The STATMed Test-Taking Philosophy: Weighing the Options

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The STATMed Learning Boards Test-Taking Strategies 

Don’t let bad test-taking strategies keep you from your dream career. Many of the bad test-takers we meet get tangled up navigating and assessing the answer options as they try to choose the best answer. In this video, we dig into multiple ways students approach med school tests and board-style exams and while there’s no one-size-fits-all way to take tests, there are patterns we hear from bad test-takers.

So, what is a good test-taking strategy? Well, sometimes that can depend on the student. Some med students and doctors can breeze through med school tests or boards exams. If that’s you, that’s great! But this video probably isn’t for you. However, if you’re a bad test-taker, try a strategy that limits the burden on as many cognitive processes as possible. Basically, we want to lighten the cognitive load as much as we can. So, how do we accomplish that when faced with multiple answers? We want to weigh each option in isolation, alone, one by one.

Looking for more strategies specifically for bad test-takers in med school or a related discipline? Check out our blog and podcast

If you’re a self-identified bad test-taker, STATMed’s Boards Test-Taking Workshop can help you identify what you’ve been doing wrong — and how to fix it.


Boards testing and the STATMed test-taking philosophy, weighing the options. 

I think a lot of bad test takers at the medical boards level do many predictable things wrong. I’m talking about those taking the USMLE, COMLEX, NBMEs, NAVLE, NAPLEX, self exams, your in-service exams, Specialty Boards like Emergency Medicine, anesthesia, Internal Med, et cetera, and most other medical board exams. One of those predictable things is this, most of the bad test takers we meet get all tangled up navigating and assessing the answer options as they try to choose the best answer. 

To visualize this, let’s imagine a scale, then let’s pull up a board-style question beside it. Now, let’s imagine each answer option is a unique gemstone, each one is a shiny rock, and we have to use our brain power to somehow weigh and assess each option. But here’s how I see what we see happening with a bad test taker when we see how they are weighing the options, they’re not weighing them alone in isolation. Nope, more likely than not, they’re weighing options together in some capacity like this, putting two or three, maybe all of them on the scale at the same time. How can I get the weight of say B when I never put it on the scale, so to speak, by itself? This animation of putting all the options on the scale at once, is how I interpret how many of our bad test takers are operating strategically when trying to assess and weigh answer options. And, yeah, I think this is a common issue with many bad test takers. 

When I talk to med students and physicians who identify as being bad test takers at the board’s level, it’s always interesting to hear how they have traditionally been navigating the answer options when working board-style questions. The things they say are not necessarily bad, in fact, they might be good or even great for other med students and physicians. That’s the nature of this particular beast, we can’t treat this as a one size fits all situation and even as I talk about the bad test taker we have to remember, this can’t be a universal statement because it’s never going to apply to everyone in all situations, even on my end of things. But this is an interesting aspect of test taking to consider. 

So, here are four of the main things my self-identified bad test takers will often cite regarding how they navigate and answer options. Again, caveat, caveat, caveat. Some of these things could be good for the good test takers of the world. Number one, some might say, “The first thing I do is skim over the answer choices to see what the question’s about.” So here they jump right into the options, running their eyes over them and maybe seeing that, “Hey, this is about cancers, maybe breast cancer, okay.” 

Here’s how this can be effective for many test takers. This might frame the test taker’s thoughts, priming or accessing the information on the topic from memory. That can be positive for sure. It might help them accelerate through the reading of the passage, since they know what neighborhood they’re in clinically and diagnostically, that can also be good, but it can also be a negative for a certain kind of test taker. A common pattern we see with our bad test takers, it can induce a bias if we see an option we know more about and we can then let this bias shape and manipulate the way we read the passage, twisting the square peg to fit into the round hole using our knowledge against ourselves, or it can freak us out and shut us down and make us decide game over before we even get into it, or it can flood our working memory as we try to queue up everything we know about all five options, which would also make this a bad strategy for that kind of test taker. 

