Mastering Board Prep with the REACT Framework

Maya Brooks

Hi everyone! Welcome to the AI Med Tutor Podcast. In today's episode, we're gonna be breaking down how you can get the most outta the time you spend reviewing practice questions, delving into the REACT framework for efficient, effective review so you can get the most out of your precious board prep study time.

Maya Brooks

I'm Maya Brooks, an AI-generated avatar of a 4th-year medical student created to assist with podcasting.

Dr. Randy Clinch

And I'm Dr. Randy Clinch. I'm a DO family physician and medical educator.

Maya Brooks

Look, we know you're putting in the work, you've got your UWorld subscription, maybe AMBOSS, True Learn. You're definitely grinding through those question blocks, hours and hours of it,

Dr. Randy Clinch

Hundreds, maybe thousands of questions.

Maya Brooks

Exactly. But here's the thing we hear all the time. You're answering questions, putting in serious effort, but those scores. They just aren't budging the way you want it feels, overwhelming. Maybe a bit like you're stuck.

Dr. Randy Clinch

And that feeling, it's actually unfortunately backed up by some pretty solid research. We looked into how med students typically handle board prep Q-bank review, and it's kind of startling.

Maya Brooks

How startling?

Dr. Randy Clinch

Over 80% of students are using review methods that are frankly inefficient and ineffective. They're putting in the time, the raw hours are there, but they're not getting the score improvements they should be.

Maya Brooks

Over 80%. Wow. Okay. So what's the single biggest mistake you see people making? Where does it go wrong?

Dr. Randy Clinch

I think the core issue really is focusing almost entirely on quantity. How many questions can I finish today? How fast can I get through this block?

Maya Brooks

And then spending what, maybe a few minutes, just glancing at the answer?

Dr. Randy Clinch

Or even seconds. That's the fundamental misunderstanding. Look, the high scorers, the people who really crush these exams, they get it. The real learning, the skill development that actually translates on test day - that happens during the review.

Maya Brooks

Not when you're just clicking an answer choice.

Dr. Randy Clinch

Exactly. It's not about passively recognizing something you just saw. It's about active analysis. So this whole deep dive today, it's about giving you a system to shift from that quick glance to, really analytical learning.

Maya Brooks

Okay, let's get into it then. Before we talk about the solution, maybe we should diagnose the problem first. Pinpoint those bad habits that are, costing people points. What are the big traps?

Dr. Randy Clinch

Good idea. We've identified five main ones that really sabotage study time. And number one, the absolute most common one is something we call the passive skim through.

Maya Brooks

Okay - Passive skim through. Paint a picture for me.

Dr. Randy Clinch

You know how it goes. You get a question wrong. There's that little sting,

Maya Brooks

Yep. Annoying.

Dr. Randy Clinch

So you scroll down, you read maybe the first sentence of the explanation. You'd see the buzzword you missed and you think, oh, right. Knew that. Just missed that one detail and then...

Maya Brooks

On to the next question. Got it. Keep moving.

Dr. Randy Clinch

Precisely. And why does that feel okay, but actually fail you?

Maya Brooks

Tell me.

Dr. Randy Clinch

Because it's all about short-term recognition. Your brain hasn't actually grappled with the error. You see the right answer and think, that makes sense now. But you haven't processed why your first thought process - your initial logic - was wrong.

Maya Brooks

So you haven't fixed the underlying issue.

Dr. Randy Clinch

Exactly. You haven't done the cognitive work to prevent making that same mistake again. When the pressure's on, you're basically doomed to repeat it.

Maya Brooks

That makes sense. What's the second trap? You said there were five right?

Dr. Randy Clinch

Number two is almost the flip side, but just as bad: information overload and explanation, burnout. Think about those super detailed explanations like in UWORLD sometimes.

Maya Brooks

Multiple diagrams, charts, deep dives into biochemistry.

Dr. Randy Clinch

Exactly. And the trap is feeling like you have to memorize every single word, every diagram, every footnote. It's like trying to drink from a fire hose. You just get overwhelmed.

Maya Brooks

Totally.

Dr. Randy Clinch

It's cognitive overload. Your brain literally cannot, cannot sort the crucial high-yield takeaway from all the surrounding, secondary details. So what happens? You don't retain much of anything effectively.

Maya Brooks

So skimming is bad. But trying to memorize everything is also bad. Tricky balance. What's trap number three?

Dr. Randy Clinch

Trap three feeds right into this, and the research suggests it may be involved in over 50% of medical licensing exam questions: the cueing and recognition illusion.

