Related Posts:

• Advice for the . . . → Read More: Congratulations Lilibeth, USMLE Step 1 Score 206]]> I would like to congratulate Lilibeth for passing the USMLE Step 1 with a score of 206  which she took last October 28,2011. Lilibeth is a member of Askdoc’s USMLE Step 1 Prep Course. We wish her well as she prepare for the USMLE Step 2CK.

Related Posts:

• Advice for the Old IMG taking the USMLE

• Why You Need Three Phases in USMLE Prep – I

• Is the USMLE getting tougher every year?

• What to Do on the Day of the USMLE Exam

• Other AskDoc Student’s who Passed the USMLE

I would like to congratulate Masuma for passing the USMLE Step 1 with a score of 99/230  which she took last July, 2011. Masuma is a member of the April, 2009 batch of Askdoc’s USMLE Step 1 Prep Course. This was a long and arduous process for her and her score is well . . . → Read More: Congratulations, Masuma. USMLE Step 1 Score 99/230]]>

I would like to congratulate Masuma for passing the USMLE Step 1 with a score of 99/230  which she took last July, 2011. Masuma is a member of the April, 2009 batch of Askdoc’s USMLE Step 1 Prep Course. This was a long and arduous process for her and her score is well deserved. We wish her continued success in the future.

Related Posts:

• How to Score 99′s in the USMLE

• The Key to Getting a 99 in the USMLE

• Can I get a 99 in the USMLE?

• Mastery, Know and Familiar applied to USMLE review
• Concept of Mastery, Know and Familiar in USMLE content
• What to Do on the Day of the USMLE Exam
• Other AskDoc USMLE Students who passed the USMLE Exam

For most people, preparing for an exam involves learning the material tested in the exam. After doing so, they feel that is enough for them to do well in the examination. For most short quizzes and even shelf exams, that is usually enough. But for examinations like the USMLE, it calls for a . . . → Read More: Why You Need Three Phases in USMLE Prep – I]]>

For most people, preparing for an exam involves learning the material tested in the exam. After doing so, they feel that is enough for them to do well in the examination. For most short quizzes and even shelf exams, that is usually enough. But for examinations like the USMLE, it calls for a different, more thorough approach.

There are people who can study for the USMLE the same way they have always studied and do well. The main reason is that these people already have good study habits and skills which they just carry on into their USMLE prep. They usually do very well in medical school due to these same skills. However, study habits and skills good enough for medical school will be inadequate because of the unique requirements of the USMLE.

The USMLE is different from all other exams for the following reasons

1. It’s coverage is very broad.
2. It’s a very long exam.
3. It’s a very clinical exam.
4. It’s a time-pressured exam.
5. It’s all or nothing

Let’s go over them in detail

The USMLE has Very Broad Coverage

Unlike most examinations we commonly encounter in medical school including shelf exams, the USMLE covers a lot of materials. For example, when you have a shelf exam for anatomy, you only need to remember anatomy until you finished the exam. Then you can start forgetting it while you prepare for the Physiology shelf exam.

In the USMLE Step 1, you need to know all 7 subjects at the same time and you need to be able to retain and recall all that information on the day of the examination. Therefore, it requires additional preparation in order to do well compared to the usual exams we encountered before.

The USMLE is a Very Long Exam

The USMLE Step 1 is 7 hours long with a 1 hour break totalling 8 hours. The USMLE Step 2 CK is  8 hours long with a 1-hour break totalling 9 hours. USMLE Step 3 covers 2 whole days. The most important problem you need to address here is fatigue. Believe me, by the time you hit the 5th block, your head refuses to work. You need to reread questions. You can’t think straight and it takes longer just to think of the answer.

The USMLE is a Very Clinical Exam

Lately, the USMLE has become more and more clinical, with over 50% of the questions in Clinical Vignette format. This adds a level of complexity to the exam which can impact negatively anyone unprepared for it. Therefore there is a need to make sure you can diagnose clinical cases even in USMLE Step 1 which is primarily Basic Sciences.

The USMLE is a Time Pressured Exam

The questions are long and you need to analyze the questions well before you can answer them. A lot of the questions require two to three step thinking which lengthens the amount of time you need to answer the questions properly. Therefore one of the biggest problems examinees have is finishing the exam within the time period provided. There is a need to take this into account during your USMLE prep and not just during the exam

The USMLE is All or Nothing

For the purpose of the USMLE, if you cannot answer the question, usually in about a minute, then you do not know it. It does not care if you forgot it. It does not care if you can’t just recall it. It does not care if you run out of time. If you can’t answer it, you don’t know it and you don’t get partial points. In medical school, we are used to being graded over our performance for the full semester or year. The USMLE does not care how much time you spent studying, how many sleepless nights you have gone through, nor how may questions you have practiced on. If you can’t answer it, you don’t know it. So again, there is a need to study a certain way to ensure you can answer those questions when the time comes.

