Test-taking errors medical students and doctors make on board exams.

On the STATMed Podcast: More Test-Taking Errors Med Students and Doctors Make on the Boards

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Don’t Let These Common Pitfalls Derail You

Over the years, we’ve seen the students and doctors we work with make many different test-taking errors. And we’ve seen patterns in the types of errors they make.  So, in this podcast mini-series, we’re walking through 13 of the most common errors that medical students and doctors make on board exams and other tests.

This is episode two of the series.

Test-Taking Errors: Part 2

In this episode, Ryan and David discuss four more common mistakes med students and doctors make when taking medical board exams:  misreading the question and the clues, focusing on a single point of contact, rounding down, and twisting.

More Test-Taking Misses

We’ll dig even deeper into test-taking pitfalls in future episodes. Be sure to stay up to date on our latest podcast episodes, videos, and posts by joining our mailing list!

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Episode Transcript

Announcer: Welcome to the Stat Med Podcast, where we teach you how to study in med school and how to pass board style tests. Your hosts are Ryan Orwig and David LaSalle. Learning specialists who have decades of experience working with med students and physicians. In this episode, Ryan and Dave continue their conversation on the 13 ways people can go wrong when taking board style tests. If you haven’t checked out our previous episodes on this topic, be sure to. This episode is just one of a multi part mini series on test taking missteps.

David LaSalle: I think one of the big reasons that rounding down happens is that when we are reading a question, there’s a lot of information in there. And we want everything. So if we’re trying to grab and hang onto more then our working memory can handle, then again our brain’s going to try and help us out. And the way that it’s going to help us out is it’s going to take things that are these weird specific shapes and it’s going to sand off all those rough edges, so that it will fit. And we can kind of hang onto it. Kind of hang onto it generically in working memory.

David: And then you’ve taken the very specific clues that the question writer has given us and we have turned them into these sort of bland generic clues. And we can make them whatever we want to.

Announcer: Here are Ryan and Dave.

Ryan Orwig: Hey, Ryan Orwig and David LaSalle here with Stat Med Learning. We talk about studying, timing and testing in medical education. And today we’re going to talk about types of test taking misses bad test takers experience. The next mistype is what we call a misread. Which is because it’s a misread.

David: Yeah, reading something wrong.

Ryan: Yeah. Guess what? That’s bad. But, gosh and this can apply up in our first phase, it can apply in the second phase when you’re down answer options. Probably can happen in various ways in the third phase tie break. I mean again, I got to laugh because it’s like misreads are bad.

David: Right, don’t do that. Yeah.

Ryan: Yeah. So what can we say about misreads?

David: Well, so there are certainly people with organic reading differences, where you’re going to be dealing with a diagnosed reading disability. And that’s a whole different set of remediation tools that you’re going to need access too.

Ryan: We can help within a certain scope.

David: Yeah.

Ryan: But we’re talking more generally, right?

David: Yeah. For folks who aren’t dealing with those particular issues, I think that misreads oftentimes happen for two specific reasons. I think that people are sprinting and therefore are more prone to misreading. And I think that people are multi tasking and are therefore more prone to misreading.

Ryan: By multitasking you’re talking about more of a discrete multitasking within the question, not reading questions and listening to music and playing on their phone.

David: Exactly. Exactly. The sprinting is obvious, this is like I’ve got to get this question done because I’m sick of all the questions or because the clock is ticking or whatever. That ones pretty straight forward.

Ryan: Let me just jump in on the sprinting. I think a lot of laypeople think that reading is like a laser scanner, like a barcode scanner. Where it’s like buzz across the thing. So we think the layperson might think about I want to read fast or I just need to buzz go across faster. But that’s not how reading works. Reading, the eye itself cannot capture a fixed image print on the screen or the page while the eye itself is moving. So we read in these snapshots. Snapshot, slide over, snapshot, slide over.

