The STATMed Way to Approach Medical Boards Prep
In this episode, host Ryan Orwig is back with Dr. Jim Culhane, Assistant Dean for Student Academic Success Programs and Professor of Pharmaceutical Sciences at Notre Dame of Maryland University School of Pharmacy. They dig into strategies students can use to prepare for medical boards. Here, they discuss strategies to implement when preparing for medical boards.
“You’ve got two real tracks or approaches to board prep. You’ve got the study component to it, where you’re interfacing with the materials that your school provided or that you purchased. And then, you’ve got the practice question side where you’re actually, going to mimic the exam or in the test-taking environment, in that way. And they cross over, they overlap, but they are two separate entities.” – Dr. Jim Culhane
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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 exam. Your host is Ryan Orwig, a learning specialist with more than a decade of experience, working with med students and physicians. In this episode, Ryan and Dr. James Culhane, Assistant Dean for Student Academic Success Program. And professor of Pharmaceutical Sciences at Notre Dame of Maryland University School of Pharmacy. Hear their insights on preparing for medical boards. In part two, they dig into strategies med students can use from fairing to the board.
– So if we teach them how to find structure on the upfront, then, it greases the wheels and everything accelerates downstream. So you can do this in a variety of ways, I think. The way that I do it is through, the skill that we’ve develop called frameworking. With the use and utility of practice questions.
– Right. So what you’re saying is you’ve got two real tracks or approaches to board prep. You’ve got the study component to it. Where you’re interfacing with the materials that your school provided or that you purchased. And then, you’ve got the practice question side where you’re actually, going to mimic or mimic exam or in the test-taking environment, in that way.
– Yeah. I mean, I look at, I consider word prep as a dual track process where you have two silos, side by side.
– And they cross over, they overlap, but they are two separate entities. The study side, that’s where we’re organizing, enriching, fortifying our knowledge. I think, a lot of people don’t know at this level, how to figure out, what do I know concretely? What do I not know? And then where are the, where am I fuzzy? Where are the holes? And again.
– It’s gonna vary from one person to the next. And there are methods, study methods, that can be used to absolutely fix this and address this, right?
– Now, let me ask you this question. What are some of the common things that you see students do wrong with this, with the studying component for board prep? What are some of those things that they do that are just, you know, that can give them low, that are low yield methods that they might use. Right, what are some of those things?
– Yeah, we’re talking about like just low yield study methods, right?
– So this is, just watching and rewatching videos without, any kind of proper setup. This is… And then banking that like, hey, I just covered that. Therefore I know it because I watched it once or twice. Like, that’s, again, that to me is an office drone mentality. Like, I’m getting paid ’cause I punched the time clock. How productive were you today? Doesn’t matter. The boss is gonna pay me. I’m on salary. But if I’m the entrepreneur, and I’m like, I worked all day, like, what do you have to show for what you accomplished? I mean, sometimes it’s nothing. Sometimes it’s a long day of bumping my head against the wall. Sometimes it is, I go down a rabbit hole and it doesn’t, it’s not fruitful, you know?
– So again, you have to own what you’re doing. Like how much yield are you actually getting? Maybe another mentality would be at the gym. Just because I go to the gym, and hang out for two hours a day every day, doesn’t mean I’m getting as good of a workout as the person who’s there in and out in 45 minutes doing a high intensity regimented workout.
– Just ’cause I’m there I might be hanging out and socializing. Maybe I’m lifting weights, but then stopping when I start to truly struggle. And I’m not getting the benefit. So again, not all studying is equal for all people. And you can deploy different strategy. So obviously then, if I am reading and re-reading material, obviously, one of the highest like, you know, low yield things. If I’m highlighting and underlining, if I’m roughly recopying, now, you know, a lot of people are gonna, at board’s level they’ve mostly realized, you can’t recopy everything. You know, one of the common things you hear, from going from undergrad and master’s programs into med school or a pharmacy school, they realize like, oh, I used to succeed by rewriting everything. And now I don’t, I can’t, because there’s so much speed, volume density, fire hose. Now, hopefully, they’ve figured that out by the time they get to boards that’s not gonna work. But, you still, people, we still believe, a lot of people still believe that that is the big money maker, and it’s not, you’re–
– It’s poor condensing. Poor condensing notes. That’s what I see a lot of my students doing they’re recopying, condensing. And unfortunately, with this board prep stuff, like the board prep book that we use at our school, it’s very, very condensed already. It’s, you know.
