A lot of people think that all they need to do in order to do well in the USMLE Step . . . → Read More: How to Master the USMLE Step 1 – an Introduction]]> Hello Everyone, this is actually my first time to try posting videos in my blog.  So please excuse the effort if the quality is not too good. Hope to get better at doing this in the future.

A lot of people think that all they need to do in order to do well in the USMLE Step 1 is to get the correct study material and viola, they will get a good score. In reality, using the right study material is just one of many things you need to do right if you want to pass, much less get a high score in this exam.

This video is a short introduction to the first lecture in the series of lectures offered in my course on preparing for the USMLE Step 1. The original lecture is almost 2 hours long. This video is posted in my facebook page

The following is a link to the youtube version: http://www.youtube.com/watch?v=Jiq4dE7nt1g

If you have not read the previous two posts . . . → 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.

“Downloaded” NBME 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.

I would like to announce that I’ll be accepting applications for the June Batch of Askdoc’s USMLE Step 1 Prep Course which will start on June 1, 2009 and end on November 30, 2009. This is the 4^th batch of enrollees for this course and again due to experiences with the previous batches, changes are being implemented to the program for this batch.

As you may well be aware, the first batch started last September, 2008. No fees were collected, however, the applicants were required to have failed Step 1 at least once. Tong, the first to take the exam from that batch has passed with a score of 97/232. The second, Marlene just passed with an 88/213. Most of you may know Marlene. She was the one who was ardently negotiating a position in the prep course on this blog last July to August when I first announced the course. Well she finally made it. You can read more about their exam experience here.

The February batch is mostly on schedule to take their exams in June and July, except for two who have requested to be move the June batch and one who is MIA. So a total of 4 will be taking their exams soon.

Most of the April batch is currently way behind schedule. Which is the main reason that the June batch will be affected. As you may well know, I limit class sizes. The main reason is to maintain the quality of the prep as too many students means that I cannot look after everyone. So despite the fact that a total of 21 people applied for the April batch, I accepted only the first 10. That is also the reason why you have to keep to schedule when you join the prep course. Because any delay means that I will have to limit even more the number of students I accept in the next class which in this case is the June batch.

Because of this, I will only guarantee to accept five students for the June batch. If in the next 2 weeks, somehow the April batch will speed up, I may accept 2 or 3 more into the batch for a maximum of 8. This is due to the 2 students who transferred from the February batch. Of course new rules will be imposed to prevent this situation from happening again and rules will be tightened on the April batch to make sure they speed up and do not affect the August batch due to unnecessary delays.

In order to make people understand better why we have rules, I believe I have to describe the course in more detail including expectations and the amount of work needed so there is no misunderstanding.

1. The course covers USMLE Step 1 which is seven subjects all in all. The course is 6 months long. Therefore telling me that you do not have enough time to finish 1 subject in 4 to 6 weeks means you won’t have time to finish the course period. Therefore please be ready to invest the time needed to do the course. Nothing less than 4 to 6 hours a day at least 5 to 6 days a week is needed. If you are unable to commit this time, then this course will not help you.

2. The reason you would want in on this course is that it will teach you how to prep for the USMLE in the proper way. Therefore you must be prepared to follow instructions. You would be surprised at how many people insists on following their own methods of studying rather than those outlined in the course. If you will not follow the course’s review methodology, why bother enrolling?

3. If you ask my current students, proper methodology increased their scores dramatically. In fact, a few chapters into the course, some students have a tendency to start wanting 99′s whereas just a few weeks before all they wanted was to pass the exam. However, enrolling in the course does not automatically raise your scores. YOU STILL NEED TO STUDY. I cannot magically put information in your head, only you can do that. Since this is an online course, I cannot stand behind you and monitor whether you are studying or not or force you to study. Although there are quizzes and progress reports in the online course, I cannot force you to take the quizzes or write down your progress reports. So if you are not ready to really study, then this course will not do you any good.