Ryan: Faster readers run on really tight rails. And they have larger, these fixation snapshots. And so, but then if you are more of a choppy stepper with your reading, with really small fixations, you grab one word, you jump over other words, you grab another word, you jump over and grab another word. Right? So when the sprint happens, yeah you’re grabbing this word, you’re grabbing another one, sprinting to the next lily pad as you’re lily pad jumping here. And your brain auto fills.

Ryan: Imagine if our communication or interpretation depended on when we’re texting somebody for the auto correct, auto fill function. Gobbledygook goop. All kinds of miscommunication. So I think that’s one manifestation of sprinting, reading too fast.

David: Yes.

Ryan: Heavens knows what’s going to happen in the weight of that kind of thing. So a really good reader is going to identify this doesn’t make sense, right? And then I need to go back and correct it. The ticking time bomb clock, all the other stuff can be happening within this. I mean-

David: And our brains are decent at auto filling with things that do make sense too. My brain will plug in something else that fits, that fits the context.

Ryan: Yes.

David: That isn’t actually what’s on the page.

Ryan: Yeah.

David: And feel actually okay about it.

Ryan: Yeah, that’s true. Maybe it’s less gobbedly gook and it’s more like in the neighborhood.

David: Yeah.

Ryan: But in the neighborhood is dangerous on a test question.

David: That’s worse then way off, yeah.

Ryan: Yeah because the wrong answers are in the same neighborhood. At least some of them are.

David: Yes. With regard to that multitasking we were talking about, it is exactly what you were saying. Basically that idea that I misread answer C because my brain was still churning on answers A and B. Or because my brain was already leaping ahead to answers D and E and I couldn’t wait to get the question done. I was thinking about the question globally instead of just staying focused on working exactly the answer I was working at that moment.

David: So I kind of think of our brains while we’re testing as an old clunky PC. Where it can run one program just fine. But if I start trying to run a whole bunch of stuff in the background, it’s going to get buggy quick. So I think if I’m trying to read and process answer C and think about what I know about answer C and connect it to the clues up above, that’s a complex enough program to do without also worrying about was I right about answer B? And was that a stronger answer then this one? Or thinking about the question as a whole all at the same time.

David: I think that, oftentimes when we see misreads, I think that’s what’s going on.

Ryan: Well and then you can tie these misreads into anything. So let’s say I’m working a question about this kid with all these issues, including, let’s say it’s asking about lesions of the skin. And let’s say the prompt is like, analysis of the skin lesions will most likely tell us that they are blah blah blah. That’s the prompt, the last sentence being asked. Well you can misread that, I mean it ties back into a prompt misread and turn it into what’s wrong with this kid.

Ryan: You might see neurofibromas in the answer options. Which would be a type of skin lesion I guess. And then you start reading it as what’s wrong with this kid, because I misread the prompt and I’m turning it into what’s wrong with the kid. And then I see neurofibromas and I start thinking neurofibromatosis, which is a diagnosis.

David: Yeah.

Ryan: And now I’m reading it to shape, obviously I’ve gone out of order, we’re not using our sequence because we’re looking at the answer options, we’re thinking about them. And then you’re reading it like da da da, and then you’re triangulating. And it’s sort of kind of fits this diagnosis of neurofibra, it’s not even asking, they’re not asking about the diagnosis. They’re asking about a type of skin lesion that is clearly delineated in one of the sentences. And you’re just taking that description of the lesion and putting it as oh, these kind of lesions could be with neurofibromatosis.

Ryan: And now all of a sudden you’re picking that. So you’ve now misread neurofibromas as neurofibromatosis. You’ve misread the prompt as asking most likely diagnosis. And now you’ve made multiple misreads. And you’ve worked.

David: And that’s your brain trying to be too helpful. Trying to be like well neurofibromas doesn’t work, doesn’t fit what I’m thinking. But neurofibromatosis does, so let’s turn it into that. It’s like when you go get a sandwich and somebody’s like trying to be super helpful. And so they throw a whole bunch of extra mayo on there because they’re hooking you up because they love mayo. That’s what your brain is doing. Your brain’s like, it’s trying to help too much.

