Tips and Trends: Deciding to Succeed
Steven R. Daugherty, Ph.D.
Director, Education and Testing
Kaplan Medical
Succeeding on the USMLE means making decisions. The exam does not ask you to tell what you know, rather it asks you to make decisions based on that knowledge. It is decisions that are tested. Knowledge is assessed only by inference. You must know critical details; however, these details are means to an end, not the end in themselves. At the end of each exam question is a decision. Your performance on the exam rests not with what you know, but how you make decisions.
Decisions on the USMLE have some essential parallels with medical decisions in the real world, but also some critical differences. Real world medical decisions and USMLE questions both involve some of the same knowledge. Both require the integration of content of a number of subject areas to solve the presented problem. Both require the capacity to sift presented information to decide what matters and what does not matter.
But real world medical decisions and USMLE decisions are vastly different in their consequences. In the real world, if you make a bad medical decision, you could kill a patient, or at least cause avoidable pain and suffering. If you make a bad decision on a USMLE question, then you simply get the question wrong. Now, getting a question wrong is something you want to avoid, but you must admit that the consequence is a lot less traumatic and a lot less enduring.
Because the consequences of your decisions are different on the USMLE, your decision processes must be different than those in the real world of medicine. In the real world you must strive for certainty. If you are not sure, get sure. If you need more information, get it. Because life and death may be hanging in the balance of your decision, it is vital that you seek as much certainty as possible. In the real world you strive to get as close to 100% certainty as possible in order to assure yourself that you are making a decision that you and your patient can live with.
On the USMLE, you will rarely attain this level of certainty. You simply do not have the time. You must learn to make decisions you can live with without having the time you would like to allow that feeling of certainty to emerge. On the USMLE you must learn to make decisions, not when you are 100% sure, but when you are 51% sure. Fifty-one percent sure is when you think maybe you have the answer but you are still not sure. That “maybe” IS the decision! The added time you spend on the question after that point is not going to improve your score, but simply allow you to feel more comfortable with the decision that you have already made.
Train yourself to make a decision and move on. Do not wait for certainty. Read, decide, and move. There is another question waiting for you. Remember that, at the end of the day, what matters is not whether you get this particular question correct, but rather your total score across all the questions you face.
If you find yourself short on time during the exam, you will not gain speed by reading faster, but by deciding sooner. Your reading speed is essentially a constant for the exam. No matter how much you may want to read faster, you really can’t. You can’t read faster, but you can decide faster.
The time we spend making decisions is really composed of two parts. The first bit of time is about thinking and choosing. The second bit of time is simply dedicated to feeling good about the decision we have already made. This second part of the process does not make our decisions better, but merely helps us feel better. Forget about feeling better. You do not need to feel better to do well on the exam. You need to make a decision, live with it and move on to the next question.
When you think that you may have identified the best answer, you most likely have. Make the choice and stick with it. Stand with the courage of your convictions and in the confidence of your ability to decide. Learning to make these kinds of decisions is the key to attaining that USMLE score that truly reflects your abilities.
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