What to Study for the USMLE – Part III

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We begin part 3 of our series on “What to Study for the USMLE”. For those just joining us, please refer to previous post here and here. Due to the sheer number of review materials available to examinees, we need to classify them in order to make it easier to choose and mix and match between them.

Broadly, we can classify our study materials into three. First are reading materials, mainly books and other written study aids, eg. Flashcards, etc. Second are Question Banks, which by themselves are very important and crucial study materials. Lastly and increasingly gaining importance are audio and visual resources like lectures both audio and video.

We can divide books into reviewers and textbooks. Simply, reviewers are for revising and textbooks are for learning. Often people complain of going through a reviewer and having a hard time remembering what they’ve read. They go through it a second time, thinking it’s a problem of retention (it isn’t) with the same disappointing result and poor performance in Q Banks. The problem is not with retention and recall but with understanding of the concepts. The right solution will be to go to textbooks. Reviewers assume you more or less know are familiar with the concepts and are just reviewing, so explanation of concept range from none to really succinct and concise explanations, using buzzwords and even acronyms. On the other hand, textbooks assume you know nothing and explain things in details. There are even complaints that textbooks tend to discuss the same concept in different parts of the same chapter, however, the main reason for that is that some concepts have slightly different importance in different contexts and the textbook is trying to make sure you understand that and leave it up to you (or your professor) to integrate the concepts.

It is maxim that you cannot review what do not know and therefore you cannot use reviewers to learn concepts you do not know. Learn them first using textbooks. Also you cannot use textbooks for revising because its too long. So the solution is to switch back to reviewers to revise the concepts once you’ve learned the concepts turning back to textbooks only if your understanding of the topic seems murky.

For most people, they can just pick up a reviewer, start revising and feel that there is no problem with their revising and that is probably true a lot of times. But sometimes, the problem is relatively small that they don’t feel the problem but actually enough to lower their scores a few points. So if you are going for a high score be aware of this. To illustrate, for example out of 100 concepts you need to know you don’t know more than half of it. So going through reviewers, you find it tough-going and have a hard time raising your q Bank scores, so you go through textbooks which solve your problem. However, if already learned 70% of the concepts and have problems with only 30%, your q Bank score will probably be good enough that you think you’re OK. In reality, if you’ve bothered to identify this 30% that you need to learn and went back to textbooks to actually learn the stuff before returning to reviewers, you would be scoring 90’s or even 99’s instead of 80’s. Even First Aid acknowledges this and asks its users to go to textbooks to “fill in” what they feel is missing in the reviewer.

And, to emphasize. I know textbooks are too large for revising and so after going through them to learn the concepts, GO BACK to reviewers to revise the material multiple times if required, but not afraid to go back to textbooks for concepts you remain iffy on.

Now reviewers themselves can be further divided into two types. What I call outline notes and study notes. Outline notes are shorter and more compact, while study notes contain more details. Good examples of outline notes are FA, HY and BRS. While good examples of Study notes are Kaplan Lecture notes, NMS, Blueprints (esp. OB-gyne, IM and Peds) and Recall series as well as Step UP.

The main reason we need two types of reviewers is the sheer amount of information we need to learn, retain and recall for the USMLE. In shelf exams, the amount of information you need to retain at the same time is smaller and therefore easier to manage.

In order to understand the need for both outline notes and study notes, we must understand how we retain and recall information we store in our heads. No matter how good your memory is, its capacity is finite. People differ in how much information they can absorb and retain and even differ in how fast they can absorb and retain information. So questions like is 3 months enough for revising has really no exact answer. You cannot increase your memory capacity, although you can improve the amount of material your memory can contain by organizing the information in your head. I wrote this in the comment section for someone who has problem retaining and recalling information and I am quoting verbatim

“The main reason you have problems with retaining and recalling information is that you do not organize the information you have acquired in your head. That is very important for good retention and recall. If you have not read my post on “Information Recall and the USMLE“, please read them first before continuing.

For some people, organizing information they have read or heard in their head comes naturally and without effort, just like me. However, for others it is far from natural and they need extra effort in order to do so. Most people can get through medical school with poor memory since the amount of information they need to retain per exam is small. But the boards is different and this weakness can be devastating.

A good metaphor is if you have around 20 items and you place them in a desk. Since the number of items are small, you can just place them anywhere and you can easily find them. But imagine if you have enough items to fill that desk 3 feet deep. If you just place them on top of each other without organizing them, you know that…

1. It’ll probably take you a long time to find any item you need, unless you’re lucky enough that it’s on top

2. That if any item got lost (it fell out of the pile) you may not even realize it.

3. That there is a good chance you will not find the item you need even if its in the pile because its just too disorganize

That’s the reason you get confused when you read other books, since they just make your pile deeper and more disorganized therefore more confusing. Doing qBanks and taking notes do not help much either because you’ll just pile those information into your head without organizing them into meaningful relationships for easy retrieval.”

That’s why superbly organized outline notes like BRS and Goljan Rapid Review for Pathology helps a lot of people remember and retain more information, then more poorly organized ones like First Aid.

We will stop here. Next time, we will continue discussing the two types of reviewers and we will revisit the different types of recall and how to take advantage of them to vastly increase the amount of information you can store in your head at any one time. To paraphrase Dr. Goljan, the more concepts you read, remember and can recall at the time of the examination, the higher your score will be.

 

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