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Guide to USMLE Step 2: Clinical Knowledge

The USMLE Step II CK exam is a test of the clinical knowledge gained during the third year medical College core clerkships. It is similar in format to Step I, but is more clinically oriented, i.e. you are given a patient scenario and asked about the diagnosis or next step. The exam consists of eight blocks, which is one section longer than the seven blocks of Step I. 

Subjects tested include Internal Medicine, Surgery, Pediatrics, Obstetrics and Gynecology, Psychiatry, Neurology, Emergency Medicine, Dermatology, selected surgical sub-specialties and Radiology. There are a few questions that feature audio and/or video clips. More detail on all aspects of the exam is available on the USMLE website. 

The Jefferson AOA Guide to the USMLE Step II CK will answer your Common Questions about the test, will assist you in Planning a Schedule, and will suggest the Right Resources to help you prepare appropriately. Also, please check out the official USMLE Step II website for more information:

Common Questions

How important is the USMLE Step II CK score anyway?

A passing score on the USMLE Step II CK is required for all medical students prior to beginning residency. Although less important than the Step I, a strong Step II CK score can only help your residency application, as programs will see your score regardless of when you take the exam.  Due to the more clinical nature of the exam, most students improve on their prior Step I score.

What is the best time of year for Jefferson students to take the USMLE Step II CK?

Some students prefer to take the test right after third year because they feel well prepared coming off of their final shelf exam.  Additionally, they feel that taking the exam early and scoring well is a great way to strengthen their residency application, especially if they may have been disappointed with their Step I score. There are usually 2 weeks between 3rd and 4th year that students can use to study. If you have internal medicine or family medicine as your last rotation of third year you’ll be in great shape to take Step II soon after the shelf exam but others have still taken it and done well coming off Psychiatry or even the more demanding OB-GYN.

Other students choose to take the exam during the first few months of 4th year or after they submit their residency application. If you decide to take it later, programs can invite you for an interview without a Step II score.  However, you will need to take the exam before they can rank you. Some people recommend taking it later if you are happy with your Step I score, but in the end the decision should come down to the amount of time you need to study.

For those of you who were happy with your Step 1 score and who want to take Step 2 later due to concern about “ruining” a Step 1 score with a potentially poor Step 2 score, keep the following in mind. First, most people do the same or better on Step 2 as they did on Step 1 – trust us, it’s true. Second, your shelf exam scores will give you a good idea of how you might expect to do on Step 2. Third, taking Step 2 in December is not always the best option. You don’t always know what interview season will hold and Step 2 can become a lot more stressful than it needs to be if it’s intertwined with trying to coordinate interviews and traveling.

Resources

One of the best sources for step 2 CK is to study from our medical notes, which are designed professionally to let you study the high yield information, therefore they save your time and let you memorize the important concepts easily. 

Practice Questions

We recommend starting questions about one month before the exam if you’re on an elective, maybe earlier if you plan to get through all of them. Some students only do UWorld questions and fit all of them into a two-week period. Not everyone completes the UWorld either before taking Step II CK. If you are strapped for time it’s not necessary to complete the bank as long as you feel you are improving, but the more practice the better. Check out some online resources below.

USMLEWorld: There are approximately 2000+ questions in the UWorld qbank. Some people will do blocks throughout 3rd year to study for shelf exams and then repeat the questions before taking Step II. Others wait to purchase the Q-bank when they begin studying for Step II. Either way, getting through all of the questions at least once is definitely enough. 

Kaplan Q-bankVery few students use this resource. It is another good yet more expensive option and consists of 2,200 on-line questions; similar to Q-Bank for Step I.

The Bottom Line: The majority of people use USMLE world Q-bank and a supplementary review book (e.g. First Aid or Step-Up to CK).  You shouldn’t need much more than this.

Planning a Schedule

The schedule for Step II CK preparation varies significantly depending on how much time has passed since completion of the clerkships, and whether you are studying during vacation or during a 4th year rotation.  Overall, study time usually ranges from 1-4 weeks with most students taking 2-3 weeks.  Students who take the exam during a vacation will often need less time since they have more time each day to study.  Students who take the exam while on rotation might need to start studying earlier given that they have less free time during the day.

The daily study schedule is constructed similarly to a Step I schedule.  Intersperse question blocks and sections from the review book, making sure you review most/all topics at least once.