– It’s been boiled down to the essential elements, so there’s not much more condensing that you can do. And even with that, there’s still a a ton of information that you have to assimilate.
– Well, and then, yeah, but it’s this idea that by condensing, I’m going to then get yield from it.
– You know, and then also, it’s like, the snowplow effect, or you know, of massed learning. Where they’re like, and that’s where you’re like, I’m on this page, I’m on this chapter, I’m on this slide, I’m gonna burn it into my brain now, because I’m not gonna get back to it. So it’s like, this is just like, burn, burn, burn, like, literally trying to sear it into their brains. By staring at it or rep, rep, rep, repping it. You know, and this is getting into that learning science of it, it’s mass learning. They’re not getting into distribution and interleaving and all that stuff. But these are the things that got people there, from undergrad to masters, what have you. Those things have, I mean, those skills, I guess, we have to say those skills work. I mean, I hate to say it. But, like, those things do work well enough at other, in other academic arenas. And people believe that that stuff works. But just because you think it works doesn’t mean it does.
– It’s environment specific. Yeah, certainly, you need some short-term benefit from cramming and mass setting like you pointed now. But, when you’re studying for board exam over weeks or months.
– Months. Yeah.
– Long term is really key. And you know, fortunately, I think, the benefit for students that are studying for boards is hopefully, they have some foundational knowledge of this material. That they’re not starting from scratch like they might in a course in the didactic curriculum that they are.
– They might or they might not. Yeah. Or they might or might not.
– The faster we hope that they do.
– I mean, I tell them, but I tell people even like struggling to get through those first few years. Like, one of the bigger problems you see in like a first or second-year student, is gonna be a pharmacy student, a med student, what have you, is like, they’re what? They’re so worried about boards.
– And I’m like, look, right now, you focus on this upcoming block exam.
– But what if I don’t learn it well enough or worse? I’m like, I hear you, but, you’ve gotta put, you know, we gotta sequentially our priorities. So in that sense–
– Yeah, and the fact is, if you learn it well the first time, and you use good learning strategies, you know, will all of it stick with you? No, but a big chunk of it will. And you’ll be better prepared–
– It’ll make it easier.
– Make it easier when you get ready to prepare for the boards, absolutely.
– Yes. So, you know, but those are a lot of those low yield study methods that we’ve got. I mean, and again, if somebody’s like, these skills, they’re not a problem until they’re a problem. So a lot of the people that we meet, are coming to us because of first, second-year problems. And we put them through our STATMed study skills class, or our one-on-one study skills course. And we fix it then. But, I’ve certainly met people at a board’s level, even like downstream, like secondary tertiary boards, where that’s where it becomes a problem. I mean, like emergency medicine doctors all the time, they’re like, I never even struggle, but now I’m like teach, I’m living my life and I’m working and I’ve got kids and a family, and the old study methods are no longer working. And then, they wanna default back to rereading, rewatching, just iterate, iterate, iterate, and it’s that wrong kind of effort. It’s the wrong kind of desirable difficulties, whatever we wanna say on the learning science side of it, right? So we’ve gotta avoid all of that. Now, somebody might be like, but they just described how I study minus the other piece. So again, to bring back to my dual track.
– I believe on the one side you’ve got all the study side stuff. Okay? The learning, the organizing of the information, the encoding, the retrieval, attempts at retrieval, that’s where I want people to get to. I think, you should be setting yourself up. And getting to organized retrieval practice, as early as possible and as frequently as possible. Okay. That’s the study side. You do not need practice questions to engage in retrieval practice. This is one of the big misconceptions.
