Problem of the Old IMG – Relearning What Have Been Forgotten

By askdoc / April 5, 2011
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When I started my own prep way back in 2005, the biggest problem I faced is the fact that I have forgotten most of what I had studied before. This is especially true for the basic sciences. Even for the clinical sciences, although I am very familiar with cases found commonly in clinical practice, there is a big problem with rarer cases as well as atypical ones. Therefore, I realized that there was a need for me to relearn all the things I have forgotten before I can even begin to achieve the level of mastery needed to do well in the USMLE.

The same thing holds true for most old IMG. They differ only in the amount of things they have forgotten and this is mainly a function of how long ago they graduated and have been out of medical practice.

It is a maxim that you cannot review what you do not know. You cannot master what you have not learned. Therefore if you have a lot of medical concepts that you are unfamiliar with, you need to learn them first. And learning is best done using textbooks and lectures not reviewers. Reviewers are used primarily for review and therefore not suitable for learning concepts.

The Need for a Prolonged Learning Phase

So old IMGs need a prolonged learning phase. If you would recall the three phases of USMLE prep includes learning phase, mastery phase and test preparation phase. While most new grads can dispense with the learning phase altogether and some US third year medical student can even dispense with part of the mastery phase (that’s why First Aid and Q bank alone can work with them) most old IMG have no choice but to do all three phases.

What to Do During the Learning Phase

Starting from the basics can be daunting but old IMGs have no choice but to do so. The best way to relearn the basic sciences is exactly how it was done in medical school.

First, read through anatomy and physiology, trying to understand the concepts as much as possible. Remember the learning phase is where you seek to understand what you are reading rather than memorizing in detail. The goal here is to be able to explain the concept without going into details.

For example, can you explain the brachial plexus and it’s clinical importance. What syndrome arises from it. For physiology, can you explain acid base balance. At this stage all the details and inter-relationship should be left for the second round.

Second, this is important. Do structure and function integration between anatomy and physiology. For example anatomy of the heart including valves in physiology of blood flow and heart sounds. Do this on a second round reading.

Third, read through biochemistry, one round again basically just understanding concepts. Then integrate with anatomy and physiology as appropriate.

Fourth, read through Pathology again first round just to understand the concepts. Follow through a second reading by integrating into Anatomy, Physiology and Biochemistry as appropriate.

Fifth, read through Microbiology and Immunology. Integrate with appropriate section in anatomy, physiology, biochemistry and pathology.

Sixth, read through Pharmacology. Integrate first with biochemistry. Then integrate with Microbiology and Immunology. Then finally with Pathology.

Lastly, study Behavioral Sciences.

You can opt to do one more round of pathology, integrating it to anatomy, physiology and biochemistry. Remember every pathology results from the disruption of anatomic structure or physiologic and biochemical processes and attempt of the body to restore function or compensate for loss of function. Once you understand that, you can now integrate the pathology to pharmacology. Therapeutics is about restoration of function or compensation if unable to restore function. Therefore you need to understand how drugs do this.

Once you have done all the above steps, you are ready for the mastery phase and test preparation phase. For recommended textbooks to use and other tips, look for it in future posts.

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