OldManDave's Method for Mastering Med School Exams

I am starting this thread in reaction to the “Thoughts on the MCAT” thread started by Adam (Pi1304). I have been asked many times to elaborate on what I mean when I say you need to approach the MCAT NOT as a simple factual recall exam, but as an interpretation & application exam. Furthermore, in my demented mind, the concepts & strategies associated with this are directly applicable to examinations in medical school. So, here goes my first stab at laying out my argument & resultant strategy.

The million dollar question is, “How does one prepare for an intepretation/application exam?” In med school, this is what virtually ALL of your examinations will be. Honestly, this is probably the most difficult type of exam to prepare for, esp since the entire US education system emphasizes wrote memorization/factula recall exams. The “assumption” this style of testing makes is that ‘IF’ you can regurgitate all of those factoids, then interpretation & application of them into a dynamic system will naturally follow. Two problems immediately arise with this tactic: 1) it is very difficult to write valid exams to test your capacity to take the next step - interp & app. 2) this assumption is far far from valid. I am sure that you can vividly recall classmates in HS & college who could vomit up facts like there was no tomorrow, but when they were prompted to explain what they meant or, even worse, to make extrapolations of those premises to unique situations - they were stymied. But, since the focus of US-education’s testing paradigm was & is factual recall, they were not penalized, and in fact were rewarded, for their limited abilities…I would even proffer that many of our high-ranking classmates found themselves substantially challenged when they attempted to get beyond HS & Ugrad because graduate work & professional schools require the ability to interpret & apply not just regurgitate.

To prepare, you will still need that ‘fund of knowledge’ I mentioned, which is essentially the information & processes from all of your pre-med courses. While there is no direct testing of genetics, biochem or math, per say, there is some benefit in having had these courses as they start demanding that next level of ability over & above the general pre-reqs. And, they convey a familiarity with some of the concepts & terms you may encounter both on the MCAT & in the first 2 years of med school - make no mistake, these courses at the Ugrad level go no where in sufficient depth nor is the focus the same such that years 1 & 2 of med school will be “easy” or a repeat. But, simply having memorized a bunch of facts & formulae will not get you successfully through the MCAT.

The next layer is the interp & app level of understanding. To get here requires loads of practice MCAT questions. I do not mean just doing practice exams over & over again. Take the exams in smaller blocks & know the ins & outs of each question. Not only must you know the correct answer was correct; but you should also know why the other choices were less correct or wrong. This is dynamic learning - you begin to resolve the concepts into congent, working models that you can mentally manipulate. If I have this system - ALL systems are dynamic to some extent - and I do ‘x’ to it, what can I expect the result to be? The questions you use do not have to be from the old MCATs sold by the ACME, although those are great. But, you can employ the question sets from any MCAT-prep book that provides the answers, a break down of the rationale for the choices made & references - a very common format for exam-prep textbooks to be printed in. Unavailable to me at the time were the on-line question banks. I am not sure how great these are because I did not use them for the MCAT. However, I did use the Kaplan Q-Bank for both USMLE & COMLEX steps 1 & 2 and it worked well. The downside is that you could print out the questions, answers & answer rationales. But, you could still employ the same concept - know why the correct answer was correct AND why the ones that were less-correct or even wrong were that way.

The next layer is what you will need to work towards in medical school. This requires the above skills & strategy with an additional twist. Prior to med school, the overwhelming majority of multiple choice exams were formatted such that there is a question stem followed by x-number of choices. Of those choices, there was 1 correct one, 1 or 2 slightly correct (but, if you ‘knew’ the material, obviously not quite as correct) choices & the remainder were damned near silly. In med school, ALL of the choices will be varying shades of correct with 1 being the most correct. Most professors will maintain large databases of question sets where they can manipulate the stem & any one of the subsequent choices such that any of those choices can be made to be the correct one. If they didn’t, they’d spend all of their time writing & rewriting exams & never have time to do research. But, this habit can be a dynamic learning GOLD MINE! If you can obtain copies of old exams - many med school allow student organizations to sell old test files for fundraising purposes - the absolute best way to study is from old exam files. No, it is not cheating because the liklihood that you will gain a significant number of free points from memorizing question & answer combinations is phenomenally low - I know people who tried this & learn the hard way. However, by taking those question sets, you can yourself learn how to manipulate question stems & choices to make each one correct or incorrect & why they are that way. You have now gained the ability to not just vomit up a collection of facts, but to place the data into a cogent, dynamic system that you can mentally manipulate. Once you can do this, YOU KNOW THE MATERIAL IN DEPTH!

