What to Study for the USMLE – Part II

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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. All you can be sure of is that you have a high probability of getting that score. The reason for this is varied and not all of them under your control. For example, since different exam sets are given to different examinees, the exam set you wind up with in the actual exam has a big impact on your final scores. It’s a universal fact that nobody can know every concept tested in the USMLE, therefore the more the exam set covers what you have studied and remembered, the higher your score will be. If it happens to cover a lot of materials you never read or do not remember then you are out of luck.

Second, two persons can study the same material, but what they remember, how much they remember, let alone how much and how complete their understanding of the material they’ve studied will vary. It seems everybody is studying the same material and doing the same Q Banks and yet the results vary from failing the examination to getting double high 99’s. Therefore, it is not enough to know that you have read Kaplan notes or First Aid, etc. You must know how much of what you have read, you understood and can recall.

Remember, for the purpose of the USMLE, what you cannot recall, usually in a minute or less, you do not know. In fact, the USMLE does not care whether you’ve read the concepts or understand it. You’ve to have read it, understood it and can recall it instantly in the examination. That is a stiff requirement. Therefore, it is not enough to have read the materials, you need to be able to understand and recall them. You need to read, understand and be able to recall at least 75 to 80% of Kaplan Notes to be able to pass the exam and yet most people just read them numerous times, hoping that that would be enough to pass the exam. You probably need to be able to recall 95 to 100% of Kaplan notes to score in the 90’s and depending on how much you were able to absorb from the qBanks have a small to average chance of getting 99’s.

Third, as I stated in my ebook “How to Create a Study Plan for the USMLE”. It is a universal truth that people usually miss their target therefore it always make good sense to over study a little bit. If you just want to pass, aim for an 80 so that you have enough allowance in case not everything go as planned. Therefore our recommendations will take that into consideration

If you haven’t read my other posts on high yield concepts, Mastery, know and familiar and information recall, please read them first. Then come back and join us in the discussion.

Dr. Goljan emphasized in his lectures that the more you read and know the higher your score will be in the USMLE. I will add something to that. The more you read, understand and can recall in the actual examination, the higher your score will be in the USMLE.

If you are aiming just to pass the examination, then you don’t have to read, understand and remember as much as someone who is aiming for a 99. However, it is still good policy to aim for an 80 or so, just to make sure you will pass, as too many variables not under your control can affect your final scores and the higher the score you actually aim for the lower the chance that you will fail.

There are 2 ways to achieve a passing score. One is to study only high yield stuff, ignoring lower yield ones. It requires mastery of high yield concepts, that is knowing enough details about high yield concepts that you will be able to answer the tough questions that is inevitably the form most high yield concepts will appear in the exam. This is because you will invariably miss a lot of low yield easier questions as you did not study them.

Two, is to study both high yield and low yield stuff. This way, you do not really need a high level of mastery of the high yield stuff as you can pick up points answering the lower yield stuff. The question now is how much detail you go into the high yield stuff and how much low yield concepts you need to know. Again this is a judgment call and not everyone is skilled in making this judgment on their own.

You also need to do q Banks even if you are just aiming to pass. This is mainly to familiarize yourself with CBT type of examination. Struggling with the computer software during the actual exam can lower your score significantly. However, using q Banks as a study tool is only advised if you are using the second strategy of studying both high and low yield stuff.

If you are aiming to score average to above average (85 and above) again it is advisable to aim for 90’s. You must study the high yield stuff and master the proper amount of detail. But it is also imperative that you cover lower yield stuff. You can use q Bank, especially UW to cover the lower yield stuff, but you must take notes and reread those notes at least a couple of times. Goljan’s Pathology lectures can help you achieve the right level of mastery at least in pathology to help you score above average. Goljan also covers the other subject albeit not as comprehensively in his notes. Kaplan notes have the required level of detail to score average to above average scores but you must be able to recall at least 95% of the details in the notes to do so.

