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On the STATMed Podcast: Creating Systems to Navigate Test-Taking on Medical Boards and In the Classroom Part 2

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More Strategies for approaching test-taking on medical boards and in the classroom the STATMed way

You know that a lot rides on your med school tests and board exams. The pressure can be immense, and it only gets worse if you have test anxiety. But bad test-takers don’t have to give up the dream of med school (or vet school, a Pharm D program, or a related career). STATMed Learning can help you navigate test-taking on medical boards and in the classroom.

In this episode, host Ryan Orwig is back with Dr. Jim Culhane, Assistant Dean for Student Academic Success Programs and Professor of Pharmaceutical Sciences at Notre Dame of Maryland University School of Pharmacy. They dig into test-taking on medical boards and in the classroom. In part two of this two-part podcast, Ryan and Dr. Culhane examine test anxiety and the psychology of behavior changes for bad test-takers. 

“This is a fact of human nature. Behavior change is hard. It takes time. It might take one person five days, and it might take somebody else 15 days, it might take somebody else 30 days. It might take somebody five hours of concentrated practice, and it might take somebody 30 hours of concentrated practice. You just don’t know. But this is why it’s so important to have the knowledge, and have access to the practice questions, to be able to actually train.” – Ryan Orwig 

Do you struggle to prep for medical boards or in-class exams? We can help. Learn more about the STATMed Boards Test-Taking Workshop to get the most out of your study sessions.

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– [Announcer] Welcome to the Stat Med podcast, where we teach you how to study in med school, and how to pass board style exams. Your host is Ryan Orwig, a learning specialist who has over a decade of experience working with med students and physicians. In this two part episode, Ryan and Dr. Jim Culhane continued their discussion on test taking on medical boards and in the med school and Pharm D classroom.

– [Ryan] And so, we’re all largely conditioned to make a determination. Do I know it or do I not? And predicting the answer option is beneficial in my estimation on a first order question, let me predict who the 5th president is to see if it was down there.

– [Jim] Right.

– [Ryan] But when we get to this level of this very unique construct of clinical vignette, multiple choice exams, the kind of thing we see on step one, step two, step three, the NAPLEX, the NAVLE, specialty board, subspecialty board shelf exams. There are different creatures, yes, they’re- So a related thing I wanted to throw at you is what I call “The problem of Schrodinger’s Cat”.

– [Jim] Okay.

– [Ryan] So Schrodinger’s cat, now I only know about this through reading blogs about time travel movies-

– [Jim] Mm hmm.

– [Ryan] And alternate realities and quantum realities, I don’t know about it from the actual science, because that’s not my deal. I think I read about it first, probably talking about some episode of “Lost”.

– [Jim] Oh, I know I learned it in physics class, but that was many years ago and-

– [Ryan] I did not take that class. So anyway… So anyway, the idea of Schrödinger’s cat is this; let’s say I’m reading a passage, a clinical vignette, most appropriate next step in management, in treatment, whatever. And let’s say, it’s a question, we’ll keep it simple, it’s a bunch of people go on a trip, they come back, the patient and somebody else has a rash, they describe the rash, you’re trying to figure out the most appropriate next steps, say in, diagnosis, I’ll change it. So we gotta figure out, we have to suspect what the person has, and then we have to draw the conclusion, what do we think this person has up in the passage? And then down below is gonna be some sort of test, that will either confirm the suspicion or get us closer to that suspicion.

– [Jim] Mm hmm.

– [Ryan] So is the second, third order question, ’cause you have to arrive at what you think the person has. So, what you are not allowed to do is come up with multiple realities, multiple diagnoses, you can’t be like, “Well, if it’s scabies, then this, but if it’s poison ivy, then this.” And you can’t-

– [Jim] The cat’s both in the box and not in the box, right?

– [Ryan] Or the cats alive and dead, I don’t know.

– [Jim] Or alive and dead, right, that’s right, yeah.

