askdoc-usmle

We now come to Part III of our discussion on “Preparing for the Step 2 CS” In Part I, we discussed how to prepare for the medical interview part of the clinical encounter. In Part II, we discussed the physical examination part of the clinical encounter. We will now tackle the social aspects of the clinical encounter which is usually called bedside manners.

We can further divide the social aspects of the clinical encounter into two. Those that you do in every clinical encounter and those that you do in specific situations. We will start with the first one.

So what are the things you do in every clinical encounter?

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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.

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We now come to Part II of our discussion on “Preparing for the USMLE Step 2 CS”.  In Part I, we discussed how to prepare for the medical interview part of the clinical encounter. We will now tackle the physical examination part of the clinical encounter,

To answer the first question on a lot of people’s mind. No, you should not do the physical examination while conducting the medical interview. Not only is it rude, you miss the opportunity of building rapport with your “simulated patient”. A question your “patient” is asked is if they would want you to be their physician and depending on the source could be an additional 1 or 2 points for you.

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We begin part 4 of our series on “What to Study for the USMLE”. In Part I, we discussed the need to choose our review material based on what we want to achieve in the exam. We also discussed the use of substituted judgment when we rely on reviewers to know what to review for the examination, and the need to make sure that these judgments are based on the same goals we have with regards to passing, scoring well or acing the exam.

 In part 2, we discussed that the score you want to achieve not only dictates the review materials you choose, but also how much of those review materials should be mastered and not just read through. In part 3 we talked about the various materials you used for review and the need to go back to textbooks for concepts you do not know, since you cannot review concepts you do not know. You have to learn them first and you need textbooks for that.

 In part 4, we will discuss the two types of text reviewers you should be using for your review and how to use the concept of different types of recalls with the reviewers to maximize the amount of material you can store in your head for the exam.

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I would like to announce that Askdoc’s Method of USMLE Review for Step 1 is now available at my prep forum at http://forums.askdoc-usmle.com. As I promised to some of you before, it contains more or less the same instructions available to the participants in my prep course. It includes suggested alternate reviewers and q Books you could use for your review. If you have any questions about the review methods, feel free to post your questions there.

The prep course participants are currently revising pathology so only the pathology review methods are outlined. Once they’ve reached the other subjects, probably around 1st week of October, instruction for the other subjects will be posted there too.

The prep forum is currently limited to Step 1 and Step 2 CS only as it will take time before I can write up enough materials to fill them. However, one feature it has which members may like is a Groups section where members can form themselves into groups and have a place where they can do their group discussion and learning in privacy. Only group members can enter and post in their forum. They could also limit visibility of the forum to their own group. Groups wanting to have their own forum section should sign up at Askdoc’s USMLE prep forum and submit the names of all group members and the name of their group (which will the name of their forum under the Groups forum) via personal message to me. Please include if you want to keep it invisible to the public. Your group is good for 30 days. You can extend it twice at 30 days each time for a total of 90 days by sending me a personal message before the 30 days expire.

Small private groups are handy for discussing Step 1 concepts and even Step 2 CS cases.

For the past few months, I’ve written articles that deal with all the different Steps except for Step 2 CS. So this will cover preparations for Step 2 CS.

Like most IMGs, I felt really anxious preparing for the Step 2 Clinical Skills. This was primarily due to the novelty of the examination method. (simulated patients, etc.) Although, we had a type of clinical skill exam in training, we had actual patients which we examined rather than a simulated patient and what was graded was more on did we get the diagnosis and treatment right, rather than how we did the interview or physical examination. In other words, on the results rather than the process.
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We begin part 3 of our series on “What to Study for the USMLE”. For those just joining us, please refer to previous post here and here. Due to the sheer number of review materials available to examinees, we need to classify them in order to make it easier to choose and mix and match between them.

Broadly, we can classify our study materials into three. First are reading materials, mainly books and other written study aids, eg. Flashcards, etc. Second are Question Banks, which by themselves are very important and crucial study materials. Lastly and increasingly gaining importance are audio and visual resources like lectures both audio and video.