We will continue discussion of the three phases of USMLE Prep on future posts.

Related Posts:

• Why You Need to Master the USMLE Step 1

• NBME Self Assessment Tests and USMLE Review

• How to Create a Study Plan for the USMLE

• Answering USMLE Type Questions – Part II

• Guide to Self-Evaluation in USMLE Prep

When I started thinking about taking on the USMLE way back in last quarter of 2004, I would scour through all the forums. Trying to find any information I can get on how to tackle this difficult exam. I would pay special attention to the postings on exam experience. And whenever I see . . . → Read More: How to Score 99′s in the USMLE]]>

When I started thinking about taking on the USMLE way back in last quarter of 2004, I would scour through all the forums. Trying to find any information I can get on how to tackle this difficult exam. I would pay special attention to the postings on exam experience. And whenever I see someone posting that they got a 99, I will read it avidly, desperate to find out how it is done and wishing that it was me.

However, it wasn’t long before I notice that everyone was reviewing the same materials. Kaplan notes, FA, Kaplan and UW Qbank, Goljan notes and yet the results range from failing to high 99′s. So it wasn’t the materials that they were using that is the key to scoring 99 although it makes sense that they should be important.

So I did my own research on what it would take to get a high score. I went through various study materials available. I devised specific approach to each study material to maximize my ability to retain and recall the information in them. I tried to apply what I know about good study methods for maximum retention and recall.

I took my USMLE Step 1 Examination in April 2006 and scored a 99/256. I took my USMLE Step 2 CK in November, 2006 and scored a 99/258. So I finally made it. I have now proven that my system works for me. The test is will it work for other people.

I had written extensively of how I did my review in the forums, especially at www.prep4usmle.com. And a lot of people have sought my advise. Although not everyone got a 99 there were a few who told me that they got a 99 by following my advise.

That is why I am starting this series of blog posts on how to get a 99. Now don’t get me wrong. Not everyone can get a 99. Obviously limitations on intelligence, reading speed and memory capacity will limit the maximum score you can get. But a lot of people who failed to get 99′s could have gotten them. And the difference lies mostly in how they studied rather than in what they studied.

Therefore, I hope you will follow me on this journey of discovery. On how to learn more effectively and efficiently. And how to get the best score possible in the USMLE

The Series so far:

Can I get a 99 in the USMLE?

The Key to Getting a 99 in the USMLE.

Hi. I’m Mike, otherwise known as Askdoc. Some of you may already know my story. For those who don’t, well, I am a very old IMG, graduated way back in 1989. I took the USMLE Step 1 in April, 2006 and scored a 99/256 and USMLE Step 2 CK in November, 2006 and . . . → Read More: Advice for the Old IMG taking the USMLE]]>

Hi. I’m Mike, otherwise known as Askdoc. Some of you may already know my story. For those who don’t, well, I am a very old IMG, graduated way back in 1989. I took the USMLE Step 1 in April, 2006 and scored a 99/256 and USMLE Step 2 CK in November, 2006 and scored a 99/258. Subsequently I took USMLE Step 2 CS in March, 2007 and passed. Lastly I took USMLE Step 3 in August, 2007 and scored a 90/219.

I know what it is like to be an old IMG, about to take the plunge into this challenging exam called the USMLE. I know about all the naysayers, who say that you are too old. Even if you pass, how can you match with a low score. I know about the anxiety, the fear of not being able to make the grade and to fail.

Therefore, I have decided to start a series of posts advising Old IMG’s on how to tackle the USMLE. How to evaluate what they need to do in order to be able to do well in this series of exam. Don’t get me wrong. The challenges for an Old IMG in taking the USMLE exam is enormous. But it is not insurmountable.

With patience, determination and proper study methodology, you can pass the USMLE exam. Some of you may also be able to ace it. So see you as we go on this journey of discovery and feel free to write me if you want me to write about a particular topic.

The Series so far:

• Common Problems Faced by the Old IMG in USMLE Prep.
• Am I too Old to Take the USMLE?
  

It’s been over a year since I first published “NBME Self-assessment Tests and USMLE Review.” Little did I know it will become the most popular of my post with over 14,000 pageviews in the past year. Since that time a lot of things have changed, hence this update.

If you have not read . . . → Read More: NBME Self-assessment Tests and USMLE Review – An Update]]>

It’s been over a year since I first published “NBME Self-assessment Tests and USMLE Review.” Little did I know it will become the most popular of my post with over 14,000 pageviews in the past year. Since that time a lot of things have changed, hence this update.