– [Ryan] I mean, like I said, I didn’t actually learn about it, I just read about it as a thing to explain whatever show I was watching, or movie I was watching. So, but yeah, that’s the idea. So you can’t roll with Schrodinger’s cat operating with two realities, in their quantum reality of then going, ’cause you know, our blueprint is like, you have to work through the first phase, the first phase is everything above the answer options.

– [Jim] Yeah.

– [Ryan] The question being asked, the clinical scenario, any images, any labs, and if in a next step question, you have to come up with a suspected diagnosis. You can’t be like, “Maybe scabies, maybe poison ivy.”

– [Jim] Right.

– [Ryan] You can’t do that, it’s impossible. “Well, but what if I’m wrong?” Then you’re gonna miss the question. Go with the thing you think. And if you’re not sure you’d be like, “Well, I don’t know.” You don’t even know enough to guess, then you’ve gotta say, “Well, does it look like it’s something broadly in one category versus broadly in the other, not going with both categories.” So, this is an important thing that’s sort of a newer concept that we’ve really started hammering on. And it seems to really help provide some clarity moving forward in those kind of testing constructs.

– [Jim] And you said something that really resonated with me too, and with my students, so one of the things that I’ve seen, more and more over the last five or six years, are students with severe test anxiety. Right?

– [Ryan] Okay.

– [Jim] They get into a test, as an academic coach I work with ’em all the time, they get into a test, they start the test, they take the first 3, 4, 5, questions, and then they freeze, right? And I can always tell these students, in some ways because they’re the ones that are done in 20 minutes in a two hour test, they just give up because they’ve frozen. And one of the things that really resonated me as I’m learning this methodology and having talked to a lot of these students, and working with them, is that the methodology or the stepwise methodology and approach, right? And the fact that… And the coding system you use for each of the answers, forcing them to say, “Look, this is what I think the right answer is, this is a possibility.” And I won’t get into the coding system here because that’s not… But it really, I think in a lot of ways, and then when you say, “Look, whatever the highest level code that you have on an answer, that’s your answer, and then move on, and don’t worry about it, don’t sweat it.” And I think that could be really freeing.

– [Ryan] It is, it is. Oh yeah, test anxiety is a legit thing. What I tell people is, now I’m not a clinician, I’m not a therapist.

– [Jim] Yeah, neither am I.

– [Ryan] What I tell people is, and take all of this with a grain of salt. If it’s a generalized anxiety disorder that has been diagnosed, and not treated, well, that methodology can’t cut through that. That’s a bigger issue that has to be addressed through the proper channels. Now, most test anxiety, again, there might be like a far end of the spectrum where this maybe is not valid, but most people who cite legit test anxiety, this locking up, this freezing up, the retrieval pathways are shutting down, everything gets hazy. Generally speaking, methodology, our methodology, can cut through that type of anxiety.

– [Jim] Absolutely. It’s a safety blanket. And listen, and hear me out here too, because I think a lot of times what happens with students, and when I talk to students, “But what happened?” When they start to freeze up, they don’t know what to do. They don’t have-

– [Ryan] There’s nowhere to go, they have no tools.

– [Jim] There’s nowhere to go, right.

– [Ryan] Nowhere to go, yep.

– [Jim] It’s sort of like, if you’re on an airplane that’s crashing, right? And the flight attendant didn’t go through all of the crash procedures with you, you freeze up, okay?

– [Ryan] Sure.

– [Jim] Or okay, as I was in the military, they spend basic training, weeks and weeks and weeks drilling you how to operate your rifle and to move under fire and things like that. So that it happens automatically in those high stress situations. If you’re getting shot at that’s a high stress anxious situation. And so, as I was learning I’m thinking to myself, here is the… I’m missing words here, but here is a approach you can learn that can kick in automatically if you’re feeling it, and so that you can approach a question and break through the freezing, right? Because that’s really what you want it to be.

– [Ryan] I want people to unhook their locust of control from their emotions, and their personality and their judgment.

– [Jim] Yes!

– [Ryan] And hook it on the system.

– [Jim] Yes.

