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On the STATMed Podcast: I Failed My Board Exam – What now?

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We can help you figure out what’s next after a failed board exam 

“Help! I failed my board exam… can you help me?” 

We hear this – or a version of this – statement nearly every day. So, if you’ve failed a board exam, you’re absolutely not alone. And, you’re not necessarily looking at the end of your medical career. At STATMed Learning, we work closely with students who have failed the COMLEX, NAVLE, USMLE, or other medical boards exams. 

In this episode of the STATMed Podcast, Ryan Orwig and David LaSalle dig into how STATMed Learning can help students who have failed their medical boards. They break down what students can expect from the STATMed Boards Test-Taking  Workshop and the Boards Study Skills Course.

“Just to be clear, I think sometimes it’s easy to think that what we’re talking about is that we’re going to teach you some “hacks” to get past the test-taker, to read the mind of what they’re doing, to “beat the test.” That’s not what we’re talking about. These tests are not something where we can institute two hacks, and all of a sudden our scores are improving. This is really about learning about who you are as a test-taker, historically. We have identified about 15 individual bad habits that people implement while taking tests and working on a test. Most people aren’t doing 15 things wrong, most people are doing maybe four or five things wrong, and of those, they’re doing two or three things wrong all the time, and that’s what is costing them the majority of their questions. So that’s what the Boards Workshop is about; [discovering] the two or three things you’re doing wrong, how to spot them and what to put in place of that behavior. It’s in-depth, it’s intense, and it’s super effective.” – David LeSalle 

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Welcome to the STATMed Podcast, where we teach you how to study in med school and how to pass boards style exams. Your host are Ryan Orwig and David LaSalle, learning specialists with more than a decade of experience working with med students and physicians. In this episode, Ryan and Dave discuss what happens when someone fails their boards and what’s next.

For when somebody contacts us no matter when during the year they contact us and they say, oh help me, I’ve failed my boards. We have the STATMed Boards Test Taking Workshop. Test taking means the act of showing what you know, on these board exams. The other side of the equation is our STATMed boards study skills course. This is for the person who says, I just don’t know the best way to study. I never learned how to study, I somehow got to where I am, I never learned the best way to get the most bang for my buck every time I sit down to study. Hello and welcome to the STATMed Learning Podcast, where we talk about study timing and test taking for med students, physicians, veterinarians, and those in related fields. We look at everything through the filter of reading and learning, since we are reading and learning specialists. I’m Ryan Orwig and I’m here with my STATMed teaching partner, David LaSalle. And we’re going to talk about what happens when someone reaches out and says help, I just failed my boards, can you guys help me? Dave we hear this a lot, right?

Yeah, unfortunately we do because there are a lot of people out there, smart, capable people who are struggling, but thankfully we know how to help. I think, honestly Ryan, you tend to hear this a little more than I do, because you’re oftentimes the first point of contact for people. So, I think this is a conversation that you are frequently having, as people calling up saying like, I don’t really know what you are or what you do and where do I even begin? Because it’s a little nuanced, there’s a couple sort of forks in the road that people can take. And it seems like it all starts with the question of who are you and what are you about? So, do you wanna talk a little bit about the types of people that end up calling us?

Yeah, I mean I have these conversations every day, sometimes up to like, I don’t know, four, six, eight times a day, I think when people come in, number one, they’re beaten up and they’re traumatized, they’re horrified that this happened, and they’re scared and oftentimes confused just from their own situation coming in. Maybe they failed USMLE, step one, step two, step three, maybe COMLEX one, two, three, maybe they failed their NAVLE for the veterinarians. Maybe it’s issues with shelf exams, maybe it’s farther down the line, maybe it’s in services when you’re in residency and so that’s more like a prefail unless of course they’re actually in trouble with their standards based on their program. Could be initial certification. How many emergency medicine doctors do we meet just because of some of our other affiliations who have failed that initial certification by, on the two dig at scale by one or two points. Could be concert re-certifications 10, 20, 30 years out. Sometimes these people have a history of struggling with standardized exams. Sometimes this is absolutely the first time. And then how do you even define struggling? Somebody might come in and say, well, I never failed. Let’s say somebody failed step three. I never failed, I didn’t fail step one or step two, I never failed my shelf exams, but my scores were always off, my scores were always a little lower. I don’t know, so a discrepancy, but it had never caught them. Well, it’s not a problem until it’s a problem, that’s one of our main mottos.

Yeah, so you’re meeting people who are literally some of them really in sort of the first blush of this, just in shock of having failed this major exam, they felt like they were gonna pass, ’cause they were doing everything that everybody said they should be doing. And maybe they’ve been successfully in practice for years even, and all of a sudden they can’t pass this research. Or at the other end of the spectrum, I guess you’re meeting people who have had five attempts at the NAVLE and who are just feeling so bewildered, confused and beaten down. So that’s tough, that’s awful.

It is a weird place to have found myself in professionally having these conversations with these people. And it’s good though because we are going to at least look at their situation, listen to their story. I always tell ’em that’s the most important thing is we’ve gotta hear the story first. And I wanna hear like what they’ve been doing, and sometimes it’s really nuanced, sometimes it’s really good, sometimes it’s really vague. And if you can’t describe your prep process other than I worked really hard. And if that’s how you feel, I wanna hear that. I worked really hard, I put in so many hours, I did X number of questions, why did I fail? I mean that’s very murky. We have to okay, okay, let’s clean this up a little bit. This all starts with a lack of, it’s a cultural failing. We don’t have robust vocabulary to talk about discreet skills that separates the preparation side, the study side, the organization, the encoding, the retrieval, the application side, versus the test taking side.