If you have not read the previous two posts on this topic, please do so as I will not be repeating what I have said there in this post. You can access Part 1 here and Part 2 here.

How well does NBME predict your USMLE Score?

That has been the number one question asked of me since I wrote about this topic. My answer is still the same. Fairly well. Although correlation is never 100% more like 70 to 80%. However, certain development in the past few years have made the assessment tests less reliable for some people.

One of the reasons for this problem is that a lot of NBME questions, especially the earlier forms of step 1 have been discussed extensively in various forums. What’s more some of these posters did not even bother to warn people that what they are discussing are NBME form questions. Going into the NBME assessment tests knowing some of the answers already can invalidate the predictability of those assessment tests. In fact just knowing some of the questions beforehand can also invalidate the results. The reason is that knowing the questions ahead, means you’ve had time to consider the questions and possible answers before, not just the 1 minute or so that you will actually have in a real exam. That can skew your result.

It has also come to my attention that some NBME questions or variations of those questions have come out in online qbanks. That is bad news, too as it has the same effect of invalidating some of the questions in the NBME forms. Even if you did not get the answer, encountering the questions in the NBME form for the second time rather than the first time means you had more than the 1 minute allowed in the exam to think through the questions and look for the answers.

So what are the remedies for these problems that seem to have cropped up recently. Well first is to actively avoid discussing posted NBME questions in the forums. Of course since some posters do not have the courtesy of even warning people about it, avoid participating in any discussions on questions in forums unless you know for sure that they did not come from an NBME form.

Another solution is to try to use the later forms. In Step 1 this would be form 4. 5 and 6. NBME forms for Step 2CK does not suffer from the same problems as those in Step 1 as they are not discussed as often as those of Step 1.

Doing at least 2 forms instead of just 1 as I recommended before may also help. Just make sure one of the form is not the first 3.

What about the “Downloaded” NBME Self-assessment test version.

I can never understand the popularity of the so-called “downloaded” version of the NBME. IF saving a hundred dollars or so is worth scoring low or failing the USMLE altogether, then it is understandable. But ruining your long term career to save a couple of bucks is not a very intelligent move.

In earlier posts, I have said that the value in the NBME does not lie with the fact that the questions mimic the USMLE. In fact, in general, they are much easier than the USMLE. The main value of the NBME forms is that they are fairly reliable predictors of performance in the USMLE due to the correlation they’ve done with NBME results vs. actual USMLE performance.

However, recently, some posters in my blog have commented that they are able to “predict” their USMLE scores, since there are answer keys and correlation tables available with the downloaded version. So I decided to give it another look.

So what did I find out? Well, first, there is a problem with the answer keys. There were some answers that I completely disagree with. In some cases where I myself am not sure what the right answer is, I tried to verify the possible correct answer by researching them and I still cannot decide what the right answer is even after searching through textbooks and the internet. Therefore, there is a question of how accurate the raw score one is getting for each of those NBME forms are. And that is a major problem. In my case, anywhere from 2 to 8 answers in each form fall into this category and for me, an “unknown” of 4 to 16% in the raw scores completely shoots down any chance of actually knowing the exact raw score you should be getting.

A second major problem is that there is only one correlation table in existence, instead of the 6 correlation table I am expecting. That is one per form. There might be additional correlation tables out there, but the one I got is just 1. Why six tables? Because the forms are of different levels of difficulty, you expect the same person will get different number of questions right in the different forms depending on the level of difficulty. So you need a correlation table for each form to make them comparable. Having only one correlation table means we don’t even know to which form this correlation table belongs. See the problem, now.

A third really big problem is that people who used this downloaded forms has a tendency to keep on using them throughout their prep multiple times. Probably because it’s free. In fact, it was justified that since they did not try to look at the answer, they can redo the same form and expect it to still be accurate in predicting their scores. That is actually wrong. Again, one of the reasons why USMLE is hard is the time limit imposed in answering questions. When you go through the same question multiple times, you’ve had more than the 1 minute per question limit imposed by USMLE to think of the answer and therefore will tend to score higher. That skews the predictability of the NBME.

Therefore, again, do yourself a favor and use only the online NBME assessment tests and use them only when you feel you are ready for the USMLE, to confirm your readiness. The “downloaded” NBME forms may seem free, but it’s hidden costs may be greater than you are willing to pay.