Ryan: That’s horrible.

David: Yeah, it’s horrible. And it’s adaptive for, again for most of the reading I do in my life, it doesn’t matter that much if I misread a word or two here or there. And I appreciate the fact that my brain will sort of patch over those gaps for me.

Ryan: Yeah I don’t know how reading a novel would work if it didn’t do that.

David: Right.

Ryan: But this is such a specific reading activity. Engaging with these very specific textual constructs and it requires very specific reading strategies. And if you are not using the right ones and the right balance and the right combination for your brains needs, it’s going to lead to a lot of issues, including these misreads. So again misreads can happen up and down the chain. So I think we talked about how that might look.

Ryan: So the idea of how to fix misreads is to, I think installing a robust system that limits burden on your processes. Learning how to identify when and how they’re happening, reflecting on them. And then really building strategies around them to buffer those occurrences. Again it’s sort of, you’ve got to have a new system in place that gives you feedback, so we can see where within the scope these are happening, how often they’re happening. And then through reflection, build self monitoring mechanisms.

Ryan: Because you take some people that are really rampantly bad with this and we can really cut them way down, right?

David: Yeah. Right. I think a lot of it comes down to getting people to focus on what they are working at that moment. What the step is that they need to be focused on at that moment. Doing that one task at a time. I think that really does help reduce the number of misreads.

Ryan: Yeah, a misread is more just a symptom of other larger systemic problems often.

David: Yeah.

Ryan: So if you fix the system, it helps reduce the misreads. And again if you have a reading disorder or something like that, you just have to almost, there’s probably going to be, depending on the nature of the reading disorder, it could be fixing the structural stuff helps offset it. Or you just have to get tighter everywhere else to account for whatever kind of wash you’re going to have there. Those kind of mistakes, right?

Ryan: All right, so another mistype that we see with bad test taking is what we call a single point of contact. And this is where you build all of your comprehension around a single clue, usually in the passage itself, up in the clinical vignette itself. You grab onto that one clue and you build off, it’s kind of an opposite of a triangulation. So we want people to maybe pick three, you offset that by picking three clues. And again, it’s not a perfect fix, but it does fix it.

Ryan: So how might you see some of these single point of contact misses happening? What would you say about that Dave?

David: Well, I mean I come back to the idea that so much bad testing is emotionally driven. And I think that people who are oftentimes making single point of contact errors are reading questions a little desperately. They’re reading questions hoping that something’s going to connect. And they’re so excited when something does. It’s just something clicks right in and it feels great and it’s exciting and a-ha. I found the thing and I recognize it and I know it’s associated with this.

David: And it’s this huge relief that floods my system. But then what happens is I am pinning everything on one clue. And we know in these vignettes, there’s more then one clue.

Ryan: Well we know, and the way that these questions are built, wrong answers are designed to be partially correct.

David: Right.

Ryan: So yeah you’re grabbing onto this one thing and that facilitates ruling answer options in instead of ruling answer options out. And our, a key tenant of our philosophy is that we want to learn how to rule options out. Ruling them in is just a very, you’re playing with fire. Sure it’ll work sometimes, but it’s not going to work over the course of the exam.

Ryan: So yeah you get this really excitable, like oh you can rule it in. And then you’re going to ignore other clues. By definition, if you’re single point of contacting it, and we see this all the time-

David: All the time.

Ryan: I grabbed onto this and this fit.

David: Yup. And it might be, so it might be somebody who just isn’t doing great process. They aren’t doing a neutral read and triangulation, they’re just grabbing one clue. They see it, they get so excited, they go to the answers, they pick that answer and move on. That’s the gross version of it. The subtler version of it is somebody who is doing their process, they’re going through the paces. And they do grab three triangulation points, but really the whole time they’re just so excited about that one triangulation point. And they already know it’s going to fit so nicely with this answer.

