Course & Exam Preparation

There are multiple pathways to the same academic performance outcomes - every learner is unique and there is no 'one-size fits all' approach to academic success.

Given the variation and variety of pathways, the Medical School developed a Content, Questions and Assessment model (C-Q-A) to guide learners in a way that honors everyone's unique style and needs, while also providing needed feedback on progress and identifying gaps in performance. The C-Q-A process applies to all levels of training from year 1 midterms to the series of USMLE Step exams.

Look below for specific C - Q - A  tips, considerations & resources matching your exam needs

C - Content Resources


Content refers to the 'toolbox' of resources and materials that comprise one's knowledge base for whatever subject/discipline is being tested. To effectively acquire knowledge, learners benefit from using a range of previewing, note-taking and reviewing approaches. These active steps enable cognitive 'schema' (or mental folders) to take shape and personal meaning for each learner. A learner's ability to be aware of their knowledge inventory in various schema and to access and 'work with' this knowledge shapes their ability to work with a greater efficiency and fluency needed for high performance.

Despite one's best intentions and efforts, mastery of Content is often thwarted by gaps in knowledge (schematic blindspots) that cannot be exposed simply through repetition. This is where the second part of the C-Q-A process (Questions) comes in.  As will be noted in the next section, Questions represent application of knowledge and serve a vital feedback function in the knowledge acquisition process by exposing schematic blindspots. Many learners fall into an unfortunate trap of trying to 'master' content before attempting any practice questions. While an understandable (and admirable) pursuit, it creates unnecessary anxieties by exposing blindspots in the proverbial eleventh hour and misses invaluable learning windows that could have been utilized earlier in the preparation process by simply doing practice questions earlier (and/or more often).  Learners waiting until just before an exam to complete practice questions is no different than a concert pianist waiting days before a recital to stop studying a musical score and begin practices.  In this regard, the C-Q-A model advocates for adopting an attitude of embracing failure in the preparation process - i.e., better to miss practice questions early to learn where the blindspots are in one's schema than to discover them just before or during the exam.  

In each of the web pages dedicated to exam performance (from pre-clinical exams to the sequence of NBME Step exams) you will find a Content section dedicated to recommended information and resources intended to enhance successful performance on exams. For questions related to these resources (or to suggest inclusion of resources you find useful, contact Scott Slattery in the Learner Development office,

Q - Question Resources


Questions are wonderful micro-applications of the knowledge learners are expected to acquire. When it gets down to it, questions are puzzles requiring learners to first identify which schema (or multiple schema) contain needed information, and secondly, to go into the schema to properly draw out information needed to solve the puzzle. Learners lacking fluency with schema (mastery) will get tripped up in either or both of these processes. More often than not, students can find the correct schema, however, once in that 'folder' of information, confusion and/or lack of coherency in how information is organized in the schema create problems in deciding among answer options (e.g., option B vs. D vs. E ??).

The wonderful thing about practice questions is that they don't count. In fact, the only time performance on questions matters is on the exam itself. Outside of the exam, missed questions (technically 'failure') are excellent opportunities for learners to highlight information missing from their schema or ways existing information may be inefficiently or inaccurately organized. Because practice questions don't count, they stand as excellent opportunities for learners to discover these schematic blindspots before taking exam questions that do count.  Many learners have an aversion to questions because not answering a question accurately can be experienced as a personal failure. While avoiding this kind of experience is understandable, it is important for learner's to consider embracing a 'failure' mentality when it comes to practice questions as not doing so runs the risk of missing opportunities for schematic clarification (that translate to 'success' on the exams that do matter).

In looking at Questions, it's also important to understand that they they represent more than a feedback opportunity for learners. Rather, they also serve as a significant 'lever' for testing improvement. For example, let's say that Student A has truly mastered Content in biochemistry and receives a biochem question. We would consider this to be a 'high probability' question for success. Despite this Content mastery, Student A may still get the question wrong if the style of Question or way the information is presented is novel, obfuscating or twisted.  Similarly, if Student B gets a question with Content she has never seen before (a 'low probability' question), she may still get it correct if she has familiarity with the style in which the Question is presented. In other words, successfully answering a question requires skillful preparation in both Content and Questions - if you want to improve performance, become a master of Content and/or master of the style of Questions being asked.