Overall, studying for Step II is much less intense than Step I, but be sure to give yourself enough time to get through most/all of your resources.  If you do this, you should be in great shape. If you want more practice you can purchase a practice test along with the qbank. This isn’t entirely necessary since you now know what it’s like to take a day-long test, but if you want it it’s there. 

Good Luck!

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How to Survive Medical School

 

Surviving medical school can be tough, but there are a number of strategies you can use to help keep you on track. This article will describe some of these strategies which will lead you to success in medical school.

 

1

Learn how to be organized.
  • Study materials. You will find it impossible to survive medical school without at least finding a way to keep your notes and books in order. Binders, color coding, and organized folders on your computer are some examples of how to do this.
  • Schedule. Always know where you need to be and when. Keep a schedule with you at all times with your lecture schedule, exams, rotation schedule, meeting times, etc.
  • Study space. If you study at home, make sure you have an area dedicated to studying. Keep this area free from clutter and from distractions (i.e. television)
2

Figure out how you learn best.
  • Use study tools.The value of study tools really comes into play during medical school. Everyone has a different style or different things that work for them, and don't be fooled into thinking that you're doing something wrong if you do it a different way yourself. Have a study system, and stick to it.
  • Consider studying with other people around your study area. This works well for some people and poorly for many others. Having study partners, much like exercise partners, may help you stay on target and avoid quitting early. Also, the company may keep you from feeling isolated and overwhelmed. Others however find that they get overly distracted when they study with others. Experiment and find out for yourself if you find it helpful.
  • If what you're doing isn't working, don't be afraid to try a different method.
3

Create a study schedule.
  • It helps to plan out your work, even as far ahead as several weeks. This way you can avoid getting behind, which can be devastating in medical school.
  • Having a well-organized schedule will also allow you to plan out free time. Try to give yourself a half to a full day off each week. This will keep you focused during the rest of the week and keep you from getting burnt out.
  • Never cram. If you keep to your schedule, this won't be an issu4
    Prepare for the boards and for the application process.
    • Board exams. Sign up well in advance for the boards, as you will find that testing dates become very limited if you wait until a month or two prior to your preferred dates.
    • Residency application/interviews. This is something you need to stay vigilant about. Know the application schedule well, and be ready to submit your application as soon as possible. When you start getting invitations to interviews, respond immediately or you will find it very difficult to plan out your interview season.
    5

    Be professional.
    • Be on time. Part of surviving medical school is learning how to be professional, and being on time is a key aspect of this.
    • Dress professionally. No exceptions.
    • Treat everyone with respect. This not only goes for your professors and acquaintances , but your classmates as well. It's much more to your benefit to be a team player than it is to disregard others.
    6

    Ask for guidance.
    • Your professors and Deans of Student Affairs and Academic Support are immensely valuable resources that you should take advantage of if you feel you are struggling.
    • Look to your seniors. Talking to those a year or two ahead of you can be very helpful since they were recently experiencing the same thing.
    • Find a mentor. Many schools assign faculty mentors to you, but if not, consider contacting a faculty member that you know or someone in your field of interest to meet with you.
    • Find a tutor. Most schools offer tutoring of some sort, and tutors can meet you at any level. Tutoring also doesn't mean that you are a poor student, because even the best students can benefit from having someone go through material with them at their own pace
    7

    Keep your body healthy.
    • Medical school is in some ways as taxing on your body as it is on your mind. It may be difficult, but it's worth it to take the extra time to make a healthy meal or spend a few minutes in the gym or on walk.
    • Allow yourself time to relax. Know that it's OK to spend time with your friends and family, because medical school survival also involves taking the time to socialize when it's appropriate.
    • Get enough sleep. Whether for you that means 5 hours or 10, it's essential to get regular, restful sleep.
    8

    Recognize the difference between stress and depression. Stress is a common and often necessary part of not only medical school but of life in general. However when stress begins to affect your quality of sleep, your eating habits, or your ability to function in general, stress is no longer a motivating factor but rather it is holding you back. Seek out support in your family, friends at school, old friends, and upper-level students if you begin to feel down or depressed.
     
     
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15 Quick Tips to Prepare for the USMLE Step 1

The USMLE Step 1 tests knowledge that's gained over about 3 years of full-time medical study and some background material from undergraduate learning. That’s a LOT of information. 

For those preparing (or re-preparing) for this test, the amount of material to cover is daunting. What if you’ve been out of school for a few years and/or are preparing to take the exam again after a lengthy absence? 

Here are some quick guidelines for how to prepare:

1. Know Yourself

How much of the material have you retained since your last exposure? 50%? 20%? 

