Board Prep? Stop Procrastinating and Start Preparing – Here’s How!

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Procrastination snowballs; that is, procrastination leads to ever more procrastination. The stress of delay leads to more delay, which leads to more stress and so on. Procrastination grows until the pressure to do the required task grows so high that, finally, action is taken. Of course, once action is taken, the work is often done under conditions of emotional duress, a reduced ability to focus, and too little time to get the job done well.

Since procrastination has led to these self-inflicted delays, inevitably regret and, perhaps even, self-loathing sets in. And all this emotional turmoil is on top of often failing at one’s assigned task, whether it’s completing a work or school assignment or passing a board exam.

I know. I’m a procrastinator too – always in recovery, always relapsing.

Interestingly, procrastination is often limited to only certain types of tasks. Thus, the procrastinator may be a highly successful and effective individual in most areas of life. You wouldn’t be reading this if you weren’t both highly successful, given you’re a medical board exam candidate, and having a bit of a procrastination problem.

So, let’s get into how to overcome procrastination. What is it? Procrastination is simply avoidance, avoidance of doing the tasks that require doing. Some tasks without a deadline never get done. Others with a deadline get done – usually – but less well and at much higher cost than it would have taken minus the procrastination.

The start to solving procrastination is to divide the work – in our case, exam preparation – into two parts. The good news is that the first part, “Orientation,” is much easier, less time-consuming, and less avoidance-inducing than the second part, “Study Plus,” despite being just as important. I call the second part “Study Plus” because it includes study, of course, but also additional ways of preparing for the exam, as I outline below.

The solution is to orient yourself and, once oriented, to launch into the Study Plus part, which is easier to launch into once one is oriented.

Let me stress this point: The procrastination that plagues most of the learners I’ve counseled about board prep starts at the very beginning. Even the not-very-hard first step of Orientation is avoided, which then prevents the Study Plus part from ever commencing.

So, why is this small but crucial first step of Orientation avoided? Because it is not viewed on its own but instead as part of this huge, looming, and overwhelming project of being fully prepared for the board exam. This entire project looms so large that it is avoided from its inception.

To stress: Getting past procrastination is accomplished by simply taking the very first step. Once a person is in motion, further steps are easier to take. Confidence grows, and some learners then really get into their studies, thus converting a doom loop into a virtuous circle.

Let’s now get into details. Below, I lay out the components of the Orientation part of board prep.

Part 1 – Orientation: Scoping Out the Job of Exam Preparation

Part 1 starts with a simple cognitive task: it is to disentangle Part 1 – Orientation (reviewing what is on the exam and developing a realistic yet effective plan to pass the boards) from Part 2 – Study Plus (following the preparation plan as laid out in Part 1). To be effective, the procrastination-proof approach requires strictly separating, in your mind and in time, Part 1 from Part 2, like this: Orient yourself. Stop. Start preparing sometime later, even if it is as soon as tomorrow.

Orientation requires the following and can be done in about one to four hours, depending on how far you’ve already gotten and on the level of detail you seek to achieve:

1. Scope Out What is Tested on the Board Exam
2. Develop a Realistic Preparation Plan
3. Stop and Reward Yourself for Getting Part 1 Done!

Now, for the details on the Orientation steps outlined above.

Part 1:1 – Scope Out What is Tested

Simply review the exam blueprint on your board’s website. We’ve included relevant board organizations in the footer of this website.

The exam blueprint may itself seem overwhelming. Take a deep breath. Don’t leave now. Download the exam blueprint PDF. Review it once while you’re still on the board website. Review it again in more detail, a little later on your computer, and periodically throughout your studies.

The longer and more detailed the blueprint, the better off you are. It gives you more information on exactly what is tested on the exam. It defines the required knowledge base.

Part 1:2 – Develop a Realistic Preparation Plan

To be optimally effective, the following four approaches should be undertaken during your preparation. So, your plan should include a focus on each part.

Plan How You’ll Acquire the Knowledge That’s Tested on the Exam

You’ll have to acquire and/or refresh the requisite knowledge needed, as per the exam blueprint, to do well on the exam.

When looking at the exam blueprint, attend to the percentage of questions in each topic category. Most exam blueprints provide this info. If they do, then note which topics are the big ones. These topics need to be your main study focus. You will be following the Doc Sutton rule of board prep: “study where the questions are.” (The bank robber Doc Sutton was asked why he robbed banks. He responded with “That’s where the money is.”)

