You have been taking high-stakes exams your whole life, and here you are studying for

the boards in preparation for the Board Certification or Maintenance of Certification

exam, just as nervous as ever. That’s natural! But knowing how to study for the boards
and avoiding these 10 mistakes is crucial. After all, failing the exam can have
repercussions, and you don’t want to have to retake it.

Unfortunately, many learners, at all levels, have misconceptions about learning and do
not prepare effectively. Most of us don’t know which learning methods are most
effective, and we often prepare for exams using inefficient learning strategies.

Mistaken Beliefs About Learning When Studying for Boards

Many people have a poor understanding about what leads to success in learning and
remembering knowledge and skills. These beliefs are not harmless; faith in them can
lead to failure.

1. Believing that being good at a subject is a matter of inborn talent rather than
hard work

Have you always been strong in certain topics? Do you tell yourself that your success is
a result of your inborn intelligence and natural skill? Conversely, have you told yourself
you’re just “bad” at something and no matter what you do, it will always be hard for you?
Well, this line of thought is hurting your ability to learn and improve your
performance. Studies show that people who think that ability is innate tend not to work
hard or persevere. In fact, a growth mindset (the belief that intelligence is not fixed and
can be developed) is a comparably strong predictor of achievement.

2. Assuming that learning is fast

With the limited time you have around clinical and personal obligations, it would be nice
if learning new things (and reminding yourself of things you once knew by heart) were a
quick process. However, if you want to understand the learning material and remember
it, you need to be prepared to spend some time on it — and go back to it again and
again.

In one of our interviews with Ulrik Christensen, founder and CEO of Area9 Learning, our
adaptive-learning technology partner, we asked, “Does NEJM Knowledge+ enable
physicians to spend less time preparing for their medical board review studying for
board exams?” He answered:

No, adaptive learning is not magic, and this is a very important thing to understand.

Broadly speaking, people need to study much more than they think they do. To a
physician who is under pressure because of an upcoming board exam, an adaptive
learning system may feel like more work than a traditional study method because the
system will be better than they are at identifying what they don’t know and need to study
more. But, if adaptive systems don’t make people study harder than they otherwise
would, I don’t think they would work very well.

3. Thinking that knowledge is composed of isolated facts

Weaker learners try to memorize items independent of their relationships with

interrelated concepts. Reading through a textbook underlining important nuggets may
make you feel like you’re learning, but looking over those terms later will not help you
synthesize information coherently — and will not be useful in retrieving knowledge in the
real world.

Robert Bjork, PhD, a well-known expert on learning and memory, wrote that “it is
important to remind ourselves of some of the ways that humans differ from man-made
recording devices. We do not, for example, store information in our long-term memories
by making any kind of literal recording of that information, but, rather, by relating that
new information to what we already know…and the retrieval of stored information is a
fallible, probabilistic process that is more inferential and reconstructive than literal.”

4. Believing that multitasking is easy, especially during class or studying

Focusing on two or more tasks at a time is a fact of life, but believing that you can do
more than one thing at a time effectively is a myth. You may convince yourself you have
both read up on the contraindications for a new medication and listened to your mom
berate you for not calling often enough at the same time, but neuroscience studies show
that your brain was in fact switching back and forth between these two tasks, and you
are likely to have missed important information in the meantime. Nancy K. Napier, PhD,
in Psychology Today says, “That start/stop/start process is rough on us: rather than
saving time, it costs time (even very small micro seconds), it’s less efficient, we make
more mistakes, and over time it can be energy sapping.”

Sadly, believing in the multitasking myth has even led to medical errors.

Bad Decisions in Studying for the Boards

The reality is that you have a limited amount of time for studying for board exams, so it
makes sense to have a plan of attack. Don’t fall into the following traps, and you’ll have
a better chance of success when studying for the boards.