Aiming for 99’s is much, much more difficult. You need to cover not only the high yield stuff and master them, you need to cover a lot of low yield stuff, plus you cannot have a weak subject. Since you need to make sure you score high in all sections of the examination, having a weak point in a subject can cause you points you need to reach 99 or high 99. In fact the higher the 99 you are aiming for, the more you cannot afford any weak point. Whereas, you can afford to cover major subjects only if you are aiming for above average scores, eg. mastering only Pathology, Microbiology and Pharmacology in Step 1 or Internal Medicine in Step 2 CK and Step 3 while just skimming through the rest. You have to master almost all subjects if you are going for 99’s. Kaplan notes is not enough for 99’s in Step 1 even with UW q Bank or Kaplan q Bank, your chance for a 99 is low to average. You need at least Goljan or Robbin’s Basic Pathology for Pathology, Jawetz and Levinson’s Microbiology and Immunolgy as supplement to increase your chances of a 99. For Step 2CK, Kaplan notes, mastered at 95 to 100% + UW q Bank at 80 to 90% is minimum if you want a good chance of getting a 99. In Step 3, doing well in the MCQ section is not enough, you need to do well in CCS section too as it is 25% of your score.

Remember, you can study less than what I have stated and still get the score you desired, however your chance of doing so is much lower and your chance of failing to reach them is much higher. In sports, records are considered broken only if it is achieved during competition and not during practice. Therefore athletes aiming to break world records, break those records numerous times during practice to insure that they have a high chance of doing so during actual competition. Otherwise, they can break records only through pure luck. The same goes with the USMLE. You must consistently score high during practice and review to insure that you will get the score you desire and not depend on luck.

We will stop here and continue our discussion next time. We will give more detailed discussion of the various resources you need to use for each of the above scenario for Step 1, Step 2 CK and Step 3. We will then continue on to discuss individual resource and their pros and cons in achieving your objective in the USMLE.

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18 thoughts on “What to Study for the USMLE – Part II

  • July 24, 2008 at 6:36 am

    Hello askdoc:

    I’m an IMG from Taiwan. I just started my study plan for step1 for 2 months. I agree with your concept and follow your suggestion form the forum and the blog. Please give me some suggestions.

    I got all kaplan video and lecture notes on ebay together with Goljan materials and other books. Now I finished all behavior science, all anatomy and half biochemistry videos of kaplan. I found it’s hard for me to recall after that. I decided to start my study from gross anatomy and pathology for suggestion of FA. Now I’m study NMS anatomy and Goljan notes. I can only finish about 10 pages of them in 1 hour, and after a chapter I can answer 80% of questions of NMS correctly, but only 50% of Robbins review. I’m worried for two reasons. One is I think my reading speed is low and it may takes more time I have totally for finishing my KA process. Another is that I don’t know what I have to memorize. Sometimes I memorized nothing during my reading but sometimes amounts of tiny stuffs with still low performance for the qs after the chapter. The same situation happened in my school course. I’d spent all of my time studying but my grade is still below average. In the pathology case, I plan to change my material to BRS as guide and Robbins basic pathology as main text. Can you give some comment?

    I’m still a medical student in clinical years. I plan to commit all my time after clinical and laboratory works, and that’s 4~6 hour per day in average. And I hope reread all subjects at first. I hope that I can take the exam before next July. I want a 99, otherwise it would be meaningless for me to prepare for this. I know my starting point is low and I want to jump high for my only 50% ranking in my faculty. But I think I can improve gradually. For me, writing here is a relief because no one around me I’ve heard had the experience of USMLE.

    Thank you for reading this long post.

  • July 24, 2008 at 9:35 am

    Some things I have to clear up. How good is your english comprehension? You may have to listen or read things up more than once if your comprehension is not good enough. Another thing, I would suggest you read up first before you listen to lectures, else actively take notes while listening as that would make it easier to remember what you’ve heard.

    Another reason why you may have problem remembering things is you did not organize the information you’ve read or heard first and therefore cannot remember them very well. For me I can do it in my head, but for those I can’t, I usually write an outline in a notebook or the margin of the book I am reading. This helps me organize the information in my head. The outline notes is what I memorize really well and use them to aid in recalling other information I’ve read. Everytime, I read something new, I file them in a related topic and try to relate them to information I already know. It makes it easier to recall.

    If you read what I wrote in How we recall information about immediate recall and aided recall, you will understand that what I am suggesting is putting this outline into immediate recall and using aided recall to recall any other information you need.