You’ll find that a quarter or so of the topics account for perhaps about 2/3 or more of all the questions on your exam. You will prioritize these topics.

Next, consider which of the large topics you’re most and least knowledgeable about. The ones you’re least knowledgeable about will be your priority.

“Priority” means prior to anything else. This means that a priority is singular. So, from your “priority” list, choose the single topic that will be the very first topic you’ll start with.

Is it silly to be so precise, to know exactly which topic you’ll start reviewing? Not at all. If you picked out the exact topic that you’ll start with – it doesn’t matter which one you choose as long as you choose one – then when it comes time to study, you won’t hesitate and ruminate on where you should start. If you leave open where to start studying until it’s study time, you’re opening yourself to another bout of procrastination. Yes, it’s amazing how little it can take to have procrastination rear its ugly head once more.

Consider also how much time you can afford to spend each week between the time you start your prep and your exam date. Of course, the fewer weeks you have available, the more time each week you should devote. There are limits based on what your life allows. It’s better to come up with a stripped-down plan of what you can realistically accomplish vs. making a grand plan that you’ll immediately realize is unattainable.

Learn How the Exam Tests the Required Knowledge

Knowing which topics are tested on the exam is insufficient. You must also learn how your board exam tests that knowledge. The best way to do so is to answer many, many board-reflective exam questions. Board-reflective means that a question is not only on a relevant exam topic but is in the correct board format and style. Take note that not all QBanks are equally board reflective.

For example, exams rarely test diagnostic criteria by asking, “Which of the following is a required symptom criterion for disorder X?” Instead, they test recognition of disorders by presenting a case vignette of a patient with certain symptoms and, perhaps, lab and other testing results, and ask you to choose the most likely diagnosis.

Another example: exams will often test you on your knowledge of treatment algorithms. They may do this by presenting a case vignette of a patient with a particular disorder who failed or could not tolerate first-line treatment and, perhaps, even second-line treatment. It then presents options for what in effect are third-line treatment options. Or they present a patient case of a patient with a particular disorder who also has severe cardiac, hepatic, or renal disease, and ask you to choose the best and safest treatment.

Complete Practice Exams to Become a Good Test Taker

Still another part of board prep is learning how to become a good test taker. Here are two things you should focus on.

First, ascertain the pace at which you need to complete exam questions in order to avoid running out of time on the exam. One of the most common topics for exam candidates to unhelpfully ruminate about is whether they’ll have enough time to finish all the questions on their exam. This should never be a concern going into the exam because your exam pace should always have been ascertained beforehand. This is done by going through a board-style practice exam – a full and board-reflective one.

This perhaps sounds like what I recommended in the section above. It is not. A learner can go through many exam-style questions in order to acquire the knowledge that the question is designed to test – which is done in what is called “flashcard mode” – or to assess their level of knowledge – which is done in “exam mode.” Both of these modes are helpful in preparation. However, in establishing your exam pace, you need to be in the QBank’s exam mode and set up the practice exam to mimic the real board exam. This means you need to go through just as many questions on the practice test as there are on the real exam and time yourself to ensure your pace is adequate to avoid running out of time on the real exam.

Additionally, this practice exam must mimic the topic distribution of the real exam, so you are testing yourself under as realistic board conditions as possible. If your pace is too slow, at least you have discovered this ahead of time and can continue practicing to increase your speed. If your practice pace is fine, then you can now put your running-out-of-time fears to rest.

There is an additional reason to take a full and realistic practice exam: it is to assess your stamina across the entire duration of the exam. This aspect of preparation is done through taking a full practice test, just as I discussed above. But when you do so for this reason, you also should pay attention to your ability to maintain your focus and your mental and physical stamina. Maintaining stamina across the many hours of a certification exam, which can last up to 9 hours, is an underappreciated factor in exam success vs. failure.

Stamina can be increased in two common-sense ways: first, try to get a good night’s sleep the night before, rather than trying to study throughout the pre-exam night. And second, make sure you hydrate, eat, and take bio breaks throughout the exam hours. It is common for exam-takers to avoid drinking fluids to minimize bathroom breaks to save exam time. This is a mistake. If you cannot afford two 5–10 minute breaks during the exam, you need to practice to pick up your pace. Hydration and some degree of calories are key to maintaining mental acuity.

