Spring feels like the season of studying for exams. Traditionally, medical students across the country start “dedicated” study time for the USMLE Step 1 exam. Graduating residents in most specialties are registering and studying for their written and oral board exams. By the time a physician is practicing unsupervised, he or she has taken at least six high-stakes exams (e.g. MCAT, USMLE four times, board certification). Many of us are well-versed in preparing for exams.

I am by no means an expert in exam preparation, but I am human and have made a number of mistakes along the way.

Amorphous Goals

When I first started studying for the MCAT in college, I purchased a set of review and question books then progressed slowly through the material. When the exam was a couple of weeks away, I felt overwhelmed with how much more material I had left to review and memorize. My goals for studying at that time were to finish the materials I had. But those weren’t effective goals. Peter Drucker - an author and consultant in organizational development and management — coined the concept of “SMART” goals. “SMART” stands for Specific, Measureable, Acceptable, Realistic, and Time-bound. My broad, non-specific goals to finish some study resources clearly weren’t “SMART.” While Drucker’s acronym was created with organizational success in mind, they can also be applied for individual success.

By the time I was a second year medical student, I recognized the importance of structuring a study plan for the USMLE Step 1 exam and thus spent hours creating a spreadsheet to breakdown exactly how much material I had to get through each day during my dedicated study time. I also created a weekly set of goals for the time I still had lectures. Within my weekly plan, I built in time off from Step 1 studying to account for medical school exams and other life events. I also built in buffer time at the end so that I could catch up (since, it’s inevitable that I would get behind). My new approach to studying would have made Drucker proud.

Not Budgeting

Exams are expensive. Thus far, I’ve spent more than $5,000 on exam registration fees for medical training. My Anesthesiology APPLIED board exam will cost me another $2,100. While many people budget for registration fees, what is often forgotten are the associated costs. For example, my APPLIED board examination is only available at one testing center, meaning I need to consider the additional cost of travel and lodging when I budget for the year. I also will be purchasing exam preparation material, so I may end up spending more than $1000 (our oral board exam has historically been the most challenging one, so preparation will be key!). Realistically, I’ll probably need to spend more than $4,000 for my board exam — assuming I pass the first time.

Overconfidence

The overconfidence effect “measures the difference between what people really know and what they think they know.” Most of us feel confident about certain subjects that we are exposed to over and over again; this becomes dangerous when we fail to recognize when gaps in our knowledge start to form. When studying for an exam, many of us brush over familiar subjects because we feel comfortable about it. But without objective assessment, it’s hard to really know what we know. We are often blind to our weaknesses and faults. One study examined students’ confidence on their exams and showed that most students were overconfident.

The best ways to try to address overconfidence is through acceptance and self-reflection, objective measures, and outside assessment. Let’s all just accept there will be times when we feel a bit overconfident in our ability and skill. This act of acceptance allows us to self-reflect and be open to other possibilities. Objective measures include performance on simulated examinations. Finally, having someone you trust and admire provide feedback may help identify areas and ways you may be overconfident.

Overconfidence can lead us to take exams we are actually not ready for. Make sure this bias is addressed before exam day.

Letting An Exam Define Me

When I started researching how to succeed in medical school, I felt like all the advice I received centered on scoring insanely high on the USMLE Step 1 exam. When I got an average score, I felt simultaneously relieved and disappointed. I didn’t think it was possible to get my top choice residency with an average score. Despite passing the exam, I felt like a failure.

I’m now less than three months away from graduating from my top-choice residency program in Anesthesiology. At some point along the way, I started to accept that I would do my best on exams and if they didn't go well, I would accept the outcome and move on. I would reflect upon how I could improve next time, and focus my attention on the next challenge. Exams will come and go, but if you let them define you, your future success may be stunted.

What mistakes have you made in preparing for high-stakes exams?

Amanda Xi, MD, MSE is currently a resident at Massachusetts General Hospital (MGH) in Boston, MA and upon graduation will be continuing at MGH as a critical care fellow. She is an active blogger at her self-titled website and also active on Twitter (@amandasxi), Facebook, Instagram (@amandaeleven), LinkedIn, and Doximity. She is also a 2018–2019 Doximity Author.