An easy way to find out where you stand today is to do two mixed blocks of questions in UWorld and average your score for the two blocks. Once you know how much you have to re-learn you will be able to plan a realistic schedule.

2. Know Your Lifestyle

How much time do you have each day to devote to study? If you're serious about your Step, in an ideal world you'd be able to solely focus on preparing for said exam. 

If you're working full time and will only be able to squeeze in an hour or two of study each day, it's going to take quite some time to be fully prepared, and the longer your studies drag out, the harder an uphill battle you'll fight with retention and burnout.

If your schedule doesn’t permit a review course then independent study is the best approach, but you must be consistent. Anything less than your best effort will not do.

3. Ready for a Review Course?

Take a look at a review course's schedule and material, specifically the lecture notes. Is everything familiar? How long would it take you to review the notes for one week of class? (Time yourself reviewing a typical set of notes for a day’s schedule within the course.) Are you able to keep up this kind of schedule and stay ahead of the course? If not, you may need to adjust the other demands in your life to be able to do so (see #7).

4. Preparation is Key

If you choose a review course, make sure you prepare at least the first two weeks of material before the course begins. You want to be in a position over the first two weeks of SOLIDIFYING knowledge rather than learning it from scratch in the course. And again, as I said above, you want to consistently stay ahead of the course.

5. Schedule Your Time 

If you are taking a course, one of the ways to stay ahead is to be sure to schedule time to prepare for upcoming lectures and to review the past ones. Another easy tool for success is to re-read your lecture notes right before and right after a lecture.

6. Keep Materials Simple and Few

First Aid, BRS Physiology, and the UWorld question bank are more than enough for your initial run-through. 

Just like getting into shape, you can't just join a gym and have the pounds melt away. You have to show up, put in the effort, build muscie and sweat it out. The same thing applies to the USMLEs.

7. Make Room in Your Schedule

Make a schedule that takes into account how much you have to learn and your expected rate of progress. For example, a very general rule of thumb is that a page of the First Aid could take an hour of study. 

And as I mentioned before, the more seriously you take this exam, and the more you're able to make it your sole focus, the better and swifter results you'll see.

8. Use First Aid as your Study Strategy

Use a systems-based approach to learning. Work through organ systems, i.e. cardiology, using First Aid as a checklist. And remember: First Aid is meant to be a high-yield skeleton upon which you build your studies. It is not the end-all be-all encyclopedia for every single detail you'll need to know for your exam. Knowing this, and following these tips can help you maximize the Step 1 "Bible."

9. Use Your Tutor Wisely

If you're working 1-on-1 with a tutor, save high yield questions that you do not understand for your sessions. Email your tutor the night before with some of your questions for the next day. 

We may know what you need to cover to be fully prepared for test day, but we cannot read your mind. Help us help you and always be honest with us. If anxiety's getting the better of you, or you really want to skip ahead to something, tell us, and we'll be able to either adjust accordingly or bring more perspective to the approach.

10. Celebrate Small Victories

If you finally understand the ventricular volume and pressure loops after two hours of study you have done well! Congratulate yourself! The same thing goes with harder-earned victories. If you've been beating your head against a wall trying to master a difficult concept, and things finally click, celebrate! 

You're essentially running a marathon, so it's important to celebrate the little victories to keep yourself energized and to keep going,

11. Be Realistic

Most students require several months to learn the material. If you’ve been away from the material or have limited time to study each day it will obviously take longer — possibly in the range of 6-12 months or more. 

Be patient with and kind to yourself throughout the process. Remember that you're not studying to take a driver's test; it's a beast of a medical licensing exam, and like any mountain worth climbing, persistence and determination are needed to persevere. After all, the harder the struggle, the more glorious the triumph.

12. Accept the Multiple Pass Approach

You will not learn everything the first pass through. Period. The sooner you accept this, the better off you'll be.

Instead of aiming for unachievable perfection on your first pass, try to focus on high yield material and make notes sparingly. You will have to review this material at least 4 times so don’t let your first pass through First Aid or UWorld take months.

13. One Foot in Front of the Other

Learn something every day. Even if it is something small. Don’t lose momentum. Keep at it. You can do it.

14. Adjust Your Schedule Every 6 Weeks to Address Areas of Weakness

As you make your way through your studies, you will uncover areas of weakness that you may or may not have expected to be there. Don't shy away from the tough spots.Lean into the challenge. The more you embrace the harder areas head on, the more empowered you'll feel as you chip away at them and slowly but surely gain mastery.

