THE PLANNER

STUDY GUIDE

THE PLANNER’S GUIDE TO STUDYING FOR BOARDS
When it comes to preparing for your board exam,
you’ve identified yourself as a “Planner.” Typically,
this means you make a plan and a study calendar well
ahead of time, with the intent of proceeding systemat-
ically through the knowledge base. If this sounds like
you, congratulations! This is an ideal strategy, both
for passing the test and for lifelong learning.
In fact, your planning and discipline have likely con-
tributed to your successes in life and in medicine. But
those same personality traits can also get in your way
when it comes to board review. The typical physi-
cian’s drive to be comprehensive may especially apply
to “Planners,” whose tendency to dive deeply into a
topic can become counterproductive.
If you create a 12-month plan to review organ systems
and diseases, but then feel you must master every
nuance, you will inevitably fall behind schedule. The
prospect of running out of time before covering all vital
topics may introduce unnecessary additional stress.
Planners may leave big gaps between reviews of major
sections of a curriculum and tend to miss opportuni-
ties to consolidate and reinforce prior learning.
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THE PLANNER
When you face a test of generalized knowledge,
such as boards, studying can go off track. But with
self-knowledge, vigilance, and the right tools, your
planning nature can work to your advantage.
KNOW HOW TO STUDY
Your goal is to study what you need to know in a
focused and targeted manner, without getting bogged
down in extraneous detail. Instead of covering just
half the material at 90 percent depth, you are bet-
ter off if you cover 90 percent of the material at 50
percent depth in your first pass at it. This leaves you
time to circle back to topics to reinforce and expand
upon what you know. Fortunately, new understanding
of how we learn and retain knowledge can help you
study more strategically — and new tools can keep
you on track.
A key concept is “metacognition,” which in education
terms means recognizing your own strengths and
weaknesses and even knowing where you are over-
and/or under-confident. This self-awareness helps
you focus on what to study and how to use your study
time effectively. You’ll want to return to key principles
you struggle to remember, and avoid repeating areas
you know well.
“Active learning” also is important. Actively engag-
ing with the material brings deeper understanding
and may aid retention. Traditional learning tends to
be passive, especially in the first two years at some
medical schools. For board preparation, habit drives
many physicians back to the familiar textbooks, taped
lectures, and flashcards. The systematic and seem-
ingly comprehensive nature of these traditional study
tools appeals to Planners. But passive learning is of
questionable effectiveness. Worse, once you invest
time with these materials, you feel that you must be
learning; often that’s not true.
In contrast, tools that require you to apply knowl-
edge — typically through problem-solving with case
studies — engage your mind more actively. Physicians
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 THE PLANNER

tend to remember information best this way.

It is how we build our clinical reasoning —
patient-by-patient — in everyday practice.

Repetition is also important to create a strong scaf-

fold for your learning. The Planner may not initially
see an advantage to going over material more than
once. But it has become clear that repetition and
re-exposure to material, especially for weak areas,
helps to make your knowledge stick.

AVOID A LINEAR PLAN

Planners also tend to create a linear plan of study, but
this runs contrary to the best evidence for knowledge
retention. A typical linear plan is a calendar-based
schedule starting six months before the exam, with
a week-by-week assignment — perhaps the first four
weeks on cardiology, then two weeks on respiratory
medicine, and so on. As you finish each topic, you
tick it off your list.

This type of plan, while comfortable for you, may not

be the most effective. Educators now know that if you
move through curriculum in this linear fashion, by
the time Month Three comes around, you may have
forgotten what you learned in Month One. Without
reinforcement during subsequent months leading up
to the exam, much of your study time is for naught.
Even a thorough review shortly before the exam is
probably not enough to reinforce material that hasn’t
been revisited in several months.
CHOOSE TOOLS THAT KEEP YOU ON
TRACK
Question banks have become an essential and
useful tool for board preparation. Evidence shows
that answering questions or retrieving information
from memory — as we do when taking tests or
answering questions — is more useful than simply
studying. A question bank is optimal for a Planner,
especially if it:
•• Is comprehensive and contains references, thus
satisfying the desire to delve deeply.
•• Offers immediate feedback and explanation of
the key learning point, especially for a wrong
answer. The negative experience of an incorrect
answer may increase your attentiveness. A tool
that offers feedback in that moment may
capitalize on an opportunity for learning while
your mind is most receptive.
•• Employs “adaptive learning,” a technology that
serves questions based on your prior responses.
Algorithms determine which questions to pres-
ent to you, depending on your past correct
or incorrect answers. This creates a reliable
“metamemory.” Sophisticated question banks
move quickly through topics that you know well
and focuses your study time (and repetition) on
weaker areas. These tools may allay counterpro-
ductive anxiety about covering all the necessary
content, with the added bonus of constantly
reinforcing your knowledge.
Textbooks, journals, lectures, and flashcards are
not necessarily time-efficient or adequately focused
on what you need to learn. Even for someone who
begins studying far in advance of the test, there is no

