Comprehension monitoring helps medical students determine whether they are properly applying knowledge to material to be learned, evaluate whether they understand the material, decide whether their strategy is effective or whether a better strategy is needed and know why strategy use will improve learning. Self-questioning, rereading, checking consistencies and paraphrasing are monitoring processes.

Some textual material periodically provides medical students with questions about content. Students who answer the questions as they read the material are engaging in self-questioning. When questions are not provided, students need to generate their own.

Rereading is often accomplished in conjunction with self-questioning. When students cannot answer questions about the text or otherwise doubt their understanding, these cues prompt them to reread. Checking for consistencies involves determining whether the text is internally consistent, that is, whether parts of the text contradict others and whether conclusions that are drawn follow from what has been discussed. A belief that textual material is inconsistent serves as a cue for rereading to determine whether the author is inconsistent or whether the reader has failed to comprehend the content. Medical students who periodically stop and paraphrase material are checking their level of understanding. Being able to paraphrase is a cue that rereading is unnecessary.

Affective techniques for USMLE review create a favorable psychological climate for learning. These methods help one cope with anxiety, develop positive beliefs, set goals, establish a regular time and place for studying and minimize distractions.

Affective techniques help medical students to focus and maintain attention on important tasks in USMLE review, manage time effectively and minimize anxiety. Self-verbalization helps keep students' attention on the academic task. At the outset of an academic activity, medical students might think to themselves, "This might be tough. I need to pay close attention to the USMLE review speaker."

Goal setting is an effective time management strategy for USMLE review. Students who set overall learning goals and subdivide them into short-term goals are self-regulating their efforts by evaluating goal progress. In goal setting, students set time limits for accomplishing sub-goals. The belief that they are making progress instills in them self-efficacy for learning.

Anxiety about tests, grades and failures interferes with an effective USMLE review. Medical students who ruminate about potential USMLE failure waste time and strengthen doubts about their capabilities. Anxiety-reduction programs employ systematic desensitization, modeling and guided self-talk.

For students who have difficulty taking tests, a specific program to teach test-taking skills may prove beneficial. These programs typically teach medical students to subdivide the test, establish time limits for each part and not spend too long on any one question. To conquer negative thoughts while taking a test, medical students are taught relaxation techniques and ways to refocus attention on test items. Test performance and beliefs exert reciprocal effects. Experiencing some test success creates a sense of self-efficacy for performing well, which leads to more productive studying and better USMLE review and ultimate USMLE boards performance.