Studying After "Failing" A Test

I’ve been humbled by the many people who have had the courage to contact me over the past few years to ask my advice on preparing for various exams. I don’t claim to be an expert at the various exams, but I do want to help my fellow colleagues succeed in any way possible, and if this website helps more people fare better on their tests and also become better ophthalmologists, that’s great.

One of the more common questions I’ve received has been from people who have been preparing for an exam multiple times and have been trying to figure out how to study in such a way to get their score up. This has been true of OKAP, WQE, and oral exams, as well as some people taking similar tests in other countries. Since this is a fairly common question, I wanted to write out a few thoughts I had that might be helpful.

Obviously, I can’t speak specifically to each situation in a general article like this. However, I think there are some common themes that may be helpful, and my hope is that this would be a useful reference for those looking for some ideas.

Before I start, I realize that many of the people who are e-mailing me this type of question are somewhat desperate, and may feel somewhat self-conscious reading this article. So I do want to say a few things before I start on my thoughts:

  1. You’re not alone. I really have gotten many e-mails asking me for help. The pass rates for many of these tests are not super high. Having to retake [insert test here] does not mean that you’re a failure at life (though I know it can feel that way).
  2. My article is not meant to be judgmental in any way. There are many different ways to study and prepare for tests. Some people are naturally better test takers than others, and so some people can have maddeningly good results on tests without much visible prep. Others may spend hours every day for months preparing and still fall short. This is not meant to be an indictment on the past; I want to try to offer various considerations for moving forward.
  3. Ultimately, you’re the one taking the test, and you’re going to know what strategies are going to work best for you. I want to offer as many different ideas as I can to help people study, but you’re still going to be the one who puts in the bulk of the work. That’s not meant to be discouraging, but hopefully empowering - you’re still in control of your destiny!

Reassess Your Study Plan

Before jumping right back into studying, I think it’s worth taking the time to do an honest assessment of your studying plan up to now. This may take a day or several days; it may be easy or difficult. If you have some friends taking the test as well, compare notes; while study plans are going to be very different for each person, it can be helpful to see what works and what doesn’t.

Here are some questions to ask yourself; intentionally carve out the time to make this a meaningful activity. You don’t have to beat yourself up, but you should be honest. If you have a mentor or close friend who can help point out your blind spots, ask them to help give you some insight into your situation.

Am I giving myself enough time to study?

Depending on your fund of knowledge, experience, and general understanding, you may find that you need a full year to study, or 6 months, or 2 weeks. Look over how much time you gave yourself on previous attempts, and see if you need to plan on giving yourself some extra time.

For those taking the OKAP, it might mean restarting right after taking the OKAP (giving you essentially a full year before taking the exam again). For those taking the WQE, it might mean starting in March of the year before you take the exam, or maybe even postpone registering for the WQE by a year to make sure you allow yourself adequate time to prepare.

Am I studying at a comfortable pace?

The counter-argument for making sure you have adequate time for study is that we probably will never have enough time to study/learn absolutely everything about ophthalmology before taking any test. So while it is important to make sure that you allot enough time for yourself, you also need to make sure that you find a pace that works for you. That may mean reading 1 hour/night and 30 minutes of questions every day, it may mean more, it may mean less. Studying for these exams is a marathon, not a sprint; because there are other responsibilities we must also shoulder (clinical responsibilities, duties to families, maintaining friendships/social lives, etc.), we need to make sure that we commit to a reasonable plan that will allow us to study hard without alienating ourselves from the other parts of life.

Is my study time meaningful (or, am I actually remembering what I study)?

Many of the people who have reached out to me have mentioned that information retention has been a major challenge. And unless you have a eidetic memory, information retention is probably going to require some effort. I think we have to be honest with ourselves and not only identify whether or not we are remembering the information well, but also if there are other ways to help make that study time more effective.

Studying a wide base of knowledge like ophthalmology requires dedication of significant amounts of time and energy - there are no easy shortcuts. However, if we can isolate the distractions and make sure the time we spend is optimized, I think it will boost the confidence we have in the material we have just studied. For example, I’ve found that studying at home is generally ineffective unless I work in one of our guest bedrooms where there isn’t a TV, games, books, etc. to distract me, and the door is shut so the kids won’t interrupt every few minutes. For some people, going out to a cafe is too distracting because the ambient noise bothers them; for others, studying in silence is too distracting.

By this point, I think that you have developed good study skills - you would not have been able to become an ophthalmologist without having studied well thus far. While life certainly gets busier and it can be more difficult to focus on studying the same way as you were able to in medical school, managing your study time effectively can make a big difference as you prepare.

What are my weak points?

Hopefully you’ve developed a decent sense of what your strengths and weaknesses are as you’ve been taking practice tests and received feedback from the actual tests you’ve taken. While I don’t recommend completely ignoring your strong sections, knowing your weaknesses may help you figure out where to focus more time or energy. Identifying specific weak points may also help you determine if you need to find additional resources for that specific topic (for example, getting a supplemental glaucoma text if you’re weak at glaucoma, etc.).

If you don’t have a good sense of what topics are more challenging (or you feel like all sections are challenging), then plan to allocate enough time for every subject.

