Slow is Fast: Why Cramming for the USMLE Takes Longer

by Alec Palmerton, MD in Plan

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You have a dilemma. You want a particular score. Maybe you need to make up for issues in your residency application. Or you want to match in a specific location/specialty.

The problem is that you have this nagging feeling that you don’t have enough time. You wonder how you can fit everything into your schedule. Your mind races with schedules and self-imposed deadlines. Your school keeps asking when you’ll take your test.

But your scores aren’t moving as fast as you want them to. The only solution your anxiety-riddled mind can come up with: cover more in less time. You need to rush.

Of course, you don’t call it rushing. In my experience, few rushers realize they are moving too quickly. You may know that cramming is terrible, in theory. So you tell yourself you’re not cramming, per se. Just…speeding through the material. You’re efficient!

If any of this feels familiar to you, stop. Take a deep breath. You are likely making the cardinal sin of USMLE studying: rushing. It’s natural to cram – you have a perceived deadline, and a score you need to achieve.

However, as much pressure as you are feeling, rushing is not the answer. While it feels good to rush and cover more material than you can digest, it is paradoxically slower.

Even worse, rushing will likely cause your score to be even lower. Every year, students sacrifice months/years studying full-time with minimal score improvement. Why? Virtually every one of them was rushing.

In this article, you will learn:

• Why rushing is natural, especially with time scarcity
• Research demonstrating how time scarcity and rushing can hurt your score generally
• Why moving too quickly is particularly bad for the USMLEs
• Signs to know if you’re rushing, and
• Much more

Table of Contents

Rushing is Natural…and Bad for Studying

Scarcity is a growing field of psychology research. Researchers study many instances of scarcity, including poverty, loneliness, and time scarcity. Through the theory of scarcity, rushing is a natural response to having too little time.

A central finding to the studies is that scarcity leads to lower bandwidth. Bandwidth includes scores on intelligence tests and impulsivity.

A classic demonstration of scarcity’s power involves sugar cane farmers in India. Interestingly, these farmers harvest (and receive money) once a year. In other words, the month before they are paid, they have scarcity, in that they have relatively little money. The month after they’re paid, they are no longer experiencing scarcity, at least to the same degree.

It is the same people under different conditions of scarcity and abundance. You couldn’t hope for a better experimental design. Different farmers are paid in different months, making it even more of a social scientist’s dream. In other words, some farmers are paid in January, others in February, etc.

The upshot? Scarcity has a dramatic impact on mental bandwidth. Farmers had the equivalent of an 8-9 point decrease in IQ testing the month before harvest when they have the least financial resources. They were also more impulsive. (More on impulsivity later). The study authors noted scarcity in that instance was “like having just pulled an all-nighter.”

Think about that. One standard deviation in IQ testing is 15 points. An 8-9 point decrease would be more half one SD – a substantial drop in fluid intelligence. While these results involve a lack of money, the impact of scarcity in other domains – like time – is similar. In other words, having too little time to study likely is reducing your performance.

Sound like rushing sets you up USMLE disappointment? It gets worse.

Scarcity Leads You to Sacrifice the Long-Term for Short-Term Gain

Decreased fluid intelligence not enough to scare you away from rushing? Don’t worry – scarcity leads to other reasons for poor USMLE performance. Specifically, scarcity often leads to poor long-term planning.

Another classic experiment looked at decision-making in situations of time scarcity. Princeton students played a version of the guessing-based game show “Family Feud.” One group of participants had a significant amount of time to make their guesses. The other group had 1/3 as much time.

The “twist” the researchers introduced was the ability to borrow. Participants could borrow one second for the present round. However, they would lose two seconds in the future.

You can guess the results. The time-starved Princeton students borrowed more, which tanked their final score. How much did stealing time from future rounds cost the students? When the researchers removed the ability to acquire more time in the present, their scores improved by 60%.