5. Relying too much on your instructors to prepare you

Our brains acquire and retain knowledge best under certain conditions: when we need
the knowledge at that moment in time and when the new information has context. The
majority of learners who are taking courses to prepare for the boards and residents
taking their assigned roster of courses assume that if they attend class, listen and take
notes, look over the study guides instructors have handed out, and so on, they will be
ready. Textbooks, handouts, study guides, and slide decks can be a great starting
place, but just being present and reading over the materials is not enough to guarantee
that you will do well on the exam. If you are committed to succeeding, you need to take
responsibility for ensuring that you truly understand the material.

6. Not leaving enough time to study

It may seem like the best strategy for success would be some concentrated cramming
sessions close to exam time, but with the scope of knowledge you need to commit to
memory so large, it is likely you will underestimate the amount of time it will take to
review all the material. Given that you’re a busy person, you’re going to want to hold at
least some of that knowledge in your long-term memory, and that means not forgetting
what you learned at the beginning of your study sessions. Repeated studies have
shown that spaced repetition is the most effective method for retaining learning over the
long term.

7. Studying in an arbitrary, rather than priority, order

You can’t know exactly what’s going to be on the exam, but the boards do
publish blueprints showing what portion of the exam will be on the various topics (e.g.,
cardiology 14%, primary ethics 2%, etc.) as well as (for the Internal Medicine board
exam) which tasks (diagnosis vs. treatment) are more likely to be tested on for a given
topic. So, it would be better not to go down the list of topics alphabetically when
preparing for board exams but to use study materials that are proportional to what’s
covered on the exam — and to focus your attention on the highest priority items.

8. Wasting time reinforcing your strengths

It is a common error to believe you know more than you do; this mistake arises from
ignorance rather than arrogance. Psychologists have shown that one of the main
differences between strong and weak learners is that the latter have
poor metacognition. Many learners gravitate toward reviewing and even testing
themselves on subjects they already understand rather than delving into topics they are
not sure they know very well or at all. For example, NEJM Knowledge+ gives you the
option of choosing which subspecialty module you want to do first, and allows you to
switch between modules at will. Would you start with the module you are most
comfortable in or with a module you know you are going to answer most questions
wrong at first? People tend to like doing what they are good at; it makes them feel
confident and sure of themselves. The problem is, you really need to learn in the areas
you are least comfortable with or you will run out of time to tackle the problems that you
find difficult.

9. Using passive study strategies

The most common method of studying for the boards is reading, reinforcing your
knowledge through repeatedly reminding yourself of the information you have to
remember. It is also the most passive method and leads to poor memory
retention. Henry Roediger and Jeffrey Karpicke, psychologists at Washington
University, found that, “Relative to testing, repeated studying inflated students’
confidence…even though repeated-study subjects actually showed much poorer
retention on delayed tests.” Which brings us to…

10. Not testing yourself on the material

As Roediger and Karpicke wrote in their 2006 research article in Psychological Science,
“Testing has a powerful effect on long-term retention.”

The testing effect is real. Dozens of studies show that you will recall 50% more of
learned information by testing yourself than by using the same amount of time to study
(for example, one research team found a score difference of 67% with testing vs. 45%
with studying).

The good news is that all of these mistakes are reversible.

Research suggests that if you learn about the research underlying effective study
strategies, you are more likely to abandon mythmaking, adopt effective approaches,
and succeed on your exam than people who have not been exposed to this information.

Now that we’ve told you some mistakes to avoid…

How TO Study for Boards: 10 Ways to Prepare for Your Board Exam

Now that we’ve told you some mistakes to avoid when studying for the boards, here are
some tips and strategies that are sure to help you conquer this milestone and hopefully
ease your anxiety along the way.

1. Discover your learning style

The methods others use won’t necessarily be as effective for you — including those
used by members of your study group. Are you a visual or an auditory learner? Finding
out which style works best for you is something to consider in the early stages of
preparing for board exams. If you are a visual learner, try videos (like NEJM Quick
Take). If you are an auditory learner, record lectures and play them back. Adaptive
learning works especially well for those looking for a dynamic experience that is based
on learning theory and science.