– [Ryan] It’s like, “Hey, it’s not personal guys.” The system says, I have to pick C with a week, maybe, because everything else is a slash or a question mark. You’d be like freaking out, “I’ve gotta pick something I don’t know a lot about, I don’t like that.” And it’s like, “Hey man, it’s not personal.”

– [Jim] Or, “I don’t know the answer, oh my God, I don’t know the answer, I don’t know the answer, what do I do?” And you freeze, and it’s like, “Okay, well, wait a minute.” All right? If you follow the approach and the steps, and if you have partial knowledge, and you just take your time and take a deep breath, the likelihood of you getting that question right is much, much higher.

– [Ryan] Well, and we train so that it’s not even about getting it right. You train them into condition, like, I’m going to miss questions.

– [Jim] Right.

– [Ryan] I’m going miss questions. I’m not gonna get every question right. If I have a question mark, a question where I’ve got three slashes and three question marks, that means I don’t know the answer. Don’t spend much time there, pick one of the three question marks and get out. That’s better guessing one outta three, one outta six, bank that time moving forward. But yeah, the idea is that you train so rigidly with the system, that then you can lean on the system and when anxiety is there, you’re still going through some of those waves, those profound waves of anxiety that are just bashing you in those first few hours of say, the board exam, but then your ship is still intact at the end when the storm has worn itself out after a few hours. Whereas, without a system, the storm obliterates you, and then your test is over. The damage is… You can’t recover from the hole you’re in, and worn you out.

– [Jim] I mean, here’s a little anecdote if you’ll bear with me on this ’cause I think it really… And I think your listeners may resonate with this. So, as I mentioned before, I was an emergency medical technician and combat medic. And I ran ambulance for about 10 years, and my last, my very last call as an EMT, when I hung up my stethoscope and my shears and all that stuff, and I never went on an ambulance, it was 10 minutes before my shift was over and the paramedic I was running with, Melissa at the time, we got a call for a child choking, and it was five minutes from the ambulance garage. So we drive up and she’s in the back getting the oxygen, the innovation equipment, she sends me up the hill, people are yelling and waving for us, and I get up there and there’s this four year old kid, and his mother is holding on to him, and she turns him around and he’s blue like a Smurf, right? Again, I was trained in all of this, but I’d never seen a choking victim like this. And I kneeled down in front of this kid and I’m like, “Okay, what do I need to do?” I’m like, “Okay, first thing, call 911.” And I swear, this went through my head, right? “Call 911.” And then, “Wait, I am 911.” Okay, second- I mean, it’s so funny, but just in a split second. And then I’m like, “Okay, next thing, Heimlich maneuver.” Right? And so, I knew exactly what to do, so the training kicked in.

– [Ryan] Yeah.

– [Jim] In a moment where I could have been paralyzed, right?

– [Ryan] Yep.

– [Jim] It’s the training and the thought process that kicked in, and long story short, we were able to dislodge the obstructed airway, it was a grape that the kid had swallowed, after a little bit oxygen he was back in his living room watching cartoons. His little sister comes over to us and she says to us, and we are both exhausted at this point, “Thank you for saving my brother’s life.” And Melissa and I both cried, and that was it. I said, “I’m done now, I’m gonna go check out.” But again, it just illustrates-

– [Ryan] The training.

– [Jim] The training and the methodology.

– [Ryan] Yes. And that’s why methodology has to be rigid, it has to be structured. And this is why I tell… So people will ask, “How long in advance should I do the board’s workshop?” And I say, “Well, you wanna at least have three weeks.” I mean, three weeks is tight. Anything less than three weeks, I’m feeling really uncomfortable, because it’s bringing the system on board, on what Dave and I call onboarding the system to somebody is not that hard.

– [Jim] Yeah.

– [Ryan] Give it seven, 10 days, you can onboard it. But the back half is the training and the behavior change. We have the tools for that, they’re built in, they are very meticulous, they’re very demanding, in a good way. But if somebody asks me, “How long is that gonna take me?” I’d say, “I don’t know.” I don’t know because behavior change is hard.

– [Jim] Yep.