15. Stay Positive

This is a difficult process. Allow for failure. When you stumble, pick yourself up, dust yourself off, and try again! 
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How to Create a Study Plan for the USMLE

Why create a study plan for the USMLE?

Although studying for the USMLE is a big endeavor, studying how to study for the USMLE is no mean feat either. Just like an architect or engineer needs to plan out how to build a building before actually building it, we need to plan out how to prepare for the USMLE before we even begin studying.

 

Steps to creating a USMLE study plan.

Often, in forums, We’ve heard people refer to taking the USMLE in military terms. Going to War against the USMLE, they call it. Military generals never go to war without a thorough battle plan, that is if they expect to win and neither should you. We’ll be tackling this topic head on.

The Steps to creating a study plan are:

  1. Determine your objective
  2. Know thy enemy
  3. Know the learning process
  4. Know the components of a good study plan
  5. Know the factors that can affect your study plan
  6. Scheduling
  7. Importance of sleep, rest and recreation
  8. Putting it all together

Determine your objective for the USMLE.

Just like all battle plans, you start out with what is your main objective.

  1. Is it to pass the exam?
  2. Get an average score?
  3. Beat the mean?
  4. Ace it?

High scores isn’t everything in the match. But it can make up for other deficiencies in your resume, like less than stellar grades in medical school, older grad, lack of USCE, etc. Often you see people in forums posting their study plans and asking if it is enough, but enough for what. Determining your objective is the first step in assessing whether your study plan is adequate or not.

So how high a score should you aim for? Well, it is a universal truth that most people do not achieve what they aim for so it is a good maxim to aim high. In the Greatest Salesman in the World, Og Mandino stated that

“It is better to aim for the moon and hit an eagle then to aim for the eagle and hit a rock.”

If you aim for a 75 and fail to reach it, you are in trouble. If you really want a 99 aim for a high 99 so you have points to spare in case not everything went as planned.

One word about setting objectives is to never set it in stone. As you finish your study plan and even as you begin your studies, you may find that your objective may change. Either you’ve underestimated yourself and have found out that you could do better, or your situation’s change, (e.g. your wife gets pregnant or you got pregnant, lost your job, got promoted, etc.) Do not be afraid to reset your objective, just be aware how it will impact your over-all chance in the match.

We’ve often heard about how people downgrade their objectives when they are unable to follow through on their plans. But how often have you heard of people who failed to upgrade their objectives when presented with the opportunity.

In 1863, on the first day of the Battle of Gettysburg, when Gen. Robert E. Lee’s Confederate Army defeated the Union Soldiers defending the three ridges south of Gettysburg, Lt. Gen. Robert Ewell refused to take Cemetery Hill, which wasn’t part of the original Battle Plan, even though it was lightly defended at that time. On days 2 and 3 after Cemetery Hill was reinforced by Union troops, the Confederates made numerous charges to take Cemetery Hill to no avail. This led to the famous Pickett’s charge by 12,500 Confederate troops on the 3rd day of battle which was repulsed by union rifle and artillery fire at great loss to the Confederates. By refusing to upgrade his objective, Gen. Ewell missed an opportunity that could have changed the outcome of the war and the destiny of the United States.

 

Know thy enemy.

Now like all good Generals, we have decided on our main objective for the USMLE. The next step is to study the nature of the enemy, only then can we know how to defeat it.

Now someone might say, why don’t you just post a study plan and like good soldiers we will follow them. Well that would be easier for me, but I doubt it will work or be effective for a lot of you. You see, a plan presumes that there is an objective, takes into account where you are coming from, your skills and particular strengths and weaknesses and your particular condition. A one-size fits all plan presumes you have the same objective, the same skill sets, the same background and the same prevailing environment which is just not true.

Now normally when somebody asks you how to go to Times Square, you presume he is somewhere in NY. But in the internet, the person may be in San Francisco, Baltimore, London, Karachi or even Manila. And the answer would be different in each case.

So too must your study plan be different depending on your particular circumstances. Just as a doctor tailor makes his treatment plans depending on your circumstances (child, adult, geriatrics or healthy, immuno-compromised, debilitated) we must tailor make our study plans accordingly. But just as doctors have treatment guidelines to guide them in formulating a good treatment plan, so too does this book attempt to provide you with guidelines on how to study to help you formulate a good study plan.

Now a thorough analysis of the USMLE even just Step 1 is impossible in a short article such as this due to its complexity. For those who want more details, refer to my post here and here.

