Today’s inane image of the day:
If you’ve stumbled across this entry, it is likely that either you or someone that you care deeply about has failed some sort of examination. It may be a low-stakes or a high-stakes one. It may be in the setting of a course, or it may be in the setting of a medical board examination. Either way, there is something so disarming about failing an exam. It really cuts deep. I am going to make the generalization that most people who are seeking advice after failing an exam are those who typically haven’t encountered this challenge before.
Either way, you are here and seeking advice on how to move forward.
Are you even qualified to give advice on this subject matter?!
Maybe? I personally failed an exam. A bunch of people visit my entries to prepare for the USMLE board exams and anesthesia board certifying exams. I believe that as a result of these entries, some people on the internet also believe I could advise on how to approach an exam after failing. Who knows if I’m qualified, but here are my thoughts/opinions/ideas on the matter.
Let the news settle in, but don’t let it become your identity
A lot of high-achievers take failures very personally. We tell ourselves elaborate stories of being inadequate. We question our successes. We feel defeated and wonder if we will ever be able to pick ourselves back up again. How can you trust yourself not to stumble again?
Well, life is all about failures. It is about overcoming challenges and adversity. A failed exam is just an unexpected detour.
When I’ve faced challenges in the past, I am quick to jump into problem solving. When I failed my exam, I started to plan how I would study for the re-take. I did not want to dwell on the event and let it drag me down. Looking back, I was suppressing a really hard thing rather than facing it. I think because I carried this as a weight around with me, I wasn’t able to focus on the real task of studying effectively.
I find it really hard to ask for help. But when you’re faced with a challenge like failing a high-stakes examination, that is an opportune time to reach out. It is a time to lean on your friends to work through the failure and feel all the things. Do something cathartic. But in sharing this event, recognize that it does not define you. You are not a failure.
Reflect on what happened and be honest with yourself
After you’ve done the first part where you digested the news, it is time to reflect on how you prepared for your exam. Did you have a plan? Were you distracted when you studied or took the exam? Did you follow through on your study plan? Has something changed in your test-taking ability? Really be honest with yourself without placing blame. Putting yourself down and external blame will not help you identify concrete ways to approach studying for the exam again. The only way to avoid insanity [i.e. the definition of insanity is doing the same thing over and over again expecting a different result] is to be honest with yourself on where your weaknesses lie.
If there is someone in your institution or among your academic circle that you trust, consider reaching out to them to help you dig deeper into assessing your weaknesses. Sometimes it helps to have an outside voice reflect back what you are saying to really have it sink in. And sometimes external sources can help you probe a little deeper to find things that aren’t as readily apparent when reflecting on your own. Defense mechanisms are incredible walls that can blind us to reality.
Find an accountability buddy
I thrive on deadlines. If I do not have a deadline, it is challenging for me to take the first step. I also thrive on people-pleasing. I hate letting people down. This is something I exploit when I want to get something done; I tell someone that I would not want to let down to keep me accountable. If I know that someone will be checking on my progress, I’m a lot more likely to get something done.
This requires identifying someone that will actually keep you accountable [e.g. they will express disappointment if you do not meet a deadline/goal] but they cannot be intimidating [e.g. they will not put you down if you do not meet a deadline/goal]. Find someone that believes in you, but is capable of telling you the truth. This can be a very hard balance to find. Sometimes, this might require outsourcing [e.g. is there a coach or outside service that you could pay for that would serve this purpose of keeping you accountable?].
If you’re in a structured academic program of some sort, teachers/faculty can serve as your accountability buddy. You might be able to request to work with someone that has had a good track record in the past with individuals that have had to retake exams.
Craft a realistic study plan
You’ll notice that most – if not all – of my “how to study” entries include a part where I say I did not complete everything I sought out to do. But I do make it clear that it is important to know your weaknesses so you can target them. Additionally, I stress that you must take a first-pass at some resource in its entirety. Those are essentially all of my high-level tips. Make sure that these basic tips are heeded when you study.