No, this is not easy - it is NOT supposed to be. But, if you attack the MCAT in this manner…and all of your subsequent exams…then you will truly be mastering the material. Of course, time limitations in education, esp in med school, will limit precisely how much you can truly master. But, your ability to recall & apply the info you are perusing will expand phenomenally with this approach.

I must respectfully disagree. My experience has been 180 degrees in the other direction. While the MCAT is indeed a test of analysis and interpretation, the first year of medical school is 99.9999 % memorization and regurgitation, by which I mean DOWN TO THE VERY PHRASING, which will invariably appear verbatim on the many, many multiple choice exams we take. It was only when I gave in and quit trying to take a scholarly approach that my grades started to zoom upward.

As a person who came from 1.X GPA to rise to where he is today, I tend to agree with the majority of what OldManDave’s says in regards to academics. For the 5 or so medical school classes I’ve taking, understanding the material or better yet, being able to relate it to something clinical (ie the body’s respose to ketoacidosis), has been my key to success. However as a Scientist, I found myself initially over analyzing EVERYTHING which initially had disasterous effects.

The only thing I would disagree slightly with is the use of old exams which didn’t help me one bit in only one course, Medical Biochemistry. He’s right about the questions stems being changed to generate different exams. But but what I found myself doing on my first exam, was recalling what I saw on the old exam instead of focusing on the answer to the question before me.

  • pathdr2b Said:
The only thing I would disagree slightly with is the use of old exams which didn't help me one bit in only one course, Medical Biochemistry. He's right about the questions stems being changed to generate different exams. But but what I found myself doing on my first exam, was recalling what I saw on the old exam instead of focusing on the answer to the question before me.

Precisely my point - under duress, folks default back to what we all affectionately referred to as "bulemic learning" in med school - the binge & purse of factoids. As Matt points out above, there will be a substantial amount of straight fact-recall on exams. But, the ability to recall & point out those terms on an exam does not convey nor confer any appreciable level of understanding. Much of the first two years comprises trying to 'understand' materials for which you have no true "context" in which to implement that information. This is where problem-based learning programs have an advantage - they provide a clinical context in which to place all of those factoids. Granted, they remain artifical & do not really gel until you actually see a pt, dx an ailment & observe the anatomny, pharm & physio in real time.

Thanks for the topic, Dave. In my (not-yet-med school) experience, that’s the approach that I’ve found to be successful. You’ve done an excellent job of elaborating on what might be called an understanding-based approach.

Like Matt and Path, I’ve also come across situations where regurgitation was all that was expected, and overthinking things was a detriment. I remember a particular Genetics exam - with a prof who later became my PI - where I was trying to fully understand a question, and it was suggested that I focus more on “What did I tell you in class?” When you’re being tested on straight-up factual recall, it’s easy to overanalyze. But still… for me, at least, that’s the only way to truly grasp the material well enough to actually apply it.

  • MattFugazi Said:
I must respectfully disagree. My experience has been 180 degrees in the other direction. While the MCAT is indeed a test of analysis and interpretation, the first year of medical school is 99.9999 % memorization and regurgitation, by which I mean DOWN TO THE VERY PHRASING, which will invariably appear verbatim on the many, many multiple choice exams we take. It was only when I gave in and quit trying to take a scholarly approach that my grades started to zoom upward.


First & foremost - thank you for speaking out & taking the dissenting side. This is the groundwork necessary for an educational & transparent discussion. I certainly respect your opinions as I hope you do mine.

Regarding your point: I think you have beautifully underpinned my argument - I could not have made a stronger supporting statement myself.

I will try to distill my toughts into a cogent model. To lay this out properly & logically, I must first provide some personal background & then lay the academic underpinnings of my arguement. Then, I will directly address why I think your statement strongly supports my assertion. (I love this sort of discussion!)