Ryan: And you’re using the word excited and it could be a true excitement feeling. Or it could be more of a stealth excitement. Like a relief excitement. I do think so many test takers are secretly hoping every time they open a question, it’s like I don’t know opening a present on your birthday from a bunch of grandparents. And you’re like, as a kid, like for me it would’ve been like please be a toy. Please be-

David: Yes.

Ryan: Oh. Shirts.

David: Yeah.

Ryan: Yeah. And electric toothbrush, oh my. Thank you. But this hope that you’re going to get something. And I think there’s this hope of just please jump out. Please just jump out and tell me that it’s this thing that I know and I can run with it. And that’s more of a stealthy excitement, but it’s still an excitement nonetheless. That’s I think a big, this underlying cause of the single point of contact.

David: Yeah. And I call that the click. Like when you’re playing with Legos or you’re putting together Ikea furniture and you’re struggling to get things to fit. And all of a sudden something clicks into place and you’re like oh, it fits. Thank goodness. And it’s a little exciting, it’s a little stealthy exciting maybe. And I don’t think that click necessarily means that your theory is wrong. It doesn’t necessarily mean that it’s not what you’re thinking.

David: But it also doesn’t necessarily mean that it’s right. For a lot of people that we work with, I think the click is just an indicator that I better be careful to check that theory against the rest of my clues. Because I know myself and I know I get excited when one clue matches really nicely. But the key is, at the end of the day, it does not matter how well any one clue matches. It doesn’t matter. What matters is do all my clues match?

Ryan: And again if it [crosstalk 00:15:59] too much, that’s where we use the triangulation, with just three clues.

David: Right.

Ryan: At least push on three. I think if I, it’s like if I built a tree house for my kids, I wouldn’t just be like and I’m not really good with building physical things. I wouldn’t be like get up there and try that tree house out kids. Hopefully it holds up.

David: Yeah.

Ryan: I would have to get up there and jump around in it, because if it holds me then it’s going to hold them. So you don’t want to just have blind faith that my initial clue is going to hold up. I want to try to tear it down instead of just hope that it holds up under pressure, right?

David: Yeah, can I talk about a special case here?

Ryan: Yeah.

David: Because it is something that comes up pretty regularly, is I think that questions that are very prone to single point of contact are questions including images. I think that oftentimes, when people see images, they get so excited about the image and the excitement could be a positive or a negative excitement. Some people are like oh good, there’s a picture. That’s going to help. Some people are like, oh no. I hate these pictures. Whatever, whatever format that excitement takes. I think the number one error that I see people make when dealing with questions with images is that they overinvest in the image.

David: So, that has a couple potential outcomes. Either there’s a clue in that image and I just get super excited about that clue. I see it, I identify it, I get super excited about it and I build my whole theory on that one clue and disregard anything that maybe doesn’t match it. Or I look at the image and I’m not exactly sure what’s going on. And that might lead me to over interpret the image. To force myself to see things there that aren’t really there. So that I can feel okay about that clue.

Ryan: Second one you’re saying, I can’t really tell what’s going on here. And if that’s the case, you should go down to the actual text and triangulate there. And so I’m going to make there be something I can take from this. Yeah, real danger. You’re twisting.

David: Right, like that shadow might be tumorous so I’m going to decide that it is.

Ryan: Build everything around this real shaky take.

David: Yes. And then the final thing that can happen when we look at an image, sometimes we’re like oh I got it, I know what it is. Sometimes we’re like I’m not exactly sure, but let me overinvest it-

Ryan: About that response to the clue. Like oh this is a tumor. This is a fracture. As opposed to, I don’t know, what’s this little thing here? Well maybe that’s a tumor or maybe that’s a fracture. Those are two very discretely different responses and they need to be able to identify that.

David: Yes. Yeah. And the final sort of response I see with images is that people look at the picture and they say, “Oh my gosh, I don’t know what this is supposed to be showing me.” And because they’ve invested so much significance in that picture, then it’s just tailspin-

Ryan: And then they don’t do a diligent process down in-

David: Right.

