Guide to Self-Evaluation in USMLE Prep

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This started out as a reply to a question asked by dr patel on my blog on how to evaluate one’s readiness for the USMLE and avoid making the mistake of taking the examination and failing it. However, it got a little bit too long, so I have decided to rewrite it into an article.

Failure to properly evaluate one’s readiness for the examination and one’s progress during the whole USMLE preparation process may be one of the most crucial reason not only for failing the USMLE but also for failure to achieve a less than stellar score.

Proper self-evaluation involves not only how to do the evaluation, using the right tool to measure the right parameter but also when to do the measuring to insure maximal effectiveness. Most failures in self-evaluation can be divided into these 2 broad categories.

Whenever, we mention evaluation, most people think of the NBME self-assessment tests primarily or the online q Banks like UW and Kaplan. These are very useful assessment and evaluation tools, but they are not the only ones and not necessarily applicable in all situations. Used the right way, they are extremely effective, but the propensity of most people to use them in all kinds of situation is not necessarily a good idea. The right tool used for the right situation is very effective. Using the right tool for the wrong situations makes it less effective.

You see people using NBME to evaluate themselves at various stages of their review rather than at the end, to gauge their final readiness for the USMLE is an example of an expensive misuse of a great tool. I wonder what you would think of your anatomy professor if after finishing upper extremities, he uses the USMLE Step 1 to test how well you are doing so far. Ridiculous and yet that is what most people are actually doing during their prep.

The MRI may be one of the biggest breakthrough in medicine in recent years, but it is a tool with a specific function. Using it to measure blood glucose level is ridiculous. So use the right tool for the right situation. We’ll talk about that more later.

The second area where most people commit a big mistake in self-evaluation is when to take it. One of the primary reasons being the myth that only online q Banks will do as evaluation tools for the USMLE which is far from the truth. A myth perpetrated by a lot of posters in forums and of course encouraged by online q Bank providers for obvious reasons. Again as stated before, proper tools for proper situations will provide excellent results. But for other situations other tools are better.

Usually you have people studying for 3 or 4 months, reading the various subjects, Anatomy, Physiology, etc. for step 1 and Internal Medicine, etc for step 2 CK and step 3. Then they enroll in the online q Bank, the first time they will actually test what they have been able to retain in their readings for the past 4 months. Then shock when they are scoring 40 to 50% followed by panic since they realized that they have 2 months left before their scheduled exam and that after 4 months of efforts, they’ve only come so far. So they searched the forum looking for answers that tell them all is not lost and reject anything that says otherwise. Most of the time, they take the suggestion which they so want to be true, that by just doing q Banks for a month or so, they will raise their scores. Yeah, right probably by 5% or less so unless they are already scoring borderline scores, doing that will not help. Their only choice really is to restart their review, this time doing them the right way. Don’t get me wrong, doing q Banks can raise your scores. However, there seems to be a pattern. The higher your starting q Banks scores, the more help doing q Banks will be to raise your scores. Below a certain level, doing q Banks will not help. People just fail.

All of this could’ve been avoided if proper self-evaluation have been instituted right from the start of their prep process. Self-evaluation is important to insure that you are prepping the proper way and that your prep is effective. That is why I’ve always advocated that people should use Subject specific q Banks right from the start. They don’t have to be USMLE type questions, since the main objective is to see if you know the subject, not in how good you are at answering tough, USMLE type questions. You need to know the subject well, before you can answer the tougher questions. You need to learn basic arithmetic before you can answer algebra or trigonometry. In my prep course, the course participants have a quiz per chapter (comprehensive quiz with 30 to 65 questions per chapter) to insure they know the topic before moving to the next one. Any problem is solved on the spot. So they don’t have to wait until 4 months later to realize something is wrong with their prep and they have to do them all over again.

Even in medical school, everyone knows you should evaluate performance at regular intervals to insure that people are learning. Imagine if your dean tells you that due to the huge success this method of evaluation is among people prepping for the USMLE. They will now only give one evaluation examination at the end of 4th year to test whether you will become an MD or not. That’s not very realistic is it and yet that  is what most people do when they prep for the USMLE.