It is only recently - in the last 3 or so years - that I have had the motivation to research & learn about education & learning styles. My impetus is my 5y/o daughter - Dillon. Her mind is my own recreated in a beautiful little girl that is permeated with the drive to learn & impaired by unfettered energy & the inability to focus - she is a fiery right-brained individual, just as I am. I struggled mightily to 'conform' to the style in which things are taught in US public schools - the 'left-brained' way - and only succeeded because I am blessed with the ability to comprehend things very rapidly. Honestly, I was bored to tears & constantly in trouble. In fact, my HS had to doctor my transcripts to allow me to graduate due to excessive absences despite the fact I was ranked in the top-20 of a class of nearly 500 and had multiple 4-yr full-ride scholarships. Believe me, I had 'known' every Principle in all of the schools I attended personally: talking, inattentiveness, distraction of others, fighting & more fighting. I was very frequently in the office. It got to the point that they no longer asked IF I played a role in whatever trouble had occured, but WHAT role did I play (cursed/blessed with pathologic honesty - I always admitted to it, if asked). But I do not & cannot (still can't) learn well by the traditional manner of reading, digesting & regurgitating. I read ponderously slowly but have tremendous recall IF AND ONLY IF I am interested in the topic, but 90% of the time, I am bored by the end of the page & could go back to re-read the page 10 minutes later as if I had never seen it before. That style of info-transfer is a flagrant failure for me. From very early on, I knew I thought differently but due to lack of self-esteem, choose to hide it & "disguise" myself as a left-brained learner. The end result: I never learned to learn & when I finally was academically challenged as a Ugrad - I failed miserably & choose, again, to hide/medicate this as "Blutarsky the Party Animal". And, to be perfectly frank, once I matured, learned how to learn for me & gained self-confidence, I could not have given 2-shits about what others thought about my learning style - I've been a maverick all of my life. However, that all changed when I began to 'see' those same struggles erupting in my daughter - funny how things you learned to harden yourself against become so profoundly important when it is your offspring now being affected.


Left-Brained Learners/Thinkers do so in a very linear, logical fashion. They derive the 'big picture' vis a vis a accumulation of the details. The process being once the quantity & quality of the details reaches a critical threshold, which varies vastly by the individual & their intellectual capacity, the big picture begins to emerge. A 'train of thought' is precisely that - a linear, logical sequence that through a process yields a pertinent result. That phrase was undoubtably coined by a left-brainer.

Contrast that with Right-Brained Learner/Thinkers who must grasp the big picture first & then add on the details like ornaments on a Christmas Tree. We must form the cogent, workable dynamic understanding BEFORE we begin to flesh out the details. For a severely right-brained person, the term 'train of thought' is completely foreign. Most of the time we have multiple threads going on in our heads. While the ability to parallel process may sound awesome, the reality is that an exceptionally few folks have the ability to manage more than one or two threads to completion. So, right-brainers have many potentially disparate logical threads going on, but lack the innate capacity to channel 1 or 2 of them to completion. That talent must be learned or taught and this is where the years of blood, sweat & tears are grounded - in the struggle to focus & maintain that focus. Or, for some really really right-brained folks, they become hyperfocused and then the challenge is to un-focus.

Neither format is wrong, dysfunctional nor superior to the other. Both styles have their strengths & weaknesses. They should be viewed as 2 interim points on a continuum - the endpoints of which are autism (L-brain) and pathologic OCD (R-brain). Please note that the learning sequence is essentially dimetrically opposed, but the end results are similar, if not indifferentiable. Furthermore, the overwhelming majority of people are L-brained, hence the viewpoint of R-brained being abnormal. Also, the US-education system was designed to capitalize upon & maximize the way it workd for the most folks - totally logical way to design a system to benefit the most people for the $$-spent.

Now, back to the topic at hand: yes, the first 2 years of medical school involve TONS of bulemic learning, which L-brained folks do much better at than do R-brained ones. This reflects the learning concept that "you learn to form the 'big picture' through an accumulation of the details eventually yielding a dynamic model that you can mentally manipulate & apply to novel situations". The fundamental assumption being that everyone can make that leap from a vast array of factoids to the dynamic working model.

As you can easily imagine, 'testing' an individual to assure they had achieved the dynamic-model level of understanding proves to be quite challenging - only ways I can think of are essays, oral exams &/or live/simulation-based testing. Any of the three of those can be quite cumbersome, esp when you try to apply them across a broad-base of med students & in large numbers of test-takers.

Add to this the inherent resistance from "I learn it that way & was able to make that leap" disposition of many of the professors and you have a very complex situation that simply throwing money at - the American way - will not & cannot solve.

Another complicating factor is the volume & pace which the first 2 years move at. It is truly like trying to sip water from an open fire hydrant. I vividly recall myself & all of my classmates lamenting that "fact" that we were simply moving to fast to learn anything. Our fear was that our rentention was so poor that all we would ever manage to do is to get out there as a resident, if we actually graduated, and kill patients 2/t our lack of knowledge. Over time, you realize that inculcation starts to burn fundamental concepts into your guord, but does so insidiously. In fact, you will be in conversation with classmates or physicians and all of the sudden notice these concepts & facts that flow from your mouth, while in the back of your mind you are thinking - WOW! Did I say that? Or, you will read a recent H&P on a pt you are admitting & think, "Wow! This cat sounds like a real doctor...wish I could do that" only to realize that YOU were the author of that H&P!

