High Yield Concepts and the USMLE.

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Study the High yield stuff”. “Don’t bother with that because it’s low yield”. When I was just starting my review, these are the most common advice I get from “experts” in forums and books about reviewing for the USMLE. The question is how good is this advice. If you are just aiming to pass the exam or get average scores, it is very good advice, but if you are aiming to ace the exam then watch out as it could bite you.

First, we must understand that Medicine, whether Basic or Clinical Science is a very vast field with many important concepts necessary for its practice. It is so vast that medical specialties arose because it is impossible for any one person to know everything. However, the USMLE has to be able to assess if you know enough about Medicine in 350 q’s or so per Step. Therefore, certain concepts will be more commonly tested than others will and high yield concepts will be tested more often than low yield ones.

However, although a high yield concept will appear more often, it is not 100%. On the other hand, many low yield concepts will probably not appear in the exam but again it is not 0%.

To illustrate, for example, say for Step 1 there are 3000 medical concepts that can appear in the exam. (The USMLE has a list of topics that can be tested in the exam) Let’s say about 200 concepts can be considered high yield, 400 concepts medium yield and 2400 concepts low yield. (These are not actual figures, just used for easier illustration and dividing concepts into high, medium and low yield is arbitrary but again needed for illustration purposes)

Out of the 350 q’s in step 1, let’s say around 140 will consist of high yield questions. Therefore, 140 of the 200 high yield concepts will appear in the exam giving each concept of a 70% chance of the question appearing in the exam. Now the next 100 questions will feature the 400 medium yield concepts giving a 25% chance of that concept appearing in the exam. If it takes an hour ( a day, a week or a month, whatever) for you to study 200 concepts, it is better to spend that hour learning high yield stuff as you can get 140 q’s correct, while studying medium yield stuff for the same time interval will get you only 50q’s (100 concepts divided by 2). And so it goes down the line.

Therefore, it does make sense to study high yield stuff. And if you just want to pass or get an average score, this is the best approach. Remember not all high yield stuff will appear in a specific set of exam. However, for any large group of examinees, all the high yield stuff will eventually appear in the exam. On the other hand, low yield topics will not appear all the time, but some of them will show up in the individual examinations. If you want to score high, you not only have to know all the high yield stuff, but every low yield stuff you know will be crucial to scoring high.

Further example. In Step 1, anatomy is considered low yield stuff. Why? Because although the subject is vast with lots of information to memorize, probably only 15 to 20 questions will appear in the exam, making it low yield. But 15 to 20 questions still count to your score and it may mean the difference between a mid 90’s vs. 99 or even low 99 vs. high 99.

Of course, it does not make sense to fill your head with low yield concepts at the expense of high yield stuff. There is a danger of failing the exam altogether if you do this. If you lack time for review, or have a poor memory, you should stick to high yield stuff. But if you have time and good memory and really want to score high, then go for the low yield concepts too, so long as you make sure it is not at the expense of remembering the high yield concepts.

Most reviewers contain only high yield stuff, therefore is ideal for people who only want to pass or get average scores. Textbooks have both high yield and low yield stuff, but also too much low yield stuff that won’t ever appear in the exam. Remember, USMLE will have to come up with questions even for low-yield stuff and therefore it does not have an endless pool of questions. Some concepts will be too obscure or specialized to ever be tested in the USMLE. There are very few reviewers that contain not only High yield stuff but enough low yield material that it is possible to use them to ace the exam. Usually the only way to ace the exam is to occasionally go to textbooks or for pathology, listen to Goljan’s lectures.

Now one of the reasons USMLE World Qbanks are more difficult than Kaplan’s (though not the only reason) is because UW tends to test more low yield concepts, correctly guessing that most people have reviewed the high yield stuff already and need to be drilled more on the low yield stuff to score high. I will talk on the difference between UW Qbanks and Kaplan Qbanks in another post.

So in conclusion, if you just want to pass the exam or get average scores, stick to high yield concepts. If you want to ace the exam, learn as many low yield concepts as you can without sacrificing high yield concepts. Even among low yield concepts there are some more high yield than others. Example, brachial plexus in anatomy. If you have limited time, or you know you just can’t remember that much, then stick to high yield concepts, better to pass or get average scores than to fail.