The most important word in this heading is realistic. If you’re a resident, you will not have enough time to finish a question bank 5 times in one month. If you’re a full-time medical student, you will not have enough time to review First Aid two more times. If you have young children, you will not be able to focus the same way as your peers without children. Acknowledge and accept your reality then ensure that your plan accounts for this reality.
Ask for what you need or make the sacrifices necessary to get what you need
I believe that in life you can have everything… just not all at once. In order to set yourself up for success, you need time to prepare to re-take this exam. Time is a precious, limited resource. But if this is a test you need to retake to advance toward some bigger goal, then you need to find the time to make this happen. If your work/school/institution has the ability to grant time away and you need that in order to be successful, please ask for this.
This is one of those moments when you need to be honest with yourself. Denial is an incredible way for us to protect ourselves from the reality of our situations. I worked 100+ workweeks during the peak of the pandemic, but I told myself I was ok [I really wasn’t, but what choice did I have in this matter?]. The point is that if you are in a residency program and you’re working 80 hour weeks the likelihood that you’ll be able to study effectively is low. If you need to use some of your vacation or sick days or request a switch to a rotation that will be less clinical hours, please advocate for yourself. This is the part about “sacrifice” – you may need to use some of those precious days off that you have in order to ensure success.
A couple common reasons for test/exam/boards failure
Knowledge deficit
This one is an easy one. Usually, someone just didn’t spend enough time memorizing all of the necessary things that needed to be covered. Sometimes it is because they ran out of time. Sometimes it is because they didn’t realize that a particular topic would be a substantial part of an exam. If it is a board examination failure [at least, anesthesia boards], generally you get a list of topics that you answered incorrectly to help narrow your focus topics. Just remember that you cannot neglect the things you think you’re strong on the second time around… sometimes that knowledge can fade and turn into a weakness.
Life event
Life happens. It does not pay attention to when you have a high-stakes exam. If something substantial happened in your life it probably distracted you while studying OR distracted you during the exam. Either way, if there was a serious life event that happened, this needs to be either in a resolution phase or you may want to consider delaying the re-take of your exam until you can be in the right headspace/mindset to prepare and focus on the exam.
Test-taking ability
In my journey to becoming a physician, I have been surrounded by extraordinary test takers. Often, these extraordinary test takers are hyper-intelligent or have an incredible way of learning material that I never possessed. I am not a naturally gifted test taker. I had to work hard to pass all of my board examinations.
During my preparation for boards, I noticed my internal voice contributed to self-sabotage. Often, my gut feeling is correct but then I’d second-guess and change my answer. I learned from one of my question banks that when I changed my answer, it was most frequently to the wrong answer. So I forced myself to go with my gut more. This is a skill that I had to practice over and over again. So if you think that there is something inherent to your test-taking that contributed to the failure, it’s time to spend time identifying those issues, finding strategies to address them, AND practicing those strategies so they are second-nature on test day.
Not enough simulated exam practice
It’s a good idea to simulate your exam as many times as possible. This means going to a quiet room and doing a block of questions as if you were in the exam room. This means using ear plugs [if you plan on using them] and sitting in an unfamiliar place. I suggest using different computers and spaces so that by the time of your test day you are just in another one of those spaces you became familiar with practicing in.
Additionally, simulated exams can help with practicing timing, cadence, and knowledge base. If you are a slow test-taker, this is an opportunity to see where you may have spent too much time. Generally, every question is worth the same value… so move on! Do not dwell on a single question! If you have a pattern of weak knowledge base areas after every simulated exam, that is a signal you need to take seriously. Consider reviewing these simulated exams with someone to ensure that your are held accountable for addressing any of these identified areas.
Final thoughts
I believe in you. I really do. I believe that anyone who is in a position to be taking a high-stakes examination is made of the “right stuff” to succeed. But sometimes there are other resistors that do not make success possible. Perhaps it is not the right season of life to be doing what you are doing. It could mean that this is an opportunity to reassess your strengths and find something that uses them more readily. We all possess strengths and weaknesses. Not every path optimizes on our strengths in the right way. Consider if this failure may be an opportunity to figure out how to pivot toward your strengths. Regardless of what you choose to do, keep moving forward. One day at a time.