The purpose of the USMLE Step 1 is to test your knowledge of Basic Science concepts relevant to the practice of Medicine and to that extent it has been faithful. All questions you will find are related to the basic sciences like pathology, microbiology, pharmacology, etc. However, to emphasize its relation to the practice of Medicine, a lot of the questions are in the form of clinical vignettes. In Step 1, most of the Clinical Vignettes are classical presentations rather than atypical presentations. For more information about Clinical Vignettes, refer to my post here and here

Another thing you’ll notice is that whereas in Step 2 and 3, the cases are usually common diseases, Step 1 cases includes a lot of diseases that are fairly uncommon. The reason is that USMLE Step 1 emphasizes basic sciences and sometimes, important basic science concepts are illustrated by uncommon diseases. For example, Angelman and Prader-Willi Syndromes are fairly uncommon but demonstrates the principle of Imprinting. Small cell CA of the lung demonstrates the concept of para-neoplastic syndrome but is actually less common than squamous cell CA or AdenoCA. So this should guide what you should emphasize on your review.

All USMLE Steps also require you to be able to recall all this information in a minute or so. What you cannot recall, you do not know as far as the USMLE is concerned. So knowing something is not enough, you must be able to recall it too. Increasingly, questions are 2 to 3 step in order to avoid aided recall from the answer choices themselves. (For more about different types of recall, refer to this post)

All this impacts what we have to study, how we study and what steps will be involve in our review in order to be able to do well in the exam. We will continue next time and talk about how we learn and master information and how to apply this in coming up with a study plan for the USMLE.

 

 

Know the learning process involved in preparing for the USMLE.

We now have our objective and we know what the USMLE wants us to know and in what form it will test us for that knowledge. The third part is to understand how we learn and accumulate knowledge.

I’ve found the following to be a useful framework for analyzing and understanding where I am in my review and assess my strength and weaknesses. Using this framework will help us not only in preparing our study plan, but also in assessing any problems we have during our review and remedying them. We can divide our review preparations into 3 parts.

1.       Knowledge Acquisition (KA) – This is where you put information into your Knowledge Bank (KB) Most new graduates are extremely fine here (Except if you’re one of those who barely made it. Crammed for every test and promptly forgot everything afterwards. Most Old graduates and some IMG graduates usually have problems here. This can impact how long your review period should be and the amount of “hitting the books” you have to do.

2.       Knowledge Recall or Review (KR) – This is how well you extract information from your KB. Most new graduates have some problem only here. FA and the QBanks makes a fantastic tool for improving Recall. So people with problems here (New grads mostly) usually give fantastic ratings to FA and Qbank. Other methods to improve recall include flashcards and group discussions. If you have a KA problem, you still have to do KR after you have remedied your KR problems.

3.       Test Preparedness (TP) – If you are not familiar with CBT, MCQ or clinical slant to questions, this is where your problem is. Problems with sitting for 8 hour exam is also classified here. Difficulty in answering 2 to 3 step thinking questions and running out of time during the exam also falls here. This is where QBanks are the most effective.

How long, how detailed and how demanding your study plan will depend on where you are standing right now. If you have lot’s of KA’s to do, then you have your work cut out for you. Textbooks may even be in order and not just Study Notes and Outline Notes. If it’s mostly KR, then repetition, repetition and more repetition is the way to go, especially outline notes and Qbanks. If its TP then Kaplan and UW Qbank will be most helpful.

For a more thorough explanation of the learning process, refer to my post here. For a more thorough discussion of KA, KR, TP refer to my posts here.

 

 

Know the components of a good study plan for the USMLE

We now discuss the different phases of a complete study plan.

The three phases are as follows

  1. Learning Phase: This is where you try to learn everything that you still do not know about medical concepts tested in the USMLE.
  2. Mastery Phase: at this point, you already know the concepts, you just need to put them into immediate recall so that you can recall them in the minute or so that USMLE requires.
  3. Psychological Preparation: It is important to prepare yourself both physically and mentally for the grueling 7 to 8 hour exam(16 hours for step 3). Failure to do so may mean low scores or worse failing the exam altogether.

Many people tends to skip the learning phase and go directly to the mastery phase by purchasing review books like FA or BRS then use them almost exclusively for their studies. Depending on your goals and your current situation, this could be either a minor problem or a catastrophic one. One cannot master what one does not know. You can’t review materials you do not know. You need to study them.