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16 thoughts on “High Yield Concepts and the USMLE.

  • May 31, 2008 at 4:04 pm
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    You said: “because UW tends to test more low yield concepts ….” So if someone is aiming for a score just above average, should he just do Kaplan Q bank instead of UW? so he does not waste his time with low yield stuff and further master high yield concepts?

  • June 1, 2008 at 5:26 am
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    Normally I would say yes, except of course UW is cheaper than Kaplan QBank and UW can also be used even if you just want to just score slightly above average. But Kaplan will be much more efficient since it covers more high yield stuff. But one caveat. When I took the Step 2 CK in November 2006, Kaplan had revised about a third of its questions esp. in IM by Conrad Fisher to harder ones with lots of low yield stuff. I noticed that most of the concepts can be found only if you read Harrison’s or Cecil’s and not in any of the myriad review books even Kaplan notes itself. If the trend continues and I think it has, then there might not be much difference between the 2 before long.

    There is pressure for people to score higher because the advent of Qbanks and other USMLE resources has make the competition stiffer. Even though score is not everything in the Match, it is still a big, bad gorilla as a criteria in assessing your chance to land in a good program.

  • June 1, 2008 at 11:14 am
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    Thanks a lot. Does the same apply to USMLE Step 1?

  • June 2, 2008 at 6:16 am
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    I would think so. When I took Step 1, UW did not yet have a Step 1 Q bank so I used only Kaplan. But both Step 2CK and Step 3 QBank follow the same principle, so I would presume Step 1 QBank of UW would be the same.

    As I said, scores have become more competitive especially for IMGs so Qbanks that can help people score high not just pass the exam will be more in demand. If you look at the number of people logging into Kaptest and Starttest, it’s around 8,500 a month for Kaptest and 4,500 for Starttest or a difference of 4,000 a month. Sometime in Sept. or Oct. last year, it was around 7,000 vs. 6500 or so. So Kaplan making their QBank tougher has stave off UW’s popularity quite a bit.

    For years, most USMLE resource centered on what to study rather than how to study for the USMLE, therefore the advantage now for scoring higher is learning how to study rather than what to study, since with the advent of the internet and globalization, all the study resources are slowly becoming universally available to everybody.

  • March 17, 2009 at 10:52 am
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    hiii , if someone did kaplan and uw q banks there is no need to do kaplan Qbook, I heared that it’s qs are easier than the bank, right??? does the Qbook contain high yield stuff or the q banks will cover them already??? may be there is repeats from the kaplan bank.
    thanx in advance.

  • March 18, 2009 at 8:21 pm
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    Hi lolo,

    The Kaplan q book is good for evaluation of your mastery of each subject. They are easier than the qBank and contain less low yield stuff. They are ideal to use after you finish revising each subject to see if you’ve mastered enough material before moving on to the next subject. There is so far as I’ve noticed no repeat of the exact questions from the Kaplan q Bank. In my own prep, I used both. The qbook after I finished revising each subject. And the qbank after I have finished all my revision just before the actual examination

    Askdoc

  • July 20, 2009 at 10:11 pm
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    hi,…what books exactly do you recommend for step 1.?also i m a second year med student from india.i plan to give my exam after completing my undergraduate.the topics given in the usmle website are to broad.is there a complete book where all the theory req is available for learning?

  • July 28, 2009 at 8:47 am
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    Hi sona14,

    First, what books depend on whether you are learning the concepts or reviewing the concepts. The type of books are different depending on your goal. Next, there is no one book that will cover everything tested in the USMLE. There are books that cover the highest yield concepts (Those that are most likely to come out in the exam although they cover only about 60 to 65% of the questions in the exam). There are other books that cover both high yield and lower yield concepts like the Kaplan notes (but barely enough for you to hit high 90’s or 99’s) Again depends on what are your goals.

