Introduction

The authors have been involved in the training of thousands of medical students and have explored and discussed with these students their test preparation and test-taking strategies. These students have developed into efficient, skillful test takers in order to cope with the volumes of detailed material on which they are tested. They learned to recognize key elements of course co tent and to train themselves to successfully answer thousands of test questions.

It is not just our observations of medical students, however, that we rely on to give you advice.
There is a growing body of scientific literature emerging from psychology and the neurosciences
that provides useful information about how to study for tests. These studies have identified the following very important test preparation topics.

1. Study time: HOW much you use; HOW you use it
2. Study location: WHERE and WHEN you study
3. Input: HOW you ENTER knowledge into memory
4. Storage: HOW you SAVE knowledge in memory
5. Retrieval: HOW you GET knowledge from memory

All these topics offer something to help you study and prepare for any type of examination you could encounter in the future.

Study Time

Preparation time is a necessary element for successful performance on tests but is found to be insufficient when used alone. Students have told us that they must set aside regular time periods for studying which increases their efficiency. It is not just setting aside time, however, that allows lear ing to take place. Rather, it is what happens during the regular study periods. We all know people who spend large amounts of time looking at textbooks or notes but still have poor grades because they lack effective study strategies. The most important strategy is for you to concentrate on what you are learning and to have learning as your sole purpose for studying. The goal of every study period should be to learn something new or relearn something that you have partially forgotten.

Here is a hint to help you concentrate or pay attention: If you find that your eyes are crossing a page of text but nothing is registering in your mind, and you are having trouble paying attention, you need to read faster. So fast that you will finally pay attention but not so fast that you aren't actually reading. Speed helps you concentrate. Suppose you are driving along a winding, country road at 20 mph. What arc you likely to be doing? Perhaps you are enjoying the scenery—taking in the trees, the horses in the pasture, or the ducks flying overhead. Now push down on the acceler tor until you are going 55 mph. What will you do?

You either are paying attention to your driving or are likely to find yourself in serious trouble. The point is that speed forces you to focus on what you are doing. Reading rapidly helps you pay attention to what you are reading.

Study Location

Research tells us where and when to study. If you learn something in a certain environment, you are more likely to remember this information when you are again in that environment: therefore, study in a place similar to that in which you will be tested.

Even your mood is thought to play a role in memory. While the effect is not thought to be a powerful one. researchers do believe it influences memory in two ways:

1. Recall is better for pleasant than for unpleasant material.
2. Recall is better when you arc in the same mood at retrieval time as you were when you encoded the knowledge.

You will want to study in spurts. Spread out practice over time with rest intervals spaced between. This is called distributed study or spaced practice. The amount of study material and the distribution of practice sessions affects your ability to retrieve the things you have learned.

Massed practice refers to long study periods and produces the poorest learning outcome. For most academic subjects it is best to work in a series of shorter study sessions distributed over several days if, however, you are cramming for a test, then long study sessions are better. The problem with cramming is that you do all right on an exam but don't remember much two weeks later.

Putting Knowledge into Short-Term Memory

Putting information into memory involves the encoding of incoming sensory information into a form that the brain can understand. In other words, our senses take in information from the environment, and our brain makes sense of it. A key to storing information in long-term memory so that you can easily retrieve it is organization.

Short-term memory (STM), also known as working memory, has a capacity limited to 5 to 9 items. Unrehearsed material stays in STM for 15 to 20 seconds.

What is the usual length of a telephone number? Count the digits in 555-4567. Interestingly most phone numbers have 7 digits (the ideal number of items to be remembered in working memory).

Fortunately, there are ways that your brain can manipulate the limitation of remembering just 5 to 9 items. One way is called chunking in which you arrange pieces of information into meaningful clusters and increase your capacity to remember. Take, for example, the following numbers:
76823318289190827103135466542594214.

You can't even hold this 35-digit number in your working memory. Maybe you could remember the first 3 or 4 or last 3 or 4 numbers but you're not going to hold all 35 numbers in your working memory. Now look at the same number chunked into 5 telephone numbers.

768-2331
828-9190
827-1031
354-6654
259-4214

Interesting, isn't it? Do you think you could use chunking to learn material just as apparently overwhelming and meaningless as the 35-digit number you just chunked? What is the key to chunking?

You're right—organization. It is a key to storing information in your long-term memory.

Storing Knowledge in Long-Term Memory

Strategies that encode information in a meaningful manner help you retrieve easily information from long-term memory (LTM). There are two ways to increase retention of what you are learning. Both require you to practice what you are learning. The first, overlearning, involves practicing with the material over and above what is needed to just learn it and is particularly good for learning basic facts and skills.

When you learned the multiplication tables, you overlearned them by practicing them over and over again. Furnish yourself with opportunities for overlearning of key concepts and skills. Make up flash cards and use them over and over until you have the facts locked in memory.

Repeat until you "know it cold." Most people don't have the time, patience, or determination for this approach, and it's not very efficient when you have a lot to learn in a short-period of time.

Because of these deficiencies, an approach called elaboration is often recommended. When you elaborate, you reorganize information and make it meaningful by relating it to something already in your memory. In order for you to engage in elaborative activities, you need to connect new information to something you already know. An organizational plan that is useful for school subjects utilizes logical schemes: places, dates, hierarchies, etc. Semantic categories allow you to organize by any meaningful strategy that you prefer. For example, you can categorize alphabetically, by body part, by size, by function, or by structure. Still other ways of organizing information are sounds, pictures, and colors. You should use personally meaningful categories to organize the knowledge you are attempting to store in long-term memory.