The longer you are out of medical school the more time you need to spend here. The lower your scores were during medical school, the more you need to concentrate in learning all the important concepts tested by the USMLE.

Even recent graduates who are very good students cannot remember everything they’ve studied and usually there are gaps in their knowledge due to a variety of reasons. (eg. Subject not covered by professor, etc.) Therefore, it still makes sense to realize that there will be concepts you do not know and the best place to prepare for them is during the learning phase. This is especially crucial because you should not schedule your exam before you finish your learning phase (a common mistake committed by many). You should only schedule the exam once you are in your mastery phase where the time frame for accomplishing most preparations is more predictable. We will deal with scheduling later.

The mastery phase is what most thinks of when they talk of reviewing and in truth for most people, this is where most of their preparations should be. The main objective of the mastery phase is to get as many information as possible into immediate recall so that one can do well in a timed exam like the USMLE. (Refer to my post on different types of recall here.) Given enough time, one can recall almost anything one has learned and that’s the reason USMLE is a timed exam. It wants to test how much material you’ve mastered rather than how much you’ve learned. Outline notes, Qbanks and Flashcards are the way to go during mastery phase.

The psychological preparation phase is commonly skipped and yet many times this can be crucial to doing well in the examination or even passing it. Even if you are physically able to finish 8 hours, being mentally alert by the 6th to 7th hour is not that easy. Horror stories abound of people panicking and going blank during the examination.

In boxing for example, Boxers do not do much training in the last week before the fight. They’ve finished their training by then and if they’ve not then there is a big chance they will lose. However, they still go to the gym not to train but to keep focus and to prepare themselves for the upcoming bout. Therefore, it is important to give yourself time before the exam to physically recuperate from a long and arduous preparation and mentally focus on the upcoming examination.

Know the factors that can affect your USMLE study plan.

We will now discuss the various aspects that make making a one size fits all study plan practically impossible. This will be just an overview and we will discuss them in more detail later.

An important factor that will affect how you prepare for the USMLE is your background.

  • Are you a recent graduate or an old one?
  • AMG? Or IMG?
  • Good student acing all exams? Or barely made it through medical school?
  • Top school, run of the mill or diploma mill?
  • English as medium of instruction or other language?
  • Native English speaker or poor in English? (Having to translate the questions in your head can just be enough to break the exam for you.)

Any of these factors will affect how you prepare, how long you prepare and what additional steps you have to take in order to be ready for the USMLE.

Another important factor is your strengths and weaknesses and particular skill sets which you possess.

  • Fast reader vs. slow reader?
  • Good comprehension skills vs. weak comprehension skills.
  • Good memory and retention vs. poor memory and retention.
  • High IQ vs. very High IQ. (It is presumed that since you finished medical school, you probably have a high IQ or at least above average. A minimum IQ of 125 is needed in order to reasonably finish Medical school in the time allotted for it.)
  • Whether you study better by reading, listening to lectures or group discussion.
  • Long attention span vs. short attention span.
  • Good concentration vs. easily distracted.
  • Strong self-discipline vs. poor self discipline.
  • Favorite subject. (You tend to learn and retain better information on subjects you like and if they happen to be heavily tested subjects, ie. Patho, Micro and Pharma in Step 1 or IM in step 2 and 3, this could influence how well your review will go. If you hate them, it will be harder.)

Last, but not least, your present circumstances can affect not only your study schedule but how high a score you should be aiming for.

  • Working full time, part time, jobless.
  • Head of the Family and sole breadwinner
  • Pregnant
  • Have small kids particularly toddlers and infants
  • Amount of Social support you can draw on
  • Parents take care of all financial needs (The social pressures from relatives can be particularly demanding in this situation.)
  • Family expectations
  • Visa issues
  • Your age and your health

All of the above circumstances will affect your study plan. It will also affect your schedule including when you should schedule your examination. Let’s look at them in more detail.

Your Background

We will discuss how your educational background affects your study plans. We will go to the different aspect of your background.

New grad vs. Old grad.

High scores are more important to an old grad. Also the need for longer study time and additional responsibilities like work and taking care of kids makes their study plans much more complex and demanding than for new grads.

AMG vs. IMG.

IMGs need higher scores and longer study schedules than AMGs. AMGs have an advantage in Behavioral Sciences. US medical schools prepare AMGs to do well in the USMLE. This includes special pathophysiology classes and clinical correlations. While most IMGs are left on their own to integrate the concepts. That’s the reason for the popularity of Goljan’s lectures. When he goes “mechanisms, mechanisms, mechanisms”, he means “pathophysiology, pathophysiology, pathophysiology.”