Time Scarcity – and Rushing – Leads to Poor Trade-Offs

In my experience tutoring students, these are classic short-term trade-offs students make:

• Sleeping less to do more today (then over-caffeinating to make up for their drowsiness);
• Trying to “cover” more material to try and boost their next NBME, then forget everything;
• Not doing their old Anki cards, so they can do more QBank questions; or
• Not exercising, so they have more time to study

However, this short-term thinking is similar to not changing the oil in your car. You may temporarily “save” more money – but pay much more in the long-run.

In the short-term, you will get more done when you sacrifice your production capacity. However, we ignore the intermediate-/long-term costs at our peril.

Take sleep, for example. Even modest changes in how much we sleep have a substantial effect on academic performance. In one study from my home state of Minnesota, a school encouraged extra sleep via later starts. Instead of 7:25 AM, it moved to 8:30 AM, and students slept on average 43 minutes more. The year after the change, the top test-takers scored 212 points higher. (Average verbal scores went from 605 to 761; math from 683 to 739.) The effect on sleep on academic performance is a robust, repeated finding.

We’ll stay up later, trying to do more QBank questions. Yet we sacrifice proven interventions – like sleeping, or adequate rest generally.

Cramming feels faster, but is slower and leads to worse scores.

Why Rushing Your USMLE Studying Causes You to Take Longer, Do Worse

Rushing generally is a mistake. It leads to lower fluid intelligence, impulsivity, and borrowing against our future. However, for the USMLEs, rushing is particularly bad.

Unlike crammable med school exams, the USMLEs test your ability to apply information. They state this clearly in the guidelines they give to all the question-writers. In other words, you cannot memorize your way to higher USMLE or shelf scores. Instead, you must master the information.

If you rush, how well will you master the information? The unfortunate answer is that by rushing, even though you “cover” more, you will, in fact, be able to apply less. Paradoxically, you’ll spend more time studying, since you’ll have to repeat everything.

The solution is to master the information, which will feel slow, but it is actually faster. Why is it faster to master a smaller amount every day? Because by learning it well, you won’t have to re-study it. Remember, the worst thing you can do is to “cover” something so quickly you have to study it again.

The Paradox of Speed: Why Thorough is Fast

In psychology, there is a term called the “paradox of hedonism.” The observation is that if we seek a particular pleasure, we will fail to achieve it. (E.g., those who seek only to be happy are, paradoxically, less happy).

The same can be true for studying, which you could call the “paradox of speed.”

If you move quickly, you will achieve neither speed nor quality. However, if you seek quality rather than speed, you will paradoxically accomplish more in less time.

When cutting corners, your depth of learning is the first to suffer. Poor quality studying will cause you to repeat everything unnecessarily, slowing you down.

Deep down, you’ve suspected rushing causes you to move slower and accomplish less. How often have you crammed something, only to have to return later to re-study the same thing? Or skimmed a vignette to “save time,” only to waste time re-reading it multiple times? Moving quickly may give you the illusion of speed, but it is the most inefficient and slow path.

Deliberate Learning Feels Slower But Has Extra Benefits

Deliberate studying is the path less trodden because it feels slow. You may even feel lazy. However, it isn’t; as I said, paradoxically, you will cover MORE meaningful material. However, it will undoubtedly FEEL like you are covering less. This is especially true when your friends claim to have done all First Aid in a matter of weeks.

The side-benefit of deliberate mastery is it makes you resilient to unforeseen changes. Test is canceled due to COVID-19? Prometric center shuts down because the electricity is out? You can actually benefit from unexpected events. Why? Because all you have to do is to continue your slow path of mastery.

Contrast this with crammers who “cover” all of First Aid in the month before their test. They are operating under the fragile assumption that their exam will happen in a month. They hope to achieve their peak on a particular date. But what if they find out the week before their test they need more time? The “planning fallacy” in psychology teaches us that people often underestimate how long something will take. (For more on why people underestimate how long they should be studying, see this article.) Or what if, as discussed previously, their test is canceled? They are out of luck. They’re losing their crammed knowledge like water in a leaky barrel.

How Do You Know Whether You’re Rushing?