– [Ryan] This is a fact of human nature. Behavior change is hard, it takes time, it might take one person five days, it might take somebody else 15 days, it might take somebody else 30 days. It might some take somebody five hours of concentrated practice, it might take somebody 30 hours of concentrated practice. You just don’t know. But this is why it’s so important to have the knowledge, and have the access to the practice questions, to be able to actually train. This is why, sorry, we’re gonna talk about it here, we’ll wrap this up talking about something like first year and second year test training.

– [Jim] Yeah.

– [Ryan] It’s a lot harder. The good news is, human medicine, the practice questions are so good now, compared to when I started 15 years ago, the human medicine practices questions are really good. The veterinary medicines questions are still not very good, for the NAVLE.

– [Jim] Yeah.

– [Ryan] But what we found out is they’re good enough to induce the training and the skills, and the behavior modification. So we can say, “I have really good results on test day.” Some of the specialty boards and subspecialty boards in human medicine, usually not as good, because I guess there’s probably not as much money for it.

– [Jim] That’s really interesting because the NAPLEX which is the pharmacy licensure examination, again, about five or six years ago, they revamped the NAPLEX and it became a lot of clinical case vignettes questions. And what we saw after the exam was changed, board exams scores nationally, that NAPLEX pass rate, for the first time in decades, plummeted.

– [Ryan] Wow. Makes sense, though.

– [Jim] And they’ve recovered since then because we’ve figured it out, but still, you know, this methodology would be hugely helpful.

– [Ryan] Oh yeah, for them especially, when you’re talking about the second and third order questions.

– [Jim] Yeah.

– [Ryan] So one thing we were gonna also talk about is the nature of… The nature of the evolution of this testing design, like you said, we haven’t done the research on this, it would be something to talk about the research of it, but what we were talking earlier before the podcast about the nature of partial knowledge versus the binary mentality.

– [Jim] Yeah.

– [Ryan] So that’s a key part of our philosophy and something that really resonated with you, that you sort of wanted to talk about, I think.

– [Jim] Yeah, absolutely. So, I mean, I think that we were talking just about the psychology of this, behavior change.

– [Ryan] Yeah.

– [Jim] And things like that, you and I, I think both agreed that there’s a ton of psychology involved in just taking an exam, right?

– [Ryan] Yeah, yeah.

– [Jim] And so, I think that one of the things that really hit me too, is I’m taking you through this and listening to what you’re talking is that, most students, most health professions students, and I know my pharmacy students are this way, they learn how to take exam, binary types of questions, first order-

– [Ryan] Well culturally though, Jim, culturally, we all grow up, like I’m a liberal arts background guy.

– [Jim] Oh okay, right.

– [Ryan] We grow up, if it’s not an essay test, if it’s not a fill in the blank, if it’s multiple choice, it is a first order question.

– [Jim] Right.

– [Ryan] If multiple choice is like, “Who was the 5th president of the United States?” Do you know it or do you not?

– [Jim] Exactly.

– [Ryan] It’s “Who Wants to Be a Millionaire?” It’s “Who Wants to Be a Millionaire?” questions. You know? A, B, C, D, A, B, C, D, E. And so, we’re all largely conditioned to make a determination, do I know it or do I not?

– [Jim] Right.

– [Ryan] And predicting the answer option is beneficial, in my estimation, on a first order question, let me predict who fifth president is and see if it’s down there. Let me predict before I look at the, “Who Wants to Be a Millionaire?” questions.

– [Jim] Right.

– [Ryan] But when we get to this level of this very unique construct of clinical vignette, multiple choice exams, the kind of thing we see on step one, step two, step three, the NAPLEX, the NAVLE, the specialty board, subspecialty board shelf exams, they’re different creatures. Yes, there are words up top, yes, there’s A, B, C, D, A, B, C, D, E, F, G, H, I, whatever.

– [Jim] Right.

– [Ryan] think the fact that it’s like A, B, C, D, it just makes us all think it’s the same deal, the same rules.