To read more about the alleged differences between the difficulty of the exam for AMGs and IMGs, refer to my post here.

Good Student vs. Barely Made it.

If you barely made it through med school, then there probably are large gaps in your knowledge of concepts tested by the USMLE. It is important for you to hit the books, especially on frequently tested concepts you have not mastered. Even if you were a good student, there could still be some gap in your knowledge and it pays to go through outline notes like FA or BRS to find weak points.

Top school, run of the mill, or diploma mill?

There are topnotch graduates from diploma mill schools and there are really bad students from top schools, but on average you expect students from top schools to do better, therefore your school can affect how much preparation you need to make.

English as medium of instruction.

Even if you are proficient in English, having learned medicine in a foreign language can affect you. Most medical terms are not taught or learned outside of school. English is the medium of instruction at our school. Although I am proficient in both Filipino and Chinese, I learned medical terms in Filipino only after long practice and still have difficulty with medical terminology in Chinese.

Native English Speaker or Poor in English

The USMLE is in English and having to translate medical terms and even regular words in your head can slow you down a lot. In a timed exam like the USMLE, it could prove fatal. So if you have language problems, work on it first before attempting the USMLE.

Your educational background can and will impact your performance in the USMLE. Make sure you take that into consideration in your preparation.

Your Strengths and Weaknesses

We will deal with how your particular strengths and weakness impacts your study plan. Different people possess different skill sets. Your particular skill set will determine how you should conduct your review.

Fast vs. Slow Reader

Fast readers have a tremendous advantage in reviewing. If you are a slow reader, read up on some tips to increase reading speed in my post here. Also fast readers have an advantage when tackling the kilometric questions that appear in Step 2 CK.

Good Comprehension Skills vs. Poor Comprehension Skills

If you have poor comprehension skills, compensate by rereading the topics if needed. You need to understand it to learn it. What matters if you finish fast but did not learn anything. Again, main reason why you should not schedule examination until you finish your learning phase, since how fast you learn is variable.

Good memory vs. poor memory

Memorization is just repetition. If you have poor memory, do more repetition. Mnemonics is unreliable most of the time due to time constraints of the exam. Frequently tested material must be in immediate recall. Use mnemonics for more peripheral, less tested information.

High IQ vs. Very High IQ

If you finish med school than you can pass the USMLE. You just need proper preparation. The USMLE is tough but definitely doable. Having a Very High IQ just makes it easier.

Study Mode: Reading, Lectures, Group Discussions, etc.

Some people learn better reading, others hearing lectures and others by group discussion. As I said before people learn best by association. A lot of times you remember facts not because you read them, but because the lecturer said something humorous or you remember a particular incident during group discussions. Different people learn better in different environment. Understand what environment suits you best and include that in your study plan.

Good Concentration vs. easily distracted.

Some people can study with the TV on while wearing an ipod and with children wailing in the background. Others need absolute quiet to study. You should determine under what environment you can study well. Phone calls, social events and other distractions will affect how long your preparation will eventually be.

Long attention span vs. short attention span.

Some can study for hours, while others get bored after some time. Schedule your review to take this into consideration. Short attention span can be offset by variety, either in topics reviewed or in study mode. For example, studying pathology and anatomy or physiology in parallel or alternately can offset boredom. Alternating between reading, taking short quizzes, group discussion and listening to lectures can also offset boredom.

Strong self-discipline vs. poor self-discipline.

Some people can make a study plan and stick to it. Others, well, others make a study plan and try to stick to it. (wink..wink..) If you lack self-discipline, it’s best to recruit others to help you. Enrolling in a class (and showing up) can help. Joining a study group can also help. Do not schedule your exam in the hope it will force you to stick to the plan. You’ll wind up losing $$ or failing the exam.

Favorite Subject

Pathology, Anatomy and Physiology are my favorite basic science subjects in Med School. Which just means that I tend to study and retain what I study on these subjects. You probably mastered more medical concepts in your favorite subjects than others. When reviewing for the USMLE you need to concentrate on the big subjects rather than what is your favorite subject. The big three is pathology, pharmacology and microbiology. If these are not your favorite subject then you know you have your work cut out with you. If they happen to be, then you probably can make do with less study time.

Your Present Circumstances

Each one of us have a life outside of studying for the USMLE. We will analyze how your present circumstances affect your study plan.

Working full time, part time, jobless.

