Procrastination snowballs; that is, procrastination leads to ever more procrastination. The stress of delay leads to more delay, which leads to more stress and so on. Procrastination grows until the pressure to do the required task grows so high that, finally, action is taken. Of course, once action is taken, the work is often done under conditions of emotional duress, a reduced ability to focus, and too little time to get the job done well.

Since procrastination has led to these self-inflicted delays, inevitably regret and, perhaps even, self-loathing set in. And all this emotional turmoil is on top of often failing at one’s assigned task, whether it’s completing a work or school assignment or passing a board exam.

I know. I’m a procrastinator too – always in recovery, always relapsing.

Interestingly, procrastination is often limited to only certain types of tasks. Thus, the procrastinator may be a highly successful and effective individual in most areas of life. You wouldn’t be reading this if you weren’t both highly successful, given that you’re a medical board exam candidate, and having a bit of a procrastination problem.

So, let’s get into how to overcome procrastination. What is it? Procrastination is simply avoidance, avoidance of doing the tasks that require doing. Some tasks without a deadline never get done. Others with a deadline get done – usually – but less well and at much higher cost than it would have taken minus the procrastination.

The start to solving procrastination is to divide the work – in our case, exam preparation – into two parts. The good news is that the first part, “Orientation,” is much easier, less time-consuming, and less avoidance-inducing than the second part, “Study Plus,” despite being just as important. I call the second part “Study Plus” because it includes study, of course, but also additional ways of preparing for the exam, as I outline below.

The solution is to orient yourself and, once oriented, to launch into the Study Plus part, which is easier to launch into once one is oriented.

Let me stress this point: The procrastination that plagues most of the learners I’ve counseled about board prep starts at the very beginning. Even the not-very-hard first step of Orientation is avoided, which then prevents the Study Plus part from ever commencing.

So, why is this small but crucial first step of Orientation avoided? Because it is not viewed on its own but instead as part of this huge, looming, and overwhelming project of being fully prepared for the board exam. This entire project looms so large that it is avoided from its inception.

To stress: Getting past procrastination is accomplished by simply taking the very first step. Once a person is in motion, further steps are easier to take. Confidence grows, and some learners then really get into their studies, thus converting a doom loop into a virtuous circle.

Let’s now get into the details. Below, I lay out the components of the Orientation part of board prep.

Part 1: Orientation – Scoping Out the Job of Exam Preparation

Part 1 starts with a simple cognitive task:  to disentangle Part 1: Orientation – reviewing what is on the exam and developing a realistic yet effective plan to pass the boards – from Part 2: Study Plus – which entails following the preparation plan as laid out in Part 1. To be effective, the procrastination-proof approach requires strictly separating, in your mind and in time, Part 1 from Part 2, like this: Orient yourself. Stop. Start preparing sometime later, even if it is as soon as tomorrow.

Orientation requires the following and can be done in about one to four hours, depending on how far you’ve already gotten or the level of detail you seek to achieve:

  • Learn the scope of what is tested on your board exam
  • Develop a realistic preparation plan
  • Stop and reward yourself for getting Part 1 done. You’re done for the day!

Now, for the details on the Orientation steps outlined above.

Scope Out What is Tested

Simply review the exam blueprint on your board’s website. We’ve included relevant board organizations in the footer of this website.

The exam blueprint may itself seem overwhelming. Take a deep breath. Don’t leave now. Download the PDF. Review the blueprint once while you’re still on the board website. Review the PDF again in more detail, a little later on your computer, and periodically throughout your studies.

The longer and more detailed the blueprint, the better off you are. It gives you more information on exactly what is tested on the exam. It defines the required knowledge base.

1: Develop a Realistic Preparation Plan

To be optimally effective, the following four approaches should be undertaken during your preparation. So, your plan should include a focus on each part.
Knowledge Acquisition

Acquire and/or refresh the requisite knowledge needed, as per the exam blueprint, to do well on the exam.

When looking at the exam blueprint, attend to the percentage of questions in each topic category. Most exam blueprints provide this info. If they do, then note which topics are the big ones. These topics need to be your main study focus. You will be following the Doc Sutton rule of board prep: “study where the questions are.”  (The bank robber Doc Sutton was asked why he robbed banks. He responded with “That’s where the money is.”)

You’ll find that a quarter or so of the topics account for perhaps about 2/3 or more of all the questions on your exam. You will prioritize these topics.
Next, consider which of the large topics you’re most and least knowledgeable about. The ones you’re least knowledgeable about will be your priority.

“Priority” means prior to anything else. This means that a priority is singular. So, from your “priority” list, choose the single topic that will be your very first one to start with.

