THE EPISODIC

STUDY GUIDE

FOR THE EPISODIC STUDIER — A GUIDE TO PREPARING FOR BOARD EXAMS
For a time-starved physician, putting board prepara-
tion ahead of other demands is a challenge. For many
of us, this means we fit studying in when we can —
grabbing days, hours, or minutes at a time, with inten-
sified effort as we get closer to the exam date.
The good news for the “Episodic” studier is that
short, spaced sessions are an effective way to learn
and retain information, educators say, particularly
if you review and reinforce information over time.
Active engagement in clinical practice is also in
your favor. Every day with your patients prepares
you for boards, and each act of clinical reasoning is
a reinforcement of your knowledge. You can derive
confidence from what you already know.
But physicians still need to augment their knowl-
edge with focused time to learn and study. A
successful Episodic studier uses time efficiently,
focuses on high-value learning, and is systemat-
ic. With awareness of what to study, and the right
techniques and tools to stay on track, the Episodic
studier can tackle board preparation strategically,
with great benefits for lifelong learning.
KNOW WHAT YOU KNOW, and OTHER
FUNDAMENTAL CONCEPTS
Some best practices from cognitive science and
education can guide you toward efficient studying:
Process material actively: Actively engaging with
the material brings deeper understanding and may
aid retention. Traditional learning tools — such
as books and lectures — tend to be passive. In
contrast, active studying usually involves applying
knowledge, often through case studies, to engage
your mind more actively.
Learn by taking tests: The act of test-taking actually
improves memory. When we take tests, we retrieve
information from memory, which has been shown to
be more effective than simple studying and review-
ing. Even unsuccessful attempts at retrieval — that
Call Us Toll-Free 1-855-318-9303    http://knowledgeplus.nejm.org
THE EPISODIC
is, answering questions incorrectly — can be more
effective than just studying and reviewing.
Vary your surroundings: Always studying in the
same place is not as effective as many of us were
taught. Varying the study setting, on the other hand,
may actually boost neural connections and strength-
en retention. This is good news for the Episodic
studier, who may study in the office or library, at the
kitchen table, outside a child’s karate class, or on
vacation.
Spread out your learning time: Learning that is
spread out over time, called “spaced learning” or
“distributed practice,” is better than trying to learn
a lot at once.
Learn, rehearse, repeat: Repetition and re-exposure is
a powerful strategy to consolidate learning and max-
imize retention. This is especially true in areas where
your knowledge is weak or was learned some time ago.
Know what you know — and don’t know: In
educational terms, “meta-
cognition” means being
aware of your own
learning and memory.
This self-awareness
of strengths and
weaknesses, and
even knowing where
you are over- and
under-confident,
is essential
to efficient
studying.
2

These principles all tell us that episodic learning can
be very effective, as long as you have a reliable way
of keeping track of what you have studied and can
pick up where you left off.
HOW TO GET STARTED
For the Episodic studier, there is real value in figur-
ing out what you need to know and then making a
plan for how you will study.
Step 1. Self-assess: This is where metacognition
comes in. A practice test at the outset is a good way
to quickly define your strengths and weaknesses. Be
honest with yourself about what you do and do not
know. Then, consider a study tool that can move you
through a review of topics you know well so you can
focus your time on weaker, but high-priority, areas.
Step 2. Make a plan, even if it is episodic: As much
as you can, plan out times to study, even if these
are far apart and sporadic. You may target a specific
weekend or a few days off, or the first weekend of
each month, or even specific downtime each week
to study. If you are designating entire days, be
Call Us Toll-Free 1-855-318-9303    http://knowledgeplus.nejm.org
THE EPISODIC
realistic about how much your mind can absorb
effectively at once. You may not be able to study for
long stretches as you did in medical school, and
doing so may not be the best tactic for retention.
Step 3. In the final six or eight weeks, schedule con-
sistent, protected study time: Carve out this specific
time for weekly study, then stick with it. You might
decide to designate two hours every Sunday after-
noon or one hour before you leave the office every
Monday and Wednesday. Whatever time you choose,
protect that time in your schedule no matter what.
USE YOUR TIME EFFICIENTLY
To make the best use of your time, match your
studying to the “blueprint:” Some boards post on-
line the blueprint that guides exam creation, as the
American Board of Internal Medicine does for both
certification and recertification exams. The ABIM
blueprint directs the percentage of questions in each
medical content category (i.e., 14 percent cardiology,
broken down further into the number of questions
about ischemic disease, arrhythmias, etc.) and in
cross-content categories (i.e., 10 percent geriatric
medicine).
Learn how to take the test: Knowing how to take a
particular test is essential to a positive outcome
and can be accomplished in a short time frame. For
most boards, practice with case-based questions
and master the art of multiple-choice questions.
Take practice tests and train yourself for computer-
ized test-taking if you haven’t taken a test recently.
Think in pictures: Use a study aid that stimulates
the visual side of your brain, particularly to recog-
nize clinical features of disease through radiologic
images, photographs, and EKG tracings — which
may appear in board exams.
3

