Hi there. Mike here.
Welcome to another issue of Askdoc's Newsletter. Today, we will be talking about 7 things you need to know about the USMLE if you want to do well in the steps. In order to slay the monster that is the USMLE you need to know the nature of the beast. Only then can you come up with a plan on how to defeat it.
You need to make sure that your study plan takes into consideration these 7 factors or you will have a hard time doing well in the USMLE. Most IMGs make the mistake thinking that all they have to do is begin studying without taking into account the factors below. This is usually the result of observing that most American medical students just use First Aid and online qbanks and they pass.
We will discuss in more detail why IMGs need to study harder than American medical students in the next newsletter. The two most important reasons however, are the following:
American medical students study in American medical schools who have taken into account all the factors discussed below in their curriculum and the prep sessions they hold with their students. They need to make sure that a certain percentage of their graduates pass the steps or else they lose their accreditation.
Meanwhile, foreign medical schools gear their curriculum to pass their own country's medical board. A high percentage of student passing the USMLE will not help their accreditation. Therefore, it may not be wise for IMGs to trust that their schools medical curriculum is up to par to help them pass the USMLE. The 30% failure rate of IMGs attest to that.
Second, AMGs just need to pass the USMLE to get matched. An IMG who just pass USMLE is not going to get matched. They need at least average scores to have a good chance of matching. Studying to pass and studying to get good scores require radically different approach, not just studying more.
Now let's discuss the 7 characteristics of the USMLE that you need to to take into account in your study plan.
First, the coverage is pretty large. If you look through the USMLE website, you will realize that what the USMLE can potentially cover is so large that it will be impossible to study them all much less memorize them.
Fortunately, the USMLE,does not really expect you to know everything. There are topics that the USMLE consider more important than others. Therefore, it is important to know what these are and make sure you study them. The key to doing this correctly is to have the right study materials for your prep. The wrong study materials cans damage your prep so much that you might even fail.
Second, the exam is time-limited. You have around one and a half minutes to finish each question on average. That requires you to read, think, recall analyze and choose the answer pretty fast. How fast you are doing them can impact your scores tremendously.
Third, the exam has very few questions despite the wide coverage. This means the chance that the exam will underestimate what you actually know can be very high. That makes it even more imperative that you study the right things.
And no, just studying the high yield stuff is not enough. It's more complicated than that. If you want to know more about high yield topics read these posts in my blog.
High yield represent roughly 65% of the questions in the exam with the rest being low-yield stuff. If you just study the high yield stuff, you need to get almost 100% of the high yield questions just to pass. And since the high yield questions also include questions that require analysis and questions that trick you into picking the wrong answer, unless you are a genius, you can't get 100% of the high yield questions right,
If you are an IMG, you need to more than just pass these exams in order to match. So just studying the high yield stuff is not really an option for the IMG.
Fourth, the USMLE is primarily a multiple choice question exam. The most important thing to take away from this is that unlike other types of questions, the right answer is always in front of you. There are variety of ways to arrive the correct answer if you have some idea of what the question is all about. In fact there are a lot of ways to find the answer even if you don't really know the answer.
This systematic method of finding the answer when you don't know the answer primarily works for multiple choice questions. It can also work to a limited extent on matching type questions so long as there is a one to one match between choices. Learning these techniques not only involves practicing this skill during test preparation phase, it also involves organizing the topics in the right order during prep so you can make use of these techniques much more effectively.
Depending on how well you can apply these techniques in your prep, you can raise your scores from 10-40% higher. This is how to get high scores. Because it helps you get points you would otherwise have lost in the first place. Discussing these techniques is quite long and complicated. You may want to refer to my book for details. If you want a full video lecture on the topic with examples you may want to join my online seminar workshop.
Fifth, The exam is computer-based testing. Too often, people underestimate how much impact this has on their performance. For people used to paper-based exam, it could mean the difference between passing and failing. Even if you are used to CBT, lack of familiarity of the exact software can also cause delays.
Navigating through the exam can cause you to lose from 5 to 15 seconds per question depending on how familiar you are with the software. Since as we said this is a time limited exam, it adds to the time pressure of finishing the exam on time.
Plus, both CRT and LCD screens are backlit. This causes eye strain which is non-existent in paper-based exam. You need to make sure your glass prescription is updated and your eyes well-rested on the day of the exam.
For more details on what you need to prepare in order to perform well in a CBT exam, refer to my book.
Sixth, it is a very long and exhausting exam. If the USMLE is scheduled for one hour a day, once a week for 7 days, rather than 8 hours for one day including breaks, a lot of people would be acing this exam. Very few would fail it.
A big part of the reason for the toughness of this exam is because of the fact it is scheduled for 8 hours straight for one day and that each block needs to be finished in one hour with no extension. These test conditions make the exam harder than it would otherwise be.
First, the exam condition creates time pressure, which increases the tension and anxiety associated with the exam. Tension and anxiety makes it harder to concentrate and do analysis as well as recall information. It also cause you to get tired and exhausted much faster.
Second, the length of the examination will ensure that you are exhausted by the end of the exam. Making it even harder to think and concentrate on the exam.
Remember, the single most common reason why people score low or fail the exam is inability to finish all the questions in time. Therefore, it is important that you take the time to practice and make sure you can finish all the questions with time to spare.
It took me 27 minutes to finish my first block, while it took me over 50 minutes to finish my last. So if it's taking you 50 minutes to finish your first block, you won't finish your latter blocks.
When one of my students started his online qbank, he couldn't finish his blocks on time leaving from 5 to 7 questions blank per block. After following the recommended speed building practice, he finished his first blocks in under 40 minutes. Needless to say he got a 228 eventually in Step 1. So remember, practice makes perfect.
Lastly, as far as the USMLE (and therefore the residency programs, too) is concerned, only what happens on the day of the exam counts. Too often I hear people make these kinds of arguments. "I got a 208 because I only studied for 2 months. If only I have studied for 5 or 6 months like the others, I would have gotten a higher score."
When someone found out I studied for 7and a half months and got a 256, his response was. "If I had studied for that long I could have aced the exam too and got a higher score than you."
All I can say is, the USMLE and therefore the medical residency programs do not care. They only care about the final results. Try explaining to a medical residency program that they should interview you even if you only got a 208 cuz you only had 1 month to prep. Good luck on that.
You can argue with your interviewers that they should choose you over the other guy who got a 248 even though you just have a 228 because, unlike him, you don't have the money to spend on prep courses and buying all the study resources that you need to ace the exam. But it won't help. In the end only your score count.
So anything you can do to raise your scores, be it enrolling in prep courses, studying longer, buying the necessary resource material and learning to study effectively, you should do.
It ain't what you don't know that gets you into trouble. It's what you know for sure that just ain't so
So now you have some idea of this monster we call the USMLE. And I hope this has helped you understand that you need to do more than just pick up a book and start studying if you really want to do well here.
Til next issue.
Mike here signing out.
P.S. Next issue we will find out why IMGs have to study harder than AMGs
An in-depth written guide on how to prep better and score higher for the USMLE Step 1. Read the book. Better Prep. Easier Exam. Higher Scores,
A 48-module lecture seminar on how to prep better and score higher for the USMLE Step 1. Listen to the Lecture. Better Prep. Easier Exam. Higher Scores.