    For example, one outline in pathology should go like this: Cell Pathology can be subdivided into, cellular adaptations, apoptosis, necrosis, accumulations, causes of injury. Under cellular adaptations you have hypertrophy, atrophy, hyperplasia, hypoplasia, aplasia and metaplasia and their definitions. You put all these on the outline notes and memorize them by repetition. Now all other information related to them, like examples, clinical conditions where they appear etc. can be put under aided recall. How? while repeating them try to remember what other details you have under each topic, that will help aided recall. When you listen to lectures, it is just a matter of relating what you’ve heard to the outline and other related information you already know to retain them. The same holds true for retaining information when you start doing q Banks as review tool.

    Now BRS can be used as an outline, again the same method holds true, memorize main topic of BRS. when you read Robbin’s Basic Path, relate them to the outline in BRS. (maybe even writing on the margins of BRS what you’ve learned in Robbins. Later, when you reread BRS, try to recall information in Robbins first without looking at them, if you can recall them, then you’ve got that in aided recall. So what should you list down from your reading Robbins? Well, I don’t know if you’ve seen the USMLE Wiki project I am working on. It’s in http:usmlewiki.org. I’m still writing out pathology. It is based on BRS and Robbins, but the big one Pathologic Basis of diseases. If you look at the difference between BRS and contents of USMLE Wiki, those are important information you need to know from Robbin’s if you want to get a 99 at least for pathology.

    However, one warning, you can only review what you already know. Reviewers are written for reviewing and not for learning. The USMLE Wiki is written as a reviewer or what I would like to call study notes in contrast to outline notes which BRS is more akin to. Kaplan’s note is considered study notes albeit a rather short one. If you do not yet know a concept, it is safer to use a textbook like Robbin’s since textbook are written for learning new concepts. They assume you don’t know anything and cover concepts in details. Reviewers presume you already know them and need only hints and buzzwords to recall them. So if you don’t know a concept, reviewers do not help you to know them. Same with Kaplan lectures, vs. lectures given by your professors in medical school.

    Hope this helps. If you still need more guidance feel free to ask and I’ll try to answer as much as I can. If you still have problems answering the Q’s please read my post in prep4USMLE entitled “If you failed”. Just posted it a few hours ago.

  • July 24, 2008 at 10:23 am

    Thank you, askdoc. I did have some problem with Goljan’s lecture. Sometimes I just found I can’t follow him. Your comment inspires me. I will try first (and read other your posts) then tell you if it’s work for me. Thank you again.

  • July 25, 2008 at 10:50 am

    You are amazing! I haven’t started studying for the step 1 but you make me excited to start!

  • July 27, 2008 at 1:04 pm

    Hello Askdoc:

    I have another question about doing MCQs. How can I check if I really understand the text in reviewers before doing questions after that reviewer, or I just use those questions to check my comprehension? Although I can understand the concept better after correcting those Qs, it’s frustrating to see red correct lines on my book:(

    As in your article in the forum, I found on of my biggest problem is that I don’t understand fully of the texts. When I study, most of the time I just underline the texts, repeat and try to memorize that. Once I think I get it, I have no patience to stay on those lines, otherwise, I check other sources to clarify. How can I revise my concept toward study and my study methods to check after finishing the reading I’m ready for taking those Qs rather than repeating the same chapter again?

    By the way, by your suggestion now I try to draw a outline map after I read BRS pathology, then go to the text. I hope it works for me.

    Best wishes.

  • July 28, 2008 at 9:05 am

    To Robinlee,

    First, how is your english comprehension. Even if it’s good it may not be good enough to understand highly technical texts, especially if you use chinese in your medical school. IF this is the case, may make sense to study concepts using chinese text. After learning concepts, then go to appropriate english text. This way you already understand the concept and have easier time understanding english equivalent of the concept.

    If that is not the problem then you should look for texts that explain concepts in simpler terms, before going deeper into the more complex details. Another thing is never memorize while learning. If you do not know the concept, read and reread it to understand, not to memorize. It may help to outline the concept to see if it makes sense to you. Only after you’ve learned it and understood it should you even try to memorize it. Finish learning the whole material first. Then when you are confident that you know the concept, then start memorizing it in detail.

    An example is Coagulation cascade. You should try to understand the process first before you even try to memorize the components of the coagulation cascade. Understand that there are two separate pathways and one common pathways. have clear idea what common pathway components are and the rest is either extrinsic or intrinsic pathway with extrinsic pathway using only factor 7. Once you understand this, it is on to study detail of each pathway including cleaving reactions. Then off to regulatory feedback components. Then probably laboratory tests. Then mechanics of laboratory tests. Then diseases. If you notice I organized the information into components. Then for each component, I expand my understanding of the details of that component. That way you do not forget easily what you have learned.