Maya Brooks

Cueing, illusion. What do you mean by that?

Dr. Randy Clinch

After you've done tons of questions, you start to, recognize patterns. You see certain symptoms together, maybe a lab value, and you jump to an answer based on that familiar pattern.

Maya Brooks

Like seeing the buzzwords.

Dr. Randy Clinch

Exactly. You're relying on the buzzwords, the classic presentation cues rather than truly understanding the underlying mechanism or pathology.

Maya Brooks

But isn't recognizing patterns part of clinical reasoning? Don't doctors do that?

Dr. Randy Clinch

Yes, but there's a crucial difference. Experts use patterns flexibly. This trap is about rigid cue reliance. It builds false confidence because the people writing the board exams, they know these cues.

Maya Brooks

Ah, so they'll deliberately twist them.

Dr. Randy Clinch

Precisely. They'll give you a novel presentation or two diseases that share most of the cues, but differ on one key finding. If you're just relying on those superficial cues, your knowledge isn't flexible enough and you'll get caught up.

Maya Brooks

That's a subtle but important one. Trap number four.

Dr. Randy Clinch

This one might hit close to home for a lot of listeners. Score obsession and fear of being wrong. It's focusing laser-like on that percentage correct for each block.

Maya Brooks

Everyone wants to see that percentage go up.

Dr. Randy Clinch

Of course. But when that becomes the only focus, it leads to bad behavior. Like you might start avoiding topics you find hard because you know they'll drag your score down

Maya Brooks

Or maybe switching to tutor mode on easy questions just to feel better.

Dr. Randy Clinch

Exactly. And that completely misses the point of the question bank. At this stage, it's not your final assessment, it's a learning tool. Its job is to find your weaknesses so you can fix them.

Maya Brooks

Avoiding the hard stuff is basically self-sabotage.

Dr. Randy Clinch

Totally. You're hiding from the very things you need to work on most. It feels safer in the short term, but it's terrible for your actual board score.

Maya Brooks

One trap left. Number five.

Dr. Randy Clinch

This one seems kind of innocent, but it's a missed opportunity. Reviewing only your incorrect questions.

Maya Brooks

Wait. Why is that bad? Isn't that efficient? Focusing on what you got wrong.

Dr. Randy Clinch

It seems efficient. But think about the questions you guessed on and got lucky. Or the ones you got, right, but maybe your reasoning wasn't quite solid.

Maya Brooks

Ah, so you got the right answer for the wrong reason.

Dr. Randy Clinch

Exactly. If you only review the ones marked red, you never reinforce the correct thinking for the ones you got right as a fluke. And you might have subtle misunderstandings or knowledge gaps that just stay hidden because you happened to click the right bubble.

Maya Brooks

So you're missing chances to solidify the good stuff and uncover hidden weaknesses.

Dr. Randy Clinch

Precisely. Every single question, right or wrong, flagged or not, is a potential learning goldmine. You need to treat it that way.

Maya Brooks

Those five traps - the passive skim, the overload, the cueing illusion, score obsession, and only reviewing incorrects - they definitely sound like ways to spin your wheels. So if that's the problem. What's the fix? How do we review effectively?

Dr. Randy Clinch

That's where the structure comes in. We need a systematic way to approach review to make sure we're extracting maximum value. And that's the "REACT" framework.

Maya Brooks

R-E-A-C-T. Sounds like an action plan.

Dr. Randy Clinch

It is. It's a five step process, R-E-A-C-T, designed specifically to combat those traps and make your review time incredibly high-yield. For every single question.

Dr. Randy Clinch

And before we break down, REACT, let's set expectations on time. This isn't about saving time during review, it's about making that time count. Experts generally recommend spending two, even two and a half times as long reviewing a block as you spent answering it.

Maya Brooks

Two to two and a half times. Wow! That's a significant commitment.

Dr. Randy Clinch

It is. But REACT tells you exactly how to use that time effectively. So it's not staring blankly at explanations, it's targeted active learning.

Maya Brooks

Let's dive into the steps. R-E-A-C-T. What's the "R"?

Dr. Randy Clinch

R is for "Review the question and recommit to an answer".

Maya Brooks

Recommit, even if I answered it?

Dr. Randy Clinch

Yes. This is crucial. Before you look at the explanation or the correct answer, cover it up. Reread the entire vignette - the question, stem all the answer choices - and force yourself. Pick an answer again.

Maya Brooks

Now, why do that? Isn't that redundant?