Ryan: The passage.

David: Yeah. No that’s just like I’m already drowning. I’m already drowning-

Ryan: Because the picture is so confounding to them, they’re out. It spins them out. And then just another random thing about images, so we talked so much, we’re looking at this through the filter of the way the brain reads and processes textual information. I was working with some sort of radiologist a year or two ago and it was fascinating because their stuff is largely just images. Maybe with a few sentences.

Ryan: He was doing single point of contacts on these images. He would grab onto this one thing up here and then miss it because he’d fill in all the other stuff that could be, oh it fits. But I’m like, okay you picked A, D is right. Why are they saying D is right? Well they’re saying it’s right because this. Could you have gotten that from this picture? Because I’m assuming he just didn’t know it. He’s like, “Oh no, actually this and this means, oh yeah well these two don’t go with A.” I’m like, “So if you just triangulated,”-

David: An image, wow.

Ryan: Process. So he’d go to a question, so he just added, like you’ve got to triangulate on these things. Which is what he would do in real life. It’s just a weird way some of these doctor brains work on these artificial constructs. So he’s like, “All right, I’ll see the picture. Boom. There’s really nothing else. Okay it fits.” Boom, oh, but nothing else. Oh, oh oh. And then it just built out.

Ryan: So the stuff that’s happening reading wise can happen text wise. Same phenomenon. Those are a little more fringe examples.

David: That’s great, I love that.

Ryan: But it does translate, same phenomenon.

David: Yeah.

Ryan: So anyway.

David: Yeah, but for most testers who are not taking a radiology board, for most testers, the most that image is going to provide me is one triangulation point. So I think we just need to keep images in their proper context. And we look at it and we say-

Ryan: Right

David: Point.

Ryan: Right and then to scale back out to just single point of contact. If that’s an issue, what you probably want to do to fix it is say, “Okay, what did I pick? Why did I pick it? How did that hurt me?” And then, I mean maybe I picked fever and vomiting or something that’s really low, almost like wild card, can be anything. But then I’d say well what are the other two things I could’ve picked that would’ve really helped me? Or three things otherwise.

Ryan: Just build out that, because if you keep doing that, you’re going to just get better at picking out the better clues. And again I don’t think you’ve got to pick the perfect three clues. It’s just a way to give you some three dimensional perspective as opposed to a two dimensional. Which is really important in these situations, fair?

David: Yeah. And I think also learning to recognize that reaction we might have to a single clue isn’t necessarily a big flashing sign leading us to the right answer. Which I think it very easily can feel like.

Ryan: Yeah. That’s a type, that’s a type of bad test taker who’s falling into that. Again over and over and over. Infinite mix. So we’ve got to learn through reflection to get better at it. Good, so that wraps that one up.

Ryan: So another one would be the rounding down. So number seven is rounding down key clues. Rounding down can happen in the prompt, the last sentence, it can happen in the passage itself, it can happen within answer choices. So rounding down is taking something nuanced and complex and then rounding it down to something smooth and generic and less. Less then what it is. Very dangerous. This is a bad one.

Ryan: So what can you say about this one?

David: I guess the first thing that comes to mind for rounding down is I think one of the big reasons that rounding down happens is that when we are reading a question, there’s a lot of information in there. And we want everything. So if we’re trying to grab and hang onto more then our working memory can handle, then again our brain’s going to try and help us out. And the way that it’s going to help us out is it’s going to take things that are these weird specific shapes and it’s going to sand off all those rough edges, so that it will fit. And we can kind of hang onto it. Kind of hang onto it generically in working memory.

David: And then you’re taking a very specific clues that the question writer has given us and we have turned them into these sort of bland, generic clues. And we can make them whatever we want. [crosstalk 00:24:07]

Ryan: Yeah, they become wild cards. They can fit whatever we want. And that’s where people say, well I mean I narrow down to three. And it can be any of them. Or I narrow down to two and I’m always picking the wrong one. Well if you’ve rounded down clues, then it’s going to help you push away from something you don’t know as much about. And maybe fit something you know more about. It’s one of these mini patterns we see with these sort of tie break fails. And there’s a whole medley of those things.