Bottom line is that Questions are often an underutilized resource in exam preparation. Work toward viewing them as the ally they are in your efforts for testing success, and study them in the same way you study subject content (i.e., get into the head of the exam maker).  In each of the subsequent exam preparation web pages, you will find a Questions section that includes 'hi yield' resources and information to help you master your application of questions.  If you have any questions or would want to offer suggestions for helpful resources for the web pages, contact the Learner Development office (Scott Slattery,

A - Assessment


One of the most important guiding principles of test preparation is that you can't study everything all the time. Given the volume of information provided in medical training, this becomes especially relevant. This is offered not as a ground-breaking insight, rather than as a reminder of the importance prioritization plays in test preparation.  For example, let's say that Student A has 6 topics to study for an exam.  If she is unaware of which ones are areas of strength vs. need, time will likely be devoted equally to all 6 topics in her preparation efforts.  For the areas of strength, this will be too much time (inefficient) whereas for the areas of need, it won't be enough time (ineffective).  To achieve the appropriate balance of time and effort (for optimal performance), learners need a feedback mechanism to discern their relative asset vs. need areas and Assessments serve this function.

Similar to what was noted in the Questions section about the value in adopting an attitude of embracing failure in the preparation process, the same can be said for finding an effective perspective on Assessments.  Because they don't countAssessments need to be viewed by learners an an essential ally in their preparation efforts.  Whether it is a 'low stakes' quiz in a pre-clinical course or an NBME self-assessment for a step exam, Assessments provide learners with a higher level of feedback needed to make decisions for time alocation and needed resources; early in preparation efforts, it is important to keep this functional perspective and to not view outcomes as predictors of future performance.

Bottom line, Assessments round out the C-Q-A process by providing big-picture perspectives on the preparation process and how to optimally use valued resources.  For each of the respective exam web pages, you'll find an Assessments tab with 'hi yield' information and resources on relevant assessment options. If you have any questions or would want to offer suggestions for helpful resources for the web pages, contact the Learner Development office (Scott Slattery,

Familiarity / Studying / Mastery

Familiarity / Studying / Mastery

A quick note on the process of information/knowledge mastery. As learners move to acquire knowledge, there can be a tendency to leap (prematurely) toward attaining mastery of material.  While not inherently an issue (mastery is the eventual goal), learners often lose efficiency in their efforts and/or experience undo stress when the preceeding stages of Familiarity and Studying are discounted (or, in some cases, disregarded). In working the C-Q-A preparation process, it's important to note that learners work through each of these stages (Familiarity, Studying, Mastery) in each of the C-Q-A components (e.g., learners become familiar with content, questions and assessments; they study content, questions and assessments, etc.). The following notes are intended to lend perspective to your efforts  when working the C-Q-A process.

Familiarity ...

This stage is akin to 'previewing' study material - it doesn't 'count' much in the end, but it's essential for building toward greater efficiency in efforts.  Because learners calibrate more naturally to studying and mastery (because these do count for more), there is a risk of avoiding materials because these levels require greater emotional engagement (e.g., a learner may not engage with the material until it's necessary to do so).  Familiarity is great because of the low emotional investment it requires.  Expectations for familiarity are generally low and whether you do a little or alot, any engagment is 'good.'  

While Familiarity lacks expectation demand, this doesn't mean that efforts in this step are meaningless. Instead, Familiarity efforts are essential in calibration - they give learners a 'big picture' perspective on how much (or little) work will be needed or how comfortable one is (or not) with various material, etc.  If you feel the pull of procrastination, take a moment to step back and see if there is some Familiarity work you can get done - if so, it often serves as a key to engaging in the Studying and Mastery levels;

Studying ... 

This step in the process is where the proverbial 'heavy lifting' occurs. This step requires the most time, focus and attention, and the objective of Studying is to create a strong set of notes. This 'product' varies according to each learner - some create hand written notebooks, others excel sheets, and others electronic flash cards (e.g., ANKI). Whatever approach works for you, the goal is to create content 'breadcrumbs' - brief notes about relevant information you plan to return to just prior to the exam (during the Mastery stage).  

Mastery ...

Timing for Mastery needs to occur just prior to the actual exam. Similar to any other form of performance (music, athletics, presenations, etc.), attaining mastery too early often results in inefficient use of time and frustration.  Think about someone preparing for a marathon who builds up to 20 mile training runs; if the runner peaks 2 weeks before the race, they will have the dillema of either continuing these runs daily (risking burnout by race day) or scaling back training runs (risking diminished performance).  The goal is to strive for mastery as close to the time of performance as possible.

In test preparation, there can be a tendancy for learners to work on mastering challenging material when it's identified.  While this intention makes sense from an academic integrity perspective, it may not be effective if too far away from the exam (largely due to the risk of forgetting what had once been mastered).  In working through the C-Q-A process, it's important to monitor and keep in-check, one's expectations about mastering material and to develop a strategic plan for mastering material in a timely manner. 

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