Dr. Randy Clinch

It forces you into an analytical mindset without the bias of knowing the right answer yet. You have to evaluate the clinical data neutrally. You have to really think about your initial reasoning. What specifically made you pick your first answer? Where might the flaw have been?

Maya Brooks

Interesting. So you analyze your own thought process first. Then what's "E"?

Dr. Randy Clinch

"E" is for "Evaluate the answer choices". Yours and theirs. Now you uncover the correct answer. If you got it right this time, don't move on. Articulate out loud or in writing exactly why your choice is correct and why the other main options are wrong. Do this before you read their explanation,

Maya Brooks

And if you got it wrong?

Dr. Randy Clinch

Then you diagnose your error. Pinpoint it. Was it a knowledge gap? Did you misread the stem, misinterpret a lab value? Get tricked by a distractor? You have to identify the precise failure point.

Maya Brooks

Ah, so this is the direct antidote to that passive skim through. You're forcing yourself to confront the "why".

Dr. Randy Clinch

Exactly. This self-diagnosis step is the single most important predictor of not making that same mistake again. You're actively fixing the faulty logic.

Maya Brooks

Makes sense. So "R" is recommit. "E" is evaluate. What's "A"?

Dr. Randy Clinch

"A" is for "analyze the explanations, correct and incorrect". Now you read the official explanation for the correct answer, but here's the key. Don't try to memorize everything. Identify the single most important takeaway, the key learning point. Filter out the noise.

Maya Brooks

Just one main point.

Dr. Randy Clinch

Yes, crystallize it. But then - and this is critical for building that flexible knowledge and beating the cueing illusion - you must read the explanations for the top two or three incorrect distractors.

Maya Brooks

Why focus on the wrong answers?

Dr. Randy Clinch

Because you need to understand why they're tempting, but ultimately wrong in the context of this specific patient. Why isn't it Addison's in this Cushing scenario? What subtle feature rules it out?

Maya Brooks

So it helps build your differential diagnosis skill.

Dr. Randy Clinch

Precisely. You learn the nuances, the subtle distinctions between similar conditions. That's advanced clinical reasoning, and that's what the boards test heavily. You're not just learning about one disease, you're learning how it fits within its neighborhood of related conditions.

Maya Brooks

Okay. "R-E-A". What's "C"?

Dr. Randy Clinch

"C" is "Connect to your knowledge base". This is vital. Don't let this question and its learning point exist in a digital silo on your Q-Bank interface.

Maya Brooks

What do you mean?

Dr. Randy Clinch

Take that key learning point you identified and immediately link it back to your core study materials. Open First Aid to that page. Find it in Pathoma. Yes, look at your own notes. Even do a quick Up-To-Date or OpenEvidence search if needed.

Maya Brooks

So you're integrating the new piece of information into your existing mental framework.

Dr. Randy Clinch

Exactly. You're weaving it in. It stops being an isolated factoid from question 1,210 and becomes part of your integrated understanding of, say, endocrinology. That makes the knowledge more durable and accessible.

Maya Brooks

Right. Connecting the dots. That leaves "T". What's the final step?

Dr. Randy Clinch

"T" is for "test with active recall". This is where you lock in the learning for the long term. Based on that key learning point. You create one flashcard, in Anki or TrueLearn, or even a physical one.

Maya Brooks

Okay, make a flashcard, but what kind?

Dr. Randy Clinch

Not just copy and pasting the explanation; that's passive. You need to formulate it as a new, concise question that tests the core concept you just learned. It forces your brain to retrieve the information later.

Maya Brooks

Can you give an example?

Dr. Randy Clinch

Sure. Let's say the question was about Cushing syndrome. Instead of a card saying, "Cushing syndrome is caused by excess cortisol", you might make two simpler cards. "What is the most common cause of Cushing syndrome?" "Answer: Exogenous steroids". Or, "What's the best initial screening test for Cushing's?" "Answer: late-night salivary cortisol, 24-hour urine free cortisol, or the 1-mg overnight dexamethasone suppression test".

Maya Brooks

So you're breaking it down and forcing yourself to recall specific high-yield points later.

Dr. Randy Clinch

Exactly. You're leveraging active recall and spaced repetition. The most evidence-based learning techniques we have to ensure that knowledge actually sticks.

Maya Brooks

R-E-A-C-T. Review and recommit. Evaluate choices. Analyze explanations, including distractors. Connect to your base. Test with active recall.

Dr. Randy Clinch

Great summary. Can we walk through a quick example to see it in action?