An interesting aspect of human psychology is that we are very skilled at denial. For instance, early in college, I was experiencing many of the classic signs of anxiety. I wasn’t sleeping well and experiencing palpitations. My thoughts kept drifting back to my upcoming final exams.

“I can’t be anxious!” I told myself. Mind over matter, right?

It turns out, I had deep anxiety, but was in denial. My magical thinking couldn’t overcome anxiety’s adverse effects on my life. Long story short, I had a full-blown panic attack. I learned that ignorance of worry didn’t mean I wasn’t anxious.

Unfortunately, the same lesson applies to those who are rushing. Like me, the ones who are rushing the most are often the ones most unaware.

Because it’s hard to acknowledge our missteps, don’t ask yourself, “am I rushing?” Instead, consider some of the classic signs of knowing whether you are rushing or not:

• Insomnia – difficulty falling/staying asleep;
• Sacrificing your studying capacity for short-term gains (e.g., sleeping less so you can study more);
• Wondering how you will have time to fit in everything;
• Difficulty concentrating on the subject at hand;
• Constantly worrying about your score, and wondering how you can raise it;
• Getting questions wrong on subjects you’ve already supposedly studied;
• Feeling like you need to just move on with your life;
• If you have to tell yourself, “don’t rush”;
• You aren’t excited to learn, but see it as a chore (you have little to no intrinsic motivation); or
• You focus on the number of questions you’re doing rather than the quality of your reviews

While not an exhaustive list, these are common signs people are rushing. As discussed above, rushing often leads to longer studying with lower scores.

Scarcity is More Condition than Mindset

Lifehacking articles often refer to a “scarcity mindset.” The implication is usually that you just need to change your way of thinking. They encourage us to “focus on gratitude” or abundance. However, while improving one’s mindset may help, you should address the core issue. You should remove time scarcity by giving yourself a more extended study period.

Remember, like the sugar cane farmer experiments, you can’t fault their “mentality.” The sugar cane farmers were the same people before and after being paid. The Princeton students were randomized. Furthermore, the two groups couldn’t have more different backgrounds. Yet the results of scarcity were remarkably similar.

So I’m Rushing – What Should I DO?

So what’s a busy, stressed out med student to do? Changing your mindset may help. (See more below). However, if at all possible, you should take more time to study. In fact, I’d argue you should delay your test for long enough that you STOP experiencing scarcity.

Sadly, most people don’t take enough time. They say, “well, I’ll see what happens in a month.” But because they are rushing, their score doesn’t improve. After the month, they delay for another month to “see what happens.” However, because they keep rushing, their scores still stagnate. Another delay ensues.

What will lead to a better score? Studying:

• 1 month in a rush, then another because you had to delay, then another, or
• Calmly studying for 3 months?

Note that delaying your test can be difficult. Schools are often reluctant to grant extra time to students. It is especially hard to get additional time when you are more than a month out. And what if you’ve been rushing for months, and so need more time? Schools will reasonably wonder why you need extra time if you’ve already studied for so long.

However, the literature on scarcity is clear. If you need more time, delaying sooner rather than later is better. And when you delay, you should give yourself enough time, so you stop rushing.

Concluding Thoughts: Focus On the Long-Term

If you can’t delay your test (or even if you can), what else can you do? Remember, many of the problems we face today are, in fact, the product of decisions we made in the past. Our cramming for prior midterms catches up to us eventually in the form of a weak foundation. Rushing through QBank questions causes us to repeat them again later.

Instead, act as if you have years to study. If Step 1 is in 2 months, begin your Step 2 CK prep now. Even better, prepare now to be the kind of doctor you want to be in 5-10 years. You will build the sort of foundation necessary to be an excellent physician later. Plus, you will likely paradoxically end up with even better scores than if you rushed/crammed.

What do you think? Are you or those around you rushing? Can you see the effects of time scarcity on your own studying? Let us know in the comments!

References and Further Reading:

• Walker, Matthew. Why We Sleep: Unlocking the Power of Sleep and Dreams. Scribner.
• Mullainathan, Sendhil. Scarcity. Henry Holt and Co.

Image credit: Christian Erfurt