Will That Be on the Test?

Geoffrey A. Talmon, MD

Disclosures

March 09, 2010

Question

How does a teacher choose what to put on an exam, and how can I figure that out so that I can focus my studying on those areas?

Response from Geoffrey A. Talmon, MD
Surgical Pathology Fellow, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota

I still vividly remember those late-night study sessions before exams during my first 2 years of medical school. Whenever stress reached a critical point, looking at the pile of books and thick binders full of notes and lecture handouts, our study group would almost always ask the same question: Out of all of this voluminous material, which items will actually be tested? At our institution, we had a general guideline that for each of a teacher's contact hours, 3 representative questions would appear on the test. The last few hours of every study session were always spent furiously examining each lecture and trying to guess what those 3 questions would be.

Being able to determine what questions an instructor will ask is the holy grail of medical school, a skill that appears to preclinical medical students to be even more unreachable because of the breadth and depth of information that each exam seems to cover. The ability to distinguish the meat of a faculty member's topic from the added informational "fluff" is critical because it allows the student to focus limited study time on highest-yield items. It is a skill that is not typically applied by the undergraduate student because of the slower pace and relative paucity of material covered by a single exam at that level. Medical school is often the first time that such prioritization of study is a necessity.

For students who are not as savvy in this skill, distilling large amounts of data into high-impact nuggets can seem daunting. There are, however, tools that can be used to direct your attention to important information:

  • Pay attention to what the instructor stresses in his or her presentation;

  • Study the objectives;

  • Think of material in terms of concepts; and

  • Try generating your own test questions.

Pay attention to what the instructor stresses. Some teachers are very explicit in what material they feel is critical. A phrase such as "If you come away with nothing else from my presentation, learn this" is usually a good indicator that you will see a test item on that topic. Most lecturers are less forthcoming, and this is where repetition is usually the key. For example, if a teacher has to cover an entire book chapter in a single lecture, time is limited. If a factoid or concept is repeated multiple times, appears in multiple lectures, or is given in multiple formats (eg, lecture, lab, small group), the probability is high that it is an important item. The converse is also true: If an entire presentation is devoted to a single concept or disease entity, that content should be studied in more depth.

Study the objectives. Many medical schools now require their instructors to supply explicit, well-written learning objectives for each educational encounter. In theory, the objectives should clearly state what the student should know (or at least be able to deduce) after exposure to the lecture. Put another way, the faculty member has done the work for you in determining what is important. If a presentation includes information that has nothing to do with any of the stated objectives, it is less likely that an exam question will be generated from that material. A word of warning, though: Not all teachers are adept at writing objectives and, therefore, some objectives are more useful than others. A good objective is one that unifies a handful of facts or concepts, making the student synthesize the material. Objectives that are too general are often less useful. For example, which of these seems like a better objective?

  • "Understand how the pathologic alterations in Crohn's disease lead to the clinical signs and symptoms," or

  • "Know about Crohn's disease"

Think of material in terms of concepts. This is probably the most important of all the tools to have in one's repertoire and is akin to students writing their own learning objectives. Converting an hour-long lecture into a handful of general rules serves a student in 2 ways:

  • It vastly reduces the shear amount of material that the student must commit to memory, and

  • The concepts provide a framework to which the student can add more specific factual data.

For example, rather than attempting to memorize multiple charts that delineate all of the signs and symptoms of liver failure, think about why all of those signs and symptoms manifest: The organ is no longer able to do the job that it is supposed to do. By remembering the functions of the liver, you can generate the appropriate lists on your own and, in time, add the various tidbits of information about laboratory abnormalities, physical findings, and so on.

Try generating your own test questions. Asking "If I was the instructor, what questions would I ask about this lecture?" is an excellent way to filter material. The best way to go about this is to compose questions that use clinical scenarios; most medical schools are encouraging and/or requiring their faculty to write questions that go beyond simple factual recall and instead require students to synthesize learning with case vignettes. In my experience, once my study group learned to look at material in this fashion, our study time became more fruitful and the questions we came up with were mirrored on the examination.

In summary, there are many tools and techniques to help the student sort through the occasionally insurmountable volume of data to which the student is exposed in preclinical medical education. Paying attention to repetition, studying the objectives, thinking about material as general concepts, and generating original test questions can all serve to focus valuable time on high-impact items.

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