OLD HABITS MAY BE COMFORTABLE,
BUT INEFFICIENT
When it comes to making a study plan, most of us
think linearly. But this is not optimal. If you aim to
march through the curriculum, topic by topic, you may
get stuck on a topic and run out of time before study-
ing other key areas. Instead of covering just half the
material at 90 percent depth, you are better off cov-
ering 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. The challenge for the Episodic studier is to find
a tool that keeps track of what you’ve studied.
Reading textbooks may be comfortably familiar, but
is unlikely to be time-efficient. It’s virtually impos-
sible to read your way systematically through the
knowledge base, and chances are you’ll spend too
much time reading topics you already know well.
Review courses similarly are one-size-fits-all, tend
not to adapt to your strengths and weaknesses, and
lull you into thinking you must be learning when you
are not. As cognitive science has shown, passive
learning is not particularly effective. And, knowledge
gained in a one-time, intensive review tends to decay
rapidly in the absence of effective consolidation.
QUESTION BANKS MEET THE NEEDS OF
THE EPISODIC STUDIER
As an Episodic studier, you especially need a resource
to focus your studying. Question banks have become
an essential tool for board preparation for all types of
studiers because they require case-based problem-
solving (active engagement) and memory retrieval
(learning through testing), and they harness the power
of distributed practice (study over time). Question
banks suit the needs of an Episodic studier particu-
larly well because they can be used in short bursts,
wherever and whenever you have a few free moments.
The most effective question banks use “adaptive
learning,” a technology that serves questions based
on your prior responses. Algorithms determine
which questions to present to you, depending on
your past correct or incorrect answers. This process
Call Us Toll-Free 1-855-318-9303    http://knowledgeplus.nejm.org
THE EPISODIC
can use reliable, meaningful assessment to guide
your study. The most sophisticated tools intentional-
ly return to key principles you struggle to remember,
and avoid repeated study of areas you already know
well. More important for the Episodic studier, you
can pick up where you left off, track your progress,
and capitalize on every opportunity to consolidate
and reinforce your learning.
Reflecting as you learn makes the most of your study
time, and this can be built into a question bank.
Here’s how: When you’ve just answered a question
incorrectly, the negative experience tends to increase
your attentiveness. If a question bank offers useful
feedback after a wrong answer — and you read and
process the information — you have capitalized on
the learning moment when your mind is most recep-
tive to new information.
Question banks may also be more enjoyable than
traditional studying, making it more likely that
you’ll return to them frequently and spend more
time studying.
AIM FOR HIGH-YIELD TOPICS
No matter how little or how much time you have to
study, if you approach a test of generalized knowl-
edge such as the ABIM boards thinking that you
must master every nuance,
you’ll feel like you’re
drinking from a fire
hydrant. The following
suggestions will help
to streamline your
approach.
4
 THE EPISODIC

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 diagnostically
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 days before an exam, review common lists And of course, use only study materials that you
of facts: can trust. They should incorporate current guide-
lines with an evidence base; be created by a
•• Basic formulas for gaps and gradients and
high-quality, authoritative source; and have been
acid-base interpretation.
subject to expert peer review.
•• Simple associations that are readily forgotten
but specific, such as autoantibodies associated
with various rheumatologic conditions or how to EMBRACE LEARNING
interpret hepatitis B virus serologies. Even as you strive to fit studying into your busy
Keeping up with the latest controversies and treat- life, view it as an opportunity to stay on top of
ments through journals and other means is import- your profession. A positive attitude — along with
ant for lifelong learning. But these topics are less focused, strategic effort — will take you far. You may
likely to appear on a board exam: be surprised and gratified at the benefits to you and
your patients. With little time to spare and a lot at
•• Ongoing controversies. Because questions must stake, take the opportunity to rejuvenate the love of
have a solid evidence base behind them, you’re learning that got you into medicine in the first place
fairly safe to rule out moving targets. and engage constructively with learning, for yourself
•• New therapeutics (and diagnostics) that are less and the patients who trust you.
than a year or so old. Questions must be written
and vetted in advance, so new treatments and
topics will take at least a year 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).

Call Us Toll-Free 1-855-318-9303    http://knowledgeplus.nejm.org 5

 THE EPISODIC

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.

NEJM Knowledge+

NEJM Knowledge+ was created to provide a lifelong learning solution that helps you improve the quality
of your practice and prepare for your board exam.

NEJM Knowledge+:
Great value. NEJM Knowledge+ is a solution that hones your clinical practice skills, systematically prepares
you for board certification, and enables you to earn CME credits — all at the same time.
Comprehensive. This solution features an extensive question bank with key learning points, detailed
­feedback and links to further reading, guided by the medical specialties covered in board exam blueprints.
Provides self-assessment. Each product includes two practice exams, collects and responds to your level
of confidence in both the specialty and on individual questions, and reinforces your learning based on
your assessment and your performance.
Adaptive. NEJM Knowledge+ is the only continuous learning and board review product that adapts to
you and your unique needs.
Trustworthy. Because it’s from NEJM Group, you know the questions will be accurate, the learning will be
clear, the content will be free from outside influence, and the evidence presented will be the gold standard.

See what products we have for you!

© 2014 Massachusetts Medical Society. All rights reserved.

Call Us Toll-Free 1-855-318-9303    http://knowledgeplus.nejm.org 6