I think that this question should also challenge you to consider how well you know the material and know how to prepare for each type of test. OKAP exam questions are designed to be mostly basic-level recall about most topics in ophthalmology, with a few synthesis-style questions thrown in to make sure you understand how certain concepts interact with each other. Written board exam questions are intentionally written to test integrative knowledge/conceptual understanding. Oral board exam questions are structured to test how you work through a clinical problem and make sure that you are able to correctly identify common and/or clinically significant diseases.

I believe that test-taking skills can be an advantage - however, these tests are designed so that having good test-taking skills may help you get through the test faster, but should not yield many extra points simply because you are able to deduce the correct answer. For that reason, I think that people who are “on the bubble” after taking their tests should consider taking the time to reinforce knowledge rather than look for the optimal test-taking strategy. In my opinion, it is better to aim for getting a ton more questions right than shoot for 1 or 2 extra questions right using some quick-fix method.

Formulating A New Strategy

I suggest a new strategy, R2 - let the Wookiee win.
— C3PO, Star Wars

Once you’ve gotten a good and honest look at what’s worked for you and what hasn’t, I recommend planning out a fresh study plan. While I think there are many people who have succeeded at passing their tests without a comprehensive study plan, I suspect that many of the people reading this site are looking for something more structured.

I don’t think that there is one right way to study; however, I do think that there are wrong ways - and the wrong way to study is any method that does not let you learn/review everything you need to know.

I am currently working on a highly-structured study plan for each of the various tests that I hope to someday offer on the site for those people who are looking for guidance on how to get through all of the subject material. It’s very slow-going, mostly because of the other obligations that also prevent me from posting frequently on the site. While I won’t be able to share those strategies in this post, I believe any study plan should follow these general principles:

State clear goals.

“I want to know everything about ophthalmology” is a great idea, but is not a very clear or specific objective that can help you create your study plan. “I want to read through every BCSC book before I take the OKAP” is a much clearer goal, and allows you to schedule accordingly to make sure you can achieve that goal.

Be sufficiently comprehensive.

Not all study plans have to be comprehensive, but I believe you need to decide what you want to study before you start. Ophthalmology is such a vast subject that on any individual day it is easy to get lost in the sea of information and lose sight of the overall objective. This also helps you gain the confidence of knowing that you’ve mastered a given subject.

Be systematic.

Having a systematic study plan will keep you focused and it will keep you from spending too much time on one subject at the expense of another, or overlapping subject material. It keeps you focused and breaks down the bigger goals into much more manageable chunks.

There are several different methods and ideas for being systematic in your study plan; some people might like to plan by the week, others by the day, etc. Some people like to plan by the subject, or in choosing the book or resource to use.

For example, someone I know created a checklist to help them study. They wrote out every topic they wanted to study, and made a table with every resource they wanted to use for studying that subject. During that week, they might read one resource one night, another resource another night, and they would check off what resource they’ve already read so that they wouldn’t accidentally reread the same material. Here is an example table:

Study Reading Plan Checklist.png

Another person I know listens to a podcast/audio lecture on a subject during their commute, reads about the subject during the day on breaks or between patients and after work, then does practice problems pertaining to that subject at the end of the day, supplementing with other reading only when the practice problems raise a question that they didn’t understand, or if the primary study materials weren’t clear.

During residency I used the BCSC as my primary source material, and supplemented it with several other texts and atlases. As I studied, I would read and underline/highlight, and type notes about each subject into a Word document. Eventually I was able to create a comprehensive outline of each subject, which I then used to study for my board exams and helps form the framework for the information I provide on this site.

Get started, and don't be afraid to ask for help!

Once you’ve created your plan and feel like you’re ready to get started, trust your planning and get to it. Having the self-discipline to study for hours every day for months or years on end is extremely difficult for me, and if you’re like me, it helps to have encouragement and accountability from friends and colleagues. If you’re in residency, see if you can find someone who is interested in following a similar study plan. If you’re preparing for the WQE or the oral board exam, ask your co-residents or any local colleagues who might be doing the same thing to see if they would be interested in checking in with each other.

I hope to someday develop an online forum platform that will go along with this site that will allow people to connect with each other easier (it’s one of the many projects I’d love to eventually implement for this site); in the meantime, leave comments here or contact me personally and I’d be happy to try and connect people to study.

Conclusion

Hopefully you’re getting the impression that preparing to study is simultaneously a lot of work and also pretty doable. It’s intimidating and nearly impossible to cram the whole of ophthalmology for testing purposes - I personally believe that we don’t do ourselves or our patients many favors trying to learn simply to pass a test. As such, while the purposes of focusing our studies should be to make sure we can jump through the hoops of becoming board certified, this is merely a means to an end. We should be building up our knowledge base as much as possible so that all of our patients will benefit.

Hopefully you can find this post encouraging - it can be incredibly challenging to one’s confidence and motivation after failing or not doing as well as one would like - and so while attitude is not everything, it’s also very important to maintain the attitude that performance on a test does not determine our worth. Surround yourself with encouraging people and thoughts, and press on! You can do it!


Do you have any other suggestions? Did this article help encourage you? Share your thoughts and stories in the comments below or contact me!