4. You need to give me feedback. Per experience, the course methodology works fine for most people, however, for some people they need adjustments. Therefore, giving me regular feedbacks about how you are faring will help so that I can adjust your study methodology to suit you better. This is done by doing the quizzes. If you fail to achieve the required score then we need to review your study methodology and adjust them. Also, I can see where you tend to err in answering questions and I can help you change that tendency so you tend to score higher.

5. You have to attend the weekly online chat. The weekly online chat is set up so you not only have an idea of how others are doing, but also to discuss any questions you have about the review process itself. Since an online course has no formal “class”. This is a good substitute.

6. One on one chat is only available on a case-to-case basis. This is simply because of time constraint. The participant however, can pm me in case they have individual problems.

7. You need to follow schedule. You cannot be prepping forever. Plus any delay in your prep means that there are less people who can join the course. Every batch so far, more people enroll than I can accommodate. If you do not keep to schedule, you are depriving others the chance of realizing their dreams. So there is a need for me to maintain a limit as to how long someone can keep that slot occupied at the expense of others.

8. If you are an old grad who have not opened a basic science book in years, then YOU ARE NOT READY for this prep course. This is because you have not finished your learning phase. I will explain later the difference between learning, mastery and test prep phase. Contact me first and I will tell you what you need to do to be prepared for this course. Nearly half of the reason why people cannot meet the study schedule is because of this. If you have recently prepped for the exam, whether you eventually took it or not, it is possible that you can take this course. Again, best to pm me ahead before applying.

9. The minimum time needed to finish this course is 4 months. If you can devote the right amount of time to the prep. The only way you can finish this in under 4 months is to devote at least 12 hours a day 7 days a week and have a very good memory. And if you can prep for under 2 months and pass Step 1, you do not need to enroll in my course at all. (You can’t imagine how many people keep on asking if they can finish the course in 2 to 3 months. I mean if you can pass the USMLE by prepping in 2 to 3 months, you do not need me, right?)

10. This course is not easy. Any real course that will help you pass or score high in the USMLE can never be easy. Because the USMLE is not easy. People have dropped out of this course. People have scored high with this course. People who have failed multiple times before have passed with good scores with this course. Old grads have passed with this course. But they did what others were not able to do. Stick with the course and finished it. Those who dropped out failed to even start.

11. You need the self-discipline to study on your own. If you need the someone to be physically present to prod you to study, you are better off applying with one of those boot camp prep centers like Kaplan or USMLE Pass. My students have suggested that I open one in the US soon. With the price they are charging, I might be able to offer something for half the price.

If you want a sense of how the prep course is running. Register in my forum at http://forums.askdoc-usmle.com. You can then access the site used by my students. Read their prep journal to get an idea of how the course goes.

If you have read my post, you will know that there are 3 phases in the typical study plan. The “Learning” phase, the “Mastery” phase and the “Test Preparation” phase.

The learning phase is where you try to learn all the different concepts tested in USMLE Step 1. When reading, you can attempt to draw a mental picture of what you are reading to understand the concept or you can repeatedly read through the material to memorize it. In learning phase, your purpose is to understand the concept and not to memorize them.

The mastery phase, is where you concentrate on memorizing and being able to recall medical concepts in detail and at the right speed needed to be able to answer questions in 1 minute or less.

The test preparation phase is where you train yourself to answer USMLE type questions and to be able to sit through an 8 to 9 hour long exam.

There are also 3 types of activities that you use in the 3 phases. Knowledge Acquisition (KA), Knowledge Recall (KR) and Test Prep(TP).

KA includes all activities that tries to put medical knowledge into your knowledge bank (KB). This includes mostly reading and listening to lectures.

KR includes all activities that tries to improve your ability to retain and recall the information the information in your KB. This includes repeatedly reading through the course materials, using flashcards, answering questions and doing word association drills with study mates. It is rare for people to repeatedly listen to lectures when doing KR. They usually prefer to write down notes for the lectures and repeatedly read through them instead.