I was just gonna say, which means your only sort of barometer oftentimes, is outcome. Like all I know coming in is something’s not working and I guess, you know something’s not working and the feeling with that is, what could it possibly be because I’ve done everything, I’ve followed all the advice, I’ve put in the hours, I’ve put in the sweat.

Well, let’s talk about that. So, one of the things that you wanna talk about when you come into this is what have you done? Sometimes on the vague side, it’s I studied X number of hours, or I’ve never worked harder, or I’ve done all these practice questions and then of course they’re doubting themselves. Well, maybe the 10 hours a day should have been 12 hours, maybe the seven hours should have been 10 hours, maybe the 1000 questions should have been 2000 questions. I mean, of course you have to have that doubt. I should have just done more, I should have just worked harder.

Yeah, when you’ve just spent months prepping for an exam and then you fail by two points, I can’t even imagine the second guessing and what ifs that run through your mind. It must just be on constant loop.

Well, and again since we lack culturally the ability to really deconstruct what studying looks like and deconstruct how test taking functions at this level with the medical boards, how can you analyze it? You can’t even analyze it ’cause you can’t break it apart into its constituent pieces.

Yeah, oh, I think of it like me going to the mechanic, like I show up and I’m like, I don’t know, the car won’t start. The mechanic can be like, well, what’s the problem? I’m gonna be like, I have no idea.

I’m not, automotively inclined although my brother is an engineer. And in high school he was like taking apart truck engines and rebuilding engines. And I used to always take my cars to him, Matt, what’s wrong with this thing? And he could tell me. Now with my hybrid RAV4, he’s like, take it to the shop. He can’t look at any of it because it’s a giant computer. And so you can see that break from the old school mechanic to the new world of cars. So you can think of like the like old engines, more like an open system and then like these hybrids are like closed systems. I think if I sit and look at someone, and a part of what we’re doing when we’re having these interviews is we’re opening up the system, we’re opening up the hood and you can see the gears. Through the conversation and we’re gonna explore that in this conversation. You can see the gears and see where things are breaking down. I’ve sat down with some of my friends or colleagues in review programs and talked to them. These ones that are the good test takers or the ones who are really good studiers, or even my wife, my wife is a Clinical Pharmacy Specialist in Infectious Diseases. Like my wife is a closed system, my friend, Adrian, an Emergency Medicine Doctor, he’s a closed system. He’s like, well, you just do a bunch of practice questions and you take the test and you go to the review program. I’m like, yes, and that works for him, because he’s a closed system. My wife is like, well, yeah, you study, you do questions, you look at what you’re doing right and wrong, and you do it you just do it, the elite athlete type way. I can’t deconstruct what they’re doing. We can only look at outcome there and it doesn’t matter because it works. But when somebody is struggling and there’s a breakdown, then you can get into the gears and see where things break down so, you sort of have this conversation with them. And we’ll talk about this, what these conversations look like here in a minute, but let’s first think about, the platforms that we offer to help. And so we’ve built this, we have these three platforms. We have the STATMed Study Skills Class, we’re not gonna talk about that right now as much. Could you do the STATMed Study Skills Class if you failed your boards? Sure, we’ve had people do that over the years with fantastic success. The STATMed study skills class is only offered at certain times of the year, it’s about 10 days span with a locked in schedule. It is primarily built for people who are still in the classroom learning phase. First years of med school classically thinking, could be somebody who’s entering med school, vet school, something like that. Somebody who’s stuck in between a semester, somebody who’s repeating, somebody who’s rising from first year to second year and they’re just like, that was horrible. I know I can do by better, I wanna learn study skills, time management skills, test taking skills. That is what that is for. It’s a complete tear down rebuild, with all our study skills, all of our time management tools, test taking process and some other things tying it all together. But yeah, but that’s not really what we’re gonna talk about today. We’ll do another podcast where somebody says, hey, I failed med school, help me out here. The caveat here is we’ve absolutely had physicians do this. I think of a guy who failed his neurology boards multiple times. And he ended up doing the class and he used one of the crazy outside the box skills to overcome the neurology boards. So, there are examples where that happens. But now, what we really wanna think about is our two primary resource platforms for when somebody contacts us, no matter when during the year. They contact us and they say, help me, I’ve failed my boards. We have the STATMed Boards Test Taking Workshop. Test taking means the act of showing what you know, on these board exams. The other side of the equation is our STATMed Boards Study Skills Course. This is for the person who says, I just don’t know the best way to study. I never learned how to study, I somehow got to where I am, I never learned the best way to get the most bang for my buck, every time I sit down to study. So, test taking boards workshop, board study skill course. So Dave, let’s talk a little bit about each of these.