    About Q Banks. There are subject specific q Banks like Robbins and Cotrans Review of Pathology and the online Q Banks like UW and Kaplan. Subject specific q Banks tests your knowledge of Specific subjects, while UW and Kaplan tests your knowledge of topics tested in the USMLE. So if you want to test your comprehension and recall for subject matter, better use subject specific q Banks. Once you know that you know the subjects thoroughly, use online Q Banks to sharpen your ability to answer USMLE type questions. Then, any mistake you make in online Q Bank is more likely due to tough questions and problems related to exam mechanics, rather than problems related to the subject matter itself.

  • July 30, 2008 at 6:07 pm

    Thank you, askdoc. I think my English conprehension is ok, at least for reading. But your concept of “concepts” is amazing. I had never thought about it. Can you teach me how practice I can do to build up my ability to identify concepts in texts? I’ve read an article for my problem. It pointed out that I don’t simplify what I learned, then I can’t remember. What do you think?

    Best wishes

  • August 1, 2008 at 3:52 am

    Hi Robinlee,

    It’s not really a matter of simplification, it is a matter of putting it in a context you can relate to. If you fail to understand it, then you can’t memorize it. Even if you understand it, you need to relate it to what you know. Another way to put it is that if you really understood it, you can simplify it and you can rephrase it to make it “your own”. if you get what I mean.

    About English comprehension, you can test if language has an effect by noting if it is easier for you to learn those concepts in chinese or english. If it is easier to learn it in chinese than language has an effect and although minor may not affect your comprehension most of the time, but in some cases it can especially in really technical texts.

    I’m trilingual, however for technical texts, I’m really good in English only. I have no problem reading Filipino newspapers, novels, etc. I can even read technical texts in Filipino but not in the same level as in English. My reading comprehension in Filipino can be considered average, but in English it is way above average. I can read, but with some difficulty and slowly in Mandarin. Can comprehend newspapers and easier read. Cannot read a full Mandarin novel without a chinese dictionary (doesn’t have to be chinese-english dictionary though), and completely hopeless if it’s technical.

  • August 23, 2008 at 8:53 pm

    Dear AskDoc,
    I just arrived in the US a couple of months ago and I thought being in the US is the end of my career. I am a very old IMG( turned 10years this August). My practice was confined to part time charitable general practice in our country due to my fulltime status as a homemaker. This just means I’m rusty yet ambitious to still pursue my dream. More often than not, I get feed backs like – it’s not practical for an old IMG to pursue medicine anymore coz’ the competition is tough, nursing is more lucrative… IMGs score low in the USMLE, matching for residency is slim.. medicine is equated with malpractice so why crack your head… Yesterday, I gave up my dream.. I’ve opened the doors for a career shift. But then, for unknown reason, I searched for AskDoc in google if it still exists (coz’ I’ve been reading the forum last year)… eureka! You have a website now!! I just did a marathon reading from day 1 of your blog to the present.. I thank God for sending an angel in disguise through you… There’s hope after all.. By His grace, I have decided to journey with you for the next 3-6 months.

  • August 26, 2008 at 10:03 am

    HI dokiks,
    It is true that it is harder for old IMG’s to get into a residency program. First, you have to have higher score. Than you have to work harder, be more aggressive than everybody else both to get interviews and getting matched. However, it is not impossible. But be prepared to paraticipate in more than one year’s match. If you get in your first try, consider yourself lucky. Most of the old IMG’s I know who got in, took multiple tries, despite above average scores. Again harder than normal but not impossible. My own estimate is that na old IMG’s chance for matching is less than 50% of an equally credentialled freshly minted IMG.
    So, prepare for a long hard process and don’t be easily discouraged. Good luck on your journey.