    Askdoc

  • September 8, 2009 at 11:52 am
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    Hey Askdoc,

    Thanks for your great advice. If my goal is to learn the concepts, what type of books should I use? Are the brs book equivalent to kaplan notes? I would like not only to pass the usmle step 1, but to score above average as well. I have about 8 months, and I need to devise a plan.

    em101

  • September 19, 2009 at 7:50 am
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    hi em101,

    Sorry for the late reply. Started the first ever live online lecture in my course and that took a lot of my time to prepare. 6 online live lectures on Study methods and Test taking strategy for the September batch of my course. Anyway, to learn concepts you need to study textbooks or attend lectures. The reason is that in order to understand concepts, they need to be explained and that is best done in narrative form. Plus multiple examples need to be given to illustrate the concept. BRS and Kaplan notes are not textbooks. They are review books. The hallmark of review books are they are shorter, with less explanations. Usually they are composed of bulleted lists, tables and illustrations. The reason is they presume you know the concepts. What you need is to memorize them and with limited memory, you need to compact the information so you can store more information in your head. You need to both understand the concept and memorize them as well. A lot of questions in the USMLE require you to remember enough detail in order to be able to answer them. Understanding the concept is not enough although also very important to score high. So first, read textbooks to understand concepts, use review books to memorize details. This is actually discussed in great detail in my online live lectures on the course.

    Askdoc

  • December 7, 2009 at 12:04 pm
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    HI askdoc,
    please could you arrange the part 1 subjects from high to low yield??
    I know it’s imp. to read all but I want to know.
    I heared the pathology are the most imp. next…pharma ….micro….physio…anatomy…bioch…last one the behav.
    check this: http://www.youtube.com/watch?v=lgICcofMK5g
    thanx.

  • December 9, 2009 at 7:20 am
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    Hi YK,

    I have posted on the relative importance of each subject and the percentages that usually appear in the exam. You can find a discussion in my forum under Askdoc’s method of USMLE Review at http://forums.askdoc-usmle.com. Your order is right except for behavioral science which is very high yield. I would put it a the level of physio. However, as it is hard to study for medical ethics questions rather than using qbanks, it does not merit as much book study.

    The problem with the video is that the percentages given were fixed. Different people get different percentages in the actual exam. That is why I always give a range of numbers. For example, some people have exam heavier in Pharma, others in Micro, others in Physio. Some have almost no neuro, while others will have more neuro. So it is not exactly the same percentages for all exam. It depends on which exam set you get. What is uniform is that Pathology is tested heavily. The USMLE emphasizes integration of subject. It wants to know if you have integrated all the subjects in your head. Since Pathology, Pharmacology and Micro/Immuno are what I call integrated subjects, they are most heavily tested. However, you need to draw on what you know in physiology, biochemistry and anatomy in order to answer those questions. That is why they are considered integrated topics. In my prep course, my students are told to concentrate heavily on integrating the subjects during their second revision precisely because of this emphasis on integrated topics by the USMLE.

    Askdoc.

  • June 4, 2010 at 9:50 am
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    hi..
    i will be giving my step2 ck in july 2010 n cs in sept 2010.. i would like to apply this year. will that be possible since i will have only my step1 n step2ck scores n my cs scores will be pending?
    there is another date for cs availabe in june in 10 days, but i will have hardly any time to prepare for it n i dont have any experience of interacting with patients in the us.

  • June 7, 2010 at 1:32 pm
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    Hi docarc,

    Although Step 2 CS is not really very hard to pass. One thing it needs is practice. If you are fresh grad, fresh from the clinics, or have been practicing medicine the past few years, you probably could do it in 2 weeks. But if you are an old grad out of medical practice for sometime, it may not be that easy. Also very important is if English is your language of instruction or not. You can still get interviews with Step 2 CS pending so long as you have good Step 1 an Step 2 CK scores although it is still best to have all 3 steps finished by September.

    Askdoc

  • November 23, 2010 at 5:12 pm
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    What approach Books /videos required to come up with concepts. I am old graduate. Please reply. I need to pass USMLE CK 2, CS and USMLE 3 . I just need passing score. Appreciate your reply.

  • November 27, 2010 at 9:15 am
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    hi,
    im currently doing anatomy frm hy,i hav already done histo and embryo also from hy.can u plz suggest me which qbook should i use to know that i have mastered these subjects and can proceed to the next subject.

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