#TipsforEMexams: The Psychological Science of Exams

So, I ran into my friend Meghan McConnell the other day and we got chatting about how to make examinations less of a horrible experience. Dr. McConnell is a PhD researcher in the world renowned Program for Education Research & Development at McMaster University. Her research interests are in the area of how emotions influence training, assessment and performance of healthcare professions.

Considering her interests and expertise, I thought it would be great to interview her for the BoringEM blog, and get some insights into how we might actually harness our own psychology to conquer the exams.

You can listen to our conversation here:

But, for all of busy residents ACTUALLY studying for your exams, here is a summary so you can quickly gleam all the info quickly.

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Transcript of Podcast (The Psychological Science of Exams)

TC: What are some things that we can do as people challenging exams to not “psych ourselves out”?

MM: So, a big thing in the emotions research is what we refer to as appraisal. So you can look at an event as stressful or …you can appraise it as a positive or a negative thing. So, classic example is they did this research where they looked at the effects of stress, so if you found that stress had a negative impact on your life then when you followed these people forward you found that they died a lot sooner. If you found that you had a stressful life, but you viewed the stress as a positive thing, then the[se people] actually out performed a lot of their peers. So the idea is that by looking at stress as a positive thing, so it oxygenates your blood, helps focus your attention …

TC: You’re riding an adrenaline high, right?

MM: Exactly. Stress has developed and evolved for a reason, so if you can appraise it as a positive thing – sure, you’re a little antsy, but you know what? That’s going to likely enhance your performance, and that’s really it.

TC: So in other words, don’t let stress get to you, but rather ride that adrenaline high.

MM: Exactly. Ride the wave.

TC: And considering that we’re talking to emerg residents that’s very applicable because, I mean, we ride the adrenaline high all the time, right? Like, in the emergency department … I mean who doesn’t get super psyched up for a really extra interesting case, right? Someone patches in, and needs our help, and is there…

MM: Yup.

TC: So it’s just channelling that …

MM: Well it’s finding that excitement.

TC: So can you get excited about the exam in the same go-getter way that we do every day in the department. Okay. Perfect.

MM: Yeah.

TC: What about [memorization]. There’s a lot of stuff we’ve got to cram in our brains. Honestly, it’s the biggest complaint I hear about the exam. So what can we do to better cram stuff into our brain?

MM: Best thing that I can think of – and I tell everybody this – is …. Testing, testing, testing. It’s not about different ways of encoding the information, which is what studying does, but retrieving information – because that’s what you have to do when you’re testing. You actually have to access the information.

TC: You mean, like, quizzing yourself? Is that what you mean?

MM: Yup. So flash cards – that was my go-to for all of school, and it was really great. Even just, a big part is – and I haven’t go to test this (and I would love to study it) would be to use different parts of your brain. Speaking is one thing, versus reading, versus writing – all of these are accessing different neural networks. And the more accessible this information is, the less stressful it’s going to be, and the easier it is going to be to come out.

TC: Do you think that if you’re going to be challenging a multiple-choice exam, then you should probably try to do as much multiple choice as possible?

MM: Yes. Although research has suggested that even if you … the more elaborate the processing is the better. So it’s just as efficient to test yourself using short answer questions and things like that. Because if you’re making your own quizzes, it’s kinda hard to come up with alternative options.

TC: Yeah. It’s really hard to make up multiple-choice questions.

MM: Right. They have experts on these committees that spend years doing that.

TC: We hope so, anyways!

MM: But even just doing short answer questions still shows an enhancement [in performance] in multiple-choice tests. And even, [with] Meredith Young and Christine St. Onge recently, [I’ve] published something that testing [can have an effect on] a mock licensure exam with multiple-choice questions

TC: In other words, just practice pulling this stuff out of your brain.

MM: Exactly. In as many different ways as you possibly can. Pretend you’re giving a lecture. It doesn’t have to be just be cue cards. Pretend you’re explaining it to someone.

TC: Exactly…

MM: Call up your mom like we were talking about, say: “Okay mom, I’m going to explain this to you. You’re probably not going to understand it… but…”

TC: If your mom is a doctor then she can correct you!

TC/MM: Laughter.

TC: As yours is! And my dad is… so… Obviously, that makes sense. And you can explain things to your learners, if you’re a senior in the department. Finding a learner and tell them you’re going to tell them about some esoteric thing that I need to know for myself. Think of it as both teaching and learning at the same time.

MM: Exactly, it’s about accessing that information. Retrieval practice.

TC: So you want to retrieve things out of your brain. Dust of the cobwebs and really just take it out as much as possible. Alright. And then, my final question to you would be: What do you think are things you can do for mock oral exams? Now, those are a slightly different technique, they tend to be a bit more grounded in reality – most people find them more user friendly. Obviously, it’s not quite like an OSCE – it’s more about your cognition. So, any insights on how to optimize that?

MM: So, I think, if you’ve got the knowledge base so use your testing… Well, you’ve got your comfort there, practice has to be one of the most beneficial things. Again, if you just read over the text, that’s great, but you have to – in the context of an oral exam – actually verbally access [read: represent] that information. You have to also practice the process of speaking and articulating that. And I think a lot of the time, [it’s how you get] more comfortable with it. And if you get stuck in a moment, just take two seconds – remember it’s just ride that adrenaline. So practice, and if you get stuck, it’s not [the end of the world].

TC: Like, do you think it matters if you practice with a faculty member or just with one of your buddies?

MM: I think you could practice in the mirror. I think you could practice on your cat!

TC: Laughs.

MM: The point is getting that information to flow verbally, because a lot of the time you can access it, but being able to say it is a whole other ballgame.

TC: Yeah. It’s kinda like you can watch and know how to do a dance routine but until you actually dancing… Or we’ve all been there, and on platform speeches. Where you have to give a speech – I may know the words but it’s not the same as being on stage. And I guess in some of my earlier days, I may have done some acting… And so memorizing the speech – you know a monologue from Shakespeare -is not the same performing it really well. So that performance part is what you’re talking about. It’s the practicing of that performance. You may know your stuff, but you need to practice performing.

MM: And, you even the bonus of doing it with yourself is that you need to come up with your own questions. It makes you think critically about the same material. And again, variety is the spice of life. Practice with a senior colleague, a junior colleague – they’re all going to ask different questions, and it’s all about accessing that information.

TC: And one of the things that I found was that doing those practice exams, honestly, the quizzes that my friends gave me – some of them have actually impacted on patient care. They didn’t immediately interact on it, but for sure I found that there were some mock oral exams that my friends gave me that resonated with me so much that a couple months later when I was first year staff, it probably saved someone’s life.

MM: Huh!

TC: So, I think that is worth it all. So practicing mock oral exams, learning the material… it’s all important! Well, thank you very much – this is Teresa. And…

MM: Meghan!

TC: Meghan… And thanks for tuning in! Bye!

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References:

1. TED Talk by Kate McGonigal.

2. McConnell, M. M., St-Onge, C., & Young, M. E. (2014). The benefits of testing for learning on later performance. Advances in Health Sciences Education, 1-16.

Other Resources

1. Strategies that Make Learning Last

3. To remember a lecture take notes by hand