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USMLE Study Advice (2 Articles)

Article #1: Active Recall, not Re-reading is the Key to Understanding and Long-term Memory

Study, for most people, is process of process of reading and re-reading. We think that the more times we read the material, the more we will learn. For simple rote memory, this may be the case. But, when learning higher level concepts, when we want to have the ability to think with and use what we have learned, the repetition by multiple readings is the slowest way to the goal.

A recently published article by Jeffery Karpicke at Purdue University shows that although most people believe that re-reading is the key to learning, spending time practicing recalling (retrieving) the material yields a much higher return for the time invested. 

Dr. Karpicke had students use one of three learning processes. The first group spent four sessions reading and re-reading material. A second group spent three study sessions reading and re-reading, but spent the fourth study session practicing retrieval of the material. The third group spent one study session reading, and then had three retrieval sessions. 

The results showed that students who did the four reading sessions had the worst recall, and students who spent most of their time practicing retrieval had the best recall. Even more interesting, students expected that they would have the highest recall from re-reading and the worst recall from practicing retrieval, the exact opposite of what was actually true! 

As a picture is worth a thousand words, the essential graphs from the study are reproduced below.

Equally impressive results were found when repeated reading was compared with repeated retrieval for fostering long-term retention. In this case, retention for students who just did reading was less than 20% of the material, whereas those students using repeated retrieval was close to 80% of the material. The essential graph is below.

All of this means that to get the most out of your valuable study time, do not simply read over and over the material. Instead, after an initial reading, spend time thinking about, and calling to mind the important, terms concepts and relationships. 

Retrieval, not re-reading is the key to long term retention.

Steven R. Daugherty, Ph.D.

PS. Here is the abstract for the article.

Article #2: Knowledge and Application

The USMLE exams are designed to test two things: 1) your knowledge base and 2) your capacity to reason with and apply that knowledge. Most students understand what is required to master the essential core knowledge: a careful review of high-yield topics. However, many students neglect to prepare for the application issue. In these cases, the student knows the content but cannot adequately represent that knowledge on the presented questions, and their score suffers accordingly.

Try these three techniques to train yourself to think with the material you know:

1. Study by contrasts.

The dominant cognitive process required by multiple-choice questions is not recall of knowledge, but differentiation among options. Therefore, your study strategy should focus on this issue. For example, when learning microbiology, do not simply memorize the properties of each pathogen. Instead, concentrate on what features make this particular pathogen stand out from the others. Ask yourself what other pathogens you might you easily confuse it with and then, how you will distinguish among them. When selecting among clinical intervention, the same logic apples. You must know more than what are common interventions. You must know when a particular one makes most sense. The key study question is what are the circumstances when I would select this intervention and not a different one? Look for  study materials explicitly constructed to help you learn these important contrasts.

2. Making all the options correct.

When doing practice questions, the important issue is not how many you got correct, but learning from reviewing the questions after you answer them. You must know why you got a question right or wrong. After you answer a question, review the answer and read any provided annotations. Then, return to look at the question again. Taking each option one at a time, how would you change the question asked to make each of the options correct in turn. If “C” were the correct answer, how would you need to change the question so “A” is the correct answer? So that “B” is correct? This process focuses you on the key elements that determine what the proper answer will be on any given question. Repeat this process until it becomes second nature. If you really understand a question, you can say why one answer is correct, and why all the others are wrong.

3. Checking your perspective.

Not everyone who witnesses the same scene sees the same thing. By past experience or current habit, we all have mindsets that focus on some features in a situation and overlook others. In real life, these are simply the differences among people that make life interesting. On the USMLE, these differences can spell disaster. You see, it is not enough to read the question your way. You must learn to read every question the way the examiners intend you to read it. Some questions can be interpreted in a number of ways. When ambiguities exist, one way of seeing the question is right (the way the examiners intend), and all other perspectives are wrong. Your faculty in a review course will help you understand how you should be approaching and reading questions, but you can also work on this issue in a group of your friends.

Sit and read through a question together with your friends. When you have all finished, everyone should pick an answer and jot down the corresponding letter. Then, reveal your choices. Take a moment and each person justify why they made the choice they did. This process not only allows you to review the content, but also allows you to pay attention to the way that each person reads the question, and the process by which they arrived at an answer. Experience suggests that if there is more than one way to read a question, and most people read it a certain way, then that is very likely the way that the examiners intend for you to read it.

Success is a one-two punch: mastering content and being able to apply the content as needed. Remember, exam items are not so much questions to be answered as problems to be solved. Using these three preparation strategies to practice your problem-solving processes will pay off in the end with the higher score you are seeking.

Steven R. Daugherty, Ph.D.

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