If you aren’t happy with your current test scores and you’ve tried but failed to significantly improve, it’s likely you’re feeling incredibly frustrated.

However, strategy and outlook are big pieces of the puzzle, so don’t give up!

In Moonwalking with Einstein, his book on memory and learning, Joshua Foer says that if you want to turn your performance up a notch, working hard is not enough. Instead, you must:

  1. Operate outside of your comfort zone and study yourself failing.

You’re struggling, you’re stressed, and it’s tempting to just do more of the same things you’ve done in the past, but this volume-based approach is unlikely to help you succeed unless you really haven’t been putting in enough study hours. 

  1. Seek out critical and immediate feedback.

The exercise that follows this list will give you a clear idea of the types of errors you’re making most often and on which you should focus.

  1. Use a scientific approach to test new strategies with a focus on the root causes of your errors.

The following exercise will help you to learn more about why you’re not reaching the goals you’ve set for yourself and how to address them.


  • Do two blocks of practice questions.
  • Analyze the cause of each error you make.
  • Don’t focus on the content of the question. Instead, ask yourself which of the following general factors caused each error:

 A weak knowledge base of rote facts: You may need to spend more time reviewing some of the basic facts. Lab values, prevention guidelines, the exact ages for various milestones, are all examples.  

A shallow level of understanding (relying mostly on rote memorization):

You knew the answer but the question approached the material from a different direction, so you weren’t able to manipulate the info on a deep enough level to be able to infer the answer.

 Poor reading/analysis of vignettes: You have a deep understanding of the material but answered incorrectly because you didn’t apply your understanding to the vignette. Maybe you fell for buzz words or missed important information about the patient.


Once you have figured out the types of errors you’re making most frequently, use these strategies to reduce them as much as possible:

A weak knowledge base of rote facts: For help with memorization, read pages 18-19 of Handbook on Preparing for CCSSE, CCSE, Step 2 CK and CS. (This is available on Blackboard within Organizations: Clinical Community.) You might also look into some of the Apps that are now available to help with drilling.

 A shallow level of understanding (relying mostly on rote memorization):

To ace your exams, you need to move beyond memorizing facts to understanding the logic behind the facts. Read pages 16-18 of the Handbook for general suggestions. Also, make sure you are not relying solely on review books consisting of bullet points rather than paragraphs (such as Master the Boards). Suggested alternatives: Harrison’s and IM Essentials, etc. The long-form Kaplan videos and Med-U cases are also extremely helpful in deepening your understanding. Compared to Step 1, clinical Shelf exams and CK are far more focused on critical thinking.



Take a Break

Sometimes your best option is to walk away – literally. Take a walk, go shopping, watch a movie, go out to dinner, whatever will refresh you. A day or two of relaxation will rejuvenate your body and mind. Having some distance from a problem may give you sudden insight about it.

 See Some Patients

If you’re seriously stuck and you’ve finished your rotations, see if there is a way to get back into a clinical setting for a few hours a week. When you sit in front of your books day after day, it can be hard to maintain your drive and focus. When you see patients, you have an opportunity to feel smart and competent again and to be reminded of why you went into medicine in the first place. Also, you will retain medical concepts much more readily if there are patients to whom you can tie the concepts.