I still can’t shake the astonishment that swept through me that morning as I stared at the computer with my worst nightmare staring back at me. I looked at the number again, somehow staring at it the third, fourth, and fifth time did not seem to change it, however much I wished it did. It remained what it was – 23. How did that happen? I was one of the top students in the entire college of math and science at my school, I had scored the highest in my class on every test in both semesters of biochemistry. I had even scored at the 99th percentile nationwide on the American Chemical Society biochemistry exam which also happened to break the record of the highest score ever achieved on that test in the history of my school. How then did I score in the bottom quarter of what was then the most important examination of my life? I had more questions than I had answers.

At length, I came to learn the importance of test prep and practice questions without which one is almost sure not to do well on standardized tests in the US. I had only been in the United States for two years, I had no idea how these things worked; I had naively based all my preparations on reviewing my notes on the subjects tested (which usually works just fine in my birth country, Nigeria); after all, I thought, how hard can it be? I never used practice questions, nor did I use any commercial resources. I passively reviewed all related course work and went into the test ill prepared.

As I reflect on this experience knowing what I know now, I am surprised that I did not do worse. Despite this setback, I went ahead and applied to medical schools with the hope of retaking the MCAT later. I was quite unsuccessful. Every school had a problem with my MCAT score; my high GPA didn’t seem to matter. Only one school gave me the opportunity to explain my situation and that was the school I ended up attending. With that acceptance I did not retake the MCAT.

I learnt a very valuable lesson from this experience, the importance of active learning. I had often wondered what difference a test prep resource would have made had I known about them and could afford to purchase one; after all aren’t the materials the same? Does it really make a difference whether I read about organometallic chemistry from my notes or from a test prep review book? It turns out it does.

The difference is that most test prep resources are designed to engage students in active learning using spaced repetition and periodic testing. Active learning has long been shown to be superior to passive learning. A study published by two renowned psychologists, Dr Benware and Dr Deci, showed that students who engaged in active learning were more intrinsically motivated and had higher conceptual learning scores compared to those who learnt passively. This was true even when both groups spent equal amount of time on the material. Another study published by doctors Karpicke and Bauernschmidt showed that repeated retrieval via spaced testing produced a 200% improvement in long term retention. Feng et al, were able to show, using spatiotemporal pattern similarity analysis of EEG data, the reinforcement and reinstatement of prior neural representations that occur when information is learned using spaced repetition. There are countless other studies that unequivocally shows the superiority of active learning over passive. These evidence-based methods yield great results.

When the time came to prepare for my next big standardized test, the COMLEX Level 1, I knew better. I chose a study resource that gave me the most opportunity for active learning; this time I spent 10-14 hours per day, 6 days per week, for 7 weeks in active learning; the result, my score was in the top 17% of all test takers for my year. Using the same method, I virtually duplicated my score on the COMLEX Level 2.

While I do now rejoice at being able to learn from a set back and become better, I cannot help but take into cognizance two realities of American medical education. One, people from disadvantaged background without mentors often find themselves without the knowledge and resources to accomplish their goals, even when they might have the ability. Had I had a physician mentor, I would have known the secret to performing well in standardized tests in the US earlier on and would have done much better on the MCAT. Secondly, medical school admission committees often fail to consider applicants holistically and instead fixate on one variable. I was overlooked by many medical schools because of my MCAT score, without considering other evidence of my academic competence. I was very anxious initially during medical school, especially after reading reports by the AAMC of how MCAT score correlates with medical school success. My case was an outlier it turned out. I graduated in the top 11% of my class, was inducted into the Sigma Sigma Phi Honor Society (the osteopathic equivalent of the alpha omega alpha) and matched into my first choice of residency programs.

References
Benware, C. D., & Deci, E. L. (1984). Quality of Learning with an Active Versus Passive Motivational Set. American Educational Research Journal, 21(4), 755-765.
Karpicke, J. D., & Bauernschmidt, A. (2011). Spaced retrieval: Absolute spacing enhances learning regardless of relative spacing. Journal of Experimental Psychology: Learning, Memory, and Cognition, 37(5), 1250-1257.

Feng K, Zhao X, Liu J, Cai Y, Ye Z, Chen C, Xue G. (2019). Spaced Learning Enhances Episodic Memory by Increasing Neural Patterns Similarity Across Repetitions. Journal of Neuroscience, 39(27): 5351-5360.

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