Little Black Book

Do you have a minute? I was being asked that question far more frequently than I ever imagined. Medical students, residents, and attending surgeons were coming to see me about the one thing I never wanted to talk about again: standardized tests. As an assistant professor of surgery the last thing I wanted to be known for was failing exams.

You can no longer fail the General Surgery Qualifying Exam (QE) as badly I did. Currently, graduates of general surgery programs get three attempts to pass this high-stakes multiple choice test.  Fortunately, for me, I graduated from residency in an era when five attempts were offered. I needed all five tries. The American Board of Surgery recently did away with attempts four and five for a simple reason: the average pass rate was essentially zero.  

This unusual distinction, passing an exam when it was statistically “impossible”, lead to an unexpected recognition. Nervous test takers wanted to know how I did it. Additionally, the fact that my performance jumped from the absolute bottom (lowest 2% of test takers) to the upper tier (better than 80% of test takers) resulted in tremendous interest in any “secrets” I might be willing to share. Ironically, I was becoming a standardized test “guru”.

My first, and most common, recommendation about test taking involves a “little black book”. I ask students how much time they spend preparing for their upcoming exam and the answer is always the same. I study all the time! My simple request is that they purchase a small notebook that they can carry at all times. I ask students to record the time spent studying for the exam with 100% focus. Not thinking about studying. Not time at a coffee shop texting with a review book open. Rather time spent with their undivided attention on test-relevant material. The ask of students: spend greater than 100 minutes per day, on average, for greater than 6 months preparing for your next exam.

Few students do this. Let me be blunt: if you will not put the time into preparing for a high-stakes exam, that’s your fault. The exams are not perfect, but before you earn the right to articulate their shortcomings you need to prove you have the discipline and work ethic to join the conversation. My little black book was created as I prepared to take the American Board of Surgery Qualifying Exam for the final time. I knew that failing this exam would disqualify me from becoming a Board Certified surgeon. The only way I could stomach such a blow was knowing I had worked my ass off. Documenting the hours of exam prep was proof not to others, but to myself. I still have the small Moleskin which I keep as a reminder of what proper preparation entails. If you are struggling with high-stakes exams I would encourage you to get a little black book and start logging the hours. If you are not willing to do this, you have decided to accept failure. That’s on you.