Concept of Mastery, Know and Familiar in USMLE content.

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Note: I wrote and posted this sometime ago in prep4usmle.com. Since it is impossible to know everything there is to know about Medicine, one should prioritize what medical concepts should be retained. Another post talks about how this can be implemented.

Thanks for reading my post and your kind comments. To continue.

As we all know, Medicine is a very broad subject, so broad that we are divided into specialties. However, for the purpose of the board we are required to know a little of everything. So for the purpose of the board, What you need to know is divided into 3 parts.

1. Knowledge that need to be mastered. – The so called HY materials that are almost always tested.

2. Knowledge that need to be known. – you must know enough so that they are taken into consideration in your decision making.

3. Knowledge that you need only to be familiar – aware that it exists.

Subsequently our own knowledge bank is divided into 3 parts

1. What we have mastered -we can recall this information at any time in whatever way it is twisted in whatever condition we are in.
2. What we know – we can recall this information only when condition is optimum. We may need some time to think about it.
3. what is familiar- we can recall this information only with some clues and enough time to think about them.

The more closely the component of our knowledge bank conforms to what is expected of us by the board, the higher the probability of acing the exam.

Why is this important? Because of the way the examination is structured. The concepts that you are required to master are usually presented in 2 to 3 step thinking format. Physio and Pharma concepts requiring calculations usually include not only irrelevant numbers but also may need multiple calculations to come up with the answer. The exam is extremely fair in this regard. I’ll give 2 examples in my exams (without giving away the actual question since this is prohibited)

I had a question involving p21 Cyclin D and Cyclin E2. Now I had mastered the p53 and Rb concept since I had expected this to be one of those that should be mastered. As you all know p21 and cyclin D are two components that mediate between p53 and Rb. I had also read about cyclin E2, which is the component that normally initiate the process that pushes cyclin D and Rb into allowing the cell to proceed to the S Phase. The function of p53 if you would recall is merely to act as a gatekeeper and does not initiate the process. However, I did not memorize in detail the whole process, ie. I was familiar with the role of cyclin E2 but did not master it. (Good thing the question popped up in the 4th block when my mind was still functioning). Any way they were good enough to give details in the question stem on cyclin E2 (instead of presuming you know it) Giving me a reasonably good chance of answering the question.

Another example is on transcription factors. They gave a drawing of the chemical formula of a transcription factor (believe me it was fairly obvious which transcription factor it was if you are even just vaguely familiar with it) and asked its function. If you know it, you can answer it. If you are familiar with it, it gives you a reasonable chance to get the answer.

So if you mastered what needs to be mastered and so on, you’ll probably ace the exam. Except that that is impossible. Kaplan and all those in the prep-review business will give an arm and a leg to be able to do that. If you mastered what they want you to master, you’ll say that was fair. If you mastered what they expected you to know, you’ll say that’s easy. If you know what they expect you to master, you’ll say that’s hard, If you are only familiar with or don’t know what they expect you to master, you’ll probably curse and call it experimental questions.

In reality experimental questions can be easy or hard. They’re called experimental questions since not enough statistics have been gathered on the question to rate them as hard or easy for the purpose of grading the block.

Now going back to the quick and dirty method of analyzing your weak point. If the QBank you used does not reflect the emphasis of the board (Master what needs to be mastered, etc.) What you thought is a KR problem may be a KA problem after all. The Qbank may have presented that concept in a straightforward manner (ie, you know the concept) and you readily got it, but the Board will present it in a 2 to 3 step thinking manner (expecting you to have mastered it which you didn’t) Another disconnect, hence the danger of relying only on Qbanks for review.

So what concepts should I master? Well, that maybe impossible to answer for certain, but there can be reasonable ways to arrive at what are the most probable ones. You may think FA. But FA includes all concepts tested on the exam, whether you are expected to master it, know it or be familiar with it. If you have the time to master all the concepts in FA fine, but that would probably be more time-consuming than reading entire texts. Remember memorizing is not mastering. Mastering for example the Brachial Plexus requires not only knowing the anatomy, but also what they innervate, pattern of denervation or injury, etc. Reading one line in FA should bring back a dozen or so paragraphs that represent the concept that that one line in FA represents.

A more reasonable way is to use HY books like HY and BRS. For example, you’ve decided to use Big Robbins as your main text for pathology because like me you’ve forgotten half of what you know about pathology and the other half is obsolete. You need BRS Patho because it is practically impossible to master everything in big Robbin’s. A reasonable strategy is to master and know most information in Big Robbin’s that are also found in BRS and just be familiar with the rest. If you are a more recent graduate, you could start with BRS and reference to Big Robbin’s for concepts to master.

Another good example is Micro and Immuno by Levinson and Jawetz. Master all Organisms contained in its “Brief Summaries of Medically important organism”. Know what is discussed in the text and be familiar with organisms in the minor pathogen sections. Exception is of course Immunology which you should probably master.

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