Medical Student Study Habits: Practice Questions Help Exam Scores

Sharon L. Wenger, Gerald R. Hobbs, H. James Williams, Michael A. Hays & Barbara S. Ducatman

West Virginia University
Morgantown, West Virginia 265-6-9230, USA



Second year medical students were surveyed to determine what resources best helped them study for pathology exams. The list included attending lecture, listening and viewing recorded lectures posted to the internet, reading textbook or high yield review books and reviewing posted practice quiz or published practice clinical vignette questions. Students were asked to rank these items relative to time spent utilizing these resources for studying. Fifty one percent of students in the class responded. Students who indicated they spent more time using a practice exam question book did significantly better (p=0.007) on exams than those who did not use this resource. Students who indicated they relied more on audio-recorded lectures than actual attendance of lectures did not do as well on exams (p=0.056. Our results indicate that utilization of clinical vignette exam questions helped students the most for learning and understanding material.


Medical school teaching practices have evolved over the past decade from static ‘kodachrome’ slide presentations to PowerPoint presentations, followed by voiced-over PowerPoint lectures, which are posted on a course Web site for students to review. Since each medical student in our program must now purchase a laptop computer, all have access to the Web site. The second year medical school course directors at West Virginia University have noted over the past few years that lecture attendance in the second year has been decreasing. About 70 to 75% of second year students attend lectures at the beginning of the fall semester, diminishing during the second semester with poor attendance at lectures the day before or day of an exam, to as few as 5% of the class. We asked our second year medical students to fill out questionnaires ranking resources by the amount of time each was used to study for pathology exams.


This study was approved by the Institutional Review Board of Health Sciences Center at West Virginia University. Cover letters and questionnaires were sent out to 107 students in the second year medical school class of West Virginia University near the end of the school year. The survey asked students to rank study resources they used to study for pathology exams. Items included lecture attendance, viewing of recorded lectures, use of textbook1, practice with USMLE style questions2, quiz questions posted online, interactive case studies [CD-ROM] 1, attendance of review sessions, review books and other resources (Table 1). Returned surveys were linked to student cumulative score and then the student name was removed from the data base. Bivariate fit analysis was used to compare utilization of study sources with final exam scores.


Responses were received from 55 of 107 (51%) students. Results were tabulated for ranking of resources by time of student use. Those students who spent more time using the review book containing clinical vignette questions2 did significantly better (p=0.007 than other students. Students who relied more on audio-recorded lectures than attendance of lectures showed a negative correlation with exam scores (p=0.056 although not statistically significant. Similar trends were seen when these two items were compared to scores on the NBME pathology subject exam, but again, this was not statistically significant (data not shown).

Other items including lecture attendance, utilization of textbook , use of practice questions from various sources, use of study companion interactive material available on disk , attendance of review sessions prior to exam and use of any high yield review books were not significantly different (Table 1).1 Several students used other review books, most commonly Rapid Review Pathology.3 Nine students who mentioned using Goljan had a mean score on class exams that was 3 points higher on the average than the mean for the class; this was not statistically significant due to the small numbers for comparison.

Several students made comments regarding their attendance of lectures. Lectures by faculty who were very understandable in lecture were well attended while those by lecturers who were difficult to follow or had excessive information were poorly attended.


A recently published study monitoring lecture attendance identified that almost 60% of students regularly attended lectures, whereas 30% used recorded lectures exclusively.4 The most common reasons given for attending live lectures are lack of motivation to watch recorded lectures, professionalism and respect of the instructor, interact with classmates and better value for tuition money. The majority of students viewing recorded lectures used video-accelerating technologies to save time. The students used the time saved to study other material, rest or sleep in, or pause recorded lectures to take notes.4 Several of our students mentioned saving time by speeding up the audio to almost twice the normal speed.

In another study, 83% of a medical school class indicated that lecture attendance was determined on a case-by-case basis which related to previous experiences with the lecturer.5 Students would be more likely to attend lectures if the lecturer provided understandable explanations and concepts rather than merely listing facts and integrating information.5 Availability of electronic material did not affect the decision to attend lectures for 90% of these students.5 Our students made similar comments, indicating that for lecturers who just read from their PowerPoint presentations or who covered a dense amount of material, the students’ time was better spent viewing recorded lectures rather than attending the lectures.

In another study 64% of students used recorded lectures to review for exams.6 Viewing occurred most often from home during weekends and immediately prior to examinations. Students who more frequently accessed recorded lectures had significantly (p<0.002) lower exam scores.6 These results are similar to our findings which showed that, although not statistically significant, students who relied more on the recorded lectures did not do as well as those who attended live lectures (average of 3 percentage points lower). We can hypothesize that the students who attend lecture spend more time overall on their studies than do students who simply review lectures at home. Alternatively, some of the discussion before, during or after class may stimulate learning or several adult learning styles may be facilitated by in-class lectures, including nonverbal cues that are not available to students who only review lectures online.

In one study, students rated lecture format more highly than watching closed-circuit television for the same lecture material, although exam scores were similar.7 By comparison, in a randomized trial, those students who viewed live lectures performed similarly on exams as those who accessed a recorded lecture online.8 With randomization of live versus online lectures, students on clerkship performed similarly on the exam. However, students relying on online resources required less time to complete the lecture.9

Last year Pilarski and colleagues published a positive response of 1st year medical students to recorded lectures.10 These students felt that the recorded lectures helped them learn the material, reduce stress and anxiety, and did not affect classroom attendance.10 For our second year class, posting of recorded lectures does appear to affect classroom attendance. While students have many different ways to study, which includes reading the text book, students can perform well on examinations using high yield review books and practice exam questions as resources. Students who used practice clinical vignette-type questions on average scored 5 points higher than the class average, which was statistically significant (p=0.007). Students who utilized recorded lectures over other resources overall scored 2.9 points lower than the class average (p=0.056). Our survey demonstrates that the use of resources other than lecture material may help students learn the information and, in particular, practice questions helped to reinforce the material.


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