Types of Medical School Exams

It’s not uncommon for incoming medical students to worry about the different types of exams they’ll need to take in med school. They’re probably different from tests you took in your undergrad, and the stakes are higher. Keep reading and we’ll discuss a few of the tests you’ll encounter in med school, as well as key strategies for dealing with them.

  • Multiple-choice Exams

    You’ve likely taken multiple choice exams in your undergrad, but there are a couple of things to keep in mind about this format in med school. First, medical school multiple choice questions tend to be written as short stories about sick patients. Second, answer choices are usually structured to promote the thought process of “differential diagnosis,” which is the strategy in which physicians use clinical evidence to rule out unlikely disease states and figure out what’s actually going on with their patients.
    Because this format plays a large role in licensing exams (USMLE and COMLEX), as well as in specialty board exams for practicing physicians, students are exposed to it early and often. Pay attention in class, study consistently, and get plenty of sleep & exercise; if you could pass exams as an undergraduate, you can pass them again in medical school!

  • Objective Structured Clinical Examination (OSCE)

    Throughout training, students work with standardized patients (actors) to develop their history-taking and physical examination skills. These skill sets are practiced in advance and examined during OSCEs, in which a proctor will watch the student perform pre-determined clinical tasks and grade them on their technique, with plenty of feedback following.
    Many students find OSCEs to be quite fun and formative, as this is the actual “doctor stuff” that everyone’s been working towards for so many years. Practicing on classmates and consenting friends and family members make these pretty stress-free.

  • Presentations & Write-Ups

    Medical educators know that written communication and concise presentation are important skills for every doctor to master. To help train students, many courses will have some graded component involving writing or presenting. For example, students might work together on an evidence-based presentation on the impact of health literacy on accessing primary care. Another common example is the patient presentation, where a written or oral report is given on the scientific underpinnings of a patient’s illness.
    These are usually graded more heavily for thought process than anything else, and can be a safe way to develop some really useful writing skills.

  • Board Exams & Step 1

    These medical school exams are usually the biggest source of stress for medical students because of the large role they play in residency placement (the first job a graduating MD/DO applies for towards the end of medical school). As an example, the United States Medical Licensing Examination (USMLE) or “boards” are taken in three parts called Step 1, Step 2, and Step 3. For most individuals, the USMLE-1, usually taken after the second year of medical school , will weigh more heavily in their residency application than the USMLE-2. The USMLE-3 is taken after graduation. In a nutshell, these are the MCAT’s big brothers.
    Fortunately, significant research has been done into the practices of highly successful USMLE examinees, and preparing for it doesn’t need to be a negative experience. To score above the national average, data suggests that a student should take and review 1500 practice questions throughout the course of their preparation. Other evidence exists that students who spend significant time in the clinic (either due to curricular structure or personal effort) before taking Step 1 tend to score higher.
    Here are two strategies that can help you score well:

    1. Consistency triumphs over cramming! A psychological principle known as The Spacing Effect posits that retention of information increases as number of learning events (repetitions) increases and as the distance in time between those events increases. In simpler terms, this means start prepping early. Taking those 1500 questions and spacing them out over months, or even beginning at the start of medical school, makes board prep manageable and helps contextualize and consolidate the information learned throughout school.
    2. Understanding is more effective than mere ‘knowing’. Take the time to reflect on curricular material in your clinical experience. The thought processes you employ when you work with actual patients are exactly those which are tested by board exams. Further, employing new information and using it to achieve the goals you’ve been working towards for so long (i.e., patient care) can be really fulfilling and protective against burnout, which is a significant issue among medical students and providers.

In Summary

Medical school is challenging for everyone, but that doesn’t mean it needs to be frustrating. Faculty want their students to succeed, and you’ll find ample support and preparation at every step of your training. Moreover, even when it comes to high-stakes medical school exams like the USMLE and COMLEX, a little bit of effort applied consistently over time goes a long way. Finally, self-care is always number one; everything comes more easily when one maintains their mental and physical health. No matter how busy things get, always make time for yourself! 

Adam Howard earned his bachelor’s degree in Neuroscience from The University of Texas at Dallas as well as an associate degree in liberal arts from Collin County Community College. He went on to complete an ScM in Medical Sciences at Brown University where his work focused on improving screening rates of community health center patients at risk for diabetic retinopathy. He is presently completing his medical degree at Mayo Clinic Alix School of Medicine.