Dr. Brian Radvansky, Dr. Emma Husain, and Dr. Eli Freiman contributed to this post.
Think about the last time you were engaged in conversation and your eyes and part of your attention drifted to read a text message while still paying enough attention to the speaker to keep the discussion going.
This behavior, which would have been overtly rude not too long ago, is now commonplace. We aren’t surprised when someone is distracted when speaking with us, as we’ve all become accustomed to doing two things at once.
This means we’re becoming excellent multi-taskers—able to scan through one thing while entertaining another—but we’re also becoming more and more distracted. As a result, it’s harder to maintain focus when you need to…which is absolutely crucial during medical school!
Truth is, tech distractions—while very real— are just one of many things that can sidetrack your exam prep. There are others you’ll want to avoid so you can be as prepared as possible for the USMLEs. Here are nine things that seem harmless, but when looked at objectively, can definitely hamper your studying. Let’s dive in!
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Common Mistakes to Avoid When Studying for Your USMLEs
1. The Mini-Break
We’ve all been here. You complete your hour-long question block and are proud of yourself for pushing through. As a reward, why not a quick check of Facebook or the Reddit main page? After all, you’ve earned it, right? And a mental break will help your studying, no?
But then you get sucked down a wormhole and find yourself reading Wikipedia pages about Charizard or Iwo Jima. Do we really care about these things? Or are we just searching for the dopamine rush of a liked picture or unexpected friend request?
When it comes to your intensive study period leading up to your exam (and throughout medical school, in fact), you should take measures to avoid these distractions.
Answers to your question block should be reviewed immediately after completing the questions, while you’re still 100% inside your medical mind, not while 15% of your brain is lamenting about there being too many pictures of babies on Instagram.
After all, on test day, you’ll need to be focused and present for about eight straight hours — so you might as well start building that stamina now. Sure, grab a drink, use the bathroom, but don’t lose energy and mind space to any distractions.
2. Not Setting Up for Success
As you progress through clinical practice, you’ll learn the art of “setting yourself up for success.” Placing a difficult IV? Get yourself into a comfortable position with all the tools you need at your disposal, and the ultrasound machine in a logical position. Pulling a chest tube? You want your patient in the optimal position, educated on their responsibility to exhale/hum/Valsalva on command, with your occlusive dressing within reach.
The same art holds true for studying. Have your references (i.e. First Aid) and notepad close at hand, and close all other programs on your computer. Don’t carry on a G-chat conversation while studying! Set your phone to airplane mode, get your headphones on if you’re in public, and shut the door to your office.
3. Failing to Simulate Test Conditions (Silence, Timing, Posture)
Perhaps the most important thing you can do during your devoted pretest studying is to emulate the actual test conditions. The closer your setup and environment is to the test center, the more natural exam day will feel.
Now, I’m not suggesting that 100% of your studying be done alone at a desk. There’s definite value to studying with others, getting outside, and seeing other humans during this often isolating time. But at the very least, you must spend a decent amount of time performing under the conditions you expect on test day.
This means sitting with good posture and mental devotion at a desk, not doing all your question blocks on your iPad on the couch. Also, don’t get into the habit of only doing question blocks with music on. This can make the silence of the test center feel stifling!
The biggest mistake I see students make is doing too great a proportion of their blocks on timed tutor mode instead of timed. Don’t get me wrong, timed tutor mode is useful, but you shouldn’t get in the habit of expecting a green check or red X after every question. Plus, switching your mind from answering mode to explanation mode 44 times is radically different from the test environment, where you produce answers constantly for hours on end.
4. Turning Easy Questions Into Difficult Questions
Making questions more difficult than they are is a mistake I’ve seen even veteran students make all the time. We’ve all had multiple-choice questions where we think, “It can’t possibly be this easy. I must be missing something.” So we think hard and in crazy directions to rationalize an equally crazy answer that’s wrong. And then, when we review the question later, we kick ourselves because it really was that easy and should have been a free point.
