Before starting tutoring, students sometimes ask me questions like "doesn't your high score just mean that you're intrinsically intelligent?" or "how can you translate your high-scoring skills to help more average students?" These are very understandable questions, but underlying them is often a belief in a dangerous myth that plagues the world of USMLE preparation: that you can try as hard as you want to ace Step 1, but the greatest determinant of your score is your I.Q., or something else you can't really change.
But being a great USMLE test taker isn't about anything innate or unchangeable; it's largely about strategic test-taking skills and efficient study methods, both of which can be taught. Some people tend to think in ways that are advantageous for multiple choice exams, such as tending to generalize or "search satisficing," the latter of which is technically a cognitive error that can lead to diagnostic errors, but works great on multiple choice tests.
Test-Taking Skills Are Teachable
I've done test-prep tutoring for over 8 years (SAT and MCAT, then USMLE), and I'm 100% confident that every student can improve their test-taking skills significantly by being taught to approach questions more like high scorers do, after seeing so many students get significant score improvements with strategy-focused tutoring. For students who have mastered content but are still scoring low, many are simply making systematic errors in how they approach USMLE-style questions.
Multiple Choice Tests Favor Certain Cognitive Styles
Medical students who start out scoring low on USMLE practices tests aren't doing so because they're "unintelligent". Rather, some of the most intelligent students simply have cognitive tendencies that are less suited to standardized testing. These students may hone in on subtitles, and focus more on possibilities than concrete answers, or may be uncomfortable guessing or using process of elimination because they feel they have to obtain a comprehensive understanding of each question. These students can be taught to approach questions in a way that is more likely to get them points, and this approach is specific to the particular exam (different even for Step 1 vs. Step 2 CK).
You Have to Know A Lot, But Not Everything
For exams that are so content based like the USMLE, high scores are clearly not about pure intelligence; you have to study efficiently (or study a crazy long time!) to score highly. Many students study in ways that may lead to success in medical school courses, but are not very efficient for the USMLE. This is because the way most people have been taught to learn in school is ineffective from the point of standardized test taking. Students often try to learn too holistically and attempt to learn more than is needed to get points (feeling they must understand everything), which leads to greater cognitive fatigue and poorer recall on test day. You need a well-integrated, comprehensive body of knowledge to practice medicine, but not to ace the USMLE.
A Structured Study Schedule is Key
Some students also struggle with motivation and staying on schedule to a degree that might surprise those who assume all medical students are highly efficient workaholics. As a tutor, I actually make hour-by-hour schedules for every day for my students that I adjust weekly. Many students find this really helpful to stay motivated and on track, and quickly realize they haven't been getting as much work done as they thought they were. It's surprisingly easy to be working hard studying in the library for 14 hours a day without actually learning all that much, especially for those who are very hard working by nature.
Systematic Errors and Poor Performance
In addition to students aiming for average USMLE scores, I've worked with many students who are simply aiming to pass or who have failed previously. In many cases, tutoring people who believe that they are poor test takers is often easier, because they are often making systematic errors, and quickly benefit from a few suggestions. Suggesting that scoring highly is a downside as a tutor is almost like saying how can you relate to sick patients as a doctor who is healthy? Having a tutor who is a high scorer is a great asset, no matter your score goal. In choosing a tutor, you want someone with the best understanding of the exam, someone who's outsmarted the NBME, not someone who understands the exam to a lesser degree.
Don't subscribe to the false dichotomy that high scorers are intelligent and low scorers are unintelligent. This is simply not the case, especially for content-based exams like the USMLE. Your future is not set in stone based on how you've done on exams in the past. By learning to approach the USMLE the right way, almost all students are capable of achieving excellent scores.
Alyssa Ehrlich is a fourth-year Harvard medical student and founder of USMLE Pro. She tutors for Step 1, Step 2 CK, and shelf exams.