  • August 26, 2008 at 11:51 am

    I hope you won’t mind if I’ll be asking you for some help once in a while. I wish I could join your prep class too but I know it’s full. I did what you advised to marlene. I’m starting off with pathology. I’ll just cope with the study outline you provided in WIKI. Pasalamat lang po at dasal pede ko maibigay ngayon sa inyo…Sobrang salamat po talaga…

  • August 31, 2008 at 6:10 am

    Hi dokiks,

    Kumusta, kabayan. Anyway, I will be posting the course curriculum which the participants of my prep course will be using. You won’t have access to my study materials, but there are alternate commercial prep material available and they are good. Remember that’s the one I use when I prepped 🙂 Look for it in my prep forum at http://forums.askdoc-usmle.com under Askdoc’s Method of USMLE Review for Step 1 anytime next week. It will updated as prep course members reach the appropriate segment of their review. There will be an area where you can ask questions about the prep methods. It won’t be fast, but it will eventually get answered. Anyway good luck on your prep. Aim high.

    ps. My wiki although not bad, needs revision and more work. My study notes for the prep course which was revised from the Wiki is much better. However, using Wiki syntax is matrabaho and harder than formatting in MS Word, so probably will be sometime before I can revise the Wiki to reflect the better coverage in the study notes I prepared for the prep course.

  • August 31, 2008 at 11:07 pm

    I’ve been trying to assimilate everything that you’ve been posting. Now, getting into the real stuff of studying the concepts really makes sense! I hope I could maintain my speed and enthusiasm for the prep. Thank you so much for the assistance and encouragement!

  • September 3, 2008 at 10:22 am

    To dokiks,

    Good for you. Be sure to check the forums for the study methodologies sometime this week.

  • September 4, 2008 at 9:29 am

    Welcome dokiks,
    you touched a chord in me and sent shivers down my spine. I am glad to see others fell the same way I did when I came across askdoc’s site. Journey with us then. I think it is all worth it. Good luck to all of us.

  • September 6, 2008 at 3:58 pm

    Dear Marlene,
    More than you know it, you’ve been an encouragement to me that’s why I quoted you. I’m going to give my best shot to cope up with the team coz’ the only time I have to review is during the night after putting my kids to sleep. We all need God’s grace in this endeavor…. 🙂

  • October 4, 2008 at 5:45 am

    I just want to tell dokiks and Marlene that I was an IMG who graduated from med school 10 years before I got into residency. After medical school, I worked to make a living, and actually thought about not going back into the field of medicine. However circumstances, and actually, I think God prompted me to do this, I decided to change my career path back to medicine.

    When I first graduated from medical school, I did apply to residency 2 years in a row, with no invitations for interviews, as my Step 1 and Step 2 scores were on the low side. There was only a couple of differences when I applied to residency this time. One was that I worked in Clinical Research with MD’s who happened to be affiliated with universities, and that they wrote me some letters of recommendation, and two, the experience I had working in research was related to the residency I was applying for.

    I guess what I am trying to convey is that what you are hoping for is very possible. I think that there are indeed programs that are more IMG friendly. I think government hospitals, hospitals in areas that are defined as “bad areas” and smaller hospitals tend to be. (They need bodies to work.) When you apply, apply to as many as you can (within the financial constraints). Consider areas in the midwest as well. New York has more hospitals than California. I remember when I was interviewing there were some people who were cancelling some interviews because they had too many. I only had three and felt bad about it. And I remember one of my friends said, “You only need one, don’t you?” Yes, that’s true. That was all I needed.

    And after the interviews, I sent thank you letters to the directors of the programs that interviewed me.

    Now 4 years later, I’m in a fellowship in Psychiatry in New York.

    There are also externship programs that you can apply to, unfortunately, they are unpaid. Many of the residents in the program I was in came from the hospital’s own externship program.

  • January 19, 2009 at 7:45 am

    hanggang ngayon eh tumitindig ang balahibo ko habang tina type ko ito. M also a housewife n guess what? working as an rn here in midwest. Also gave up my hope of practicing med. just checking websites then came across this. Graduated/passed >10s years ago, just took it bec lahat sa class ko were taking it n now cannot retake it again bec of ecfmg rules, pangit TOR. I just appreciated being a dr nung ma assign na ako sa province n exposed sa real medicine. Finished OB-GYN trng then have to come here bec of my hubby. Sorry for my rumblings. M just excited dahil nabasa ko si dokiks n marlene n this website na marunong magtagalog. I can relate to ur studies. Studied for nclex na may inaalagaang 2 n 5 yr olds, told to just cont being a nurse when I was looking for emotional support to pursue med again. Is this true or m I just dreaming na may website na ganito?

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