TP includes all activities that improves your ability to do better in USMLE type MCQ’s. This includes simulating USMLE exams, speed building, increasing stamina, etc.

Learning phase usually involves only KA activities. It is the most variable in terms of length of time needed to accomplish. It depends on how much you already know in the first place. Even fresh grads differ in the medical concepts they have retained even if they graduated together More so for people who are older grads.

People may wonder what it means to have learned something as opposed to have mastered something which is what the Mastery phase is all about. Well to have learned a concept means you understood the concept, while to say you have mastered a concept means you know it in such a depth and will be able to recall it fast when needed

 So what do you do on the day of the examination? The day you sit for the USMLE is the culmination of months of preparation. It may seem unfair that no matter how well your performance were in those countless q banks and test simulation, the only performance that really counts is the one you do on exam day. Therefore, it makes sense to maximize your chances of performing well for that date.

 Your preparation should begin way before the date of your examination, when you schedule the examination. It is a known fact that during review, people do reach a plateau and the best time to take the exam is just before or just after you reach your peak. Earlier or later than that can result in lower scores. When you review, immediately after learning and memorizing your lessons, you immediately start forgetting. Normally, the amount of medical concepts you are memorizing and retaining is growing faster than you are forgetting them. However, there comes a time when you reach your peak and eventually plateaus. Afterwards you will go into decline and forget more than you are learning. Most people go into plateau in about 6 to 8 months, therefore the ideal review time is around that long. That is why my prep course is around 6 months long.

 The next question you have to ask yourself is when do you actually stop studying? Some make the mistake of studying right up to the night before the exam while others start relaxing  two weeks before the exam.

 What’s wrong with studying up to the last minute? Well to illustrate, imagine a marathon runner who the day before the marathon decides to do a marathon to see if he can win the marathon. The USMLE is an exhausting exam that will test your stamina  to the limit. Anyone who has taken the exam can tell you that their brains felt like mush and refuses to function properly in the last 2 blocks of the exam. I know, mine did. Therefore, it makes sense to rest as much as possible the day before the examination to regenerate your energy for the battle ahead. In fact I recommend to stop studying 2 days before the actual examination day.

 Now if resting is good, why shouldn’t I rest 1 week or two before the exam. Again, let’s use a sports example to answer this question. Professional boxers usually arrive a week or 2 before the bout to the venue where the bout will be held. By this time they’ve already finished their training. Any boxer, who has not finished training for the bout by that time is bound to lose the fight. And yet instead of painting the town red, they spend their time in the gym, practicing and sparring. The reason is so that they can maintain focus on the bout itself. Losing focus this late may mean losing the bout. The same holds true with preparing for the USMLE. The problem most old grad have is to start their review. They usually go through lots of false starts before their review start going smoothly. The main reason is that it’s been too long since they’ve studied and there are lots of things going on in their life that its hard to focus on the prep. Getting distracted and losing focus too early before the exam can cause you to perform at less than peak condition in the examination. You need to block off everything until you’ve finished the exam.

 So what should you be doing 1 to 2 weeks before the actual examination? Well definitely you should have finished the heavy lifting and not studying anything new. The reason is that your mind will tend to remember better the most recent things you have studied and if that is low yield new stuff (presuming you studied the higher yield stuff first), that is what you will remember better and unfortunately has less chances of appearing in the exam. Therefore the best thing to do at this point is try to cover the highest yield stuff. If you are in my course, you would be enrolled in the High Yield Fast Facts (HYFF) Course, a compilation of the highest yield test materials in electronic flashcard format. If you are reviewing on your own, you can use the Rapid Review section of First Aid at the back of the book. However, it is in table format which is less effective than in flashcard format. This way you remember the highest yield information best when you sit for the exam. (Did I mention that someone who got a 99/256 use my HYFF course two weeks before the exam? see here!)

