Using Q Banks Effectively for USMLE Review – II

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We now come to the second part of our discussion of “Using Q Banks effectively for USMLE Review”. For those just joining us, please review the previous post here.

Previously we talked about what Q Banks to use and when to use them for review. We will now talk about how to use Q banks as study tools and how to use them for review and assessment.

Q banks like USMLE World and Kaplan are most effective in helping you score well in the USMLE whereas other Q Banks are more effective at increasing your mastery of particular subjects. Q Banks dealing with specific subject usually tackles the subject in more detail and testing how thorough you’ve mastered the subject, while UW and Kaplan concentrates more on concepts tested on the examination, giving different weights to different subject depending on its importance in the USMLE. To learn more about UW and Kaplan Q Bank please read my post on “USMLE World vs. Kaplan Q Bank, which one?”

We will now discuss the difference on how to use Q Banks as study tools and Q banks for assessment and test preparation concentrating of UW and Kaplan. Although both Q banks may be used for either purpose, UW is better as a study tool and Kaplan better as an assessment and Test prep tool. There is also a difference between Step 1 prep and Step 2 CK prep. There is less difference with Step 3 prep vs. Step 2 CK.

First question, Should I take down notes? Of course, you should. It is a good idea to take down notes in all aspects of your review not just when doing Q Banks. One of the things I noted in my conversation with other double 99ers during the course of my interviews is how they take down notes made a big difference in their review. I’ll deal with that in a future posts. You should be taking a lot more notes when you are using Q banks as a study tool. If you find yourself still taking copious notes by the time you are using Q banks for assessment and test preparation, then there was a problem during your initial review and you may need to evaluate your readiness to take the examination.

More important still is to know what notes to take down. As noted on my post “What to Study for the USMLE”, not everyone knows how to take good notes or judge what is important or not. Hence the need for substituted judgment. The good thing about UW and Kaplan is that all the questions really give good coverage to what is important at the right level of detail. They may not cover everything (hence, you can’t just use Q banks alone without other study tools and expect to get high scores). But you know what they cover have a good chance of coming out in the examination.

Of course, facts on questions you answered wrong should always be noted. But even if you got the answer right, if it was for the wrong reason, take note of this fact too. Ditto for questions whose answer you were not absolutely sure of even if you eventually got it right or questions you got right but took you too long to answer, since this shows lack of full mastery of the topic. If the same concept is presented in the actual exam in a slightly different way, this lack of mastery may cost you. You must also make a decision whether to supplement this notes with additional reading, especially on topics you should have mastered already in your readings.

There are also differences depending on what steps you are taking. In Step 1, any facts, even if low yield, should be taken down. Step 1 tests Basic Science facts. Even pathophysiology, Goljan’s mechanisms, mechanisms, mechanisms are facts. Step 2 CK presupposes you know the facts and would like to know if you know how to use those facts in clinical decision-making. Therefore, it is important to note the basis for deciding a therapeutic course of action, or a diagnostic test to favor in a specific case not just simple fact. Also note down any atypical presentations of signs and symptoms in individual cases, since Step 2 CK cases tend to be less typical, eg. male with Temporal arteritis (typically old female) or white male with sarcoidosis (typically black female) Same things generally holds true for Step 3 as in Step 2 CK. However, for Step 3 also note down the Treatment of Choice and the next alternative treatment of choice of all common diseases. For example, Co-trimoxazole for simple cystitis and amoxicillin only if pregnant. Very important to take notes of all ethics questions too in Step 3.

The next most commonly asked question is should I take it in blocks of 50 (48 now for Step 1). If you are using Q Banks as a study tool, you don’t have to take it in blocks of 50 (or 48, or 46, etc.) and it may not even be desirable. However, if you are using it for assessment and test prepartion, it is best to simulate the exam and take it in appropriate blocks with time limits.

The reason you avoid doing full 1-hour blocks when using Q banks as a study tool is that there is a limit to the sharpness of your attention span and for most people this is around an hour or so. If you spent that hour answering questions, you may not be fully alert when you are studying the answers and taking down notes. Better to do 20 ++ q’s in 30 minute intervals and spend the next 30 minutes in reviewing the answers and taking notes. Rest a bit then go to next block. The alternative is to study the questions another time, but you don’t get the benefit of noting down any problems in your thought process as you were answering the particular questions.

When using Q Banks for assessment and test prep, not only is it important to do it in appropriate blocks with time limits, you must also work yourself up to doing it at 7 or 8 blocks per day (depending on steps) with the same rest limits as the actual examination. That is of course the ideal, but going as close to it as possible is just as well. I do not recommend doing full day simulation a few days before actual examination as the simulation can drain you and may even affect your performance on the day of the actual examination.

As I stated in a previous post, blocks in the actual USMLE exam are balanced in that it is a mixture of easy and tough questions as well as long and short ones, mindful of the time limits imposed. In Q banks since blocks are generated randomly, it is possible to get predominantly tough questions in a block or predominantly easy ones. Ditto for long and short questions. These can be a problem when doing exam simulations with time limits. I noticed that Kaplan tends to give more balanced questions in blocks while UW can have really tough questions all in one block. You can note this by looking at the percent of users who got questions right. There is a much wider variation between blocks in UW than Kaplan. That is part of the reason why I recommend Kaplan for assessment and test preparation rather than UW.

I’ll stop here. Til next time.

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