– And so here’s, so the second silo, is anything and everything to do with practice questions. So that’s using untimed tutor mode, practice tests, timed runs, doing them on the computer, doing them out of a book, I don’t care. But ultimately, simulating the test environment. That’s everything outta the practice question silo. Do I think that’s important? Of course, it’s super important. Here’s the thing. It’s certainly what I see a lot on the med school side, and a lot of like, doctor specialty board side, it’s almost exclusively, doing practice questions. And so, when I was talking to this student the other day, and she’s like, oh, when I’m studying at night, I get really frustrated when I miss these questions. And so right there, I’m like, like, wait, wait, wait. As for me–
– My students had that experience yesterday in class when we were going through questions, I’m sure.
– Yeah. But for me, conceptually, I’m like, let’s change our vocabulary and change our framework. I was like, I would not call that studying. I would call that doing questions, doing running questions. She was in silo too. And she was making it, but the vocabulary studying made it sound like, I’m like, wait, are you going through Pathoma? Are you watching like some, in first aid? Are you reading something outta first aid? Where were you? Oh, no, no, no, I was using this question bank. So again, and so I sort of explained, like, everything’s under the board prep umbrella. You have the study side. When you’re using like a resource book or lecture series to put information in and organize, retrieve. Or the test practice question side, with the question bank. And she found that reframing of that, to be very helpful. Just so that we could have a conversation about it, but also, so she could be a little more in control of her planning, and moderating of herself as she moves forward.
– So, yeah. So let me ask you some, a couple more specific follow-up questions about this. ‘Cause I think this is so, so important for the listeners. When we’re talking about the dual tracks here, the study track and the practice question, kind of track here to prepping for boards, what are some, what’s some advice or maybe some techniques or approaches, that students can use in the study component of this preparation, to engage in active recall, or self testing? And also, how can they interface effectively with these dense board prep materials? Like a board prep book with, you know, summaries or condensed versions of topics there. So do you have any specific advice? Or approaches that they might be able to use in order to navigate that part?
– I mean, what I think is, I mean, we know that once you read something once.
– Rereading it is diminishing returns.
– Right. We know that, right.
– This is, we know. And we know, I know, that people are gonna feel more comfortable reading and rereading at this level. They don’t want to try to attempt to recall the information, without reading it three or four times.
– I mean, I’m all for, I mean, if you’re reading a physical book, I like to use a dry erase board. And read the subheading or sub subheading. And instead of reading the answers below it, write out what you think it’s gonna be, abbreviate what you think is coming up, it’s a form of a self test. Then, you do read it, but you’re now self checking it as you go.
– That’s a simple hack. If you’re, I mean, the old school note cards, I’m not a big believer in note cards. I think it fragments the information. But use a single note card and just cover as you read below. So if you got that subheading, sub subheading, read that. Try to anticipate, try to recall, you’re gonna get your butt absolutely kicked doing this.
– You will not remember hardly anything. And so it’s very, it takes away a lot of the motivation to do this. But, it will solidify the reading event. Everybody says, oh, I wanna be active when I read. We all know active reading is better than passive reading, but what are you actually doing to be active?
– Like, reading should be more of a self quizzing experience. But there’s no consequence. And then the problem with all this is, it does solidify the memory, but, you don’t get like a ticker tape printout, printing outta your head saying, your knowledge just solidified by 24%. You know?
– You just feel like, wow, I knew nothing on that page.
– So, you know, as you’re saying, what you’re saying, and we’ve talked about this before. So if you’re reading, you know, a dense passage or something in the text, you know, taking some time after you’ve read that to try to remember what you’ve read, to summarize it, to even write down basic questions about the passage that you just read, that you can use to test yourself later on.