 Another important thing to consider is how far you lived from the Prometric Center where you will be taking the exam. The exam is a high stress event. If you have to drive through traffic and you are 2 hours away, the stress can be tremendous. Worse, traffic may be unpredictable and you may get there late. In my case, I lived about 1 hour by car from the exam site. The route I have to travel is notorious for unpredictable traffic that could last for 2 to 3 hours. So instead of increasing my own stress. I booked myself into a hotel about 10 minute walk from the site the night before. I could take a cab (parking is also terrible) and be there in about 3 minutes including traffic light change. US$100, the price of one night in the hotel is small compared to the $800++ exam fees, $1000++ for books, qbanks, NBME, etc. and 7 months of prep time I had already invested so far. Cab fare is $5 plus tip. J

You can spend the last 2 days before the examination on anything to relax you. I watched a movie before my exam. A comedy, Ice Age 2. Then on the night before the exam, the most important thing is to get a good night’s rest. That involves a regular meal, not too heavy. Maybe a nice warm bath. Sleep early so you can wake up early. But do not take tranquilizers as that can cause you not to be in peak form the next day. Make sure everything you need is prepared beforehand. (Clothes, food, water, medicine, ID, Exam permit, etc.) Preparing it early in the morning just increases your stress level. In fact if you can prepare everything 2 days before so much the better.

 Remember, stress is additive. The examination itself is an extremely stressful event. Any other worries on the same day just adds to the stress. So prepare everything at least 2 to 3 days beforehand so that your only worry is the examination itself on that crucial day.

 Now a few things to remember on the day of the examination itself. The most important is to never leave a question blank. There is no penalty for a wrong answer. This is an MCQ exam and one answer is always correct. An unanswered question is a sure wrong, while a question answered even with a guess is a possible right. And just one additional right answer may mean the difference between a 74 and 75 or a 98 and 99. As sports great Wayne Gretzky said, “ You miss 100% of the shot you do not take.”

So what’s a method to make sure you do this. Well, you should allocate around 10 seconds per question to randomly pick the answer once your time runs out. At the two minute warning, it means you can randomly answer at least 12 questions. So if you have less than that to answer then you can start randomly answering the q’s that you have not finished. For example at the 2 minute warning, you have six questions unanswered. Continue answering as before, but at the one minute mark, just randomly guess an answer on the remaining unanswered questions.

Now for pacing in the actual examination. The best pacing schedule makes use of a couple of facts. One, you are more alert in the early morning than in the afternoon when the exam will have taken it’s toll. Therefore it makes sense to schedule more blocks before lunch. So 4, 3 would be good. For Step 2, no choice but 4, 4. Now you are sleepiest after lunch, because of the act of digestion, therefore schedule only 1 block after lunch then have a break afterward. Never take more than 2 blocks before you take a break with some food or sugared drink. Your sugar level starts falling after 2 hours (physiology of fasting) and sugar is the main fuel for your brain.

So best to schedule 2 blocks, 15 minute break, 2 blocks then 25 minute lunch, then 1 block, 10 minute break, then last 2 blocks.  (or 3 blocks if Step 2) You can take a break between the last 2 blocks if you feel you need it. Notice that the total break is 50 minutes. Reason is that the actual break will usually be longer than the time you scheduled it. Just logging in and out of the room will take 1.5 to 2 minutes. The rest room is usually two doors out (both the exam center in my home country and the one in San Francisco where I took Step 3 have the same layout. So I presume all Prometric centers have the same general layout) So you have to walk. If you just need a short break between blocks, just sit on your cubicle and rest for a minute or two before starting the next block. As I said logging in and out is a time waster.

Hello everyone, I will now be accepting applications for the April batch of Askdoc’s USMLE Step 1 Prep Course which will start April 1, 2009 and end on September 30, 2009. This is the third batch of enrollees for this prep course. As you may well be aware, the first batch started last September, 2008. No fees were collected, however, the applicants were required to have failed Step 1 at least once. The first to take the exam from that batch has passed with a score of 97/232. You can read more about him here.