Yeah, it sounds like such a simple question. It sounds like, okay, well, when you call up, all we’re gonna ask you is, do you need help with test taking, or do you need help with study skills? But like you said, for right now, this system is closed. So the answer to that is, I don’t know, I just know I keep failing my test ’cause I think I’m doing the best I can. I mean, some people know, some people will come in and say, oh, I’ve always struggled with standardized testing and I know I’m a terrible test taker, or I know that my study skills are a disaster, whatever. But a lot of people come in either with misconception or just with no idea whatsoever about what they need. So yeah, so we’re gonna route you down one of two paths. The test taking board’s workshop, the strength of that is, if you are somebody who has developed bad habits in your testing, who really has no methodology in your testing, the board’s workshop is going to, we’re gonna identify the bad habits, we’re gonna tear those down, we are going to replace them with a very systematic methodology. I love it because it is really prescriptive, it is very much a flow chart, it’s a series of steps you can learn, implement, and improve on as you go. And then the beauty of the board’s workshop is that it is a one-on-one interaction where you are gonna get immediate, very specific feedback. So you’re gonna come outta your first session or two, even before you get to me, even watching the preparatory videos, people come into the first meeting and they say, all of a sudden I can identify what I have been doing, I recognize myself in those videos, I didn’t know what was wrong, I knew something was wrong, now I’m already starting to see two or three things that I am doing wrong.

Right, yeah, so it’s really empowering. what I tell people is, we’re not gonna fix your test taking if we identify, yeah, you’re a bad test taker, you’re our kind of bad test taker, you’re on board, like we’re both agreeing, let’s do this. We’re not then gonna plug holes in the leaky dam. It’s like, if you’re coming on, we’re gonna tear your system to the ground. You might say, I don’t even know what my system is. Right, you’ve got a system. You’re doing something it’s probably erratic, it’s probably inconsistent, it’s damaging you. Yeah, but it’s how my best friend reads and processes, questions. I don’t care, you gotta let go of that. this isn’t about “Keeping Up with the Joneses” or whatever that stupid cliche is. This is about recognizing that you operate differently than your peers. And you might be just as equal with them clinically, but they can see through the window pane clearly and you’re looking through a muddy window pane. So this is about, we tear the individual system down to the ground and we build our system in its place.

It sounds so violent.

It’s dramatic, it’s dramatic it is.

It is dramatic it is, yeah, it feels like a real paradigm shift. And just to be clear, let me just get ahead of this a second. I think sometimes it’s easy to think that what we’re talking about is we’re gonna teach you some hacks to get past the test taker, to read the mind of what they’re doing.

Beat the test, yeah. Beat the test.

That’s not what we’re talking about. These tests are not something where we can institute two hacks and all of a sudden our scores are improving. This is really about learning about who you are as a test taker, historically, figuring out. We’ve identified like I think the list right now is at about 15 individual bad habits that people implement while they’re taking tests, while they’re working a test question, the mistypes.

Mistypes mistypes bad habits.

But most people aren’t doing 15 things wrong. Most people are doing maybe four or five things wrong. And of those they’re doing two or three things wrong all the time and that’s what’s costing them the majority of their questions. So, what the board’s workshop is about is identifying, hey, what are your two or three things that you’re doing wrong? And how can I learn to spot them before I do them? How can I learn to change the behavior? And what am I gonna put in place of that behavior? What’s my new behavior? So, it’s in depth, it’s intense and it’s super effective, yeah.

Well, it’s really mechanistic, it’s really stepwise, this then this then this then this, they’re not doing like, there’s some modification that can be done on the back end, but not the front end. It’s what I would need, I don’t know if it’s what I would want, I think it’s what I would want, it’s hard to say at this point. I know that like when I go to physical therapy, if my physical therapist is vague, I’m very unhappy. Like I’ve had multiple back surgeries and I’ve got a great physical therapist who’s on my wavelink with this, but I don’t wanna know, like do this exercise a few times a day. I’m like, no, no, no, no. Are we doing it like in the morning, afternoon, night?

Right or you can do this exercise or this exercise, or this exercise, and you can do it this way or this way.

I want it to be prescribed meticulously, explicitly that I can check it off the box.

But not one size fits all. But not one size fits all prescribed specifically for your back issue.

Yes, and I need to know where I am on that continuum and all that stuff. So, another thing I tell people is we’re teaching you two systems at once. We’re teaching you how to play the game, the way we want you to play it, that’s using our system. And then on the other hand, we’re teaching you to be your own coach, to be your own trainer. Because at the end of the day, it is about behavior change. I don’t think it’s rocket science to understand the system, we can get most people there, I think pretty directly, sometimes a little more indirectly, but mostly directly. The X factor is how long does it take the behavior changes to take root? For somebody it’s a week or two, for somebody it’s more of a month, I don’t know, it’s impossible to say it’s behavior change, behavior change is hard. But this unlocks what’s called deliberate practice where you are deliberately checking yourself. Yes, you’re going slower on the upfront, yes, you’re spending more time in the analysis phase, really studying the game film like the coach. But to truly be deliberate practice, you need expert feedback, but we don’t want you to be with us forever. Like we want people to come in and then go forth and conquer and be in charge of your own stuff. This is why working with physicians, med students, veterinarians, like highly intelligent motivated learners works by teaching them that whole how to coach thing, we’re enabling them to sort of emulate the expert feedback.

Yeah, if you are as good as you’re gonna get by the end of our sessions together, then we haven’t done our job. You should be able to continue to refine your process, to continue to troubleshoot, to continue to analyze and to get better and better and better as you go.

