June Class – Accepting Applications for Askdoc’s USMLE Step 1 Prep Course

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.

For example, the Review of Pathology course in my prep course http://prep.askdoc-usmle.com uses bulleted lists tables and illustrations since the purpose is primarily to help people master the subject. Although for most of the course participants this was not a problem, some people have a hard time using bulleted lists primarily because they have not learned a significant number of concepts. The solution was to supplement reading a more detailed texts like Basic Pathology or Pathologic Basis of Disease which helped them to raise their score significantly. If the lack of knowledge is not too severe, supplementing with Goljan’s lectures or RR Pathology may suffice. However, the need of supplementing learning activities during the mastery phase can significantly prolong the process.

It is also important in the Mastery phase to emphasize recall and that is accomplished by using a combination of  Q banks and flashcards.

The mastery phase can usually be accomplished within 3 to 4.5 months so long as the learning phase was done adequately. Otherwise, the review length can be prolonged.

The last phase is the Test Preparation phase where you try to train yourself specifically for the requirements of the USMLE. This includes learning to answer USMLE type questions, developing stamina to sit for 8 to 9 hour exams, simulating the actual examination day to insure you are in top form, including the amount of rest time you give yourself after finishing your prep to the day you sit for the exam to ensure you are fresh and alert rather than tired and burnt out. This usually can be accomplished in 1 to 1.5 months and includes primarily KR and TP activities.

The actual prep course will only cover the Mastery and Test Preparation Phase and will not cover the Learning phase. Therefore it is important that you have finished the Learning phase before enrolling in the course as not doing so will mean that you won’t finish in 6 months

Although some materials will be provided you on the online course, other materials you will need to procure for yourself. I will publish a complete list for those enrolled in the course. Below, you will find a partial list.

1. Robbin’s Review of Pathology Q Book – 2^nd Edition
2. Levinsion and Jawetz,   Review of Medical Microbiology and Immunology
3. Trevor and Katzung, Review of Pharmacology
4. BRS Physiology – Linda S. Costanza
5. BRS Behavioral Science – Barbara Fadem
6. For Biochem, Anatomy, etc. – Kaplan Lecture notes will suffice.

Also good to have a subject oriented Q book like Kaplan Q book. If you need to supplement with textbooks, usually because there is some inadequacy with the learning phase recommend the following;

1. Pathology – Rapid Review Pathology, Basic Pathology or Pathologic Basis of Disease (choose 1)
2. Pharmacology – Lippincott’s Illustrated Review of Pharmacology
3. Medical Microbiology – The review book will suffice and no need for a separate text
4. Physiology – BRS physiology is good enough except if you have problems with Acid Base physiology. Then use Guyton, Ganong or NMS physiology for Acid Base only
5. Biochemistry – Kaplan is adequate but dense. IF you need to learn concept, use Illustrated Review of Biochemistry.

You should also be ready to subscribe to at least one online Q bank, either Kaplan or UW especially during the Test Preparation phase. A “downloaded” version is not considered adequate. You should also be able to subscribe to at least 2 NBME assessment test also online and not a “downloaded”  version.

Due to the lessons I have learned conducting the first prep course and in consultation with participants of the first prep course, I will now be imposing some fees. As some of you may be aware, the current economic crisis in the US was started by subprime mortgages in the housing market. People were allowed to buy houses without any downpayment. At the first sign of difficulty, these people just walked away from their mortgages because they have no equity. There wasn’t even any effort to work through the problem and find solutions.

During the first prep course, no fees were collected. This proved to be a mistake as on the first sign of trouble, some of the participants just chose to walk away. As I stated, just enrolling in the course will not raise your score or help you pass. You need to study and follow a schedule. Some participants just walked away when they could not keep up with the schedule. Others walked away when they were being prodded to start Chapter 1!!! Therefore to insure that this thing does not repeat, a non-refundable enrollment fee was eventually collected for all those enrolled in the second  and third batch of the program. This is to make sure that the enrollee is really committed to finishing the course and raising their USMLE scores.

However, it seems $ 300 prove not to be enough to compel people to study In fact, we now have a dilemma where I will only be accepting only 5 students for this batch instead of 10. Therefore the enrollment fee is now $500. I really hope this will be enough to force people to study. If you do not study, then you would have wasted the $ 500 but if you do study hard, it may yet be one of the wisest investment you will ever make.

In order to deal with situations of people not studying or keeping to schedule, we imposed a boot camp system of calling people up and a $100 fine per month for exceeding 6 months total prep time. As is obvious, they are not working. Therefore, I am imposing a new rule starting with this batch. If you are not finished by the end of the 6th month, then there will be no extension. There will be no fine and no extension. It ends. Period. So study. A second imposition will be this. The course requires you to finish your first revision in 2 to 3 months time. For those who really studied, they had no problem finishing the first revision within 3 months or less. Therefore, anyone who does not finish their first revision in 3 months will be considered dropped from the course. That is it. It may sound drastic but no other measure seem to work. For those willing to study and get the score they want, these impositions are no problem because they’ll have no trouble keeping to their schedule. For those who aren’t sure that they’ll finish the course, then don’t apply. As one of my students pointed out. You pay Kaplan $3000 for a 3 month course. You cannot ask for an extension because you have not finished studying yet, right? However, as an incentive for people to finish the course on time, you will get a refund of $50 if you finish your first round by 2nd Month and another $50 if you finished the whole course by the 5th month.  All payable upon completion of the course. So study fast and finish the course and you’ll get up to $100 back. What could be fairer.

For the 4th batch, I am accepting a maximum of 5 new enrollees to the course. If you are not accepted, your enrollment fee will be refunded. However, once the course starts, the enrollment fee will be non-refundable

The reason for limiting the number of enrollees is that shadowing and mentoring individual students is very time consuming. More so when you have to spend time encouraging, pushing and even threatening them so they will begin to study. So in order to make sure everybody can be attended to, the number of students is limited.

Applicants will be accepted on a first come, first served basis. If you are interested in applying, please send an email to applications@askdoc-usmle.com. Include the following information

Your Name or nickname

Your preferred callsign (for use in logging in to the prep course and forum)
Year of Graduation: (old grads and new grads require different prep)
Country of Medical School:
Country of Origin:
Country currently residing (ie. where you will be reviewing – your time zone)
Sex (only so I don’t make a mistake of addressing you wrongly)
Age: (only if you want to, however, I may have to make adjustment to how to couch you depending on whether you are older or younger, so if you don’t want to state actual age, give me an idea )

You should also click the link below to submit your enrollment fee ($500) through PayPal. Be sure to put the above information before submitting your enrollment fee on PayPal, so I know you have submitted your enrollment fee. (Put either your name or your callsign).  You will only be considered to have applied once you have submitted both your application and your enrollment fee.

If  your enrollment is not accepted, the fee will be refunded through PayPal.

Please submit your application and enrollment fee on or before May 31, 2009. As acceptance to the program is first come, first serve, there is no guarantee that slots will remain open up to that date. Last time, some people emailed me first to see if a slot is still open. The problem with that is that slots were still open when they emailed me, but were already filled up by the time I answered. So they wound up missing the class.

Once you are accepted you will receive an email from me that you have been accepted and you will be given instruction to follow. I will process the application weekly So you should be able to receive an email within 7 to 10 days from the time you submit the application. If you have not received an email from me, please search your spam folder. Last time, some applicants weren’t able to find their email  because their emailboxes put them in the spam folders. If it’s not there, email me to follow up.

Please be sure you are ready to start on June 1.

Name of Applicant