The second batch started on January 26, 2009 and currently with 7 members. They paid a fee of $100 but this time around, everyone was accepted but on a first come, first served basis. Currently 4 are doing very well and 3 are doing poorly, not in terms of scores but in terms of progress. You need to be committed to finishing the course, and in order to do that you need to show up. Therefore some modification to the programs need to be done which I’ll discuss later.

Due to my experience with the first and second batch, I believe I have to describe the course in more detail including expectations and the amount of work needed so there is no misunderstanding.

1. The course covers USMLE Step 1 which is seven subjects all in all. The course is 6 months long. Therefore telling me that you do not have enough time to finish 1 subject in 4 to 6 weeks means you won’t have time to finish the course period. Therefore please be ready to invest the time needed to do the course. Nothing less than 4 to 6 hours a day at least 5 to 6 days a week is needed. If you are unable to commit this time, then this course will not help you.

2. The reason you would want in on this course is that it will teach you how to prep for the USMLE in the proper way. Therefore you must be prepared to follow instructions. You would be surprised at how many people insists on following their own methods of studying rather than those outlined in the course. If you will not follow the course’s review methodology, why bother enrolling?

3. If you ask my current students, proper methodology increased their scores dramatically. In fact, a few chapters into the course, some students have a tendency to start wanting 99′s whereas just a few weeks before all they wanted was to pass the exam. However, enrolling in the course does not automatically raise your scores. YOU STILL NEED TO STUDY. I cannot magically put information in your head, only you can do that. Since this is an online course, I cannot stand behind you and monitor whether you are studying or not or force you to study. Although there are quizzes and progress reports in the online course, I cannot force you to take the quizzes or write down your progress reports. So if you are not ready to really study, then this course will not do you any good.

4. You need to give me feedback. Per experience, the course methodology works fine for most people, however, for some people they need adjustments. Therefore, giving me regular feedbacks about how you are faring will help so that I can adjust your study methodology to suit you better. This is done by doing the quizzes. If you fail to achieve the required score then we need to review your study methodology and adjust them. Also, I can see where you tend to err in answering questions and I can help you change that tendency so you tend to score higher.

5. You have to attend the weekly online chat. The weekly online chat is set up so you not only have an idea of how others are doing, but also to discuss any questions you have about the review process itself. Since an online course has no formal “class”. This is a good substitute.

6. One on one chat is only available on a case-to-case basis. This is simply because of time constraint. The participant however, can pm me in case they have individual problems.

If you have read my post, you will know that there are 3 phases in the typical study plan. The “Learning” phase, the “Mastery” phase and the “Test Preparation” phase.

The learning phase is where you try to learn all the different concepts tested in USMLE Step 1. When reading, you can attempt to draw a mental picture of what you are reading to understand the concept or you can repeatedly read through the material to memorize it. In learning phase, your purpose is to understand the concept and not to memorize them.

The mastery phase, is where you concentrate on memorizing and being able to recall medical concepts in detail and at the right speed needed to be able to answer questions in 1 minute or less.

The test preparation phase is where you train yourself to answer USMLE type questions and to be able to sit through an 8 to 9 hour long exam.

There are also 3 types of activities that you use in the 3 phases. Knowledge Acquisition (KA), Knowledge Recall (KR) and Test Prep(TP).

KA includes all activities that tries to put medical knowledge into your knowledge bank (KB). This includes mostly reading and listening to lectures.

KR includes all activities that tries to improve your ability to retain and recall the information the information in your KB. This includes repeatedly reading through the course materials, using flashcards, answering questions and doing word association drills with study mates. It is rare for people to repeatedly listen to lectures when doing KR. They usually prefer to write down notes for the lectures and repeatedly read through them instead.

TP includes all activities that improves your ability to do better in USMLE type MCQ’s. This includes simulating USMLE exams, speed building, increasing stamina, etc.

