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The Errors of My Way: A USMLE Journey

Caroline Dias is a former USMLE Tutor at MST. She will graduate from The Icahn School of Medicine at Mount Sinai with an MD/PhD this month and start her residency in pediatrics at Boston Children’s Hospital this summer.

Picture this: It’s raining outside, you’ve been studying all day, and it’s getting late. You’re going over the answers to a set of particularly challenging questions you just did and fatigue is taking over.

As you read the last of the explanations, you aren’t sure if everything has sunk in, but you’re not sure what else to do given all the time you’ve put in already. You close your laptop and hit the hay.

Fast forward to a few weeks later, when you’ve been going through so much material, you’re actually going back to questions you already did. You’re feeling pretty good about yourself, and you redo the same question set that you did before on that dreary evening.

But GASP! your percent correct has only marginally improved! You’ve gotten some of the same questions incorrect, again! “How could this be?” you ask yourself. “Have I been wasting all my time?!?”

This has happened to me more often than I’d like to admit it. Whenever it does, I get a pit in my stomach, because I feel like I just spent days of my life studying when I could have been relaxing in Central Park for all the good it did me.

However, once I get over the disappointment, I stop and think about HOW I was spending my time studying, and what I did wrong.

And that’s really the first step to improving.

I realized that one major reason for my lack of improvement was a failure to critically evaluate the errors that I made. While this might seem obvious, it can be all too easy to focus on answering the question itself, and not on taking the time after to figure out what went wrong, or even, what went right, and why.

Even today I sometimes can’t shake the feeling of, “Hey, I did the questions, isn’t my work here done?” However, there’s a reason why I now force myself to spend 1.5 to even 3x the amount of time on reviewing the answers as I did in actually doing the questions, and why I do the same with any student I’m tutoring!

One way to overcome the natural inclination to skimp on review of multiple choice questions is this:

Formally review the questions you answered, and figure out if there are patterns in the errors you made.

Getting a question wrong generally falls into two main categories:

1. Content

This is exactly what it sounds like: not knowing the content. While sometimes this may be due to never having seen the material, it’s actually just as often an issue of having seen the material, but not processing or understanding it correctly.

Critically evaluating the quality of your studying is important for improvement in this arena. Questions to ask yourself if you find yourself getting many “content” questions wrong are the following:

 Are you using the correct resources? Are you studying for Step 1 using your textbook from your medical school class instead of First Aid for example? Or are you studying for your basic science exam with a review book when your tests are based on lecture PowerPoint’s?

 What point are you in your studying? If you just started studying for Step 1 and it’s February, maybe you can give yourself a break knowing that with the completion of your classes and more familiarity with First Aid under your belt, your errors in this arena are bound to improve. If you’ve been studying for weeks or months and this is still your weakest area, you may need to consider a major overhaul in your studying strategy.

 Are you employing strategies to maximize your recall? Flashcards for example?

 What’s the quality of your studying? Are you day-dreaming and checking your email every 5 minutes? I personally realized the quality of my studying improved dramatically when I studied in the library without my laptop (vs. at home in front of my computer). I just got too distracted with the internet, my dog, making myself a snack, etc. when I was at home. Play around with different study areas and find if a certain location enhances your studying. At the very least, you can try to avoid the areas that are less conducive to maximizing your studying.

2. Technique

This is the other main category of error in answering multiple choice questions. That is, you knew the content to answer the question, but were foiled along the way nonetheless. Running out of time, impulsively changing answers, and misreading question stems are all potential sources of technique errors. These are particularly frustrating errors to make because you actually had the knowledge to answer it correctly if you hadn’t been tripped up. Making sure you minimize these types of errors can lead to maximizing your score. Here are some important tips:

 If you’re using UWorld, you can take a look at their analysis page and see if you have too many “right to wrong” or “wrong to wrong” answer changes. If this is happening, you need to teach yourself to stick with your first choice unless you have a compelling reason to change your answer!
True story: I recently went to a game show taping where the whole audience participates — audience members buzz in their answers in a chance to win money. When we were told to vote on the last question, I changed my mind at the last second, and it turned out I went from the right answer to a wrong answer! I effectively lost my chance at thousands of dollars due to a split second decision! Changing answers at the last second is a dangerous game for most people, particularly when there is no real basis for your change.

 Also in UWorld, you can check to see how long you spent on every question. Do you always have a couple questions taking significantly more time? Although the questions where the answer is at the tip of your tongue are the most tempting to spend more time on, you may need to teach yourself to cut your losses and move on.

Running out of time? Practice checking in with the clock at ¼, ½, ¾ way through the time. Are you ¼, ½, ¾ through the questions at each of these points? As you do this more and more, you will more instinctively be able to keep the pace. I actually ALWAYS did this, at least at the half-way point, during all of my shelf exams in third year. That way I knew if I had to pick up the pace or if I could take more time.

While all of this may seem obvious, even the best of us often forget to take stock of our mistakes in a systemic fashion. By officially going through question sets you’ve completed and categorizing the errors you made, you are more likely to pick up on potential patterns of weakness, and thus also potential sources of score improvement.

How to Excel in Medical School (3rd ed) by Norma and Mark Saks provides a great Error Analysis form to help you evaluate errors. We’ve elaborated on it and adapted it for you here.

Good luck!