 

Some people have to work full-time. Which just means that they have to consider that their review period will be longer and that their schedule will be constantly interrupted. It is important for them to make sure that they set aside time for study and during those set time to isolate themselves from worries at work. The same could be said of those who work part time although their problem is not as bad as full-timer.

 

Head of the Family and sole breadwinner

 

Being head of the family and sole breadwinner is more challenging than just being employed. The pressure is physical, emotional and psychological. Having adequate social support is crucial if you want to pass or do well in the USMLE

 

Pregnant

Pregnancy brings with it a lot of problems not the least of which is going into labor at an inconvenient time.(eg. Like in the middle of the exam) Preparation for the exam and the exam itself are extremely high stress situation, so proceed with caution.

Have small kids particularly toddlers and infants

 

Children are fascinating, cute and lovable except when they won’t eat, become cranky and irritable. Then they’re nearly impossible. Hats off to all USMLE takers who have toddlers and infants and still able to study well. For others, well, asking for help from other adult family members may be needed. So it is important to anticipate and prepare for this before start of preparation.

 

Amount of Social support you can draw on

 

Support from family, relatives and friends can make a difference in your psychological preparedness for both the preparation phase and actual examination. There is a difference if people are rooting for your success or your failure.

Parents take care of all financial needs

 

Most new grads belong in this category. It is both a blessing and for some also a burden. The pressure to succeed at your first try because somebody else is paying for it can be overwhelming. Although for some there may also be a tendency to take it easy since they don’t have to worry about the financial burden.

Family expectations

High family expectations can be a spur to do well, or can hamper performance. Low family expectations can result in the same things as well. Again the result differs depends on each individual’s particular situation and their reaction to them.

Visa issues

 

You need to take the Step 2 CS exam in the United States and if you need a visa to enter the US, you will need to anticipate the time delay it takes to get one. So schedule your review with that in mind.

Your age and your health

Suffice to say, younger people have more stamina than those older, although you can also say that older people may be wiser. In addition, poor health can affect concentration and study time.

 

Scheduling.

Now we talk about scheduling. There are different aspects of scheduling that we have to consider. Foremost is in what order do I take the USMLE. For AMGs the answer is moot and academic, since this is dictated more by the medical school than personal preference. For IMGs, who are free to chose their own sequence, it is more problematic. While it is true that for some IMGs it is more beneficial to take the USMLE Step 2 CK, I believe that for majority of exam takers, taking it in sequence provides tremendous benefits. I’ll discuss the reasons in more detail in a future post in my blog.

The next consideration is how long a preparation time should I allot for review. Again, this is so dependent on individual differences, it is hard to give an estimate. However, for the ideal graduate, meaning fresh grad, good student from good school, 2 to 3 months for Step 1 and 1 to 2 months for Step 2 CK is about average to pass and do well but not to ace the exam. (Again, there are geniuses who probably will be able to ace the exam, though) But outside of ideal, you will have to make adjustments.

Often, I see in forums people who will declare that they’ve signed up to take the examination in 5 or 6 months (or 2 or 3 or whatever), then ask plaintively, “what do I do now?”  All I could do is shake my head since they are headed for disaster.

I have already discussed about the learning phase and mastery phase in your study plan. Mastery phase is most predictable. Usually 2 to 3 months to pass Step 1 on average and 3 to 4 months to ace it. Other factors like reading speed, IQ, available study time, etc. will affect it but the estimates are average. The learning phase is most unpredictable. That is why you should not schedule your examination until you are starting your mastery phase.

The last advice I can give is to schedule your exam to achieve a certain score rather than to finish by a certain date. By all means schedule your exam to finish by a certain date but if by that date you are not ready then postpone the exam. It takes as much time, effort and money to retake an exam as to cancel it and take it later. Except if you fail and retake it, it can do irreparable harm to your ability to match.

Importance of sleep, rest and recreation.

Having enough sleep, rest and recreation is very important in the review process. The worst time to burn out is just before the actual exam day. Also, studies have shown that neural connections are made during sleep and that unless we sleep, whatever we have learned during the day is not stored in long term memory. Infants sleep all day, because they have more information to process than adults. So not sleeping to study is not considered good quid pro quo.

Rest breaks are also important within the day as monotony will tend to dull your attention. Your eyes may be moving through the words but your brain is not recording it. 45 to 50 minutes study with 10 to 15 minute break is a good rule of thumb although again, personal differences may mean you have to adjust the actual rest break.

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