I’m currently studying to retake USMLE step one and while I’m disappointed that I wasn’t able to pass this exam the first time around, I’m definitely grateful for the opportunity to hone my test taking skills and learn how to be a better physician with the wonderful people at Wolfpacc.

One of my biggest problems while taking multiple choice exams is being ‘seduced’ by some of the other answer choices so I’ve always felt that my exam results don’t always show how much I know about a topic. In undergrad, and now in med school, I’ve always performed better on free response questions because I have the chance to display what I know about a topic. In the past, I’ve tried to answer multiple choice questions as if they were free response (not looking at the answer choices) but I finally feel like I have a strategy I can use for the many tests I will be taking over the years.

People’s test anxiety presents in different ways. For some, the days leading up to the test they’re unable to sleep properly. During the exam they’re tachycardic and cannot focus long enough to get through a question. My problem, and maybe this isn’t even test anxiety, is never truly feeling sure of my answers and doubting myself easily. I’ve gotten into the habit of never changing my answer unless I’m 200% sure that the second option is correct. But often, even when I’m just thinking about what the answer can be, I question my instincts to the point that I don’t actually know which one feels more right to me.

Since arriving at Wolfpacc, I’ve changed my study strategy so that I’m forced to answer every MCQ question as if it is a fill in the blank and I don’t fall prey to any of the other appealing answer choices. Below I’ve shared the steps I’ve been implementing this past week for UWorld questions and aim to use for all MCQ tests I take in the future:

1. Cover your answer choices. Don’t just say ‘I’m not going to look at them’ because you will. Use a sheet of paper or something to physically block you from seeing the answers.
2. Read the last sentence of the vignette and summarize it. Most of the time there is a lot of excess information in the paragraph above. If you read the question before reading the paragraph, it’ll be easier to identify what information is actually relevant. So take the time to really understand and simplify the question.
3. Talk to your patient and find hints. One of the professors here has encouraged us to think of the vignette as your patient. Some of the information they tell you will be very relevant to answering the question and the rest may be useless. You have to learn to distinguish between the two. As you do more and more practice questions, you’ll pick on some patterns.
4. Answer the question yourself. Before you’ve uncovered the answer choices, write down what you believe the answer is. Sometimes you’ll remember some details about it but won’t remember the exact answer but you should write down whatever your answer would be if this was a free response question.
5. Uncover the answer and pick whichever one matches what you wrote down. Even if one of the other answer choices starts to look more appealing, you still need to choose the one that matches what you wrote as your own answer. This is important for when you’re going over your question set afterwards and I’ll explain why later in this post.
6. Move on. Don’t overthink the question or your answer. Sometimes you won’t really know why you think something is the answer but you need to trust your gut.

Because I’ve just started using this new strategy, I’m doing my questions in un-timed mode and actually writing down my thought process for each question so that I can get used to it. My paper looks like the following for each question:

• Q: the question restated here in my own words
• Pt: information from the vignette that is applicable to answering the question being asked – keep this short (5-6 words max)
• A: my own answer to the question, without having looked at any of the answer choices.

Now, when you’re doing practice questions you have to remember that reviewing the entire test, including the questions you got correct, is just as important as answering the questions. This is when you correct both your technique and any holes you have in your knowledge.

For answers you get correct, make sure that the answer you wrote down matches exactly the answer choice selected. If it does, just move on – you don’t need to read the explanation or anything else from that question stem because you had the correct thought process and arrived at the right answer.

If you get an answer correct but your written answer doesn’t match the answer given in the options exactly but is generally related, you have a small hole in your knowledge and need to read the summary sentence at the end and add that to your written answer in your notes. If that still does not clarify the connection you missed, you should review more of the explanation.

If you get an answer incorrect, you repeat the same process as above but read the entirety of the explanation because this is a clear hole in your knowledge. The reason I’m recommending that you choose the answer that best matches the answer you’ve written, instead of choosing the ‘more right’ answer, is because it will be easier to correct that hole in your knowledge. If you change your answer and get it right, you’re less likely to take the reviewing process as seriously because you got it right but it’s still a hole in your knowledge. On the real exam, if you’re 200% sure that the other answer is correct and the one you came up with on your own isn’t, of course you should pick the right one. But when you’re doing practice questions, you’re still learning and you learn the most from questions that you get wrong.

Also, I usually use a different color pen to add my notes for questions I get correct (usually blue) and questions I get incorrect (usually red). If I’m ever reviewing this notebook, I usually focus on the notes I’ve written in red since those indicate the biggest holes in my knowledge.

Don’t get hung up on how many you get right or wrong. Focus on improving your technique and finding the holes in your knowledge. As you get more comfortable with the new technique, you should not have to write out as much and start doing the question sets in timed mode. And, of course, this technique may not work for everyone. It’s just something that I’ve been trying and feel more comfortable with. Happy studying!