PA School 101: MCQ Exams - Strategy
Multiple choice question (MCQ) examinations are a terrible way to test knowledge (my opinion), but are still used extensively, if not universally, for standardized tests for students taking their End of Rotation, End of Curriculum, and PANCE certification exams.
You need to have a strategy to pass these tests. Not only is your knowledge tested, but so is the speed at which you can process the information and recognize the correct answer, distinguishing it from the distractors. In my experience working with students, it is dealing with the time pressure that trips them up more than just a lack of knowledge. Don’t get me wrong, you do have to know the subject matter, but even if you know it inside and out, you can still fail due to distractions and poor time management.
Before I get to my list of top tips for passing your MCQ exams, let’s get some perspective. These types of tests are not comprehensive. They assume that if you can recognize correct answers about specific facts, then you have an understanding of the topic as a whole. For example, when I write an orthopedics exam, I don’t ask a question on every single pathology taught in my class. I select certain facts to test on, while many are left out of my final exam. The astute student can likely predict the types of questions I might ask, such as using different types of wrist fractures (Colles, Smith, etc.) as the multiple choices for a question. Because MCQ tests are about recognition, you can bet you are going to be given a list of similar things (diagnoses, medications, etc.) as the choices.
Finally, before I reveal my top tips, we must acknowledge the elephant in the room - anxiety. There is often a lot riding on the results of these tests, such as advancing in school or being certified to practice. They can be like potential forks in the road, with one path leading to success, while the other path leads to delays, shame, and many other dark outcomes in the minds of the test-takers. Failure can be a HUGE setback emotionally, financially, and otherwise. Of course, you’re going to be nervous taking your certification exam.
The physical sensations of anxiety and excitement are similar with the same physiologic response of the sympathetic nervous system. Palms are sweaty, knees weak, mom’s spaghetti…and more. One major difference between the two, however, is that anxious thoughts focus on the possible negative results, while excitement is about anticipating success. So just change your thoughts! Easier said than done, but not impossible.
One suggestion is to relabel your feelings of anxiety as excitement because, remember, both can cause that dump of catecholamines. When I start to feel “nervous,” I think, “This must be important to me.” If it’s important, then it can be something to be excited about. If the consequences of failure are so large, you can’t seem to get them out of your mind, remind yourself that just means that the sweetness of success will be all the better. I can’t stop my anxious thoughts, but I can use them as a springboard into my next thought, that of success.
Adam’s Tips for MCQs
Study harder than the test. Remember how I said memorization is harder than recognition? Study that way. Learn the material as if you’re getting ready to teach it, not just recognize the answer.
Don’t just use MCQs to study. That should be obvious after point no. 1.
Take timed practice tests. Don’t walk into an exam not ready for both dimensions of the exam - the material and the time limit.
Have a “shot clock” in your head. If you only have 1 minute per question, then don’t spend more than 60-90 seconds on a single question. Flag it and come back. For those questions you answer in less than 60 seconds, bank that time for the end, when you can go back and reexamine your flagged questions.
Don’t flag everything. If you are 80-90% sure of the answer, going back to look at it won’t help and it may hurt if you change your answer. Similarly, if you have no clue what the answer is, take your best guess and move on. You’re not going to magically know something at the end of the exam that you didn’t know walking in. Flag questions you are unsure or need more time to work out the answer. Use your “banked” time at the end to work out questions.
Read the entire stem and question without looking at the answer choices! If you know the answer to the question, you know it. Select that answer from the choices and move on. Really, don’t even look at the distractors because they might make you change your mind. Answer the question as if you had to write in the response, and if that response is one of the multiple choices, pick it!
If you don’t know the answer without looking at the choices, go through them one at a time. Eliminate answers that you know are wrong (I like to put a line through them). If you recognize the right answer, select it, and move on. Too much time is wasted considering wrong choices.
If you don’t know the answer without looking at the answers, and you don’t recognize it after reading all of the choices, then you need to start playing the probability game. This takes time so don’t spend too long. It’s better to finish the exam and come back to this question, then waste time on a question you may get wrong anyway. Usually, you can eliminate one or 2 choices on your first pass. Usually, you’ll have a 50% chance fo getting the right answer, which is better than zero if you run out of time.
