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Handling Questions Step by Step Steven R. Daugherty, Ph.D.

Director, Education and Testing Kaplan Medical

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Handling Questions Step by Step Steven R. Daugherty, Ph.D. Director, Education and Testing Kaplan Medical Knowing the material for the USMLE is one thing. Being able to demonst= rate that knowledge on the actual exam is something else. Over the years I have worked personally with a hundreds of students wh= o seem to have mastered the essential medical knowledge required for the US= MLE, yet still do poorly on the exams. All of this has led me to a simple c= onclusion: there a many, many ways to do a question incorrectly, but really= only one way to do it right. Having the right method when doing a question= will not guarantee that you will get the right answer, but it does help yo= u leverage what you know to the maximum advantage. Some people have internalized these steps and do them intuitively, wit= hout any conscious awareness. Others need to spend time learning these step= s and use them consciously, until they are an internalized habit. Remember = that test taking is not a genetic endowment, but consists of entirely learn= ed behaviors. If you have not yet mastered the basic steps of answering USM= LE questions, now is the time to learn. Think of each USMLE item, not as a single question to be answered, but= as a clinical problem to be solved. The pathway to that solution is found = by completing a series of 8 simple tasks. Each of these tasks solves one of= the cognitive problems inherent in a USMLE question. Completing each of th= e 8 tasks in sequence leads you from uncertainty to your best possible effo= rt on each question. The goal of these steps it to ensure that you gather t= he clues provided by the questions stem, think about them in a meaningful w=

ay, and then make a choice before moving on to the next question. These 8 steps can be briefly described as: 1. Read the Question! 2. Each question stem contains esse=ntial information that is vital to arriving at the best possible answer.Sk imming the questions quickly, or ignoring it all together means that these clues will be missed. You have to gather all the clues provided. It is hard to assemble a puzzle if you do not have all of the pieces. Only reading th e questions will give you access to these vital clues. Without careful read ing, you are hunting for an answer in the dark. 3. Understand the Meaning The information presented in= the question stem means something. The words you read should trigger assoc= iations and help you to call to mind important concepts. Each sentence you = read should be sorted mentally as significant or trivial. Does it matter? A= nd if yes, why is it important? Reading the words without reaping the meani= ng is like walking past someone without having a conversation. Seeing the w= ords is not enough. You have to grab hold of why they matter. 4. Order of Importance Some things matter more than ot= hers. Most questions will present you with, not one, but several points of = significance. Your task is to sort out: What is the most important issue? I= f several medical problems are described, which one should be the main focu= s of your attention? If several facts are detailed, which one should carry = the most weight as you sift though the different answer choices in you mind= ? Sorting what is primary and what is secondary will help you focus on the = core medical issue being tested. 5. Note the Actual Question The question you must answ= er is the exact question that is asked. One of the most common mistakes on = the USMLE occurs when students answer the question they hope or expect to s= ee rather then the one they are actually asked. The USMLE seems to pride it= self in asking important but unusual questions that get you to look at the = material you have mastered in new and unique ways. Be prepared for things a= bit out of the ordinary, and never lose sight of the actual question. <= BR> 6. Compare with What You Know The clues in the question stem are only half o= f what you need. You must now combine those clues with the fund of knowledg= e you bring into the exam. With the item stem read, and with the actual lin= e of the question firmly in mind, now is the time to pause and reflect on o=

ther pertinent information that comes to mind. In short, what can you add t= o what is presented? The best answer will be found by combining the clues i= n the question with the facts in your head. 7. Anticipate the Answer And then, before looking at t= he options, answer the question. Think about what makes a reasonable answer= before even looking at the answer choices given. By rule, every USMLE ques= tion should be answerable by someone with the appropriate knowledge without= any answer choices provided. Try it. You will be surprised how often you c= an anticipate the intended answer. Remember that each set of options contai= ns a correct answer and a set of distractors. Distractors are supposed to l= ook good and fool you. If you have a good bead on the right answer before e= ncountering the options, you are simply less likely to be fooled.

8. Look at the Options The correct answer is not simpl= y one that is good, but the one that is the BEST. USMLE options are not eit= her correct or wrong. Each option has a grain of truth in it. All of the op= tions are "sort of" right. Your task is to pick the one that is "most right= .." Sometimes this will be exactly the answer you thought of when you antic= ipated the answer. Sometimes the answer you want to see will not be present= ed. In this case forget looking for the optimal answer. Rather, pick the be= st of the set provided. The key issue here is to not simply stop with an an= swer that looks good, but to check though what is presented to be sure you = have registered all the available option choices. 9. Lock in a Choice And lastly, MAKE A CHOICE! Having = processed the questions stem, reflected on relevant content, and reviewed t= he options=E2=80=94it is time to choose. The biggest time waster in the exa= m occurs right here as students hesitate and vacillate. Make that choice, l= ock it in and leave it. It's time to move on to the next question. Forget s= econd-guessing yourself. A question once answered is over. Move on. These eight steps are summarized in Table 1 below. Table 1. Eight= Steps to Working Though a USMLE Question.=20 Basic Problems Getting the clues<= /FONT> Solutions R= ead the Question Key Question What is it about?<= /FONT>

Understanding mean= ing Recognizing import= ance Missing the Questi= on What do I know? Anticipating answers Best answer

U= nderstand the Meaning O= rder of Importance N= ote the Actual Question C= ompare with what you know A= nticipate the Answer L= ook at Options

What is given? What matters most?= What is asked? What do I know? What do I think? <= /FONT> What choices do I = have?

Forcing a choice <= L= What is my decisio= /FONT> ock in a Choice n? Note that if you take the first letter of phrase in the "Solutions" co= lumn; they create the useful mnemonic "R-U-ONCALL". The mnemonic is meant a= s a useful tool to help you remember the sequence. But, do not simply memor= ize the 8 steps. Practice them, use them, make them part of your question a= nswering habit.=20 One final comment, although at first glance it might seem that these 8= steps take more time then you have, once you get used to the sequence you = will find that it makes you more efficient and will actually reduce the tim= e you spend on each question. The trick is to use the time you have most ef= ficiently; to get rid of those thoughts and behaviors that waste time and k= eep those which move you step by step towards the best answer