Using Q Banks Effectively for USMLE Review – II

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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.

Q banks like USMLE World and Kaplan are most effective in helping you score well in the USMLE whereas other Q Banks are more effective at increasing your mastery of particular subjects. Q Banks dealing with specific subject usually tackles the subject in more detail and testing how thorough you’ve mastered the subject, while UW and Kaplan concentrates more on concepts tested on the examination, giving different weights to different subject depending on its importance in the USMLE. To learn more about UW and Kaplan Q Bank please read my post on “USMLE World vs. Kaplan Q Bank, which one?”

We will now discuss the difference on how to use Q Banks as study tools and Q banks for assessment and test preparation concentrating of UW and Kaplan. Although both Q banks may be used for either purpose, UW is better as a study tool and Kaplan better as an assessment and Test prep tool. There is also a difference between Step 1 prep and Step 2 CK prep. There is less difference with Step 3 prep vs. Step 2 CK.

First question, Should I take down notes? Of course, you should. It is a good idea to take down notes in all aspects of your review not just when doing Q Banks. One of the things I noted in my conversation with other double 99ers during the course of my interviews is how they take down notes made a big difference in their review. I’ll deal with that in a future posts. You should be taking a lot more notes when you are using Q banks as a study tool. If you find yourself still taking copious notes by the time you are using Q banks for assessment and test preparation, then there was a problem during your initial review and you may need to evaluate your readiness to take the examination.

More important still is to know what notes to take down. As noted on my post “What to Study for the USMLE”, not everyone knows how to take good notes or judge what is important or not. Hence the need for substituted judgment. The good thing about UW and Kaplan is that all the questions really give good coverage to what is important at the right level of detail. They may not cover everything (hence, you can’t just use Q banks alone without other study tools and expect to get high scores). But you know what they cover have a good chance of coming out in the examination.

Of course, facts on questions you answered wrong should always be noted. But even if you got the answer right, if it was for the wrong reason, take note of this fact too. Ditto for questions whose answer you were not absolutely sure of even if you eventually got it right or questions you got right but took you too long to answer, since this shows lack of full mastery of the topic. If the same concept is presented in the actual exam in a slightly different way, this lack of mastery may cost you. You must also make a decision whether to supplement this notes with additional reading, especially on topics you should have mastered already in your readings.

There are also differences depending on what steps you are taking. In Step 1, any facts, even if low yield, should be taken down. Step 1 tests Basic Science facts. Even pathophysiology, Goljan’s mechanisms, mechanisms, mechanisms are facts. Step 2 CK presupposes you know the facts and would like to know if you know how to use those facts in clinical decision-making. Therefore, it is important to note the basis for deciding a therapeutic course of action, or a diagnostic test to favor in a specific case not just simple fact. Also note down any atypical presentations of signs and symptoms in individual cases, since Step 2 CK cases tend to be less typical, eg. male with Temporal arteritis (typically old female) or white male with sarcoidosis (typically black female) Same things generally holds true for Step 3 as in Step 2 CK. However, for Step 3 also note down the Treatment of Choice and the next alternative treatment of choice of all common diseases. For example, Co-trimoxazole for simple cystitis and amoxicillin only if pregnant. Very important to take notes of all ethics questions too in Step 3.

The next most commonly asked question is should I take it in blocks of 50 (48 now for Step 1). If you are using Q Banks as a study tool, you don’t have to take it in blocks of 50 (or 48, or 46, etc.) and it may not even be desirable. However, if you are using it for assessment and test prepartion, it is best to simulate the exam and take it in appropriate blocks with time limits.

The reason you avoid doing full 1-hour blocks when using Q banks as a study tool is that there is a limit to the sharpness of your attention span and for most people this is around an hour or so. If you spent that hour answering questions, you may not be fully alert when you are studying the answers and taking down notes. Better to do 20 ++ q’s in 30 minute intervals and spend the next 30 minutes in reviewing the answers and taking notes. Rest a bit then go to next block. The alternative is to study the questions another time, but you don’t get the benefit of noting down any problems in your thought process as you were answering the particular questions.

When using Q Banks for assessment and test prep, not only is it important to do it in appropriate blocks with time limits, you must also work yourself up to doing it at 7 or 8 blocks per day (depending on steps) with the same rest limits as the actual examination. That is of course the ideal, but going as close to it as possible is just as well. I do not recommend doing full day simulation a few days before actual examination as the simulation can drain you and may even affect your performance on the day of the actual examination.

As I stated in a previous post, blocks in the actual USMLE exam are balanced in that it is a mixture of easy and tough questions as well as long and short ones, mindful of the time limits imposed. In Q banks since blocks are generated randomly, it is possible to get predominantly tough questions in a block or predominantly easy ones. Ditto for long and short questions. These can be a problem when doing exam simulations with time limits. I noticed that Kaplan tends to give more balanced questions in blocks while UW can have really tough questions all in one block. You can note this by looking at the percent of users who got questions right. There is a much wider variation between blocks in UW than Kaplan. That is part of the reason why I recommend Kaplan for assessment and test preparation rather than UW.

