Multiple choice examinations are used by basic science and clinical clerkships to evaluate knowledge base, so good skills in answering multiple choice questions are useful throughout medical school. Most students can increase their scores on multiple choice examinations from 5 to 15% by practicing good test taking techniques.  Here are some for you to consider:

1)  Misreading the question 

The single most frequent error students make in multiple choice examinations is to misread, and therefore, misinterpret questions. Many students read the possible answers of the question before they have checked to insure that they understand the question. Often they find a possible answer to the misunderstood question, and, of course, the answer is incorrect. There is a simple process that will cut down the errors made by misreading the question.

First, cover the possible answers and then read the question. Ask "what is this question asking?" Rephrase the question in your own words until you understand the question. Then, without looking at the answers, ask yourself "what do I know about that?" Secondly, review the answers carefully.  In a well written question, there will usually be two choices left after eliminating definite incorrect answers. Again, question yourself, "what do I know about this or that?" This interrogation will get you into the memory banks where the knowledge is stored.

2)  Anxiety 

Anxiety and fatigue cause students to miss questions for which they know the answer. Both conditions show up as a rather specific pattern of errors which can be corrected once the reasons are known.

There are basically two types of error patterns caused by anxiety. Many students are very anxious when they begin an examination. Gradually, the student becomes more composed and the anxiety diminishes. Students with this type of anxiety will answer more questions incorrectly in the first one-third of the examination than in the middle or last one-third.

An error string is a cluster of three or more errors in a row usually caused when a student gets a surge of adrenalin. This second pattern of errors caused by anxiety occurs because students believe they made an error or became angry at the examination (psychological projection). Since a sudden surge of adrenaline is not conducive to mental concentration, it is likely that errors will be made in the questions that follow.

One way to correct the first pattern of errors is to carry out a 20-30 minute test warm-up session just prior to the examination.  Use some of your practice questions. Find a quiet place and practice reading and rephrasing the questions. The idea is to start thinking about the subject material and to begin to concentrate. Some students listen to soothing music just before the exam.

The second pattern of errors caused by a burst of adrenalin can be handled by letting the panic sensation subside before going ahead. Keep in mind that all questions have the same weight and that one question becomes heavier only if you allow the adrenalin surge to affect you to make more errors.

Fatigue patterns usually show up in the last one-third of an examination unless a student is so tired when he/she comes into the examination that they do not think clearly. This is the usual fate of all night crammers.  A sure cure for the fatigue pattern of errors is to get a good night’s sleep before an examination, to eat a healthy diet with little if any caffeine intake, and, to exercise properly to release tension and manage stress. Cramming is a sure way to lose points due to fatigue.

3)  Passing over a question or changing an existing answer 

Passing over questions that are difficult and/or changing answers both can contribute to a higher frequency of error than lack of knowledge base would cause. In the first case, leaving questions unanswered generates anxiety since students tend to keep thinking about going back to answer them and wondering if they can answer them. We have already seen what anxiety does to concentration. Students do not need the extra baggage caused by leaving questions unanswered and then having to come back to answer them. However, you know yourself best.  You decide which way works best for you.  Most students gain little from changing answers.

To sum up:  A positive test taking characteristic is to approach each question as a problem to be solved, process the question in the time allotted per question, give your best answer, move on to the next question and leave worry about the preceding question behind.