Okay, Number two, they would say something like this, “As soon as I finish reading the vignette I knock out the obviously wrong answer options, then deal with what’s left.” So, here, they would read the passage and then skim through the options and knock out the low-hanging fruit. This will be different for each person because it depends on what you knew knowledge wise, but for the sake of argument say this person can easily eliminate options A, C, and E. Then they go back and do what they can to choose the best answer option from the remaining two. Again, many people swear by this methodology and that’s fine because some people, it’s great for them, there are many right ways to work questions but not always are good for all people. 

The issues here include, this process definitely heavily burdens working memory and I think working memory impairment or weakness is at the root of many bad test takers’ issues. So, for me and my students, I’d prefer a method that does not overly burden working memory for any struggling test taker. Also, it just throws a lot into that cognitive workspace in general, and I think it would be easy to not fairly assess each option doing it that way, again, if that’s not a problem then this is likely a solid move. This also involves assessing options multiple times at varying depths, and to me that is too inconsistent and inefficient for me to want any at-risk test taker to bring on board.

And then we have the third option, which is what I call trial by combat. I’m gonna try to poorly animate this thing so my apologies in advance. After reading the clinical vignette and doing whatever else, the test taker does this thing in this methodology where she puts A versus B, knocking them together in combat and deciding which one is the better answer option. So A versus B, in the scenario B wins. Then it goes on to B versus C, they sorta go at each other, which one’s the better option? In this situation they decide B is the better choice, so now B wins and you can see where this is going. Now it’s B versus D, bang, bang, bang, B also still wins. And now B versus E, bang, bang, bang, and we can see, yes, B is the outright winner. Thank you very much. So, this can be good for many test takers in general since it’s structured, and if you actually factor in every option that’s a good thing, but in my experience this can be a problematic strategy for many bad test takers because it heavily burdens working memory which, again, may be their underlying issue. And it can also be a problem simply because multiple items are being weighed at once, which for whatever reason can be a big problem for some bad test takers. 

Then the fourth and final example would be this, a test taker will read the vignette then make a prediction about what the answer is, then go down and find the answer in the options. That works, again, that’s great but, look, I have a lot to say on this notion of prediction and I’ll do a specific video on the dangers of prediction with boards questions sometime soon, but I’ll just say this, you don’t have to be able to predict the answer and expectations about prediction can cause a lot of damage for struggling test takers at the medical boards level. 

Yes, I know prediction is an essential transactional reading skill and the predicting can be valuable in other multiple choice test taking constructs, but with medical boards it’s not worthy of all the times it’s been recommended to you so let’s just say this, it’s fair to try to predict the answer but, one, don’t be blinded by your prediction and, two, if you can’t predict the answer, which will happen at least 50% of the time, then that’s okay and you can try to find the answer by working through the options using other strategies. 

So that finally gets me to the crux of this video which is this, bad test takers should use a strategy that limits burden on as many cognitive processes as possible, we want to lighten the cognitive load. So, how can we do that when thinking about the answer options? We want to weigh each option in isolation, alone, one by one. So let’s look at our scale again, and on the one side we’re gonna have the brain which represents what our knowledge and what we know, and then we have our answer options represented as unique gemstones, our fancy rocks, great. And then here’s the sample breast cancer question as well. Now, let’s weigh each option one by one, in order, in sequence, the same way every time. If possible, we can write down our assessment. This can be simple work, can be taught in great detail in our workshop, but to keep it simple we can go A, then B, then C, then D, and then E. Each one getting its one moment on the scale, each one getting its own moment on the scale ensuring that each option, if only for a few seconds, receives the totality of our attention free of other factors or distractions. And this can become so mechanistic that even if we are distractable or if we tend to impulsively zip all around the clinical vignette itself, this micromanagement step of weighing each option alone can keep us all in check and help us show our knowledge. 