Ryan: But if it fits everything up top earlier in the sequence, before you get tie breaks, that’s going to fix a lot of the problems. And then there are better ways to fix tie breaks. Rounding down’s probably due to working memory limitations. So you’re taking something complex and really squishing it down. If you have somebody who’s fainting multiple times during varsity soccer practice and you turn down to faints at school. It’s very different. If you have somebody that has a very de script, specific description of a rash and then you turn that into rash, I mean think about, you’ve just invalidated so much of what you’re dealing with.

Ryan: And again people would say I would never do that. That’s obviously a really bad idea. Of course. But it’s due to the way we’re processing this textual information and trying to hold onto it. So again you have to learn to see if this is a problem for you. It’s really easy to do. You do a handful of questions and then you look at the ones you missed and you’re like wow, this says purple spots on the buttock and I picked toxic shock syndrome. And I know toxic shock syndrome is not purple spots on the butt. I know that. So how did I do this? That was just a stupid mistake. No it wasn’t a stupid mistake, that’s not helpful. What happened was you turned this very specific description of a rash into a rash. And then you said well this is a rash, so yes boom I’m in and other symptoms fit.

Ryan: It could be as few as two or three words on an answer option that gets rounded down to one word. And you’re like well yeah, but I looked at this and I wrote it in, if I looked at this, I would’ve ruled it out. I mean it can happen up and down the chain. So I think that rounding down is a really, this is definitely one of the silent killers throughout. And again, it can happen all the way up and down the chain. Any other thoughts on rounding down?

David: I mean it just comes back to my mantra, that in testing the general is our enemy, the specific is our friend. If you think about how much real estate these question writers have, how much space they have to give us information, they’re choosing their words specifically and deliberately to point us towards the right answer and away from wrong answers. So if we round them down we’re not using the tools that we’re given.

David: And I think that happens sometimes because we start treating the question globally instead of zooming in and using the specifics that are in there. I think we just keep pinning ourselves again and again back to the specific language that is actually in the passage, in the prompt, in the answer option that we’re working at that moment.

Ryan: Yeah and I think just by installing a system that limits burden on working memory and makes us sort of break things into something we can focus on, it’s going to help reduce the occurrence of these. It’s not going to make it go away automatically. But again this isn’t something everybody does, but there’s a few very specific types of bad test takers that definitely do this. And again I don’t think it’s readily apparent to them on their own. It doesn’t seem like it, right?

David: Well and yeah because all of these error types are adaptive strategies that worked previously in testing. Like you can get through undergrad by rounding down questions or pieces of questions and it’ll be functional enough.

Ryan: Yeah.

David: These questions, the questions, when you’re working on a medical board exam, they’re so specific. There’s so much information in that question that we have to keep sharp and specific. So what used to work isn’t going to work anymore. I think that’s something-

Ryan: And the wrong answers are so close to each other. Whereas in a lot of testing constructs, they’re a lot farther apart from each other I think. It’s probably part of the rub. And again second and third order, the demand on inferences, this becomes, again this is probably not a problem before because the textual build of the construct didn’t really push a burden on that. And now it is.

Ryan: So this is a thing that might’ve always been a weakness for somebody that now is opening up and just blowing up in their face consistently on the test. So to fix it, yeah I mean I think you almost have to, this is more of a top down fix. Where you limit burden on working memory across the board and then you tactically start seeing if this is happening, then start attacking it from there to fix it.

David: Sounds good.

Ryan: So another test taking miss, this is a pretty popular one for us, is what we call the twist. This is when you take a clue that doesn’t fit something and make it fit. Or it’s a clue that’s just up there and you manipulate it. So the idea is you can make a square peg fit in a round hole if you hit it hard enough. Which is, and again, maybe, it’s like chicken or egg stuff too. Did I twist that because I wanted it to fit an answer option? Or did I just twist it because I twisted it?