And that’s because we are teaching you to identify and extrapolate and make explicit specific feedback loops. Feedback loops are the key and that’s woven for through everything we do. And yeah like you said, this is just to make sure, like, I’m so clear on this. This is never about beating the test, this is about cleaning up your own, the test taker, cleaning up your own interface, where reading and thinking intersect. This is about reading. And these questions, every reading construct requires its own specific set of reading strategies, sometimes it’s very broad, but sometimes very nuanced. And these questions are monstrosities. They put so much burden on your working memory. It could be as simple as if your working memory is not as robust as the rest of your intellect, that’s where the collapses happening. And if somebody’s telling you they’re gonna fix your working memory, I don’t know about all that, I don’t know how to do that, I’ll say that. We’re not gonna fix your working memory. What we’re gonna do is install a process, the reading process, the test taking process, the methodology that is in part, one of the things that’s gonna do is help limit the burden on that working memory and that’s blends into executive functioning and all that stuff.

Yeah, for sure, yeah. We need a clear, direct line. We can’t have a lot of muddy thinking, we can’t have a lot of extra chatter. The more I do this, this is sort of my hobby horse lately is, I really feel like so much bad test taking comes about because we are testing emotionally, because we are testing from our gut rather than from what we know, what our knowledge base is telling us, what information we have acquired through study. And some people can test with their gut and it works. And your wife is probably, when she does it works a test. She’s probably a lot of times going with her gut and it’s consistent for her. But the people that come and work with us, one thing we know very clearly up front is, your gut might be right to sometimes, but it’s very inconsistent, it’s not reliable. So we can’t go with emotionality because the emotions that drive bad test taking are hope and fear. We wish an answer is right and so we manipulate the question to make that answer right, because it’s the most familiar, it’s the one we’re most comfortable with. Or we’re so caught up in an anxiety storm that we can’t process what’s happening as we are reading the question. So we end up testing while there’s all this chaff being kicked up, all this dust, I should say, being kicked up. And we’re trying to read in the middle of that. And meanwhile, we’re having conversations with ourselves about like the last question or the entire block. Something I say often to clients is, our attention during testing needs to be a laser pointer. We can’t let it become a flashlight beam, much less a spotlight beam. We’ve gotta be laser focused on what we’re doing at that exact moment. And that’s how we help take some of that emotionality out.

Well, right, by adding explicit structure that we train with rigidly, that becomes the scaffolding that we then lean on and navigate through on test day. So, we train in a way that limits the burden ’cause we would never say like, just, be focused, I know you’re not saying that we wouldn’t be like. Back to the original conversation, so many people are like, I can’t trust my gut. And they feel guilty about that, they feel like they failed, because why? They talk to the good test takers like, well, trust your gut, like you study, you do well clinically, just trust your gut. You don’t make that mistake clinically, so why are you making it on the test? Well, it must be because you’re not trusting your gut. I cannot tell you how much I hate, trust your gut. Like, what does that mean? That is not a replicable thing, that is not something that we can then transfer. And again, people think because they’re the good test takers are looking through the clear window. Like if you can do it clinically, why aren’t you doing it on the test? It’s because of the reading construct, this reading act, this reading and thinking bottleneck pile up, where all the stuff is falling apart. And it all comes down to methodology, methodology matters. The methodology you use matters. Is not that our system is the only system, there are many other systems out there that are contradictory to what we do. Like we hate the idea of feeling like you have to predict an answer. We hate the idea of, looking over the answer options and flooding the working memory, let me see where I am. We hate the A versus B which one advances. There are many excellent test takers and programs that probably preach test taking, and that works really well for other folks, but it’s complete folly, it’s completely, it’s an assegai notion that we should try to treat all physicians, all med students, all veterinarians, as a one size fits all test taking approach. So, part of the interview is about making sure that if we’re saying, hey, let’s do the board’s workshop that this is the right fit for you because maybe the test taking is not the problem. Maybe yeah, you failed, but it’s really that you’re overly familiar with everything and you haven’t organized it and encoded it and built retrieval pathways. You don’t know what you concretely know, what you’re familiar with and what you don’t know. So then you just keep rereading, rereading, rereading, restudying, restudying, re-watching review programs and all you’re doing is entrenching familiarity. And now we’re moving that moves out of the test taking realm and more of a problem with study, the study side of the equation. And the boards, the test taking board’s workshop, doesn’t do anything with, I mean we give a little bit of study tips here and there, but that’s just because we feel obligated. Like let’s at least talk about this and that, but the test taking boards workshop is just about fixing all the stuff we just talked about at the top here. It’s not dealing with the study side of things. David, you wanna pivot and talk a little bit about the board study skills course or do we check all our boxes up there?

I think so, I mean, we could go on forever.

And we can talk about this for days anyway. So, this other platform we have is this board’s study skills course. It is independent of the Test Taking Board’s Workshop. You can do one and then the other, you can do them both together. You might choose one and think you wanna do the other one later, but then you don’t, you don’t need it, and we can sort of advise on do this one, then that one, but they’re certainly often used independent of each other. You can decide to do one later and all that jazz. But anyway, let’s talk a little bit about what the board’s study skills course offers just broadly.

Sure, yeah. it’s a series of videos and one-on-one meetings with an instructor scheduled however your schedule work out. And what we are doing during the study skills course is we are putting in place a system for how to comprehend and retain information effectively. I mean, isn’t that what learning basically comes down to? I wanna be able to understand the material and then I wanna be able to retain it, I wanna be able to recall it when the time comes, when I needed on testing.

Yeah, I wanna be able to organize and code, retrieve, I mean, again, these are all such mushy words that don’t seem to have much meaning. I wanna get more bang for my buck, every time I sit down to study, I think a lot of people have relied on low yield methods, and if those work more power to you.