While the current system works to produce some of the strongest, most-talented physicians in the world, I personally think it could be honed to do so more efficiently, effectively & inflict less pain along the way, esp for the R-brained minority.

For those of you who read all the way through this, thanks for doing so. It may not ever amount to a hill of beans for you, but if you are a R-brained individual, I hope that it gives you some insight & motivates you to learn more about this fascinating topic. And, for you L-brained colleagues out there, I hope it provides you with some insight on how/why we may appear somewhat quirky or frustrate you. My personal goal is to facilitate individuals with both learning styles to be more collaborative because there is a tremendous advantage in attacking problems from simultaneous multiple perspectives.

Just to play devil’s advocate… I disagree that there are two opposing “styles” of learning. I think everybody employs multiple styles all the time, and the more ways you learn something, the better you learn it.

I have a personal approach that works for me, although I haven’t hit actual med school yet. First, I try to skim the reading without attempting to understand it, before lecture. Then I go to lecture and try to absorb, but don’t take notes unless I have to. Then I go home and write things out in longhand, usually on flashcards. The process of writing seems to solidify my understanding. The last step, for me, is always trying to explain things to someone else. If I’m lucky, I find a fellow student to explain things to, and we study together to both our benefit. When schedules don’t allow, my poor husband or my mother are the recipients of this “teaching.” My husband actually enjoys it, I think. My mom doesn’t, but I subject her to it anyway. It’s great to try to explain, say, RNA interference or the Krebs cycle to someone who knows not much about it.

After talking things out and trying to explain things to someone, I always find that I remember it. It’s uncanny.

I hope that I will find the time during med school to keep up this fake “teaching,” which is actually my own favorite “learning style.”

  • starmoon Said:
Just to play devil's advocate... I disagree that there are two opposing "styles" of learning. I think everybody employs multiple styles all the time, and the more ways you learn something, the better you learn it."

A med student, now resident, recommended the book Successful Types for Medical School which helped me lot! It talks about the different styles of learning and helps folks figure out which method works best for them.


Unfortunately (or fortunately depending on how you look at it) I've found that I'm an uber visual learner which is great for classe slike Histo and Path. Not so great for classes like Biochem and Endo however, this book taught me how to make these classes more "visual".


Excellent forethought! As a former dancer (= artist), I am not surprised, in the context of all of my reading, that you favor a more dynamic, interactive learning style. While far from set in stone, folks who ‘tend’ to be artistically inclined tend to score more towards the “R-brain” end of the spectrum.

Second, you are absolutely, fundamentally correct in assessing what I have described aboe as grossly over simplified! I intentionally did so merely to make it a more conversant topic. What PathDr2Be describes below, the 4-topic breakdown employed by “Success Types” (Dr. John Pelley - originator of Success Types is a professional acquaintence & was the 1st conference keynote speaker for OPM), is probably far far more accurate & probably a better predictor of learning styles & strategies. He utilizes the MMPI (Minn something personality inventory) score to derive teaching, learning & study styles & strategies. So, you are most correct in that trying to force a single-system to work for all players portends of failure…which is precisely underlies my burgeoning interest in learning styles (to maximize my daughters learning & education).

I am an INTJ - all of my scoring was very much toward end-of-scale for those measures.

I LOVE this discussion & the style in which it is occuring. Can we keep it going? I will try to invite Dr. Pelley to see if he wants to participate. He used to be a member of OPM…although it has been a long time since he was active.

This is an e-mail from John Pelley earlier in the week in response to a similar invitation that I mentioned above. However, as I now reread the e-mail, I see he has made copies of his Success Types available via the web for FREE!

  • John Pelley Said:

Hello there, OMD (aka Dave),

I hope this note finds you and your family well. I am sending you the news that my book, SuccessTypes, is now free online at my website below. Please share this in the way you see fit. I won’t be able to participate in the forum discussions, but my email is at the website, or you can give it out (just don’t post it at the website or the spam bots will pick it up) in case anyone has questions or such. If anyone is still involved in the oldpremeds (force of habit and easier to say) please send my regards and best wishes.

My best,


John W. Pelley, PhD

Texas Tech Univ. HSC, Lubbock, TX 79430

voice: 806-743-2543 /FAX: 806-743-2990


So take serious advantage of this & download the book. It will be well worth your time, bandwidth & effort.

Awesome, thanks, Dave. I notice he has an OPM link on his page, too!

edit: the full book is in pdf format under the “SuccessTypes in Medical Education” link. I’d recommend saving it to your computer first, rather than just opening it on the web.