So now in this scenario our test taker is left with two options, B and D. This is a classic case of narrowing down to two, we hear this all the time so let’s see how this can play out in two different scenarios, a bad way and a good way. Now, look, every situation will be different based on what the test taker knows, how the test taker’s brain is wired, and the methodology the test taker uses. In scenario one we’re going to see how a classically bad test taker might miss this question, when in fact he knew enough to get it right. 

Now, there are lots of issues under the surface here for him in the example, including a binary mentality where he thinks he needs to know everything, he’s got some prediction issues where he pretty much freaked out early on because he’s weaker knowledge-wise with breast cancers, and specifically because he can’t remember what stellate goes with. So all of these, and more, are overloading him and pushing him toward missing the question when in fact he knows enough parts to likely get it right. This isn’t about beating the test, it never is, it’s about cleaning up his own test taking interface. Then we’ll look at the way he could get it right using the parts of what he does know. The key here will be how he weighs the options, does he weigh them together or individually? So here’s our bad tie-break scenario, and he’s weighing the two remaining options together and, as you can see, it’s a messy tangled process. All the thoughts about clues in the passage like stellate to self recriminating thoughts about how he should have studied more, to a mix of thoughts on each of the options all tangled together. So he ends up picking D, fibroadenoma, but the question is, why? Basically he was upset that while, yes, he knew some stuff about B, he didn’t know enough so why not pick it? Well, it was partly due to the haze of cognitive overload that makes logical thinking so hard. Basically, he wanted to know it all and he fixated on what he didn’t know, he didn’t know if it was bloody and he didn’t know if two centimeters counted as a small mass, so he just kicked away from the safer option and landed on D. That’s a common pattern we see for those who say, “I always narrow to two and pick the wrong one.” Weighing in isolation is just one way to avoid this pitfall and break this pattern. So let’s look at weighing each option alone, a good way to break a tie. Now, there’s no way to get every tied answer right but we can be consistent, we can use the parts of what we know, we can look to rule out with partial false and choose the safe answer option that connects with what we know, no matter how limited, fragmentary or broken. This can in part be facilitated by weighing options in isolation throughout the process. So, he takes B and puts it on the scale by itself and asks what he knows in relation to the vignette, and he’s like, “Well, I’m pretty sure there’s a discharge and a small mass associated with this, and those are in the passage.” But then he has to reckon with the fact that he isn’t sure if the discharge is bloody and if the two centimeters counts as small. 

This is an inflection point for him, and since his cognitive burden is lessened by weighing the options alone, he’s more likely and more able to acknowledge that while he isn’t sure this is not against what he knows, so this isn’t enough to say this option’s wrong or even for him to say that this is a bad option, this doesn’t mean click it but it also doesn’t mean to strike it out, which is what he did in the other messy scenario. So then he would put D on the scale and see what he knows about that, and he’d realized he really only associates that with younger women, and in his mind this is more benign. Again, all anyone can do is use what they think they know, and he’d have to realize he doesn’t know much more about this and the stuff he knows doesn’t connect here, so then he can ask, “What is the safer option based on the parts of what I know between these two?” 

And that would clearly be B, B is safer, B is what he picks and B is right in this scenario. But right or wrong, I don’t care, that’s what he has to pick because it’s safer based on his knowledge. 

And that’s how he has to learn to work every question all the time, and this is much easier to accomplish if he weighs each option alone, each one on the scale by itself, every time, all the time, boom, boom, boom, repetitively like clockwork. That’s a part of how he will keep his processor from being overloaded, and be able to show what he knows consistently on board exams, which is the name of the game. 

Ooh, well, that wraps that up, this one got away from me, what can I say. Anyway, if you like this kind of thing and wanna learn more about our STATMed test taking process, of which this is only a piece of one cog in the machinery, look into our STATMed boards workshop or just explore our YouTube channel and our blog for more insights. Hope you found this interesting, thanks for watching.

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