I’ll stop here. Til next time.

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12 thoughts on “Using Q Banks Effectively for USMLE Review – II

  • July 10, 2008 at 5:48 pm
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    Great stuff yet again. Thanks!

  • May 3, 2009 at 8:19 am
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    Hey askdoc,

    So lets say I finished learning all the high yield concepts 3 months before where I scheduled my step. Would you recommend that I start with 2 months of UWorld first, for more further learning, and then 1 month of Kaplan Qbank, purely on test prep?

    THanks!

  • May 7, 2009 at 6:28 am
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    Hi JLee,

    The problem with your plan is that you have skipped mastery altogether. There are 3 phases to the preparation, not 2 and the key to high scores is Mastery and Test Prep. But of course you cannot master what you have not learned therefore, you need the learning phase to make sure you know the concepts. Please read up on my blog on what learning, Mastery and test prep phase are. You can get some more detail about those 3 phases on my post about my Step 1 prep course.

    Askdoc

  • June 5, 2010 at 12:03 pm
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    Hiii,

    i have 20 days for my step 1, if everything goes right!

    I am left with 500 questions on uworld qbank. Because of inconsistency in study, the scores on the uworld tests till now cannot be used for assessment. so i wish to use the 500 questions left(10 tests) to know whether i am ready to give exam.

    The problem is, I also wish to reuse the used questions of uworld for my system wise last review and this is not possible as uworld allows either unused questions or all questions but not used questions.

    So, I am thinking of using up remaining uworld for review and buying Kaplan Qbank for assessment ( instead of 500 unused uworld questions) of whether i am ready for test. This extra money spent may cause my inability to buy NBME.

    What do you suggest?

    If you suggest taking kaplan, then what should be the scores on last 10 random, unused, timed tests for 1) passing 2) above 90 3) 99percentile.

    It will be great if you can tell the similar scores for uworld too; as all this info is not given at one place on your site.

    Thank you so much for your time.
    Smita.

  • July 31, 2010 at 9:23 am
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    hi askdoc, great post by the way as always!
    I’ve done most of UW but only scored at most 50% right. I noticed that i got many questions wrong because I was unable to answer the final step of the 3 step questions: I got all other steps leading to the final answer right, except for the final piece of info I needed to choose the right answer. I want to start my prep all over again, start from scratch. How do u suggest I go about fixing the problem?

  • July 31, 2010 at 10:01 am
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    never mind! I read on your other post about UW vs Kap, that the qbanks may require more mastery of a topic and knowing multiple details, not just a few to do well on the 2 to 3-step questions. I think i will work on my mastery of topics; is that KA or KR problem?

  • August 2, 2010 at 4:09 pm
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    Hi jonyc,

    The way to distinguish between KA and KR is whether you know the answer but can’t think of it during the exam. If after looking at the answer, you know the missing piece but failed to recall it, it is a KR problem. However, if you know the missing piece but was unable to connect it to the main question and was surprised that they can be connected that way, it is a KA problem. You failed to integrate and correlate your knowledge. Of course, if you don’t know the missing piece that is a KA problem. If KA problem, you need to reboot and start from the beginning and prep correctly this time.

    Askdoc

  • October 4, 2010 at 6:14 am
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    Hi,Askdoc,
    Thanks for this post.I started my preperation for usmle step 2 a month ago.
    I have been reading a chapter/topic from internal medicine and doing the corresponding questions in usmle world.Is that a good study method?
    But from your other posts, i gathered that online q banks are done after entire review.Can you please suggest some good q banks for chapter wise review, which will help me in mastery of that particular topic/chapter?
    Thanks.

  • October 11, 2010 at 5:40 am
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    Hi Becky,

    For Step 2 CK, I did not do per chapter quiz. The best method is to review is to write out algorithms both for diagnostic workup and therapeutic management. You can use Kaplan Q Book for the per subject quiz. Always reserve qbank after initial review.

    Askdoc

  • October 12, 2010 at 4:58 am
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    Thanks for answering Askdoc,
    I’ll try it and let you know how it goes
    Becky.

  • October 21, 2010 at 12:54 am
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    Hi becky,

    Good luck. Keep me informed.

    Askdoc

  • November 13, 2010 at 1:15 pm
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    hi
    I am failed twice in step 2 ck .
    Did UW/Kaplan q banks…twice
    did again twice for 2nd attempt….total 4 times…
    yet failed step 2 ck ….

    where to start now????.
    correct knowledge bank. or knowledge recall….?

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