– [Jim] And the approach, the approaches to solving those are so different, right? I mean, that’s one thing that really struck me after completing unit two, it’s like, wow. The way that you approach just a basic recall binary type question-

– [Ryan] Yeah, for me it is, I don’t know that it’s true for all med students and pharmacists, they might, if it is different, it’s like somebody saying, when I swim in the lake it’s the same as swimming in the pool. They’re like, “Yeah, I’m swimmin, I’m swimmin.” I guess there are probably, I don’t know, like for me, I swim in a whitewater river or I swim a pool, it’s different. But I’m not an expert swimmer.

– [Jim] I think it may appear that way-

– [Ryan] Yes.

– [Jim] Because I think there’s a lot, when you’re solving a case vignette question, for the people that have good test taking habits and do that really well, it just happens unconsciously. So to them it appears like they’re using the same processes in the binary, they just know the answer, right?

– [Ryan] Yes. But their stuff happens subconsciously just like, if I’m swimming in the ocean or a lake or a river, I’m probably I’m using different muscles, I’m using different response mechanisms. If I’m running on a track versus running on a trail versus running through the woods, if you’re like some elite runner athlete, you’re just like, “I just run. I just run.”

– [Jim] Yeah.

– [Ryan] You know? I mean, surely you have to acknowledge that your foot is falling differently on these different surfaces, and your eyes are assessing the ground in front of you in different ways. “Well, yeah, yeah, of course.” They might say. But it’s like, yeah, but you didn’t say that, because the expert does things so innately, and so many things happening subconsciously, autonomously on the fly, but the bad test takers-

– [Jim] Mm hmm.

– [Ryan] The struggling test takers, the ones who don’t consistently show what they know, they’re the ones that are not able to make those adjustments subconsciously, and they pay the price. And that’s where I think methodology can come in and make a huge difference.

– [Jim] Oh yeah. Well you know, and I look at it, I can see, you’ve got these categories, bad test taker, good test taker, and I know you would agree with me on this. I think that there’s a whole spectrum there, right? And I think you’ve got your extremes, the exception of the rule, those really great test takers, and you’ve got some that are just really, really bad. I think for me, again, experiencing unit one and unit two, I am convinced that the method could help any, I mean, minus the exceptional test takers-

– [Ryan] Yeah.

– [Jim] But these are just a set of skills and an approach that you can use that can benefit anybody. If you’re B student it might make you an A student.

– [Ryan] Yeah, yeah. I guess my caveats are the willingness-

– [Jim] Oh yeah, right.

– Am I willing to not just listen, am I willing to roll up the sleeves and do the work, whichever that work might be, and that work might not be that hard for some people, you know?

– [Jim] Yep.

– [Ryan] But yes, I mean, there’s definitely something in the back of my mind of like, what if we did make all the bad test takers good test takers? What does that do to this whole cumbersome testing apparatus that we’re rolling with? You know what I mean?

– [Jim] Look, I think it’s very, very positive. Actually, it would be a very positive thing, okay? And here’s why, I think that if there are faculty members out there that are listening to this, they might be cringing because they think this is a kind of a system to beat the exams and things like that.

– [Ryan] No, gosh! Yeah, please. Let’s abuse that.

– [Jim] In fact, I will tell you, if I’m being a hundred percent honest, I had those feelings first when I started taking this, and then I realized that’s not what this is at all.

– [Ryan] No!

– [Jim] What this does is it eliminates one of the confounding variables, okay? That are in your way of collecting accurate data to tell you what your students know, and don’t know. I never ever want one of my students to miss an exam question of mine, and I assume that they don’t know something because the question was written so poorly or they got tangled up somewhere. Or they made some sort of reading error that caused them to, whether it was my fault or not. ‘Cause then I don’t get accurate data and an accurate reading.

– [Ryan] Exactly, I was thinking about that when you were saying that. When you were talking about the software data it provides.

– [Jim] Yeah.

– [Ryan] What it can’t do, ’cause we’re not cyborgs is tell what was happening in the reader’s interpretation of the text.

