Last updated on October 19th, 2023
Question: “Dr. Jack, how do you recommend pacing ourselves during the clinical vignette sections of the ABPN board exam? You mentioned aiming for 70 seconds a question but how would that work if there is a long vignette question stem or a 2-3-minute-long video?”
This is a great question and I’ll answer it here (and then move on to address a larger question): Not every medical board exam question takes the same amount of time to answer. The pace at which one completes the exam refers to the average rate at which one answers questions per unit of time. For most ABPN board exam takers, the questions in the linked vignette sections take considerably more time on average to answer than do questions in the stand-alone sections. But within each exam section type (linked vignette and stand-alone sections), individual questions also vary considerably in the time needed to answer them.
For example, and in response to the question from the reader: a linked vignette may be in the form of a 2–3-minute video or audio clip or in the form of a written vignette that can take 2-3 minutes to read. However, each of these linked vignettes (of whichever form, video, audio, or written) is linked to more than one question, usually to approximately 2-4 questions that immediately follow it. Thus, in such a case, the time spent viewing, listening to, or reading the vignette is amortized over these 2-4 questions. (Note also that many linked vignette questions are linked to a clinical vignette broken into 2 or 3 parts, with each part directly linked to 2-4 questions that follow it. But this fact does not change the average of 2-4 question per each vignette part.)
Given all this, linked vignette questions are likely to take longer than the 71-second average provided to the exam taker of, for example, the psychiatry board exam. (See table below for ABPN exams with linked vignette questions and the average amount of time given per question.)
On the other hand, many stand-alone questions are only a single sentence long and are also fact-based. The benefit of short and fact-based questions is that they take (or should take) very little time to answer, sometimes only 10, 15, or 20 seconds. On these types of questions, you either know the fact that’s being tested, or you don’t. If you don’t know the answer, you take an educated guess by eliminating response options you know are wrong or likely wrong, and you guess from among the remaining response options. This does not take much time at all (unless you remain frozen in indecision). Note, however, that some questions in the stand-alone exam sections are also vignette based. They differ from the vignettes in the linked vignette questions by being single best answer type questions and by not being linked to a vignette shared with other questions. So, even in the stand-alone exam sections you face questions that will take a longish amount of time to read.
To conclude this part of my response: all medical specialty board exams are designed to allow the great majority of test-takers to complete their exam in time. The neurology boards and psychiatry boards take into account the longer amount of time needed to answer linked vignette questions. Below I include a table of the exam sections from the American Board of Psychiatry and Neurology exam that incorporate these linked vignette exam questions. To help you make sense of this, note that the MOC exams (psychiatry MOC and neurology MOC) provide more time per question than do the certification exams. This is to allow the older (and slower) brain to adequately process questions. The outlier is child and adolescent psychiatry, in which the certification and MOC exams provide the same amount of time per question.
Now I segue to a more general issue I believe this question raises and that I’d like to explore here.
So far, I’ve focused on pace as the average speed at which one answers exam questions. But this focus doesn’t address how one’s pace is to be established. I raise this topic because I have found that a common problem among exam candidates is they worry so much about running out of time that they start answering questions sub-optimally.
Pace should be based, first and foremost, on this: you must give yourself sufficient mental time and space to adequately engage with each question.
So, even before considering how much time you spend on questions, focus on how well you engage with questions. Are you giving yourself sufficient mental time and space to come to rest, to dwell, within a question? Does the question you’re working on have your undivided attention?
Of course, the exam is timed, and each minute is precious. Thus, it is important to spend each minute wisely. So, stop to consider what you’re gaining from the time you’re spending on each question. Make sure the time spent is worth it!
What does this mean practically? It means:
- Do practice tests ahead of time to establish your pace and ensure you will have sufficient time, based on that pace, to complete the exam within the allotted time.
- Reflect on how well you are spending your time when answering each question. Are you giving the question you’re working on your undivided attention? Are you reading with comprehension and are able to ‘rest’ in your considerations long enough for the correct or most reasonable response to come to mind?
- If you find yourself distracted while completing practice tests, keep doing them until you desensitize enough that your thoughts are not overly captured by anxious ruminations that have nothing to do with the question at hand.
- Remind yourself that paying attention to the question content is your only job during those minutes and hours of taking the exam.
- Perhaps a meditation practice established beforehand and mindful breathing during the exam can help keep your mind focused.
Last thought: Every ABPN board exam taker engages with questions differently and reads and thinks at different rates and, as a result, spends differing amounts of time answering questions. Any pace is fine, short of, of course, running out of time. But very few exam-takers run out of time while many more are distracted by the fear of running out of time. Within the allotted exam time, some candidates take every last minute while others complete the exam in less than half the time. Any pace is fine as long as it affords you adequate time to engage with each question.
All the best, and may the test-taking force be with you. And if, for some reason, you need to repeat the ABPN board exam, here’s what to study for your exam re-take.
Jack Krasuski, MD
“Everything and everyone at their own pace. Flow with not against yourself.” ― Akiroq Brost
“When everyone you know is going at a fast pace and you still remain where you are, remember that it’s not who gets there first, it’s who makes the greatest impact in the process.” ― Ojingiri Hannah
“If a man does not keep pace with his companions, perhaps it is because he hears a different drummer. Let him step to the music which he hears, however measured or far away.” ― Henry David Thoreau