– I mean, people definitely can do marginal questions. You can, as you’re reading it, you take the information, you break it apart. You can figure it into a question, you write it in the margin. Then you can go back and quiz yourself on the margins. That’s a low fire way of doing it, gives you a bottom up way to reapproach the information. I mean, obviously I’m a, I think about all this and I mean, I want to framework at all. I wanna use our framework, super framework strategies.
– Right. That’s where I was Why do you talk a little bit about that? Because, I know, you have, you’ve developed a number of different approaches that students can use very effectively to, you know, engage with content material like this. Obviously, we can’t get into it in a lot of detail, in a podcast setting like this, but maybe you could describe it briefly to our listeners in terms of what that entails.
– Yeah. Well, I mean, big picture. I think that, let me just speak conceptually, and I think this speaks to boards issues. What I’m thinking about all the time now are what I’m calling bottom-up learners versus top-down learners. I think, most students in this field, in the field of medicine, pharmacy, veterinary med, what have you, are fully, proficient, bottom-up learners.
– Right, what does that mean?
– I mean, they can, that they can learn from defragmented details. They can just jam all kinds of disconnected details into the closet of their memory, close the closet. They’ve got these what I call these elves, like little fairy elves coming in, waving their magic wands. And then the closet opens and everything’s organized. Hierarchically, everything goes where it goes. That’s a bottom-up learner. These are the people that benefit from They’re learning, they’re taking information, they’re shattering it into fragments, jam it in the closet, open it, it’s all organized. Organization means it’s encoded with effective retrieval access pathways. So that they can access it in the future. These are people who are also, we talked about the study side silo, the practice question silo. There are many, many people, they are bottom-up learners and they are studying primarily if not exclusively, through practice questions. Now, but practice questions are just elaborate, dressed up, fragmented scenarios. Filled with like, highly nutritious, high yield factoids in the explanations. But it’s still a bottom-up learning methodology or approach. And again, they’re taking all these disconnected, I mean, they’re contextualized in a small scenario. But, that small scenario, if you plugged it into the larger framework of the review book, for the test, for the NAVLE or the NAPLEX, the USMLE, it’s just such a, it’s a drop in the ocean of the water. It’s a drop of water in the ocean. So they are learning from bottom-up conceptualization. It’s not wrong. It’s great for them because it works. And I think, this comes to a very, from a very fundamental aspect of how they’re wired and how they’re built, okay? I don’t know what that percentage of them are. Is it, 30%, 40%, 80%? I don’t know. Probably depends from school to school.
– Percentages of people that think that way and operate that way. And by the way, I wish my brain operated that way, but it doesn’t.
– We know mine doesn’t. So the other side of that equation, the opposite side of the coin is the top-down learner. These are people who require explicit, organizational structures built on the upfront, to then house the information. So these people, if they take all the fragments, these are the people that are really frustrated by learning. These are the people who are like, I’m doing questions, but it’s not all sticking together the way I need it to, knowledge wise. These are the people that they jam the fragments in the closet, they close the closet, there’s no elves. The elves don’t come. You open the closet, it’s still a mess. Eventually they open it and now it’s like leaky. There’s like water damage in the corner. There’s a hole over here. There’s like an electrical fire happening. It’s not working.
– I’m seeing it. Yeah, that’s my brain to a T.
– It’s me, it’s me. So they are top-down learners. Okay. These people need a step in between. Can they live without it? I mean, yeah, but they’re living more, it’s more painful. It’s less efficient. It’s more at risk.
– More work.
– More work.
– More work and so much, unnecessary work.
– Toiling, okay. So if we teach them how to find structure on the upfront, then, it greases the wheels and everything accelerates downstream. So you can do this in a variety of ways, I think. The way that I do it is through the skill that we’ve developed called frameworking.
– Now, when you’re talking about finding the organization or super structure, you’re referring to finding that in a board’s prep book. Like a chapter.