So how do you go about doing your self-evaluation? In the beginning, when revising the subjects, you should be prepared to test yourself chapter by chapter to insure that you know your stuff before moving on. When you finished each subject. Test yourself using by subject q Books. You use online q Banks after you’ve finished your first round of review, both to assess how much you know and help raise your scores. Then just before the examination, you use NBME to confirm your actual readiness for the exam and if you are going for a certain score, whether you will make it or not.

For example you are preparing for Step 1. You can use Robbin’s Review of Pathology q Book as a chapter by chapter quiz for Pathology. It is important that the chapter quiz is comprehensive and not the short ones usually found in the end of Kaplan notes chapters or BRS Pathology chapters. For an example, you can go to my prep site at http://prep.askdoc-usmle.com. Log in and enroll into the Pathdemo program to access the quiz. Compare how comprehensive the Cell Pathology quiz is to the Cell Pathology Study Notes provided or even the Cell Pathology notes in Kaplan lecture notes. That is how comprehensive the chapter quiz should be. For Microbiology and Immunology, Levinson and Jawetz have a very good chapter by chapter quiz. My prep course will also develop its own as it is finished. For Pharmacology, Trevor and Katzung also have a comprehensive chapter by chapter quiz. For the other 4 subjects, there is no comprehensive chapter by chapter quiz q Book that exists, although, the Kaplan q Book which covers by the subject may be an adequate substitute.

For Step 2 CK and Step 3, no adequate chapter by chapter quiz exists. Harrisons q Book contains too many low yield stuff and may be more helpful for ABIM rather than Step 2 CK or Step 3. Good subject exams include the Kaplan Q Book and the Blueprints q books.

Although I have chapter by chapter quizzes in my prep courses, only Review of Pathology is available and will take 6 to 9 months to finish the rest. However, good commercial chapter by chapter quizzes are available for Pathology, Microbiology and Immunology and Pharmacology as stated above and I would suggest you make use of them right from the start of your review.

If anyone knows of other chapter by chapter q Books available, I would appreciate it if you can bring it to my attention, especially for the other subjects, so I can evaluate them and make recommendations.

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12 thoughts on “Guide to Self-Evaluation in USMLE Prep

  • July 6, 2009 at 3:02 pm
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    great piece of work

  • July 10, 2009 at 9:58 am
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    Hello!

    Did you find useful taking notes from Katzung’s review? or is it just a waste of time and more easy to just study it, review the important stuff recommended and answer the chapter questions? I’m taking notes, but keep thinking that maybe I shouldn’t, since it takes some time away rewriting what is already in the book and it is very well structured enough to remember the important facts.

    Thanks!

  • July 13, 2009 at 5:52 pm
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    Hi I guess what I was trying to ask is if I should combine my study of Lippincott with Katzung. I started on Lippincott, and then started answering some questions on Katzung. Though many times I answered the great mayority of the subjects already studied, there where some concepts that weren’t covered in lippincott. I then decided to continue the subjects I still havent covered in Lippincott in Katzung. I’ve studied some 6 chapters aproximately, But find myself concentrating too much on learning and comprehending each chapter, so I’m not making the progress I would like (3 chp. per day). Should I continue on Lippincott for mastery and then only focus on Katzung for the questions and help recall concepts? Or do you think only Katzung should do?

    Thanks!

  • July 28, 2009 at 8:25 am
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    Hi Francisco,

    Sorry for late reply. Anyway, do not take notes for Katzung’s review. Just use the drug list, OK.

    Askdoc

  • July 28, 2009 at 8:36 am
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    Hi Francisco,

    Use the drug list in Katzung primarily. You can use Lippincott to read about the drugs themselves but use Katzung as guide as to what drugs you need to know. The method is memorize the prototype, know the difference between the prototype drugs and the major variants. As to minor drugs, just know what class of drugs they are. If the drugs mentioned is in Lippincott, then read it there, the detail is just about right. But if the particular drug is not in Lippincott then read it off Katzung itself. Questions in Katzung is more difficult than actual USMLE pharma questions.

