Irrespective of how much time you have available to study for your board exam, you need to prioritize your activities. However, the shorter your available time, the more prioritization gains in importance. An additional challenge looms when time is short: even when maintaining discipline and attending to identified priorities, it is easy to let anxious feelings and ruminative worry thoughts distract you from maintaining that necessary discipline.
There are two ways to think about your available study time. Depending on which way you choose, you can increase or decrease your level of distress, irrespective of whether it is a lot of time or very little. One way is the subtractive approach: you start with all the exam-relevant topics stuffed into your allotment of study time. When you likely realize it is unrealistic to study so many topics in the available time, you begin to subtract topics. I submit that this is a less effective approach, especially when time is short. When you attempt to subtract what you will NOT study, each topic confronts you with the hard choice of eliminating it or keeping it. Everything seems more or less important, but nevertheless still relevant. It’s easy to get emotionally exhausted by ‘tossing overboard’ topic after topic to get to a manageable small number of topics to devote yourself to within your limited available time. Because of this, it becomes easy to become a ‘topic hoarder’ trying to keep way too many topics to study. At the end of this removal process, you are likely to still be left with an unwieldy list of study topics. Then, when you are studying and trying to focus on the topic at hand, your mind may drift to thoughts of how much is left to do.
I submit that the opposite approach, the additive approach, is more effective. It leads to less emotional exhaustion and fewer distracting thoughts that arise from the realization of how much more is left to do. In the additive approach you start with zero study topics and add into your study time allotment ONLY the ones that are MOST crucial to exam success.
This raises the question of which topics and how many are most crucial to board success. The answer relates to the fact that the number of questions related to various exam topics varies dramatically: some topics have a large percentage of exam questions related to them, while other topics, ones that may be equally complex and hard to learn, have very few questions related to them.
Here’s an example: on the psychiatry certification exam, there are 8 topics that together account for 60% of all the exam questions. The remaining 15 topics account for the other 40% of questions. Of course, if mastering these remaining 15 topics together took less time than mastering the top 8 topics, it would be a wash in terms of study efficiency. But this is not how it works. For example, sleep disorders are a complex (and fascinating) area of medicine. Much time can be spent reviewing the dozens of disorders and subtypes found in this class of disorders. And yet, on average, only 4% of the psychiatry exam is on the topic of sleep disorders. What is likely the case is that you can gain the same level of knowledge spending in about the same amount of time studying depressive disorders instead. They account for on average 10% of the exam questions.
Thus, your study efficiency would be two and a half times greater studying depressive disorders as compared to studying sleep disorders.
So, with the additive approach, it is imperative that you prioritize the top topics. Now, on your particular exam, you will be more knowledgeable about certain topics than you will be about others. So, you should prioritize by focusing more on the topic you know less well. For example, on the psychiatry certification exam, both depressive disorders and substance use disorders account for on average 10% of the exam questions. I am personally much more knowledgeable about depression than I am about addiction, so I would choose substance use disorders as my first priority to achieve the most ‘bang’ for my study time ‘buck.’
While establishing your study priorities, there is a related mindset that can help improve your morale and ability to focus. As you study, think to yourself that with every minute spent studying, you are increasing your level of preparedness. You started with zero preparation (that is, zero beyond the already great deal of knowledge you possess in your field). And each little, tiny, itsy-bitsy minute you spend studying adds to that considerable pre-existing knowledge.
I will end with some good news. We have launched BERACUDa, which is the acronym for Board Exam Review Assessment and Curriculum Design. Rather than me explaining it here, take a look yourself. Click here. It lives on this website. It may be extremely useful to you. It is free, and there is no obligation to buy anything ever.
Thanks, and all the best on your exam,
Jack Krasuski, MD
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