Early in my Med School Tutors career, I was presented with a student who I knew would be a challenge for me. In reviewing his dossier, I learned that he had scored above 240 on Step 1, and was hitting this mark or better in his recent Step 2 CK NBMEs. Coming from a foreign medical school and desiring a US residency, he came to us to score as high as possible and maximize his chances. I looked through his UWorld blocks, only to see most scores above 80%. My normal approach, combing through a block or two, would normally generate plenty of material to go over in a two-hour session. But for him, the only incorrect questions were the most esoteric — questions that only ~20% of test-takers were answering correctly. What did I, a freshly-minted tutor, have to offer this student who clearly had it all figured out?

Here’s some simple considerations I’ve put together based upon the lessons that I’ve learned.  It will help in approaching a challenging situation such as this one, both for students and tutors. Utilizing these techniques will help ensure that your student is getting exactly what they need from your educational relationship.

1. Ask How You Can Help

How will you know exactly what they need from you? With most of the medical knowledge figured out, and the test-taking skills certainly up to par, what can you offer? The best way to find out how to serve your student well: Explicitly ask what they are looking for from you. Ask how you can be of greatest value to them in between now and their exam. Like the old clickbait adage, the answer might surprise you. Maybe your student wants nothing more than to maintain their knowledge between now and the test, and needs some extra structure to do so. Maybe they are starting to feel burnout creep in, and need someone experienced in handling it to tell them what’s the least amount of acceptable work. Perhaps they are comfortable with most of their medical knowledge, and are looking to gain that “next level deeper” understanding that can’t be picked up from the book or a lecture.

As teachers, it can feel humbling, even embarrassing, to ask a student what you can do to help them. You’re a tutor; shouldn’t you already have that part figured out? But a high-achieving student will likely have the insight to know where they stand, where they want to get to, and how you can help them get there. Swallow your pride and ask – it will be incredibly more beneficial to you both than guessing.

2. Challenge Yourself

Embrace the challenge! Like stoic philosopher Marcus Aurelius reminds us, “What stands in the way becomes the way.” This is the reason that you are a teacher: to help students in need no matter where they stand, and no matter what it takes. Having higher level discussions on medical concepts is usually more enjoyable than rehashing the Urea cycle for the 25th time. If anything, you will be able to provide greater value to students that have all of the conceptual framework figured out. You provide something that can’t be read off of a list in First Aid. Keep in mind that we are most effective and engaged when appropriately challenged, and a situation like this should provide the fuel to have you perform at your best.

3. Know your Limits and Communicate Them

It’s okay to say “I don’t know.” This is taking the high road when compared to misinforming a student who is counting on you. Even the most brilliant of physician-teachers cannot be expected to have every factoid of USMLE knowledge internalized. It is not your job to. The value that you provide comes from seeing the forest for the trees, and making the higher-level connections between concepts that a student would have trouble appreciating. Your student(s) will respect you for your honesty.

4. Be Flexible

Sessions with high performers should be more of a conversation and less of a didactic session. You should continually challenge your student in a way to push the limits of their knowledge base. Remember, you are not a mission to stump them and assert yourself by knowing something they don’t. But they will absolutely need to be pushed to the limit to get the most value from your relationship.

Your sessions will likely be more freeform as you uncover whatever small knowledge gaps that exist. Delve deep into these areas, and you will leave your student feeling more confident as the holes get plugged.  

5. See Yourself In Them

If you’ve made it to the point of teaching high-achieving students, you were almost certainly one yourself. Think back to those times, when you felt like you had most of it mastered but still needed a little something more to reach greatness. What was that something? Was it an objective third party who could hold you fully accountable? Or someone to affirm that you were approaching studying and preparation the right way? Maybe you had the necessary knowledge but had trouble applying it to boards-style questions. Every student will have different needs, and it is up to you to perform an assessment early on, and see exactly what you can offer.

Have confidence in yourself, and don’t become intimidated by a student of yours who is a cut above the rest. Be creative and find out how to add value to their preparations, and it will be a fruitful relationship for you both.