“Why would I be wound up? I’m either ready, or I’m not. Worrying about it right now ain’t gonna change a damn thing.” 

– Floyd Mayweather Jr. just before a fight, as recalled by Paul Levesque

This is a really great episode for anyone who wants to learn more about studying for high-stakes exams and test taking in general. 

And instead of me doing the interviewing, I had the honor to be interviewed by Jessica Veale, a talented and motivated PA student at Duke University. 

Jessica is the host of the wonderful podcast “The PA Process”.

In this interview, Jessica and I explore test-taking strategies—but not your ordinary test-taking strategies.

We talk about some common learning theories such as retrieval practice, the testing effect, and elaboration, and uncommon ones such as the illusion of knowing.

But where things get really good is in our discussion about:

• How to digest large amounts of information, especially in the health professions.
• How studying failure can lead to greater success
• Engaging in self-talk to increase your test score
• Using the “I’m an average test taker” theory to answer the most difficult questions (one of my favorites)
• How to learn from the famous boxer Floyd Mayweather to feel confident on exam day
• And so much more

If you are a student of any kind or someone who has to take a high-stakes exam, I promise there is so much value for you in this episode. 

I encourage you to set some time aside, turn up the volume, and listen to this wonderful conversation with Duke University PA Student and host of The PA Process podcast, Jessica Veale.

AUDIO TRANSCRIPT

Jessica Veale:   Hi everyone. My name is Jessica Veale. I’m the creator of The PA Process. This podcast is dedicated to giving advice to pre-PA students, connecting with current PA students, and anything related to the PA profession as a whole. Thanks for tuning in today and let’s get started. Welcome everyone to season two episode two of The PA Process. On today’s episode, my special guest is Dr. Adam Rosh, an ER attending physician and the founder of the well-known question bank Rosh Review. He’s here today to share tips on test-taking preparation, strategies, and tactics. Welcome, Dr. Rosh.

Dr. Adam Rosh:   It’s great to be with you, Jessica. It’s really wonderful to be able to reach out and speak with all of the great PA students around the country.

Jessica:   Thank you. So Dr. Rosh, as a current PA student, I’m quite familiar with Rosh Review and all that it has to offer. But for my listeners who may be unfamiliar with it, can you explain it and what it is and what your motivation was for creating such a useful study tool?

Dr. Rosh:   Yeah, absolutely. I think most people who are in the health professions at some point in their career have taken a standardized test, certification exam at some point and have used a Qbank—a question bank. Rosh Review at its core, it’s a question bank. How that question bank is formulated and structured is very different, I’d say, than most types of question banks that people engage with. It’s not necessarily obvious on the surface. I think the attraction to question banks is based on a lot of good data that we have on the testing effect or retrieval practice. That’s another name for it, right. So when we want to actually test our knowledge because one thing we have to be very cautious of when we’re studying is to avoid something called the illusion of knowing. So just reading something in a textbook and saying to yourself, “I got this. I know it.” You’re probably lying to yourself in one way or another. 

The way to solidify your knowledge—one of the ways at least—is through the testing effect or using retrieval practice. Ultimately, multiple-choice exams are one of the best ways to do that. So we get a question in a question bank and we quiz ourselves. We have to then pull that information out of our brains. Every time we do that, your neurons are making stronger and stronger connections. Whether you know very well the answer or not, you have to think very hard about it. As itself, the retrieval practice is really critical. What we’ve done in Rosh Review is to take that and amplify it. So you have a question with answer choices, you use the testing effect, and then you have this explanation that comes after. This is what a lot of people give us feedback about of why this is such a valuable research for them through their training. So essentially, these comprehensive explanations are structured in a way that was built around how I studied. 

This kind of goes back to ultimately why this ended up being called Rosh Review. When I first started it, I named it something else. I named this product Next Step, and my wife laughed at me. She said it can’t be Next Step. You have to make it Rosh Review. I think I’m at least a modest person, although I’m sure I have tons of flaws as well. We went with Rosh Review because of the method of the content, of how the content is put together. So when you’re reading the content in Rosh Review you may notice that it’s very patternicity, believe it or not. What we include for learners is content that is organized in a way that is logical, it’s supportive. Each line kind of supports the other. It allows you to build connections as you’re reading it. So this amplifies the concept of the testing effect. It really provides a one-two punch for studying. So that’s a long-winded answer to that question. 

Jessica:   No, that’s perfect. It actually kind of falls into my next one. I suffered my first semester of PA school from this illusion of knowing that you are referring to. I battled with the need to make sure I reviewed every PowerPoint lecture, required reading, and then rarely found enough time to actually test myself on what I had studied. With your method of Rosh Review or this question bank, I would love to hear your thoughts on how you incorporate passive learning and making sure you have the content knowledge with active learning. 

Dr. Rosh:   Absolutely. This is something that, I would say, the majority of students deal with at some point in their career. In fact, I dealt with this probably up until my third year of undergrad. I didn’t know how to learn, right. So I set out on my own personal journey of learning how to learn. It was due to that journey that books and education and learning became so valuable to me. Going through a health profession school, the amount of information is enormous, right? We all know that. A lot of the traditional ways of engaging in that content has to do with highlighting and rereading and rewriting your notes, over and over again right. 

What’s really fascinating is as much as I am in people’s lives to help them pass exams and do well in their classes, I also spend a lot of time studying failure. I do that because I want to understand what are the behaviors that are leading to people not performing how I believe that they can perform. Because if you’ve made it this far, it’s unlikely to be a medical knowledge issue or a knowledge issue in general, right? It’s almost never the case. If you don’t pass your PANCE but you made it to PA school, 99% of the time it’s not a knowledge issue. It’s something that you’re doing in your studying. Oftentimes we hear this line. We hear, “They’re a great clinician. They’re great with patients, but they just can’t pass the exam.” Right? So that attracts me. I love to take a deeper dive into those situations. I often—I have many, many people that have reached out. I think this is where the greatest impact comes for me in my personal life in that because I struggled with similar things that I get to reach out and work with these people. So I look forward to that. 

So oftentimes if it’s not due to a distraction at home, it’s about how they’re studying. Almost always the person says to me, “Yeah, I rewrite the notes over and over again until I know everything.” Then I say to them well, you think you know everything. Because it’s in a format and a context that is very familiar to you. The minute you take it out of that context, you won’t be able to answer that question. That is exactly what an exam does. It takes the fact or the critical thinking out of the textbook page or the review book page and it moves it into a different context. So you have to be very mindful of that when you’re studying and preparing. I think if you have time to prepare—like you’re studying for a certification exam or you’re in a classroom, you’re studying for let’s say a rotation exam—it’s okay to do a first round of note taking, a first round of reading. That’s totally fine. You need to get familiar with it. The next step then is to employ educational techniques and theories that we know work. So some of the things that work for me, which I think works for other people as well, is while I’m reading, I will try to make connections in my brain. So not just digest the information that’s been given to me but start elaborating on that information. What that means is to take details and to talk through it. Start asking why. Why is this the way it is? How do these things relate to one another? And to talk my way thro