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 THE PLANNER

guarantee that the content is mapped to the test or the blueprint directs the percentage of questions
zeroes in on your specific knowledge gaps. Similarly, in each medical content category (i.e., 14 percent
review courses are one-size-fits-all, tend not to adapt cardiology, broken down further into the number of
to your strengths and weaknesses, and lull you into questions about ischemic disease, arrhythmias, etc.)
thinking you must be learning when you’re not. As im- and in cross-content categories (i.e., 10 percent
portantly, what is learned during a one-time, intensive geriatric medicine). Seek out tools that are mapped
review course tends to decay rapidly in the absence of to the blueprint.
effective consolidation.
Step 3. Self-assess: This is where metacognition
Among the study aids you use, seek one out that comes in. As you begin your study plan, identify
stimulates the visual side of your brain to recognize your strongest areas, where you don’t need much
clinical features of disease through radiologic images, work, and those that require more brushing up. Prac-
photographs, and EKG tracings. tice tests will help with this. Be honest with yourself
about what you do and do not know. Consider areas
that you don’t encounter in your daily practice. Then,
GETTING STARTED as you are choosing a study tool, seek out one that
Step 1. Carve out time: A year in advance is a good will move you quickly through reviews of topics you
time to look ahead at your schedule. But no matter know well in order to focus adequate time on your
where you are in the certification cycle, the key is weaker areas.
to carve out specific, protected time for study and
review on a regular basis. Successful exercisers know MAKE PRAGMATIC STUDY CHOICES
the great value of this. You may designate two hours
every Sunday afternoon or one hour before you leave Planners, especially those who lean toward
the office every Monday and Wednesday. Whatever compulsiveness, must make special effort to be
you choose, it is essential to protect that time in your pragmatic. The following tips
schedule. Make sure studying fits into your routines may help you to use your
so that you can keep at it for at least six months be- time well.
fore the exam. You should also be realistic about how
much studying your mind can handle effectively at
once. You may not be able to study for long stretch-
es as you did in medical school, and doing so may
not be the best tactic for retention.
Even the most disciplined Planners may require a
sense of urgency to buckle down to a study schedule,
and a six-month plan is a reasonable timeline.
Indeed, every day of your practice prepares you for
boards, and each moment of clinical reasoning is a
reinforcement of your knowledge. But for true lifelong
learning and board preparation, most of us need to
augment our knowledge with focused time to read
and study.

Step 2. Become familiar with the “blueprint ”

for your board’s exam: For example, the ABIM
“blueprint” guides the content of Internal Medicine
certification and recertification exams. In this case,

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What to study:
•• Well-established treatment guidelines from
national organizations for common diseases
such as type 2 diabetes, hypertension, asthma,
and hyperlipidemia.
•• Screening guidelines such as those for breast,
colon, and cervical cancer.
•• Specific physical findings that can be diagnostical-
ly useful, such as knee maneuvers and murmurs.
•• Problems that are frequently encountered in a
practicing physician’s office, such as sinusitis,
depression, migraine, chronic pain, COPD, etc.
•• Be ready to recognize uncommon presentation of
common diseases, but only typical presentations
of uncommon diseases.
•• Anticipate common drug interactions.
In the final days before an exam, review common lists
of facts:
•• Basic formulas for gaps and gradients and
acid-base interpretation.
•• Simple associations that are readily forgotten
but specific, such as autoantibodies associated
with various rheumatologic conditions or how to
interpret hepatitis B virus serologies.
Keeping up with the latest controversies and treat-
ments through journals and other means is import-
ant for lifelong learning. But some of these topics are
less likely to appear on a board exam:
•• Ongoing controversies. Because questions must
have a solid evidence base behind them, you’re
fairly safe to rule out rapidly moving targets.
•• New therapeutics (and diagnostics) that are less
than a year or so old. Questions must be written
and vetted in advance, so new treatments and
topics will take a couple of years to be worked
into a certification exam.
•• Advanced therapeutics that ordinarily would be
in the realm of a specialist (such as bone mar-
row transplantation or managing a dysfunctional
pacemaker).
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THE PLANNER
PLAN — AND STUDY — FOR SUCCESS
As someone who plans ahead, you’ve probably given
yourself a bit of time to study and are likely to use
more than one study tool. Even so, you want each
one to be effective:
•• Use study materials that you can trust. They
should incorporate current guidelines with an
evidence base; be created by a high-quality,
authoritative source; and have been subject to
expert peer review.
•• Find tools and practice tests that are in the
same format as the exam. For most boards, it is
important to practice with case-based questions
and to master the art of multiple-choice ques-
tions.
•• If you haven’t taken an exam in a while, train
yourself for computerized test-taking.
•• Use technology to optimize your time. Adaptive
learning in particular is time efficient. Choose a
tool that helps to quickly reinforce your stronger
areas, and then moves on to topics that may
require more review.
Being a Planner has served you well and will continue
to do so in your quest for lifelong learning. But as you
face a certification or recertification exam, you’ll be
reassured by tools and tactics that keep you focused
on what you need to know. This frees you up to make
the most of your “planning” instincts and go forward
with confidence, and to achieve success on boards
and, most important, with your patients.
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 THE PLANNER

References Interviews
Bell, DS et al. “Knowledge Retention after an Online Tutorial: Teresa Carter, Associate Dean, Professional Instruction and
A Randomized Educational Experiment among Resident Faculty Development, Virginia Commonwealth University
Physicians.” J Gen Intern Med 23(8):1164–71. School of Medicine.
Carey B. “Forget What You Know About Good Study Habits.” Trish Kritek, Associate Professor, Division of Pulmonary and
New York Times. Sept. 6, 2010. Critical Care Medicine, Associate Medical Director of Critical
Care, University of Washington Medical Center.
Kornell N, Hays MJ, Bjork RA. “Unsuccessful Retrieval
Attempts Enhance Subsequent Learning.” Journal of Graham T. McMahon, Executive Editor, NEJM Knowledge+;
Experimental Psychology 2009, Vol. 35, No. 4, 989–998. Associate Professor of Medicine and member of the Academy
at Harvard Medical School.
Schwartz BL, Son LK, Kornell N, Finn B. “Four Principles
of Memory Improvement: A Guide to Improving Learning
Efficiency.” The International Journal of Creativity and Problem
Solving 2011, 21(1), 7–15.
Storm BC, Bjork R, Storm JC. “Optimizing retrieval as a
learning event: When and why expanding retrieval practice
enhances long-term retention.” Memory and Cognition 2010,
38(2), 244–253.

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