I guess.

I know I feel weird saying that.

If you’re willing to put that time in.

Right, we worry so much about efficiency in all other walks of life, but when it comes to studying at this very high level and in med school on boards, on rotations, in residency, I don’t know very many people that study using optimal study methods, I think people just gut it out. So, I don’t know. I’m like, yeah, I like the adages, it’s not a problem until it’s a problem, but I guess it also depends on how we define problem. To me, efficiency is king, like I wanna get the most out of all the stuff. So yeah, study skills course, a lot of times they’re coming to us and they’re saying no that that’s the problem. Like I just don’t know how to study, I’m familiar with it all, but I haven’t really organized and retained it. So, the study skills course we’re teaching a series of very specific study skills on one hand, but also what falls under time management on the other, which sounds so lame, but it’s not, so, it’s the glue that holds it together. It’s generation of workflow offloading like your tracking of what you’ve done and what you haven’t done. And I think study skills might also sound not so glamorous, but man, it’s pretty amazing stuff when you really get into it. Especially if you spend so many hours of your life doing this, like studying for such a high stake situation, like your medical boards.

Yeah, and I think a good starting place to talk about those study skills is maybe what you were talking about with the enemy, which is studying for familiarity. The sort of study that a lot of people do, and we all everybody’s heard at this point, like you should be active in your study, not passive in your study and I think that that’s being really vague advice, often misinterpreted, we don’t really know what that means to be active in our study and we don’t know why we’re being active in our study, but we know that we watch the YouTube video and it’s better to be active in our study than passive in our study. But a lot of people spend a lot of hours lot, oh my gosh, so many hours. I mean, just for a second, just so much respect to med students and medical professionals, the amount of work that you all put in is astonishing.

It is, it is.

So it’s not about motivation. If you’re sitting there beating yourself up because you haven’t done the work that you should be doing, please give yourself a break. Okay, all right, that was just an aside. I mean, you’re doing the work, you’re highly motivated people, my goodness, but you don’t have the right tools yet. So, for a lot of people, it is about reading things over and over again, taking information from one source and writing it down, condensing the information onto another sheet of paper, watching a video and condensing that information.

Well Dave, but isn’t that one, that’s one of the promised lands. The promised land of condensed notes. I wanna take these 50 slides, these 30 pages, and I wanna condense them to three to five pages that I can then read over, read over, read over. Once you read something once and you are rereading it, you are getting diminishing returns. And so, that’s this whole motivation to that. But then people might be saying, yeah, but I crushed it in my high school honors classes doing that, I destroy my undergrad doing it like that. Like I was at the top of my group and I grad, I mean, yeah, I hear you. But the arena is so vastly different. The arena is so, I mean, like it’s such a vast difference. You’re talking about traveling from one place in the continental United States to the other, you’re talking about going from Pittsburgh to New York, you’re talking about going from, Baltimore down to Jacksonville or whatever. When you go to med school and through the rest of your education, you’re talking about going from the earth to the moon, the exponential difference here. And you guys know this, if you’re listening to this and you’ve at least step foot into med school or vet school or PharmD programs, or what have you, you know, it’s a staggering difference. So I think you’ve gotta get away from that worked for me in the past. Just because it worked well, number one, the arenas changed, this sheer amount of information. And then especially at this level we are not talking about you’re through the didactics, you are at step one or beyond, you’re at your boards, you are into your clinical experiences. Like now you’ve seen it all. I mean, that’s the thing they’ve seen, it’s not like, you’re like, wow, I’ve never heard of this before. I mean, every now and then whatever, some medication, some obscure zebra type thing, but by and large you’re not failing ’cause you’re like, yeah, there’s just so much stuff, I just never heard of it. And you might fixate on that one question you missed because it’s something you never heard of. That’s not why we’re having the conversation we’re having. It’s the low hanging stuff that you’ve gotten and Dave to bring it back to what you were talking about, it’s just this idea of like, of this robust over familiarity is a killer, and I think that’s where I hijacked. So back to you were talking about like this trap of familiarity stuff.

Sure, yeah, yeah, yeah and of course I mean, how incredibly frustrating to be so familiar with that much material and then on test day, you’re looking at a question, you’re looking at a set of five answers and you’re like, yeah, I’ve heard all of these, but I don’t have the ability to go into long term memory and find the specific pieces of information that are gonna help me differentiate between those.

Okay, let me jump in there again. So, one of the most common things that somebody might say to me when they contact me for this conversation, I just failed, help me out, oh my gosh, the sky’s following. I always narrow down to two and picked the wrong one. Now, we use that as one of our sort of main identifiers for bad test taking. I narrow down to two, I always picked the wrong one. But that can be test taking or knowledge. Let’s talk about it as a test taking mistake first. I narrowed down to two, picked the wrong one is, okay, I liked A, but I didn’t know everything about A, so I picked B because I knew more about it in general, but as my working memory gets flooded, I’ve lost sight of the specifics of the question, and if I tried to rule it out, I could rule it out whatever, you realize you should have gotten it right when you read the explanation. That’s a pretty common test taking narrow down to two, pick the wrong one, indicating you’re a binary test taker. And that’s like, board’s workshop, we gotta fix this because there’s at least three or four things going on underneath the surface of that behavior pattern. But let’s say I always narrow down to two and when they’re saying like, I pick the wrong one and I’m using air quotes here, they’re saying like, I just always narrow down to two or three, and I just don’t know the answer. That means your knowledge goes like three levels deep, but the question is asking for the fourth, fifth or sixth level deep on that hierarchy. And that’s where you’re saying, like, I know I can narrow down to these two or three, but then who knows, because I can’t parse it because of the way it’s organized, encoded and retrievable in my memory system. Does that make sense?

