to believe you know more than you do; this mistake arises from ignorance rather than arrogance. Psychologists have shown that one of the main differences between strong and weak learners is that the latter have poor metacognition. Many learners gravitate toward reviewing and even testing themselves on subjects they already understand rather than delving into topics they are not sure they know very well or at all. For example, NEJM Knowledge+ gives you the option of choosing which subspecialty module you want to do first, and allows you to switch between modules at will. Would you start with the module you are most comfortable in or with a module you know you are going to answer most questions wrong at first? People tend to like doing what they are good at; it makes them feel confident and sure of themselves. The problem is, you really need to learn in the areas you are least comfortable with or you will run out of time to tackle the problems that you find difficult.
9. Using passive study strategies
The most common method of studying for the boards is reading, reinforcing your knowledge through repeatedly reminding yourself of the information you have to remember. It is also the most passive method and leads to poor memory retention. Henry Roediger and Jeffrey Karpicke, psychologists at Washington University, found that, “Relative to testing, repeated studying inflated students’ confidence…even though repeated-study subjects actually showed much poorer retention on delayed tests.” Which brings us to…
10. Not testing yourself on the material
As Roediger and Karpicke wrote in their 2006 research article in Psychological Science, “Testing has a powerful effect on long-term retention.”
The testing effect is real. Dozens of studies show that you will recall 50% more of learned information by testing yourself than by using the same amount of time to study (for example, one research team found a score difference of 67% with testing vs. 45% with studying).
The good news is that all of these mistakes are reversible.
Research suggests that if you learn about the research underlying effective study strategies, you are more likely to abandon mythmaking, adopt effective approaches, and succeed on your exam than people who have not been exposed to this information.
Bonus: All You Need to Know About the “Learning Styles” Myth, in Two Minutes, Wired, Jan. 5, 2015.