Ryan: It’s where you’re taking this clue and again this happens in the passage, it can happen in the answer options, it can happen with concrete clues, it can happen with the way you’re thinking about how things connect, it can happen with a prompt, it can happen with tie break process. So a twist is when you’re adding additional information to the equation of the passage and the scenario and the answer options that is not inherently there in black and white.

Ryan: So if an inference is good, you have to be able to infer certain things. An inference is something an overwhelming majority of people are going to read and say this equals this. A twist is whenever you’ve added something that not everybody can infer because you’ve added to the scenario. So what can you say about the twist?

David: Yeah, I agree with that. It’s an inference taken to a troublesome extreme. Like we’ve gone past reading between the lines and now we’re writing in between the lines. We’re adding information.

Ryan: Yeah.

David: Yeah, harder oftentimes for doctors, I think, to avoid twisting then it is for students to avoid twisting. I think that oftentimes people’s clinical experience pushes them to twist, where they’re recognizing their patients in these hypothetical vignettes. So they’re importing all of this external experience into the question. It’s paradoxically it’s tougher the more clinical experience you have sometimes, it’s tougher to work these questions because we’re not looking for the real world answer or the analog that you had in your clinic last week. We’re looking for the textbook response.

David: So I think it’s easy to start importing that stuff.

Ryan: Yeah, for sure. But that’s not to say of course that our step, someone taking step one for the first time isn’t twisting like crazy. And this is when you’re going out of the bounds, you can’t see the boundary lines of where the inference ends and then where the twist begins. So like you were saying, if you have somebody that’s fainting multiple times at varsity sports practice. That should tell us, there’s an inference to be drawn there. This person is fainting when, during exertion. If they said after practice, does after practice mean, like is the heart rate? It makes it a lot less valid to say that’s during exertion. That would probably invalidate the question.

Ryan: If somebody says that they’re fainting multiple times at school and you’ve got to say, no here’s a better one. If this says you’re fainting multiple times during ping pong at school, does that mean and you might say, well that means maybe they’re sitting down and standing up and going over. And then they’re, [inaudible 00:32:59], they’re dropping, and it’s like pretty leisurely. So why would you be passing? This isn’t about valid question scenario at all. But then I might say, oh no, ping pong to me, at school, that’s intense. There was money being exchanged, there was sweat, people’s heart rates were up. That’s not valid, you can’t say that.

Ryan: You can’t use ping pong at school to imply, to expect the person to infer intense cardiovascular exercise. Even saying kicking a ball around is probably not valid because it’s not a universal, like your heart rate is up. Varsity practice indicates that sort of thing. So you’ve got to see where there’s something that is an inference that everybody should draw versus these things that you add what if, but maybe, all that jazz. Right?

David: Yeah. I didn’t tell you this, I had a client the other day, it was great. We have a question that is analogous to this, the varsity soccer practice that we use in lecture. And I had a client working that question. She decided that this kid who was fainting during the varsity soccer practice had an eating disorder. And the reason that made sense was that this girl had a crush on her coach. And was in the process of trying to drop weight and look good for her new coach on the soccer team.

David: And I pointed out to her, this coach might be an 88 year old woman. We have no idea, this coach could be her mom. We just don’t know. So any time we set that up where all the stars have to line up just so in order to make that answer right, like well it could be an eating disorder if this girl had body issues and the coach was new and it was a young person just out of college who was very attractive and and and.

Ryan: Right. So it’s what if. What if is the connector that links you off. And again it can’t be something that everybody, yeah. And people, usually once they start having to articulate it, they realize oh. [crosstalk 00:35:30]. Yeah. It’s like oh that’s embarrassing. Or it’s like okay now write out these things you think are there. Now go back to the black and white print and tell us what’s actually there.

David: Yup.