Students do this because we never get over the expectation that board questions are supposed to feel really hard. This feeling persists despite hundreds of hours spent studying and makes very prepared students get simple questions wrong. Remember that the USMLE is not out to trick you! Prepared students should be confident enough to let the easy questions be easy and not get in their own way.
5. Going With the Answer You Don’t Recognize
Picking unrecognized answer choices is something students do frequently when feeling defeated by a question. I call this mistake “raising the white flag.”
Many students underestimate their knowledge and ability when it comes to answering questions. Thus, when faced with a question that doesn’t have a readily apparent answer, they assume it must be something they’ve never learned and pick an unfamiliar answer. Ironically, many of these questions are perfectly answerable and the student simply gives up too quickly.
I tell my students that if they’ve adequately prepared for the exam, they’ll rarely see questions where the correct answer is something they haven’t seen before. More likely, it’s just a different approach to a common or easier concept.
In these situations, I urge students to go back to the stem as they’ve often skipped over or missed a certain key piece of information that suggests the more simple answer…and lo and behold, they get it right!
6. The Inexplicable Answer Change
Changing answers (from the right to the wrong answer) is one of the more frustrating mistakes students make. Many students make their way through a question stem piece by piece, logically thinking over each piece of information. They predict an answer and notice to their delight that it’s one of the answer choices.
However, here’s where things go wrong: students often feel the need to rule out every other answer choice. During this process of perusing the other choices, you may encounter something that seems plausible and choose—without regard for your previous thinking—to switch your answer and ultimately get the question wrong.
When I ask my students why they did that, they’re often left wondering why as well. The advice I give them is to not change an answer unless they can explain why the new answer is better. This leads to more correct questions and higher scores!
7. Confusing “Increase” and “Decrease”
If a question asks “what would decrease,” be sure you don’t answer with what increased instead!
8. Confusing “Next Step” and “Overall Solution”
When reading questions, be sure you understand what’s being asked. If a question asks for the “next step,” that’s what your answer needs to be! Not the overall solution to the problem.
9. Confusing “Complications” With the Disease Itself
Don’t mix up the name of a disease with discussing the disease’s complications!
How to Handle Strategic Mistakes When Answering Practice Questions
Often, students will repeat the same type of mistake over and over again, so that more than 20 questions are lost per practice NBME for one single, repeated mistake. More than 20 questions lost on an NBME practice exam corresponds to about 30 questions on the real exam—this creates a huge difference in their score, one that even months of studying can’t overcome.
Here’s a list of “double checks” (imagine you’re writing them to yourself) that can help you spot repeated mistakes:
✅ When I see an increase/decrease question, I’ll highlight the word and write an up or down arrow on my scratch paper.
✅ When I see a management question, I’ll verify whether they’re asking for the next step or a later step.
✅ When I see a pathophysiology question, I’ll verify exactly what they’re asking the pathophysiology of.
✅ When being asked about the explanation of a symptom, I’ll check my answer to make sure I’m explaining the symptom they’re asking about.
You need to read this list before doing every practice question—even if it means you have to do your first blocks of practice untimed! Refer to this list before, during, and after the question. Make sure you’re respecting the recommendations on the list. Very soon, the list will become endogenous and you won’t need to look at it.
When reviewing your questions, if you make the same mistake as one on your checklist, put a red mark next to it. If you make the same mistake tomorrow, put a blue mark next to it. Green the day after that. Be responsible for fewer mistakes of each type every day. And enjoy your extra 20-30 correctly answered questions!
Final Thoughts
These small changes in your study habits can go a long way. While tiny distractions and simple mistakes may seem like little hangups, they’re definitely not helping you master the fund of knowledge necessary for your USMLE exams.
It’s crucial to be honest with yourself! If you truly want to excel, you have to take measures that’ll set yourself up for success. When it comes to distractions, do your best to eliminate them and maintain your focus. We’ve written before about the best lesson from a mentor: be 100 percent on when you’re on, and 100 percent off when you’re off. Give everything you have to work when you’re working, and don’t think about it at all when you’re relaxing. Let there be in-betweens. Real-life distractions (family, sirens, hunger) will always exist, but do what it takes to maintain as much focus as possible, and you’ll benefit immensely.