– Let’s say of a chapter on infectious disease that’s 70 pages long. So this process, you know, you can approach it from two ways, from a bottom-up learning standpoint. You can just do two under practice questions that are associated with that particular chapter and drill them over and over again. And if you’re not a bottom up type of person, it’s just not gonna be very effective or efficient for you. If you’re a top-down learner, what you need to find is the overall super structure of the chapter. You need to use a process, a learning process, that helps you to deconstruct the chapter and then reconstruct it. So you can find some of the structure to it or–
– To, yeah, I mean, to a degree. So frameworking was developed, primarily, when I was looking at, the advice that a lot of med students are given to preview, a lecture. So I developed frameworking as a plugin for lecture-based learning. And I felt like I was teaching, previewing or pre-reading, and it felt like a bunch of garbage. I was like, this is not gonna help me. Yeah, it’s familiarizing me with some topics, but it was, it took something that was vague and made it slightly less vague, but still super mushy. So I’m not a big fan. And I was like, I’m not gonna teach this. This is not helpful. It’s a very, I think one of the biggest fears you have as an instructor, especially when you’re dealing with learning strategies, especially learning strategies for highly intelligent people under extremely high stakes, like med school, vet school, pharmacy school, is the emperor has no clothes. That to me is the biggest fear. You do not wanna be up there preaching something to these people, under these stakes, under these circumstances and not actually be able to put your money where your mouth is.
– And I felt like previewing was like a big one of that. So we ended up finding that, like, there are aspects of previewing that could actually unlock all this stuff. And so that’s where we really develop this ability, can I go in and… And I’m gonna talk about this in a lecture-based model, before talking about how you extrapolate, flip it over to dense review book or textbook study.
– And this is like, frameworking put very simply, is you are at the bird’s eye view. And you’re coming down with like a claw, and ripping out the skeletal structure. So if you’re coming down on a map of a city.
– And it’s got the roads and the rivers and the parks and the yards and the houses and the buildings and the, all that. And you’re just getting the claw’s like ripping out just the streets.
– Just the streets, just the skeletal structure. And that can be achieved through what I call, like multiple non-linear passes through the text emphasizing hierarchy.
– And so it’s an act of seeking and finding and searching. It gives the learner something to do with a finite scope. And it is a matter of, it’s a reading strategy. It’s a non-linear reading strategy. We’re taught to read linearly. It’s really hard to get outta that paradigm, but it’s totally doable.
– And then, it’s like you’re finding the schema. And then you’re able to then build around it. It’d be like trying to teach somebody about World War II, without having any historical or geopolitical or geographical understanding. Like, if you told me to learn about, I don’t know, sort of like the colonialism in India. Like British colonialism in India. I mean, I know it happened. And I know more now than I did, but like, if you asked like 18 year-old me when I came through like the American school system where it was all very centric on, you know, through the American lens, I would’ve had nothing. So if I’m watching a drama set in colonial, and there’s like social factors going on. Like, I don’t know anything. It’s gonna be a lot harder for me to understand that movie or read that book and have understanding of the deep context. I’m probably got less retention, because I don’t have the framework for it, right?
– So if you have a framework, you’re gonna retain more, you got background knowledge. But, I think, the framework is more specific than just general background knowledge. For example, ’cause background knowledge is crucial for good reading retention. But, I can, like, I can’t really watch like, one of your lectures. And pull a lot away from it ’cause it’s not my specialty, right? But if I framework one of your lectures, which I can do, as a lay person, like, I actually am learning stuff. Because I’ve now built the skeleton structure to build stuff around.
– And that’s pretty fascinating. So we then realized we could flip that skill. And extrapolate it upwards, to textbook reading, to review books. And I was like, yeah, maybe it’ll work for 30 pages, maybe it’ll work for 50 pages. I mean, we can apply, I’ve had people apply to chapters that are over a hundred pages, like a hundred plus pages.
