As a very old IMG, I was faced not only with the problem of having forgotten a lot of what I knew before. I also have a problem that a lot of what I know is obsolete and there are a lot of new concepts that I do not know. Medicine is constantly advancing and new knowledge is being added everyday.
Even as a practicing physician, I can only keep up with the most recent developments relevant to my practice. Meanwhile a big chunk of the basic medical science is not really that relevant to my practice. It’s even more difficult for the specialist as they usually only keep abreast of the latest development in their specialty.
Unlike knowledge you have forgotten, obsolete knowledge are more problematic. Knowledge that you have forgotten are still true to a certain extent, whereas obsolete knowledge have been proven to be false. If you read my post on various types of recall, you know that knowledge you have forgotten can much more easily be relearned than learning something entirely new.
Therefore, you face the following dilemma with obsolete knowledge.
First, you don’t know the concept at all. It will be harder to learn that new concept and you may have to go through basic books and read things that will never come out in the exam just to understand the more advanced topics that will. Over all it means a much longer prep time and more frustration if you don’t do it right.
In my case, I didn’t know anything about molecular biology, plus there had been so many advances in biochemistry that when I first read through Kaplan Lecture Notes on Biochemistry, I did not understand half of it. I got a more basic book on Biochemistry, Lippincott’s Illustrated Review. And once I understood the basics, understanding Kaplan notes became a breeze.
I use NMS Genetics even though 70% of the topics in the book will not come out in the exam. But without the 70%, I had difficulty understanding the 30% that did. Embryology is another example, I had read through Langman’s embryology even though more than half of it will never come out in the exam in order to understand the topics that will.
Our understanding of pathology of diseases now has its basis in molecular biology. And until I understood the concepts in molecular biology, understanding the pathophysiology of these diseases is at best incomplete. When I first encountered these topics, it was confusing. However, eventually things cleared up.
Second, a lot of times, obsolete knowledge is the basis of distractors in the exam. Which means old grad with obsolete knowledge are more easily distracted by these questions.
Unlike fresh grads, you can’t rely on your stored knowledge from classroom discussions, hospital rotations and clinical encounters to know the right answer, because that could have been years ago and they are obsolete. Recent grads can rely on the fact that so and so topic was discussed on clinical rounds last year and be confident it is correct even though he had not really studied it recently. Old IMGs can’t.
Therefore, there is a need for you to cover everything thoroughly, unlike the fresh grads who can rely on relatively recent experiences to remember concepts they have not studied recently. That is why so many old IMGs who subscribed to study plans favored by fresh grads fail miserably.
When I started researching on how to prepare for the USMLE in 2004, the consensus was that it is impossible for old IMG to get high scores. Most are struggling to pass and only very few does so. Even then all the suggested study plan were the ones favored by the fresh grads. That was why I was wondering why the most popular study plans involve studying the least amount of medical facts for an exam that tests how much you know about medicine. It defies logic until you understand that for most fresh grads, they have a pool of recent knowledge they can access for medical concepts even if they did not study it recently in their review. Since they just encountered them quite recently in the classroom and during clinical rotations.
One last example just to make sure it’s clear. If the total stored knowledge for a fresh grad is worth 20% more points in the exam since he can rely on remembering this from recent experience( actually it could be higher since there is a presumption that someone who just graduated from medical school knows enough about medicine to practice it) and for the old grad is 0. Then if both used the same study plans, which help them learn enough to be able to answer 50% of the questions correctly. The fresh grads final score will be 70% compared to the old grads 50%. 50% correct would roughly be about 175 while 70% correct would be > 220.
Therefore, as an old grad, there is a need for you to concentrate on using a study plan designed for old grads, or design one taking all the special problems of an old grad into consideration. We will discuss just how to do that in future posts.