Ryan: And it’s pretty, because I mean teaching inferences is actually really hard. Like how to draw inferences, it’s like a key deep reading skill. Most of our students do, are capable and able obviously. But they just sometimes have been engaging in this unchecked behavior where they’re actually twisting and they’re getting no feedback. So again if somebody does this, what they do is they write out how you missed it and then you write out how you should have worked it. And that kind of iterative self reflection will lead to better self monitoring, to help extinguish this negative twisting behavior.

Ryan: But man it’s a good one. Like if I were a med student or a physician, I would’ve been a twister. I would’ve butchered these things. I’d be like, I think that’s why I’m good at this, is that I would probably have done all these things. But I would’ve twisted the heck out of stuff. And again especially if nobody’s sitting there, I like to think that I’d be really coachable. Maybe that means I’m like the least coachable person, who knows? But I think if someone would be able to sit down and explain to me the rules and the patterns, that would be really empowering to me. And that’s sort of how I built all this stuff.

Ryan: I mean if nobody’s explaining to you and you’re just off doing questions on your own and reading the explanations, like dang it, missed it again.

David: Yeah.

Ryan: I was stupid. Why do I keep doing this? It does lead to this horrible feeling. So it’s like the idea of every time you touch something that’s metallic and black it burns you. Or no, okay every now and then you touch something that’s metallic and black and it burns you, you’re eventually going to become paranoid if everything is metallic and black. Until someone explains to you, oh no, that’s the burner on the stove. Oh don’t touch that. But if you don’t know why you’re getting these negative shocks, this negative feedback, it’s going to make you feel terrible, it’s going to make you not trust yourself. It’s going to make you hate the test. It’s going to make you hate the test makers. And then you’re trying to get into their heads, which we don’t want to do.

Ryan: Just keep that clean interface and learn how to get feedback on how you’re missing these things. But twisting has got to be something that’s just absolutely maddening. And once you can learn the rules for it and how do I identify it after you do it, then you can get control of it. It brings everything back down, if that’s one of the things that’s happening to you.

David: Yeah. Can I add just one thing? Because it just crossed my mind. It’s one of my favorite quotes that a client ever said to me. So he was analyzing this process and he said, “I have to remember that when I’m working these questions, I’m like a doctor on ER, not a doctor on House. Meaning, I’m doing middle of the road medicine. I’m doing stuff that everybody who sees these clues, that’s what we’re going to see. Not solving obscure medical mysteries. I’m not going to read the answer explanation and be like oh my gosh, that’s brilliant. That’s some Sherlock Holmes stuff there.” It shouldn’t be like that. We don’t have to bring that much baggage in to put all the clues together. We just want to take what’s there and see what it adds up to.

Ryan: Yeah and it can be something that’s closer to a zebra then a horse. But, it still has to fit whatever that diagnosis is.

David: Yeah.

Ryan: And it’s not like you have to do all these, like with House it’s just doing these crazy back flip, somersault, finding these Sherlockian level of connections to get to solve the mystery. That must be what that means. And it’s more like let’s just cut right through it, boom, boom, boom, boom, boom and work to the most logic. And that’s why it’s most likely, most appropriate, are so incredibly integral to this whole textual construct working. It’s not asking what could it be. It’s like given these limited clues, what’s most appropriate? What’s most likely?

Ryan: And that will help I think keep us in line and general, but especially in regards to twisting.

David: Absolutely. Power to prompt. Yup.

Ryan: Yeah. Back to that prompt, that last question being asked, anchoring back to it will take you through.

Announcer: Thanks for tuning into this episode of the Stat Med Podcast. In future episodes Ryan and Dave will discuss additional ways test takers can go wrong on the boards. If you liked this show, be sure to rate it on iTunes, Stitcher, Spotify or wherever you listen to your podcast. And be sure to subscribe so you don’t miss future episodes. You can find more test taking and studying strategies, specifically designed for med students and physicians, over at our blog on StatMedLearning.com. Thanks for listening.

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