Mnemonics arc schemes designed to assist you in remembering. "Fall back, spring forward" is a way of remembering to set your clock forward in the spring and back in the fall. "Every good boy does fine" and "FACE" help us remember the lines and spaces of the musical staff. "Please Excuse My Dear Aunt Sally" stands for the order of the following mathematical operations: Parentheses, Exponents, Multiplication, Division, Addition, and Subtraction.

You remember these mnemonics, don't you? They are unforgettable acronyms or sentences used to recall a set of already existing strong associations. Other mnemonic schemes include methods of associating things you are trying to remember with words (peg word method) and with locations (loci method).

Peg Word Method

With the peg word method, you begin by using the sequence of numbers 1 to 10 to memorize a word that is concrete and rhymes with the number beside it. For each number, you memorize the word that rhymes with it. Here are 10 numbers and words.

1. bun
2. shoe
3. tree
4. door
5. hive
6. stick
7. heaven
8. gate
9. line
10. hen

These words make up a peg list. You use it to memorize new, unrelated sets of items. Place each item to be remembered in an image with a peg word. For example, if you wanted to memorize a list of words that begins muscle, tissue, cell, energy ..., you could imagine a muscle burger bulging through a bun, Mother Hubbard's shoe house covered with toilet tissue as a result of your high school's big victory, a tree growing through a jail cell, and a door swirling in the sky captured by the energy of a tornado. Try this method with lists that you need to memorize. It could be fun to use the peg word method.

Loci Method

The loci method lets you use knowledge of the spatial arrangement and contents of some familiar place, like your own home or neighborhood. When trying to remember a list of words, take an imagined walk through your location, placing each item in, on, or near some familiar, easily remembered object. To return to the sample words above, your muscles would be seen in the mirror in the bathroom, tissues would be on the nightstand in your bedroom, the cell phone would be on the kitchen table where you left it, and the energy would come from the furnace in the garage.

To retrieve these items you recreate the stroll and retrieve each item as you come to it. To remember these words, you imagine driving into the garage and seeing that the furnace is aglow with energy. You open the door inside the garage and enter the kitchen, where you immediately notice your cell phone on the kitchen table. While picking up the phone, you knock over the pepper shaker and start sneezing. You run to your bedroom, where you pick up tissues from the nightstand so you can blow your nose.

Then you decide to take a shower. While entering the bathroom, you can't help but stop and admire your muscles in the mirror on the bathroom door.

These methods may seem silly, but you really ought to try them.

Retrieving Knowledge

Retrieval is difficult if the information you are trying to remember is not encoded appropriately. Remember, organization is the key to storing information in long-term memory so that you can easily retrieve it. Also, do you remember the importance of studying in ah environment similar to the one in which you will be tested? Retrieval tends to be best when the context in which it takes place matches the context present at encoding. Two things that you have control over and that affect your ability to retrieve knowledge from memory are the amount of time you spend practicing and how you distribute your practice. What is the best way to distribute practice? That's right— study in spurts, take breaks, and study over time.

There are two ways in which you are asked to remember on tests. One is to recall information without cues, as with fill-in-the-blank and essay questions. These are considered the hardest questions, because recall tasks provide few cues to the answers. The other way you are asked to remember is called recognition, which requires you to identify material previously learned. Multiple-choice and matching items are typically aimed at asking you to recognize word associations. Both recall and recognition require retrieval of data stored in long-term memory.

Forgetting

It appears that there is no practical limit to how much information we can put into long-term memory.

Many psychologists believe that information is permanently stored in various places in our brain. For them, forgetting is failure in retrieval. Other psychologists theorize that aging, lack of use, and disease decay memory and cause our brain to forget. Still other psychologists think that the ability to remember is linked to the use of the same cues for encoding and retrieving items in long-term memory.

A basic problem with retrieving information from memory is that there are lots of things that interfere. So being forewarned may help you overcome some of the things that will interfere with your ability to remember for recall and recognition tasks.

There are two classic interference effects that we all face when trying to put new knowledge into memory: the recency/primacy effect and the retroactive and proactive interference effect.

Retroactive interference refers to the new memories impairing the memory of something that you previously stored in memory. Proactive interference refers to the effect that old memories have on your ability to remember new material. For example, you memorized the names of the muscles and bones of the leg last week.

This week you are trying to learn the names of the muscles and bones of the arm. What will happen? You will have a tendency to forget the parts of the leg as you learn the arm parts (retroactive interference), as well as a tendency to forget some of the arm parts because you learned the leg first (proactive interference). You should avoid studying similar things in consecutive time periods.

Remember that long list of 35 numbers you saw earlier? We told you that virtually no one would remember that list. But we did say that you might remember the first couple or the last couple of numbers, which is an example of the recency/primacy effect. You tend to remember the beginning and end of any list much more easily than you remember what is in the middle.

When you go to a restaurant and the waitress names 8 or 10 salad dressings, you tend to ask for either the first or last one she mentioned. Or you ask her to repeat the list because you can't remember the fifth one she mentioned. The moral of this story is to make short lists.

Summary

Factors that enhance learning and memory are:

• Study time and place.
• Characteristics of what must be remembered.
• Strategies for storing knowledge and remembering.
• Context characteristics of practice and test situations.