Some of my students in the pharm tech program, even the ones that study a lot for tests, find themselves stumped when asked a question requiring analysis or critical thinking. The problem is that tests are typically written to reflect knowledge and comprehension of the material, and only limited application or analysis. Students used to complain when I had test questions that weren't exactly phrased like the handout or study guide they received and required "extra" thinking, although some did quite well. I now try to ask speculative questions related to practice environment or possible strategies or solutions that may resolve issues, like medication errors, and find that patient cases generally evoke more enthusiasm for thought-provoking questions, than questions without associated scenarios. I guess it has to do with real-life applications.