2. Plan to put in the time

As we mentioned above, mastering the material you need to know for the boards will
take some time — perhaps more than you bargained for. Between all of your
obligations, it can be hard enough to find the time to get enough sleep, let alone put it in
an hour or two of studying every night leading up to the board exam. Before registering
for your exam, do your best to allocate study hours over a larger period of time. Check
out this article for ways to fit studying into your schedule. It’s best to plan months, or
even a year in advance. The last thing you want to do is resort to cramming.

In a study done by Nate Kornell, spaced repetition of the material you’re learning proved
to be more effective than cramming by 20%. Implementing spacing allows you to retain
more information than cramming with a higher recall rate.

Bonus tip: Try studying during your morning and evening commutes. All of that time
adds up!

3. Start a study group

Preparing for board exams with your friends is a great way to help address each other’s
weaknesses. You may have one area completely covered to the point where you can be
the teacher in that group, yet struggle immensely in another area. Try to have everyone
agree on a set time to meet. Your discussions will go a long way.

Speaking of discussions, be sure to check out one of the latest NEJM Resident 360
discussions, How to Ace Your Next Standardized Exam. See all of the advice residents
and experts gave!

4. Avoid burnout

The last thing you want is to be burned out studying. It can be extremely beneficial to
take study breaks. Research suggests that doing something you enjoy the day before
the exam has a more positive effect than continuing to study up to the last minute.

5. Exercise during your breaks

According to this study reviewed by Harvard Health, those who exercise with moderate
intensity 30 minutes per day, every day, have improved memory and concentration. If
you feel as though you’re in a fog, start exercising regularly. You may even find, like Dr.
Monique Tello, that you can review your board exam materials at the gym!

6. Take advantage of mobile resources to study for boards

There are numerous apps that can give you the tools to create your own flash cards and
exams. This study shows that students who use online studying tools have higher test
scores than students who don’t. Reviewing board exam flash cards (or fill-in-the-blank
questions like those in NEJM Knowledge+) on the bus is a lot easier than trying to
search through a textbook for a specific review section.

7. Find a better study environment

Study somewhere that is free from as many distractions as possible. If you’re reviewing
notes — or better yet, testing yourself — in front of a TV, chances are you won’t be very
productive. Find a quiet corner in your local library that you can rely on for a focused
study session.

8. Prioritize challenging subjects

As we noted above, it’s tempting to procrastinate on the harder subjects — but you
don’t want to be caught without enough time to master them. Do you know what you
know and what you don’t know? Knowing which subjects present the biggest challenge
to you allows you to decide how much time you’ll dedicate to them versus reviewing
what you’re more comfortable with.

9. Get enough sleep!

This study published in Nature shows that irregular sleep directly affects academic
performance. Aim for at least 7 hours of uninterrupted sleep.

10. Test yourself

Testing yourself may just be the best way to study for boards — as we’ve noted,
studying by reading over your materials and not testing yourself may be the biggest
mistake you can make in preparing for your exam exam. One effective method of
assessing your knowledge is to use practice exams, which simulate the timed
environment of the actual board exam you’re taking.

The reason taking practice tests help is that they reinforce your knowledge by asking
your brain to struggle with recalling the answers and practice tests can prevent the
effects of stress on memory. According to this study by Smith et al., when participants’
studied using practice tests, they experienced fewer of the typical negative effects of
stress — such as forgetting the answers.

Being prepared for test day means knowing what it feels like to take the exam under
pressure. For example, NEJM Knowledge+ contains two 60-question practice exams
that simulate the actual timed exam. Questions in the practice exams align with the
exam blueprint. Adding this layer of realism to your prep can increase your confidence
and help you be more confident on exam day.

There you have it—HOW TO STUDY FOR THE BOARDS—10 common mistakes to
avoid and 10 tips and strategies that will help you to build confidence, maximize your
study time, and pass the exam!