– [Jim] You know, it’s really interesting that software, and this will be something for another time, but that software actually tracks your behavior on the exam. So it will tell you how long it took you to answer each question, whether you switch answers, it’s a real, I’m just fascinated to see where that goes over time, and how we might be able to use that kind of data to maybe identify bad test taking behavior, kind of diagnostically, I don’t know, That’s just where my brain goes. I like to-

– [Ryan] Yeah, no, I mean, again, until we can track-

– [Jim] What you do, but it’s really interesting to me.

– [Ryan] Well, no, I mean, eventually software will probably be able to track where your eyes are on the page.

– [Jim] Right!

– [Ryan] And then that would be, that would be to me-

– [Jim] They actually have proctoring software that will do that now.

– [Ryan] Well, I mean, I know it’s coming, they’re talking about when you look away, if you look away from the computer screen, or when you’re watching the ads.

– [Jim] Exactly, yep.

– [Ryan] No, it’s all coming, it’s hard to imagine right now, but it might be passe and just like a done deal in five years. But yeah, that’s coming, where it’ll say you were… I mean gosh, having a heat map of where your eyes are going on then screen, that’ll be a watershed moment.

– [Jim] Yeah.

– [Ryan] Where we can get some real data that really interests me.

– [Jim] Right.

– [Ryan] So yeah, but we can teach people to extract that with the way we teach them how to do this stuff. So there’s definitely a lot of upsides here, but yes, no, thank you, this is never about beating the test. I think when people hear people talk about test taking, they think you’re talking about how to outsmart or outwit the test. It is the opposite of that.

– [Jim] Yep.

– [Ryan] This is about cleaning up the user interface, to level the playing field so that the bad test taker can actually evenly show what he or she knows, as opposed to always operating in a deficit. I dunno if I’ve told you this, do you know what my theory is on how the bad test taker survives?

– [Jim] No. You may have, but go ahead.

– [Ryan] They survive by overcompensation with over studying and over knowledge, and they rely on that binary mentality because to tie all that back, if you rely on knowing it all, either I know it, or I don’t know it, like a first order question, that’s what I call the binary mentality. The good test takers are the opposite, they’re learning to use their partial knowledge, their fragmentary knowledge, rule things out that are partially false using the parts of what you know, and pick the safest of what’s left. Safest means which parts of what you know connect with the answer option, ’cause the bad test taker kicks away from the partial thing because they so dearly and desperately want to know it all.

– [Jim] Yep.

– [Ryan] They will say, “Well, I like A, but I don’t know everything about A, so I’ll pick B this thing I know less about.” That is such a stark… I worked with one student today and that was her primary sin. That was her primary issue.

– [Jim] And how much anxiety must you generate when you put that kind of pressure on yourself that you think you have to know everything, right? I wonder, like I said, I think there’s, for me there just feels like there’s this connection there between student test anxiety, this idea of binary thinking, and the whole idea that, “You know what? I have to know every little piece of information in order to answer the question right.” Well guess what? Life doesn’t work that way. I mean, sometimes it does.

– [Ryan] No, it’s nice. Sure, it’s nice when you know everything, it feels good, but it-

– [Jim] It feels good, but sometimes-

– [Ryan] If you wanna rely on that-

– [Jim] You gotta wing it with just what you know, and hope-

– [Ryan] Yeah, relying on that is a very difficult game. And then lastly, we were just gonna talk a little bit about, we’ve talked a lot about though, is it is much easier to intervene once you get to a board prep level. So where we started and where we’ll end is coming back to this idea of the didactic test taking, test taking in the first few years of med school of the Pharm B classroom. You asked me, “Could the system be used to hack into the bad test writers…”

– [Jim] Yeah.

– [Ryan] Exam? So I don’t know if you’ve had more thoughts on that now that you’ve watched more of the workshop. I have my thoughts on it, I’ll let you go first.

– [Jim] I think it depends on what the problem with the question is-

– [Ryan] Exactly.

– [Jim] Yeah, so I’ve thought about this, I mean, so yeah, so I’m gonna leave it at that.