Absolutely, yeah, yeah, yeah. So we’re talking about recall, specific recall on test day, which leads me to another trap in study that a lot of medical professionals fall into. One is, I’m gonna try and condense everything onto a page, or I’m gonna read and reread and reread and reread, and those are very, very passive. I should say, even condensing material onto one page, it feels more active, ’cause our hand is moving, ’cause we’re copying things, but our brain’s not super active when I’m copying information from one page to another. I mean that’s not engaging me cognitively. So that’s one, I call that the enemy, I’m gonna call this other trap, the adversary, which is okay, I know I need specific detail recall on test day, so, I am just going to drill myself on the million specific details that I need to know. And Ryan I know that you’ve been diving deep on Anki lately and getting yourself all worked up about it. So, here’s the deal, we love self testing, we love retrieval practice, love it, such a powerful tool, so effective, can be so efficient, but not by itself, not if it’s not part of a system, it needs to be a part of a system.

Yeah, let me interject. Like there’s gonna be at some point in my life, I’ll have my whole dissertation on why Anki is not great for everybody, the emperor has no clothes, all that stuff and it’s coming eventually it’s labor of love. Many med students and physicians thrive drilling on these details that Dave is harping on here. Like that is how they are learning, those are the bottom up learners, those are the two trackers, they’ve got the elves in the closet, whatever metaphor we wanna go with. They can learn by just jamming a bunch of random disconnected details into their head. Those people are probably not gonna find their way to us, at least the overwhelming majority of them. Most of the people that find their way to us, that this disconnected, fragment based bottom up learning does not work. So, I feel like somebody listening to this might be like your best friend, your colleague, your peer, they study purely on Anki and purely doing practice questions. And that fills all the holes, it encodes, it builds the memories, sets up random access retrieval, all that stuff. We don’t know a lot of those people, I mean, that’s the thing, we’re not talking to those students, those physician.

Oh yeah, they’re not calling us.

No, they don’t need to, they’re fine. Those are the ones that they put in X amount of work, they’re going to get the payoff. It doesn’t mean that they’re gonna be better physicians, it doesn’t mean that they’re smart than somebody else. It’s just that’s the way their brains are set up to at this learning circuit to receive the information and learn from it. Most of our students and physicians, the ones that work with us, the board study skills course, they need to come at it from the exact opposite direction. And I think that’s probably where you were going with this Dave. I mean, Dave only talked about five things on an infinite loop with all this stuff. Like, that has to come from what we call the framework. Like we gotta find this framework, we gotta build the big organizational hierarchical structure first to then build around with strategic retrieval practice. I’m assuming that’s where you were going. It’s just that part of the conversation when you’re talking to our potential students has to start with, I mean, that’s one of those early conversation points, is helping them identify, are you a bottom up learner or are you the sort a bottom up learner, it’s a different situation. Now, do we meet people that are like some bottom up learners are bad test takers and maybe the board’s workshop is a better fit. But if you are a true top down learner, you need the structure, you’re not benefiting from just tons of Anki, or any other format of drilling in details, just relying on just pushing hundreds and hundreds and hundreds of questions and not seeing results. You can get in there and parse if that is a test taking issue or a study based issue.

Yeah, one of the questions that we used to ask in our intake survey, I don’t know if it’s still there, I don’t think it is, was, at what point in your study process does the big picture of a concept come into view for you? And not that uncommon or response to be like, yeah, what big picture? There’s too many details for me to learn, so I spend so much time drilling myself on details. I hope that by test day that I understand the structure of the thing, what the pieces of this concept are and how they fit together, I hope I do.

Or the answers were typically like too late, not until like the day before the test. And then often we would hear at during the test, or after the test is when it would all click in, oh, that’s the relationship, the organizational scheme. Whereas I think all learning has to start with organization, with your brain seeking, finding, extracting, and mapping out the organizational super structure of a lecture, of a topic, of a chapter, whatever the case may be. So, as we teach each skill in isolation, we iterate, iterate, iterate, iterate. All of our skills are taught using authentic med school and boards relevant material. And then we flip it over to you guys using your own chosen content. Part of the secret source here is the very specific examples that we’ve curated over the years for our homework, ’cause that really helps accelerate your all’s learning. But we teach each skill in isolation and then bring them together. So it’s very much of the Mr. Miyagi methodology, which is cool. Like I’ve used Mr. Miyagi as an analogy for this for the past 15 years. And as so many of my pop culture references feel more and more dated, I don’t know with our specific demographic right now, but like my kids, teenagers are super into Mr. Miyagi. They know all about Mr. Miyagi, ’cause Danielson talks about him endlessly on the show “Cobra Kai.” Dave are you on “Cobra Kai?”

No I’m not on “Cobra Kai,” I bailed early.

Your loss.

I should get back on, okay, I know, I’ve been told, I’ve been told.