Maya Brooks

Absolutely. Let's use a classic case, hypothyroidism.

Dr. Randy Clinch

Imagine the vignette, 45-year-old woman. She's got fatigue, maybe some weight gain, constipation. She feels cold all the time. On exam, her face looks a bit puffy, skin is dry, and her reflexes, they're slow on the return phase. Delayed deep tendon reflexes.

Maya Brooks

Classic hypothyroidism symptoms

Dr. Randy Clinch

Textbook. And the question asks, "What are the expected lab findings for TSH and free T-4?"

Maya Brooks

Right? And let's say the student initially maybe rushed and picked, answer A: "High TSH, high free T-4", but the correct answer is actually B: "High TSH, low free T-4".

Dr. Randy Clinch

Perfect setup. So the student starts the review, step "R", review and recommit. They cover the explanation. They reread the vignette. Fatigue, weight gain, cold, slow reflexes. This screams hypothyroidism,

Maya Brooks

Right - the gland isn't working.

Dr. Randy Clinch

So if the thyroid gland isn't working free T-4 should be low. And if T-4 is low, the pituitary should be yelling at the gland. So TSH should be...

Maya Brooks

High TSH, low T-4. That's answer "B".

Dr. Randy Clinch

Exactly. So they recommit to B. Now step "E", evaluate. They confirm "B" is correct. They identify their initial mistake with choice "A" as a fundamental misunderstanding of the HPT axis. Negative feedback loop failure point identified. Knowledge gap in physiology.

Maya Brooks

Diagnosis done. Now, "A".

Dr. Randy Clinch

"A": analyze. They read the explanation for answer choice "B". Confirming primary hypothyroidism gland failure leads to high TSH trying to stimulate it. Key takeaway, primary gland failure, low product, high stimulating hormone. But then, the crucial part, analyze the distractors.

Maya Brooks

Like answer "A" that they picked first, right?

Dr. Randy Clinch

Analyze a high TSH, high T-4. The explanation says this pattern indicates a rare TSH-secreting pituitary adenoma, secondary hyperthyroidism. Then analyze "C": low TSH, high T-4. Ah, that's primary hyperthyroidism, like Grave's disease. Thyroid is overactive, so it suppresses TSH.

Maya Brooks

Wow. So analyzing those wrong answers suddenly clarifies three different thyroid pathway problems. Not just the one in the question.

Dr. Randy Clinch

Exactly. It builds that differential. Next "C", Connect. The student flips open First Aid or their notes to the endocrine section. They look at the HPT axis diagram. They review the tables comparing hypo- and hyperthyroidism labs side by side, reinforcing those three patterns they just dissected.

Maya Brooks

Connecting it back to the big picture. Makes sense. And finally, "T".

Dr. Randy Clinch

Test. They make two quick flash cards. Card one: Question: "lab pattern in primary hypothyroidism - a high TSH, low free T-4". Card two: Question: "lab pattern in TSH-secreting pituitary adenoma - a high TSH, high free T-4."

Maya Brooks

Simple direct recall questions based on the core distinctions they just learned.

Dr. Randy Clinch

Perfect. And now that one initially incorrect question hasn't just been reviewed, it's been transformed into a deep learning opportunity covering physiology, pathology, and differential diagnosis. That knowledge is far more likely to stick.

Maya Brooks

That really illustrates the difference. It's much more involved than just seeing the right answer and moving on.

Dr. Randy Clinch

It absolutely is, and that's the whole point. the takeaway message for everyone listening should be this. Your board score isn't determined by how many questions you do. It's determined by the quality and the depth of your review.

Maya Brooks

It's about working smarter, not just harder, during that review time.

Dr. Randy Clinch

Precisely. Ditch those passive traps. We talked about the skimming, the burnout, the cue reliance, the score obsession, ignoring correct answers. Instead, embrace a system like R-E-A-C-T.

Maya Brooks

See mistakes not as failures, but as opportunities.

Dr. Randy Clinch

Exactly. Gifts of knowledge waiting to be unwrapped. Analyze them systematically with REACT, connect them back to your foundational knowledge, and then test yourself using active recall. That is the proven path to actually mastering this material, not just recognizing it.

Maya Brooks

That's a powerful shift in perspective. So if you're ready to start making that shift, transform your study habits and really apply the REACT framework,

Dr. Randy Clinch

Thank you so much for listening to this episode of the AI Med Tutor Podcast. We look forward to seeing you in the next episode. Until then, stay curious and keep learning!