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Back in 2004 when I was just starting my preparation for the USMLE, my greatest fear was in failing this examination. My status as an old graduate made failing a stark reality for me. Every person I asked told me that as an old graduate I have no chance. The most encouraging response I got was, “maybe you’ll pass, but it’s impossible to match with really low scores.” When I went to forums, I hear horror stories of people failing which frightened me even more. Then once in a while, when I read of people celebrating and crowing about their 99’s, I secretly wished that that was me. Even my own family thought it was impossible for me to make it. It got so bad, it took me over a year to get around to seriously preparing for it.

Now 4 years later, with a double 99 in my belt, I feel bad whenever, I read about people failing the examination. If I can make it, they should be able to make it, too. 2 years ago I wrote an advise to someone who had failed already thrice and was plaintively asking people “What to do”. I’m happy she eventually passed her exam with an 82. Since that time, I am happy to note that a lot of people have passed and raised their scores and even got 99’s using that advise. A couple of them had the opportunity to catch me between Steps and was couched by me through emails to raise their scores with varying results. However, since that time, hundreds of people still failed. Some had read my advise but were doing exactly opposite of what I had written. Others, I found out did not understand how to implement what I had written.
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Today I’ll not talk about the USMLE but something else. Although I set up my blog on March 23, 2008, My first real post on the USMLE was posted exactly 4 months ago on March 28, 2008. So in a sense we are celebrating my fourth month as blogger and I’ll start by posting the different milestones my blog have reached.

After 4 months (as of July 27, 2008)

Total posts: 30
Number of pageviews: 7,046 – 4,439 in July alone
Number of Visitors: 2,290 – 1,528 in July alone
Number of Countries: 87 from 812 cities
Top 5 countries: United States: 1, 548; Canada: 122; India:117; Philippines:86; Pakistan: 48
Number of downloads of my ebook “How to Create a Study Plan for the USMLE”: 524
Alexa top rank for all websites: 3 month average rank: 2,852.091 (8,600,000 6 weeks ago)
1 week average rank: 751,712

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Today, we will talk more about the NBME self-assessment tests. We previously discussed what the NBME self-assessment tests are and how they impact your USMLE review. You can read the posts here. Now we will cover three important topics. When to use the NBME self-assessment tests, how to use the NBME self-assessment tests and how wise it is to use the USMLE World self-assessment tests instead.

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We begin part 2 of our series on “What to Study for the USMLE”. For those just joining us, please refer to previous post here. Before we discuss the various criteria for selecting study materials for review, we need to clarify some concepts and discuss some limitations.

First, there is no real guarantee that if you study certain materials you will get a particular score. Continue reading »

We now come to the second part of our discussion of “Using Q Banks effectively for USMLE Review”. For those just joining us, please review the previous post here.

Previously we talked about what Q Banks to use and when to use them for review. We will now talk about how to use Q banks as study tools and how to use them for review and assessment.

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This is a really big topic and would probably take at least a dozen posts maybe even two to finish. However, we have to begin somewhere. This is actually the most common question asked in forums. When people ask whether First Aid is enough, should I do Q Banks, do I need Goljan, etc. the question they are really asking is, what should I study for the USMLE. When they scour through exam experiences in forums, spend money on bootlegged CDs or DVDs or decide whether to use the extremely expensive UCV (you know its my pet peeve ), etc. what they really are concerned about what to study for the USMLE.

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The NBME self assessment test is another of those tools that I feel is responsible for the increasingly high scores in the USMLE. It is a great tool that allows the test-taker to assess his or her readiness for the exam. To a certain extent, if used properly, it is also a useful tool for the examinee to target a certain score, even 99’s and achieve it.

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Doing Q banks is now considered part and parcel of USMLE review. Any person still not using Q banks is taking a big chance of doing poorly in the examination. In fact I believe one of the biggest reason for the increasingly high scores among both AMGs and IMGs is due to the existence of superb Q Banks, primarily USMLE World and Kaplan. My double 99 in step 1 and Step 2 CK Continue reading »