– [Ryan] This is the problem: The problem is that a bad question is a big gray fuzzy word, it’s going to be a bad… So the questions that fall under the bad question umbrella are gonna have varying criteria, various flaws, various problems, so you can’t build strategy around a moving target, around an inconsistent target. We can build strategies around known quantities, like the way that test questions are built, that are statistically normed and validated for the boards. So what we tell people is, what I think the best way to approach test taking in the classroom years, is being consistent. So imagine an old school video game where you’ve got a road, and you’re driving the car down the middle of the road, and you’re trying to collect coins or something.

– [Jim] Yeah.

– [Ryan] And most of the coins are in the middle of the two lanes of the road. But every now and then you’ll have coins out on the-

– [Jim] On the side. I’m following you, okay.

– [Ryan] And so what you don’t want to be doing is zigzagging, trying to get those outlying coins, like the bad questions, the trick questions, the really ‘gotcha’ questions, ’cause then you’re zigzagging out and now you’re missing all the coins down the middle of the road. Maybe you’re catching the coins on the side of the road, maybe you’re not, but at the end of the day, that’s a losing strategy. Miss the poorly written question, miss the ‘gotcha’ question, drive it right down the middle of the road by being consistent, consistently-

– [Jim] Yeah, you’ll end up at the end overall in a better place.

– [Ryan] Yeah, and that’s the only way with these things. And I would say better study methods are the best solution in the classroom years.

– [Jim] Yeah.

– [Ryan] In other words, we just sort of bashed, I guess, sort of, not really, we were talking about the perils of thinking you need to know everything on boards, I mean, that’s real. But look, as much as you have to learn for a single classroom exam, and I know it’s a staggering, ridiculous amount, it is a literal drop in the bucket for your board exam.

– [Jim] Yeah. I think it’s the time component to that equation, right? You know, we’ve always talked about that, when you take the boards it’s an accumulation of all the knowledge you’ve-

– [Ryan] It’s years, it’s years.

– [Jim] Years, right? It’s a lot of information, but you’ve had three, four years, maybe more to accumulate that versus, if you had this exam every two weeks-

– [Ryan] Two weeks, four weeks-

– [Jim] Or 500 PowerPoint slides.

– [Ryan] It’s a lot, it’s a whole different game, I know. But when we are dealing with the struggling student, the students that are really trying to really get through this, we change the study methods so that they are getting more yield every week, every day, every hour, every minute that they’re studying, okay? And then on the other side, we just add some, what I would call simple, which is still pretty robust, a test question structure.

– [Jim] Yep.

– [Ryan] So that they are then keeping their car down the middle of the road. That seems to be the winning-est way to approach this, without getting all entangled and totally redesigning test taking in those first two years, because that’s a lot harder of a game to do than maybe people thinking, “That’s just what I’ve been doing for 15 years.” So, that is my accumulated wisdom on that, being sort of shared here.

– [Jim] Maybe I can take us out with one of your quotes from your workshop, ’cause I think it really will wrap up all of this. You said, the process that you were teaching, the stat med process, is not about getting every question right. It’s about passing the exam and it’s okay to miss questions. Just super profound right there. I think if that’s, if I had to pick, choose one take home message for your listeners right now, that would be it.

– [Ryan] I guess I’m sitting here nodding to myself, my own quote, that’s weird.

– [Jim] I got it right there in my notes.

– [Ryan] That’s the game, that’s the game. And I think it’s important to frame the game when you’re trying to win.

– [Jim] Right.

– [Ryan] And that’s what we’re doing here, all right? Well, thanks. Thank you, Jim, for indulging and having a nice weirdly, ramble-y, but in depth conversation about test taking.

– [Jim] Yeah, absolutely, my pleasure.

– [Ryan] And listeners, thanks for listening. We’ll be back with more soon, thanks.

– [Announcer] Thanks for tuning in to this episode of the Stat Med podcast. If you like the show, please be sure to rate it on iTunes, Stitcher, Spotify, or wherever you listen to your podcasts. You can find more test taking and studying strategies, specifically designed for med students and physicians over at our blog, at Thanks for listening.

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