Studied for Hours and Still Struggled on the Exam? Change How You Study

Andrew Butler at Washington University in St. Louis tested whether practicing recall helps with exam questions a student has never seen. In four experiments, participants read short prose passages and then either reread them several times or took repeated tests on them. A week later they took a final test. Depending on the experiment, it repeated the practiced questions, asked new questions that required a conclusion about the same subject, or asked them to apply an idea to a different subject. In every version, the participants who had tested themselves did better than the participants who had reread (Butler, 2010). Michael Green and colleagues at Yale School of Medicine later reviewed 19 controlled studies in health professions education and reported the same pattern when learners had to use what they knew in clinical situations (Green et al., 2018).

If you have studied for days, felt ready, and then struggled on an exam or froze during a practical, these findings are worth considering. Both compared ways of studying, and in both, testing yourself did better than rereading.

Rereading makes material look familiar.

Passive studying means rereading your notes, highlighting the textbook, looking back over lecture slides, or rewatching a recorded lecture without stopping to test yourself. It feels easy, and it is tempting to return to it when the material gets harder.

The problem is that it can make you feel more prepared than you are. Rereading makes material look familiar, and familiarity is easy to mistake for knowing it. Recognizing something that is in front of you is much easier than producing it from memory when nothing is there to prompt you. On a written exam your notes are not there. On a lab practical, an instructor watches you perform a skill and may stop you to ask why you placed your hand where you did, or what you would do if the patient responded differently. The research behind this difference is covered in more detail in Stop Rereading and Start Retrieving.

Exams and practicals ask you to use what you know.

Many exam questions do not ask you to repeat a definition. They describe a situation and ask what you would do, what would happen next in a process, or which answer fits the scenario best. Licensing exams such as the NPTE are written this way. Recognizing a term you have seen before will not answer that kind of question, because you have to apply what you know to the situation in front of you. An internship, a clinical rotation or a job asks the same thing when someone expects you to explain your reasoning and adjust when a plan does not go as expected.

Butler’s experiments tested this directly, because in three of the four experiments the final test used new questions that required a conclusion or an application. The review by Green and colleagues covered practice in several forms, including short-answer questions, multiple-choice questions, simulations and sessions with standardized patients. Seven of the outcomes in those studies measured whether learners could apply their knowledge in a new situation, and practice testing led to better results than studying on all seven.

One of the studies in that area was conducted with physicians. Douglas Larsen, a physician in the Department of Neurology at Washington University in St. Louis, worked with Butler and Henry Roediger on a randomized trial with 40 pediatric and emergency medicine residents. After a teaching session on two neurological topics, each resident took short-answer tests with feedback on one topic and studied a review sheet on the other, three times over several weeks. About six months later, the residents scored an average of 39% on the topic they had been tested on and 26% on the topic they had reviewed (Larsen et al., 2009).

Testing yourself shows you the gaps while you can still fix them.

The value of active studying is that it shows you what you do not know while you still have time to do something about it. If you close your notes and try to list four items from a list but can only remember two, you have learned something useful: that topic needs more work. You can check the list, review the material, and try again later without looking. In the studies described here, practicing recall and then checking the answer led to better results than rereading.

Checking the answer is part of what helps. Butler and Roediger had participants read passages and take a multiple-choice test, and then gave some of them the correct answers right away, some later, and some not at all. On a later test, the participants who saw the correct answers recalled more of them, and they were less likely to repeat a wrong answer they had chosen on the multiple-choice test (Butler & Roediger, 2008). A practice question you get wrong helps you most when you go back and find out why the correct answer is correct.

Rereading still has a place.

Passive review is reasonable in a few situations. These are practical judgments rather than research findings.

• When you are seeing material for the first time, reading the chapter before class makes sense, because you cannot test yourself on something you have never learned.
• After you miss a practice question, rereading the explanation is how you find out why the correct answer is correct.
• Before you practice a clinical skill, watching a demonstration video can help you see the order of the steps.
• Late at night, when you are too tired to do anything more demanding, looking over your notes is better than doing nothing.

These uses are reasonable as long as most of your study time goes to testing yourself.

Ways to test yourself.

• When a lecture ends, close your notes and write down everything you can remember. Then compare what you wrote with your notes and mark what you left out.
• If you use flashcards, say the answer out loud before you flip the card. If you only read the front and flip it over, the cards are doing little for you.
• Answer practice questions before you look anything up. For every question you get wrong, find out why the correct answer is correct. If your course has too few practice questions, ask your instructor whether they have more or can point you to some.
• Explain a concept or a procedure out loud in as much detail as you can recall, either to a classmate or to yourself. If you have no one to study with, record yourself on video, watch it back, and note what you left out. You can also give the recording to an AI tool and ask it to point out what is missing or wrong before you try again.

Active studying is harder and less comfortable than rereading, because you will see your mistakes more often. That is the purpose of it, since a mistake you find before the exam is one you still have time to correct.

The one thing to do.

This week, choose one topic you would normally reread and test yourself on it with your notes closed instead. Write down what you can recall, check it against your notes, and test yourself on the gaps again two days later.

My book Learn, Book 4 of The Mastery Series, sets out these methods in more detail. It includes the Recall Practice Card, for questions written from your own material and answered from memory, and the Missed-Question Log, for the practice questions you miss. Learn is available now on Kindle and in paperback. See Learn on Amazon.

What this does not show.

Butler’s experiments were laboratory studies with short reading passages and a one-week delay. The trial by Larsen and colleagues included 40 physicians in residency, not students in a PTA, nursing or other health professions program, and it measured how much the residents remembered, not how well they applied it. In that trial the tested residents also received feedback, so the result reflects testing and feedback together. The review by Green and colleagues covered 19 studies, and only seven of its outcomes measured whether learners could apply their knowledge.

None of these studies shows that active studying guarantees a passing grade. It also cannot make up for a schedule with no time to study, or a course whose expectations were never explained to you. If either of those is the problem, talk with your instructor or your advisor about it. If you are putting in the hours and your scores do not reflect them, look at how those hours are spent: how much of the time you were testing yourself, and how much you were rereading.