It’s fantastic anyway, but more for my purposes, it just brings Mr. Miyagi’s methodology back into the forefront of the popular consciousness at this point in time, which in a year, who knows. But Miyagi’s teaching methodology is all about teaching the very specific individual skills to Danielson and now Danielson to his students where like the wax on wax off, paint the fence, you don’t have to know anything about this. But he’s teaching the individual moves and then combining them later, that’s kind of our approach inadvertently. I mean it’s just good teaching, I think. You have to have the individual skill sets ’cause if you cross over it, and this is at the heart of our teaching philosophy. Like you have to learn the individual skills ’cause they’re nuanced. People think, like I had somebody ask me the other day, can I just do like a one hour crash course on study skills? I was like, man I’ve been talking to you for an hour already. You think I got a crash course? And I understand the question, it’s a fair question, I never mean to, but I mean like our answers are not short. Our answers are not short because this is serious serious stuff. And I think people, I get offended because people think study skills are like something you just moonlight on. ‘Cause that’s usually how it’s taught. If’s somebody who was like, oh, I was good at studying, so I’m gonna teach study skills. Like it’s insulting I guess.

Yeah, well just looping back to that idea of individual skills being brought together into a system. I think if what you need is you’ve got, I don’t know, you’ve got three months to prep for a retake of an exam that you’ve failed or you’ve got an upcoming step exam, and what you need is a system to break the material apart, to understand the big picture and then to lock it in those details, along with the tools to manage all that, to figure out, okay, what am I doing on a given day? How do I break this apart into chunks so it’s manageable over the next three months? How do I know if things are going well or if they aren’t? If that’s what you need, then we’re gonna be routing you towards that, the board study skills course.

Yeah, and one of the questions people might ask is like, how much time do these things take? The test-taking workshop, if you’ve got less than three weeks before your test, that’s pretty uncomfortable.

We can get you something.

Yeah, I’ve had people do it with success. It depends on like the stakes and where you are, how bad the low-hanging fruit is. But if you’re coming in less than three weeks, it’s pretty tight. Obviously the more time you have, the more you can do it. These things are built so you can do them while you’re in clinic, while you’re on rotations, while you’re working. But you will see more, if you are a bad test taker, by adding structure and shape, you can see more immediate feedback. I say that with the study skills course, there’s a longer tail, you’ve gotta build the skill, you gotta acquire the skills, then you have to go back and apply it to the stuff that you’ve studied. Again, it’s not gonna damage what you already know, it’s just gonna refurbish it or build the retrieval pathways and plug the holes. So, I don’t wanna make it sound like it’s insurmountable ’cause it’s not, but it takes longer to get payoff, I would say, wouldn’t you?

I agree with that, yeah. The only thing we haven’t really talked about is, so we’ve talked about these two platforms, the one that focuses on remediating your test-taking specifically and the one that deals more with the study end of things. But what we haven’t talked about is how do I know which one of these, is the one that I need? If I am that person who’s got the closed system where all I know is outcomes. How do I know what I need? And I know that’s a conversation that they have with you and you help them pass that. So maybe you wanna talk a little bit about that, about the questions you should be asking yourself. If you’re listening to this right now, trying to determine what makes sense for you.

Yeah, well I mean the easiest thing to do is just contact me. Our contact information is all over the website, just reach out, I’m happy to have a conversation. I think I usually start with asking you, what is your hypothesis as to what is going on? And some of ’em are like, I don’t know, that’s why I’m calling you, that’s fine. But sometimes just forcing yourself to tell me what you think is happening is a great way to kick it off. I think that a lot of my board’s workshop, students and doctors say things like, I know I know enough to pass this test. It might mean like you teach your peers, you perform extremely well clinically. Upon reading missed question explanations, you realize you should have gotten anywhere from 40 to 60% more of those questions right. So we call that the miss ratio. I say, imagine you missed 10 questions and you read the explanations, how many would be a knowledge miss versus a test taking miss? And if you’re like half and half, half are just knowledge, I just couldn’t remember it, never saw it, what have you, I was just gonna miss it on the day, fine. But if it’s 40, 50, 60, 70%, are test taking misses, like I should have gotten that right. Now, the key distinction there is not, I should have gotten it right, because I should have known that, that’s silly, don’t say that. Beating yourself up for not remembering something is useless, that is a study side issue. That’s the way you’ve encoded and you’re retrieving and all that jazz. But if you’re like, no, I should have gotten that right because I grabbed on the one clue and I ignored these other two clues. I saw this answer option down below, and I sorta shaped my reading to fit that. And now looking back, I realized I should have ruled that out. And again, some people are can do that, some people we can’t, we can talk you through that. I constantly narrow down to two and I’m always picking the wrong one, and then when I read the explanation, I realize I should not have gone that direction. Some people say I don’t have timing issues because I always get finished with plenty of time left over. Well, that sounds like a timing issue to me and that you’re going too fast. And then of course, if people are running out of time, that’s a test taking issue. And usually it’s not a reading impairment. I mean, it could, and then that’s where you’ve gotta learn how to get more effective and efficient all the way through anyway. But I find that if it’s a timing issue, it’s usually because the process they’re using is so cumbersome and unregulated that they’re just hemorrhaging time all over the place. So those are kind of some of the things that if you’re identifying with, I feel like that’s gonna most likely angle you more towards the test-taking workshop, but on the study skills side, that’s where they say, like, I’m familiar with most of the material, I just don’t know the details well enough. You’re just in that swamp of familiarity and it’s like it’s all just mush. Okay, well, that’s probably more of a study side thing. I study all the time, I never study so hard, I never study so much, it just doesn’t stick. The not sticking is a great, like weird common phrase. It’s like I do all this work to fill up this bucket of water. And then I come back a week later and the bucket’s empty. It’s like doing all the short term cramming, it’s not built for sustainability and all that stuff. I have all sorts of resources and I’ve got this video series and that review program. All this energy toggling through it, that means nothing. It’s like, let’s master one of these. Some people just come in, like I never really learned the best way to study, not afraid of hard work, I just don’t know how to get the most bang for my buck, or you’re just trying to take other people’s advice and trying to make it work for you. Those are all more study side things. Now look, I think a lot of people could hear this and say, I need both to which I’d say maybe, maybe, but maybe one is a necessity and the other is a luxury.

