Study Hacks: How to Ace Multiple Choice Exams

Developing strategies for taking a multiple choice test is sometimes frowned upon in our profession. It's looked at as "gaming the system" with the (understandable) fear that you're not really learning the material. Or worse, that you won't be able to apply it afterward.

And there's merit to this point of view.

Real life is not a multiple choice test. A patient’s medical chart doesn’t come with instructions. Evaluating a patient profile places you in an ocean of potential interventions to make (or not make). There is no handy device to narrow your choices to 4 options.

What do you do? Where do you even start?

It requires a different mode of thinking and preparation than the exams you’re used to taking.

But here’s the thing...

Every single milestone that stands between you and becoming a pharmacist requires passing a multiple choice test. The NAPLEX, MPJE, and CPJE are all multiple choice. Advanced certifications such as BCPS are multiple choice. You owe it to yourself to become outstanding at taking multiple choice tests.

After a few bad exams, many students fall into the trap of defeatist self-talk. They'll say "I'm just not a good test taker." Or they'll resign themselves to the refrain of "C's get degrees." Or even worse: "Maybe I'm just not cut out for this pharmacy stuff."

I don't buy talk like that. Sure, some people are naturally good at taking tests. These are the types that finish every exam in 30 minutes or less and still seem to get good grades. This is a very small minority of people.

The reality is, you don't need a special gift to ace your exams in pharmacy school. You just need a little refinement in your approach to studying and test taking. Test taking is a skill. Like any other skill, with diligent practice, it can be improved.

This article will review 3 of my best "high-level" test taking strategies for pharmacy school. They won't make test taking "easy," but implementing them will help remove a lot of the stress and anxiety caused by exams.

Strategy # 1: Learn Brand/Generic Names

I cannot stress this enough. This is part of our studying that we have a tendency to sweep under the rug so we can focus on the more fun "clinical stuff." The NAPLEX and other tests you'll encounter use brand names. And when you get into your practice career, that's what the majority of your patients (and other health care providers) will be using.

You might know every clinical detail about a drug. But if you can't identify it on a test, you'll miss the question anyway. This is the most frustrating thing in the world. I remember missing a simple mechanism of action question on a test because I didn't know what Brilinta was.

There are plenty of tools to help you with brand/generic. Just do a Google search for "top 200 drugs" and you'll be inundated with cheat sheets, drug cards, and quizlets. Also, when you are studying for a test in school, keep a running list of every drug that you come across (and its brand name). Review these periodically and they'll very quickly become second nature for you.

Strategy #2: Time Management

There is nothing worse than running out of time on an exam. Questions left unanswered get you zero points (and on some tests, negative points). But blindly guessing so that you have "any" answer isn’t much better. There's a good chance that you actually know the answer to many questions living at the end of the test.

So keep efficiency in mind when taking your exam. You can shave minutes off of each question by applying a simple technique.

Do not read the entire question (at first).

Your first step is to identify what the actual question is asking (hint: Look for the question mark). A lot of times, the actual question has nothing to do with the paragraph of background information.

Many questions are designed to see if you can filter through unnecessary information. It’s part of their purpose. You may come across a patient case with a complete medical, family, and social history, a medication list, a set of labs, and a chief complaint.

Then you get to the actual question and it asks “Which of the following home medications could be contributing to this patient's increased blood pressure?”

You could save a lot of time (not to mention brain power) by reading the question first, then skimming through her medication list.

There are plenty of case study questions where you need all the background information. Even then, it helps to read the question first. This way you can review the case with a filter that picks out the important information.

This technique is most useful on case study questions. But it can be used on just about every question to shave minutes off your exam time.

Strategy #3: Identify "Red Flag" Drugs

There are certain drugs that should act as a signal flare when they show up on exams. When you come across these drugs, you should immediately evaluate the question to determine if there is a drug interaction, toxicity, or both.

The following is a list of drugs that are almost always part of a drug-drug interaction:

• Rifampin - It’s one of the most powerful CYP inducers known to man. It's actual clinical use is somewhat limited (it's almost exclusively used for tuberculosis and as an adjunct to certain bone or hardware infections).
• Grapefruit Juice - It has no real therapeutic use that I'm aware of. But it's a powerful CYP and Pgp inhibitor. If it's on a test, it's almost guaranteed to be a drug interaction question.
• St. Johns Wort - A powerful CYP inducer that likes to show up on tests during your Psych module or the herbal medicine elective.

Closely related are drug toxicity questions. If a drug requires therapeutic monitoring, there's a pretty good bet that you will encounter it as a toxicity question sooner or later. Toxicity drugs often are part of a drug interaction question (where a drug interaction is leading to a toxic level of the toxic drug). So make sure you can identify these on an exam.

Be on the lookout for both toxicities and drug interactions when you encounter the following drugs:

• Amiodarone
• Warfarin
• Digoxin
• Carbamazepine
• Phenytoin
• Valproic Acid
• Vancomycin
• Aminoglycosides
• Lithium
• Tacrolimus
• Cyclosporine

Final Tips

Try hard not to put your own thoughts and feelings into the question. It’s easy to second-guess yourself and read more into the question than necessary. Multiple choice questions are usually black and white. Decipher exactly what you’re being asked, and answer accordingly.

If all else fails and you’re completely lost...remember that one of the primary concerns of the NAPLEX is ensuring that you can practice pharmacy safely. Knowing the 4th line of therapy (and its renal adjustment) for a given disease is important...but many test questions are looking to make sure that you don't harm the patient.

During your studying, give extra weight to learning black box qarnings, contraindications, and adverse effects.

Armed with this framework, you should be able to defeat any exam that comes your way. If you're interested in further reading, here's a resource that covers these topics in further detail.