    Askdoc

  • February 17, 2010 at 7:38 am
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    Hi Askdoc

    I find ur blog very impressive and extremely helpul for those prepping for the USMLE. i have been struggling with my step 2 ck. i am still not able to get a good enough score in my nbme. n every time i got a low score i go back n read more on tht topic but still there is no improvement. i m using kaplan q book to evaluate myself but i dont feel its helpng me get better. i have read ur other posts to know what i cud be doing wrong but i m not sure what my weakness is. can u plz help me

  • February 23, 2010 at 12:35 pm
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    Hi NO,

    The 4 most common reason that people do poorly in Step 2 CK is as follows;

    1. Not studying enough detail. Most common mistake. Kaplan Notes has enough detail, but you need to retain and recall 85 to 90% of it. And that is impossible to do with less than 3 revisions.

    2. Difficulty with next best step in management type of questions. The best way to study how to work up and manage patients is to use algorithms. Remember next best step depends on what was the results of previous diagnostic workup or previous response to treatment. Too many fail to learn this properly and it covers about 20% of Step 2 CK.

    3. Pathophysiology or mechanisms of diseases. This accounts for 20% of Step 2 CK and some people have not covered this part thoroughly thinking it is just for Step 1.

    4. Uncommon presentation of common cases. In Step 1, most clinical cases presents classically. In step 2 CK, although cases are common, presentation is atypical. For example, although sarcoidosis is most common in young, black female. They do occur in males, older people and other races. So in Step 2CK a sarcoidosis patient may be an old, white male instead. You need to be able to diagnoses the case even with atypical presentation or you won’t be able to answer the questions. Other ways clinical cases are tougher in Step 2 CK is the addition on both relevant and irrelevant normal findings. The addition of irrelevant abnormal findings that will not change the diagnosis. You need to be able to discern what facts are important and what are not. Remember in an actual live patient, they may present with symptoms that is irrelevant to their main complaint and you need to decide what is relevant and what is not.

    These 4 are the most common reason for getting low score, although there are other less common weak points that can cause lower score.

    Askdoc

  • March 1, 2010 at 1:32 pm
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    Thanks askdoc. i ll follow ur advice.

  • March 8, 2010 at 9:13 pm
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    heyy..woow..i mean u have outlined the difficulties im facing accurately and helped me understand my prob better…points 2 and 4 are my probs..atypical presentation and management…the next best step managemnt part im doing better ever since i swithed over to algorithms…everything is a lot clear when i ahve it down to algorithms and simplified tables…as for the atypical presentations im just hoping solving more questions and writind down points i learn from them wil be helpful..im doing mksap questions..i dont know where it stands when compared to uworld and kaplan qbank, but the explanations are very good…im getting a consistent 80% in mksap and im doing it system wise..basically trying to revise each system…and then planning on doing uworld with a mix of all questions and timed blocks so tat it reflects the exam…i ahve a month for my test…right now i just want to know if my approach is good enough or i need to change the way im preparing..i couldnt think of anybody else to ask so pls reply ask doc…thank you in advance.

  • March 13, 2010 at 10:17 am
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    Hi sanju,

    That seems a good plan. In revising for atypical cases, make sure you review each case you miss with the aim of finding out why you miss the diagnosis and taking note of the key symptoms and signs that point out the diagnosis. You can even write out a flashcard for those particular case. MKSAP is best for Step 3, but if you have the time, it is also useful for Step 2CK.
    Anyway, good luck and keep me updated.

    Askdoc

  • March 17, 2010 at 8:53 pm
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    hi askdoc,
    i am taking notes for the atypical questions and while doing mksap questions.the way im going looks like ill have another whole book of my notes. my dates getting closer and im quite scared. how much do u think i should score in uworld before im ready to give the exam with an aim of getting past 90’s?i did kapla material 2 times and a couple of topics 3 times. and did kaplan Qbook. am almost done with mksap. wil be done in another week and then wil start uworld. my date is on april 13th but im guessing ill need to postpone it. i dont think ill get even halfway through uworld by then 🙁 im sorry if i sound too mundane and like m unburdening myself on u. but thanks for the advice.

  • March 24, 2010 at 2:49 pm
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    Hi Sanju,

    You need to get in the 70’s average for last 10 blocks. Anyway keep me posted.

    Askdoc

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