I think it’s so easy to fall into that completionist mindset. Like I can’t leave any stone unturned. I have to do absolutely every single thing I can possibly do, which would be great if you had infinite time, but you don’t.

So, I typically try to help people figure out what is the necessity and which is the luxury. And we do have people who do both. I mean you’ve been rolling through tons of people right now I think. And that’s fine of course. what I tell people is the way we’ve got it set up. If you do both, there is a discount, but you don’t have to like buy them both upfront. Like if you do one and then you later do the other one, you just get the discount on the back end, just remind us, I mean, I’m sure we’ll remember, but billing’s not our strong suit. There’s no like obligation to do it up front. Like I’ll have people sign up to say, I’m gonna do this one first and this one later, and sometimes that happens. But sometimes they do the first one and I tell ’em this upfront and they realize, oh, I don’t even need that. They do the first one, and then they realize they don’t need the second one, great, great. And that’s certainly it’s built that way. It is built with that exact intention.

I guess just to reiterate, you don’t have to know what’s going wrong, you don’t have to know what you need. We can help navigate that process because we spend way too much time thinking about it and talking about it together. And we’ve gotten pretty adept at helping people figure out really what they areas of need are. So, it’s perfectly fine to call up and say, Ryan, I don’t know what I want, I don’t know more importantly need. And can you help me untangle it?

Yeah, yeah, it’s so tangled and we march people through it, and it’s always fascinating. I mean, you and I have never been in med school, we’re not physicians, we are reading and learning specialists. And by listening to these stories for 15 plus years now, I think it’s honestly just a fascinating human story anyway. These stories I hear from these people and I really respect and appreciate them sharing that stuff with me, but it does help me then navigate and understand where they’re coming from and make the right recommendation. Now, we are not a one stop shop for everybody though. There are people that will talk to me and I’m like, yeah, this isn’t the right fit for you at all, or maybe just not right now. If somebody’s looking for like a review program, sometimes I get people and they’re like, I just want like the best information. I’m like, that’s not us. There’s people all over the country, all over the world that are suited for this. And I think you gotta be careful chasing the perfect program, the perfect resource. I think you just pick one and master one or two, master it and be good. But yeah, we’re not review people, we teach you how others teach you what to know. If you’re looking for a tutor for goodness sakes, don’t call us a tutor. You can say it, I’ll correct you. That is a weird like hill I will die on. Does that bother you? If somebody calls you a tutor, Dave?

Not as much apparently, I didn’t know, I didn’t know, that was such a thing for you

You know about me?

No, I didn’t know that. Okay, I will be careful.

I don’t like it. I mean, tutors to me are not what we are. A tutor is like explaining concepts. If you need a tutor, if you’re like, I just don’t understand this process, I don’t understand this disease state, I don’t understand this procedure, that’s what tutors are for, tutors are great. We tutored back in the late ’90s, that’s what we started doing early 2000. But I realized I wanted to build systems. ‘Cause I didn’t like reinventing the wheel. And that’s where you come from pattern recognition, you build the system, you build the tools, blah, blah, blah. But yeah, if you need a tutor to explain stuff to you or to hold you accountable, we’re not really like gonna hold you super accountable other than like we tell you what to do, you go do it. If you need somebody that’s gonna like coach you or tutor you or hold your hand through it, I mean, that’s a real thing I guess, but that’s not us, is that fair to say?

That’s fair to say, yeah.

Make a study plan, we don’t make study plans. I feel like, I mean, there are people out there that do that. I think once you have our tools, ’cause a lot of people I think really want study plans, but I think that’s just because they know there’s a gap that needs to be filled a hole that needs to be filled and they think the study plan is gonna do it, but I think it’s methodology. If you give them methodology and the management tools by and large, I think that resolves it. But if you want study plans, there are other people that do that. So if you have the bad fortune to fail your boards, please know you’re not alone. And that we talk to people about this every week, going through the same thing that you are, it’s possible that you are experiencing the same patterns and problems as many of our students and clients. If you fit the of patterns that we’ve identified, there’s a good chance you would benefit from one of the platforms we just talked about. And then you can prepare for your retake in a different, highly tactical way that would give you reason to expect different results. Look, feel free to reach out anytime. We have ways to contact us all over the website, I’m always happy to chat with you guys to listen to your story and equip you with the information that you need to make the best choice for yourself. I’m never trying to sell anything to you guys, and there’s never any obligation. Check out our blog, the website, the YouTube channel to learn more or just come back for the next episode. Thanks for listening.

Thanks for tuning in to the STATMed Podcast. If you like the show, we hope you’ll subscribe. You can find more test taking and studying strategies specifically developed for med students and physicians over our blog STATMedlearning.com. Thanks for listening.

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