Learning phase usually involves only KA activities. It is the most variable in terms of length of time needed to accomplish. It depends on how much you already know in the first place. Even fresh grads differ in the medical concepts they have retained even if they graduated together More so for people who are older grads.

People may wonder what it means to have learned something as opposed to have mastered something which is what the Mastery phase is all about. Well to have learned a concept means you understood the concept, while to say you have mastered a concept means you know it in such a depth and will be able to recall it fast when needed

To illustrate, for example the coagulation cascade. During the Learning phase, you may have read all the details of the coagulation cascade, but to consider that you have learned it, you probably need to know it this way.

1. It is a series of enzyme conversion that results in clotting
2. The final step is the conversion of Fibrinogen to Fibrin
3. This is accomplished by Thrombin
4. There is a common pathway
5. There is an intrinsic and extrinsic pathway
6. The two pathways converge on Factor X before forming the common pathway
7. The extrinsic pathway involves Factor VII and Tissue factor
8. The intrinsic pathway triggered by Factor XII triggering multiple other factors
9. Extrinsic pathway measured by Protime
10. Intrinsic pathway measured by activated Partial Thromboplastin Time

If you do not know most of the points above, you cannot consider yourself to have “learned” the concept even if you’ve read all of the above or even more details.

During the mastery phase, you should know the concept in even greater detail and be able to recall them really fast. To illustrate.

1. You need to know the steps in greater detail. For example the intrinsic pathway includes Factor IX and factor XI. You also need to know that there are factors that act as catalyst to the reaction (Factor V and VIII) and factors that moderate or inhibit the reaction (TFPI, anti-thrombin and APC). These are just some of the additional details you need to memorize and be able to recall to consider that you have mastered the concept
2. You need to be able to recall facts much faster. For example, knowing that PTT measures intrinsic pathway and the factors in the intrinsic pathway will allow you to deduce the factor deficiency that causes abnormal PTT. However, it may take time for you to recall the facts if this is how you retained the information. You may need to memorize the actual factors that can cause abnormal PTT and protime directly. This is done during the mastery phase.

Of course, you need to know more than the above to truly master the concept of coagulation cascade, but the above will suffice for illustration purposes.

The Mastery Phase is composed of both KA and KR activities.  Your main purpose here is to memorize, retain and recall tested medical concepts. You still do a lot of reading for KA. However the type of reading material you use will differ. It is easier to learn concepts by using narratives. Hence textbooks are more effective. But it is easier to memorize bulleted lists, tables and illustrations as well as recall information that way.

To illustrate using the coagulation cascade. It is easier to memorize and remember the concept using a combination of illustration and bulleted lists. However, trying to learn the coagulation cascade using only illustrations and bulleted lists is a challenge. It is better to use narratives that explain the whole concept first and once you’ve learned and understood the concept, use illustration and bulleted lists to memorize them for easier recall.

A reason for using tables concerns concepts that you need to differentiate from each other. It is a known fact that an important key to scoring high in the USMLE is the ability to know the key difference between diseases rather than memorizing the key features of a disease. For example, in the exam if you get a case of inflammatory bowel disease, your problem will be if you are dealing with Crohn’s disease or Ulcerative colitis. A well-constructed question will first present features common to both and just add one or two features usually buried in between the other features that distinguishes one from the other. If you had memorized the features of each diseases either reading them in text form or in bulleted lists, you will have to review in your head, the features one by one and try to sort out the features that distinguishes the two. This not only eats up a lot of time, but you could even wind up with the wrong answer. If you had memorized it as a table that differentiates the two, your ability to answer that question correctly and fast have just increased exponentially. Ditto for example a case of lung CA. A table differentiating between, Squamous Cell Ca, Small Cell Ca, Bronchioalveolar CA, etc. is a better way to retain and recall the data than just from a plain bulleted list or even a full narrative.