USMLE World Assessment Tests

I’ve had more time to gather information about this relatively new resource. So far based on talking to my students, posters in my blogs, people who have emailed me and reading various forums, my conclusion is that the UW assessment tests is just as good as the NBME assessment tests, so far.  Although there have been some observations that UW tend to be overestimate your scores in comparison to NBME, this does not seem to happen in all cases and the score difference is not too big. So all in all, I believe the UW assessment tests have enough track record by this time that we can safely say, they are fairly accurate in predicting USMLE scores. But as in all assessment tests, correlation is never 100%, therefore expect some deviation from predicted scores in the final result.

Related Posts:

• Which NBME Self Assessment Form to Use for USMLE Step 1

• NBME Self-Assessment Tests and USMLE Review – Part II

• NBME Self Assessment Tests and USMLE Review

• How to Create a Study Plan for the USMLE

• High Yield Fast Facts for the USMLE

• Guide to Self-Evaluation in USMLE Prep

I read Kaplan notes once, FA twice and doing Qbanks now. Is that enough for Step 1? A frequent question asked in forums and in my blog but misses the point entirely. It is never a question of how much effort you put into preparing for the USMLE that determines the final result . . . → Read More: Why You Need to Master the USMLE Step 1]]>

I read Kaplan notes once, FA twice and doing Qbanks now. Is that enough for Step 1? A frequent question asked in forums and in my blog but misses the point entirely. It is never a question of how much effort you put into preparing for the USMLE that determines the final result of your prep, but how well you have retained and are able to recall the information you have studied. Although a certain amount of effort is required in order to achieve this, how much time and effort you put in to achieve equivalent result depends on the skill and intelligence you put into your prep. It is not so much studying harder as studying smarter.

In the forums, you see a lot of people studying the same things in the same way and results range for high 99′s to failing. So something else must be at work to explain the variety of results achieve using what is essentially the same study plan. And that something is the level of mastery achieved by different people using the same plan. It has to do with the different methods people use to study the material. As some people have asked time and again. When you say you have revised the material 2 times, do you mean you have read the materials twice, or you have tried to memorize the material twice. And therein lies the difference in results.

For the purpose of the USMLE, what you cannot recall in a minute or so, you do not know.  It is not enough for you to have read Kaplan, or FA or whatever, but you should be able to recall what you have read. If you cannot answer a question, it is because:

1. you do not know the concept because you have not read it
2. you read the concept but you did not understand it
3. you read the concept and understood it but cannot recall it in the exam
4. you read the concept, understood it and can recall it in the exam given enough time, but of course since this is the USMLE, you never have enough time

In all 4 cases, you don’t get points as far as the USMLE is concerned.

Other reasons include,
1. you read it, understood it, can recall it in time, but the question is in clinical vignette format and you are poor in clinical vignettes
2. you read it, understood it, can recall it, but the question require more details than what you’ve actually read and understood, ie, it requires a higher level of mastery than you’ve prepped for
3. you read it, you thought you understood it, but actually you didn’t because you never tested your comprehension

In all these cases, you also don’t get points as far as the USMLE is concerned.

So you see, you could’ve studied and read all the right stuff, but you still don’t get points for them and you could still fail. So it’s not enough to study all the right things, you need to study the right way to insure that you covered all 7 situations stated above for everything you’ve read and studied. Studying the right stuff covers only situation number one.

Only by studying the right way, will you be able to achieve a level of mastery needed to do well in this exam. So the question arises what do you mean by mastering the concepts in the USMLE.

Well it means knowing enough details about the concepts tested so you know how to answer questions that require you to know that level of details. People who think Kaplan or Rapid Review are too detailed will probably not do well in the exam, because in my book, both reviewers lack detail to get you to 99′s much less high 99′s.

Next , you need to know those details at such a level that you can recall them in the limited time provided by the exam. And that is not easy. It requires studying a certain way to do that efficiently.

You need to study the materials in a certain way that insure you did your analysis during the review and not during the exam. There are methods of doing this which is emphasized in my course. The reason for doing the analysis during review rather than during the exam is that the exam is timed and the additional time you need to analyze the facts in order to answer the questions, may be what will cause you to fail or do badly in the exam. In contrast to the actual exam, you can do the analysis during the review where you have all the time in the world to do so. So the question, instead of requiring you to recall facts, analyze then answer, now only requires you to recall the analysis you did during the review, thus insuring faster recall, faster time to answer the question concerned and consequently higher scores.

Therefore it is not enough to have just read through the materials a couple of times. You need to master the USMLE in order to do well in the exam. There are study methods to help you do this consistently throughout your review. If you want to know more about How to Master the USMLE Step 1, Watch my 15 minute introductory video, How to Master the USMLE Step 1 – An Introduction

Related Posts:

• How to Master the USMLE Step 1 – an Introduction

• Why You Need Three Phases in USMLE Prep – I

• NBME Self Assessment Tests and USMLE Review