Is it silly to be so precise, to know exactly which topic you’ll start reviewing? Not at all. If you picked out the exact topic that you’ll start with – it doesn’t matter which one you choose as long as you choose one – then when it comes time to study, you won’t hesitate and ruminate on where you should start. If you leave open where to start studying until it’s study time, you’re opening yourself to another bout of procrastination. Yes, it’s amazing how little it can take to have procrastination rear its ugly head once more.

2: Discover How the Exam Tests Your Knowledge

Knowing what topics are on the exam is insufficient. You must also learn how your board exam tests that knowledge. The best way to do so is to answer many, many board-reflective exam questions. Board-reflective means that a question is not only on a relevant exam topic but is in the correct board format and style. Take note that not all QBanks are equally board reflective.

Learn How to Take the Exam

Still another part of board prep is learning how to become a good test taker. Here are two things you should focus on.

First, ascertain the pace at which you need to complete exam questions in order to avoid running out of time on the exam. One of the most common topics for exam candidates to unhelpfully ruminate about is whether they’ll have enough time to finish all the questions on their exam. This should never be a concern going into the exam because your exam pace should already have been ascertained beforehand. This is done by going through a board-style practice exam.

This perhaps sounds like what I recommended in the section above. It is not. A learner can go through many exam-style questions in order to learn the information the question is designed to test – which is done in what is called flashcard mode – or to assess their level of knowledge – which is done in exam mode. Both of these are helpful in preparation. However, in establishing your exam pace, you need to be in the QBank’s exam mode, but additionally set up the practice exam to mimic the real board exam. This means you need to go through as many questions on the practice test as there are on the real exam while timing yourself to ensure your pace is adequate to avoid running out of time.

Additionally, the practice exam must mimic the topic distribution of the real exam, so you are testing yourself under as realistic board conditions as possible. If your pace is too slow, at least you have discovered this ahead of time and can continue practicing to increase your speed. If your practice pace is fine, then you can now put your running-out-of-time fears to rest.

There is an additional reason to take a full practice exam: it is to assess your stamina across the entire duration of the exam. This approach to preparation is done through taking a practice test that mimics your board exam, just as I discussed above. But when you do so, you should also be paying attention to your ability to maintain your focus and your mental and physical stamina. Maintaining stamina across the many hours of a certification exam, which can last up to 9 hours, is an underappreciated factor in exam success vs. failure. Stamina can be increased in two common-sense ways: first, try to get a good night’s sleep the night before, rather than trying to study through the night. And second, make sure you hydrate, eat, and take bio breaks through the exam hours. It is common for exam-takers to avoid drinking fluids to minimize bathroom breaks to save exam time. This is a mistake. If you cannot afford two 5-10 minute breaks during the exam, you should strive to pick up your pace. Hydration is key to maintaining mental acuity.

There is still another reason to take a full practice exam: if you are going to use or are tempted to use medications to help with your exam, like a benzo to stay calm or an amphetamine to stay focused and alert, you must try this out ahead of time – unless you’re continuing a regularly prescribed med. If your body is unused to benzos, beta-blockers, or stimulants, you do not know how your body will react. You simply must try them out ahead of time and ascertain how you feel across the full duration of the board-realistic practice exam.

Before I end, I want to share some general exam-taking advice: First, never give in to nihilism or despair, even if you are doing less time than you feel you need or are starting late.

You must maintain a warrior mindset: you must focus on staying alive, passing the exam, that is. Beating yourself up or crying over spilled time won’t help. Instead, remember that every few minutes you do devote to prep incrementally increases your chance of passing. Focus on what you can do right now and in the remaining weeks or days.

And second, you are probably not sitting on a lot of free time. You’re probably busy up to your eyeballs.

Join the club.

Given this harsh reality, during your prep plan, come up with the places and times you’ll be able to get some prep time in. Be specific. Will you need to get up half an hour early? Will you go into your office early to study there with the door closed? Will you stay up late? Will you devote a weekend morning or day to study? Decide this ahead of time in order to give yourself the best chance of following through.

3: Stop and Reward Yourself

Here I remind you that all that I’ve written above is to guide you in getting to a life-realistic and realistically effective preparation plan. As I said, this can take 1 to 3 hours. Of course, you can take more time. But the point is, again, that if you mix together what I just asked you to do – the planning – with the actual preparation – which comes later – you’ll likely get overwhelmed by the thought of it and shut down.

So, do your planning as best you can. You’ll undoubtedly want or need to revise your plan as you proceed through the prep months, weeks, or days. But finish it and reward yourself for now having a plan. The more thought, the better.

Tomorrow or, perhaps months from now, will be the time to start studying.

Take care,
Dr. Jack

Language Brief

“You may delay, but time will not.” – Benjamin Franklin

“Procrastination is the thief of time; collar him.” – Charles Dickens

“Only put off till tomorrow what you are willing to die having left undone.” – Pablo Picasso

“It is easier to resist at the beginning than at the end. – Leonardo da Vinci

“A year from now you may wish you had started today.” – Karen Lamb