– Right, with a hundred-page chapter where do you even start? I mean, so this is a great way to start, interface with–
– You start from that bird’s eye view. Now, I don’t know how helpful this conversation is. Because I feel like it’s probably more frustrating than anything. Because the only way for frameworking to truly work is to, really get into all the nitty-gritty details of it. So I would say, you know, I mean, so, I mean, if we’re talking about getting into, how we can approach the thing, I think even just a staging ground of, all right, how many chapters do I have? How many pages are in each chapter? How many days do I have on a calendar? You know, let me at least start breaking, like, do like a staging area. Where I can at least start to conceptualize that. Okay. And then, and if I can’t do a whole framework of like, hundred page chapter, at least do like, okay, how many sections are there? At least do that, like the top, let me start breaking the hundred pages down. Oh, it’s actually eight sections. Ranging from 10 to 20 pages. Right, now I’m starting–
– at subheadings and sub subheadings. And you know, you can really, you can start to at least in some way, even in a rudimentary way.
– Start to see the skeletal framework of a chapter by looking at the different headings within a chapter and subheadings and sub subheadings. It’s not fully frameworking, but at least it gives you a place to start working from. Correct?
– Well, yes. And what I’ll see people do though, is since these things are a little more professionally written and edited, they’ll just offload the seeking and finding of the structure because it’s there in front of my face. Don’t fall into that trap.
– Still take the time to seek and find and delineate for yourself. The seeking and finding is, and again, you’re not actually, “learning the way that you think you’re learning.” But you are actively seeking and finding and starting to build those conceptual frameworks, that will, you will benefit from. Again, I think students are, again, to me, that’s a microcosm of drone versus an entrepreneur. If you’re like, oh, well, they’ve all already done the organization for me and broken it into these sections, I’m just gonna read through it. You’re now defaulting to drone. No, roll the sleeves up, do some work and skim ahead. Like, do some superficial like recon and foraging. And be like, oh, okay, this is, 10 pages, 10 pages, 30 pages, five pages. Start breaking that up. And start understanding the outlay of it. That is structural. That starts to put you more in control. But, to flip back though, the the top-down versus bottom-up approach. I think, a bottom-up learner, we talked about those ones who can learn from fragments. They probably, now, I don’t know, maybe, I think. I think, they can probably learn better sitting in lecture and listening linearly through the lecture. Because it’s still, it’s fragments one step after the other, but they don’t see how it all connects. They can probably better sit down and read a 50, 80, a hundred page chapter in a textbook or a review book, and get more yield from it. Because it’s like they are details in a sequence. The top-down learner, you tell them to sit down and just listen to this lecture, they’re gonna fall off the train. You tell them to sit down and start reading through those 50 pages, 20 pages in they’re like, blah, blah, blah, blah, blah. They’re just punching that clock. They’re not owning it. They’re not connecting it. They’re not deconstructing it. So again, I think that they are different ways that these these models impact the learning experience. And ideally, in a future context, I would like to find a way to sift these people, into proper tracks. And then, proactively intervene with them. Because, I think, there’s a certain subset that really, really benefit from not just plugging linearly away through it while some are fine with it.
– All right. So let me see if I can summarize here for a second. ‘Cause there’s a lot people and a lot to unpack there. So some of the things not to do when you’re sitting down with your board’s prep book and let’s say, you’re beginning to study a chapter, okay. Just plowing into the chapter of the book without doing, like you said, some recon or some deconstruction work. And trying to see, you know, what’s coming up ahead? What’s the, how’s the book organized, how it’s structured. You don’t wanna reread chapters over and over again. You don’t wanna highlight things. You don’t wanna recopy things. But, you really want to be able to, like you said, act as an entrepreneur. You want to take that material, that chapter, let’s say, for example, that you’re looking into. And try to determine what, how it’s organized and the structure and hierarchy to the material that’s there. And that can help you interface with the material better. Now, again, we can’t go into the details of frameworking here. Podcast just isn’t really gonna work with that, but that kind of technique can help you to achieve that quickly and efficiently, correct?
– Yeah. Yeah, yeah, yeah. I mean, better. It’s better.
– 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 at our blog, Statmedlearning.com. Thanks for listening.