There is still another reason to take a full practice exam: if you are going to use (or are tempted to use) medications to help with your exam performance, like taking a benzo to stay calm or an amphetamine to stay focused and alert, you must try this out ahead of time, unless you’re taking an already regularly prescribed med. If your body is unused to benzos, beta-blockers, stimulants, or other performance-enhancing meds, you do not know how your body will react. You simply must try them out ahead of time and ascertain how you feel across the full duration of the board-realistic practice exam. For example, a benzo may help you before and at the start of your exam because you’re calmer and more able to focus. However, after a couple of hours, it may leave you drowsy and unfocused. Same thing with stimulants: they may not last the entire duration of the exam, and you may ‘crash’ sometime in the afternoon.

Part 1:3 – Stop and Reward Yourself

Here I remind you that all that I’ve written above is to guide you in establishing a life-realistic and realistically effective preparation plan. By ‘life-realistic’ I mean you can actually fit it into your – what I’m sure is an – already busy life. By ‘realistically effective,’ I mean that it will not be all you would hope for, but it still gets through a review of all the topics and ways of preparing.

The orientation and planning may take you 1 to 4 hours. Of course, you can take more time. But the point is, again, that if you mix together what I just asked you to do – the planning – with the actual preparation, which comes later, you’ll likely get overwhelmed by the thought of it and shut down.

So, do your planning as best you can. You’ll undoubtedly want or need to revise your plan as you proceed through the prep months, weeks, or days. But finish it and reward yourself for now having a plan. The more thought through it is, the better.

Tomorrow or, perhaps months from now, will be the time to start studying.

Part 2: Study Plus

Ok, here we are. Part 2 of board exam prep is where most of the hours of preparation are spent.

Because this part requires reviewing and mastering many topics and preparing in several ways over weeks to months, a solid prep plan is needed, just as I laid out for you above. Having such a plan will help you stick to your studies. You no longer need to think about what you need to do. You simply follow your schedule and priority list and just pick up each time where you left off last time.

In order to keep up your motivation over this long haul, you can add some motivational aspects to your prep:

• Reward yourself after a full week of keeping up with your schedule or after completing a review of a major topic. Check off another topic reviewed. Such marks of progress maintain enthusiasm by visually showing that progress.
• Maintain certain mindsets
• Know that virtually no learner maintains their study plan 100% of the time. Life intervenes, slips and relapses occur. You should definitely review what went wrong and how you can get back and stay on track going forward. Do not beat yourself up simply because this is likely to lead to greater discouragement than building up motivation.
• Think glass full rather than half empty. When you only assess yourself in terms of what ideally you should be doing to prepare for the exam, you will always fall short. Instead, remind yourself that every few minutes you spend preparing incrementally improves your chances of passing.
• Remind yourself that fretting over whether you pass or fail the exam is counterproductive rumination that leads to anxiety and discouragement. Instead, whenever you find yourself worrying, do the only thing you can to improve your chances of passing: start studying. Study is the enemy of worry, just as worry is the enemy of study because of its fatiguing and demoralizing effects.
• Maintain a regular prep schedule. When establishing your study plan, you should have identified the time and place you can prepare. Then once in this phase of prep, stick to it: wake up a half hour early, block off a weekend morning, etc. Make your prep time regular and expected. Let it become a habit, a way of life during these weeks or months.

All of these ideas I shared in Part 2 are also designed to minimize falling back into procrastination. If you do fall back into it, which is not unexpected, consider these:

• Return to Part 1 and review your plan. Look over the exam blueprint and your prep plan. Separate this review from starting to study. Remember that to overcome procrastination, you need to do something that ‘flies below the procrastination radar.’ This means looking at the blueprint and your plan and putting it away for that day. Start studying, as per your plan, the next day.
• If your plan is, for example, to study in the evening but often you’re tired, you don’t feel like it, and you end up not studying, then do this: tell yourself you will prepare for only 10–15 minutes and that that amount of time is better than nothing. Once you’re studying, you may end within that 10–15 minute time frame or, instead, find you want to keep going. If so, keep going. With procrastination, it’s the start that is always the killer. Once you’re studying, studying a little longer is often not too hard to do.
• Join a study group for mutual support and accountability. Having said this, I need to say that many study groups don’t lead to much effective study being accomplished. There’s a lot of chatting and reviewing the material in ways that are not conducive to learning for many learners. So, use study buddies or groups to maintain mutual motivation and accountability, even if you don’t want to engage in mutual study. (Mutual study never worked for me. I need to focus on the material in isolation and with as much focus as I can muster.)

Thanks for reading. Please peruse the other topics on this blog. Also, feel free to reach out to me with topic requests or to share problems I can address (without identifying you) in this blog.

Yours in exam success,
Jack Krasuski, MD