Hy 2419 To answer a recent question of why so many students falter…

[tommyk]

I am uncomfortable bringing things up like this, but some struggling students may have a learning disorder or a personality disorder that needs medication or therapy to clear up. Seriously. If you are spending a long time studying but NOT ABSORBING, it is like a cup with a hole in the bottom. You are trying to fill the cup, but the "hole" is spilling out the information.

To retain the information, you may need medication. I say this to the students who cannot seem to gain traction and who cannot figure out their difficulty. I cannot say who would need medication or who would not, but it is worth looking at.

One such person was a lady who wrote that she was really really tired and having narcolepsy while studying. Another had ADHD, a learning disorder. For them, methylphenidate would be required. The student with the ADHD I heard went on to pass Step 1. Another had a serious ANXIETY disorder. Another had Major Depressive Disorder. Having such a problem WILL prevent a passing score.

Again, I am not trying to advocate drugs. But for some, it may be something worth looking at, under the strict guidance of your physician. Who knows, after you pass the Step 1 and practice, you may go on to treat others struggling with the Step 1 with your disorder and help THEM BECOME GREAT DOCTORS!

Cheers!

You can do it!

Tommyk

[tommyk]

"Seeing the BIG picture"

Another suggestion brought to my attention is the lack of seeing the "BIG picture". NBME questions just LOVE to integrate broad based concepts. One of the best integrating mechanisms is to listen to a GOOD LECTURE SERIES like Dr. Goljan's Audio for Step 1. He is a very entertaining and good gentleman. His audio notes are available in many places on the Internet. You can buy them, but I have heard that there is very little trouble to get them for free. Your other medical students probably have them too.

Draw large mental pictures for subjects like Biochemistry to grab the grand concepts. The Glycolysis and TCA cycle is the "Superhighway". Everything, all the reactions, attempt to feed into this "Superhighway" to make ATP. If you can draw the "Superhighway", then you can draw all the other reactions like the Pentose Phosphate Shunt, Fatty acid degradation, etc. and where it all feeds in. It really helps to form these mind maps. In fact, there are many good Biochemistry diagrams in a few textbooks that link all the reactions together. Find one and print it out! Actually, there are many computer programs that allow you to draw mental mind maps and connect concepts. It will end up being like a spider web to intertwine and capture and HOLD many more concepts. When you draw out the concepts, it REALLY WORKS in that it "sticks" to your brain!

See ya,


Tommyk

[tommyk]

It may be that you cannot retain well enough and thus need more strategies. One common one brought to my attention that WORKS WONDERS is VERY ACTIVE note taking. Do not suppose that you will recall a concept just because you read it and think you understand it. You will be often surprised at how fast the information leaves. Some WRITE OUT every concept or fact in the margins of the book, on a notebook, etc. It is a much slower process, but if the information is going to STICK, it is MUCH MORE EFFICIENT and EFFECTIVE. What use is it to read a "mile a minute" and study for "one whole year" if very little is recalled and sticks in your memory. Your brain MUST have some kind of "glue" in it. Find out what materials "activate" this glue!

Cheers to you!


Tommyk

[DrDOmeNR]

great points and words of wisdom. i'm new here at the forum, i heard people mention Tommy's HY...where can i take a look at that? thanks.

[udaya]

hi!
its so nice of u.hey i am taking my exam in 2 mon plzzzzzzz send me the step 1 qs.

THANK UUUUUUUUU

Dear Udaya,

You can get the Tommy Concepts which are asked in Q-Bank style via the link at the top of the page. There is another set in the free download section. I heard that both are not yet updated so there are a bunch of questions/answers on the standard valuemd pages. Still, I heard that there are many who passed USMLE 1 by reading only the Tommy Concepts along w/ some reference books and mastering them entirely.

Kaplan may be better since the format is timed, and you can do random questions by subject, and they record % correct and so forth. But, The Tommy Concepts are free, and it is tried and tested. Study very hard. I am sure that if you put your heart and soul in, you should pass.

[or2dox]

Hello Tommyk,

I'm an IMG planning to take usmle step 1 for the first time, before reading all the threads in this forum and get confused later on by the numerous inputs which I do believe are very pertinent and important, I've decided to compile my review materials before starting my review. May I ask your expert opinion and suggestions as to what other review materials I need to get hold of for the different subjects? Thank you so much! Good Luck to all!

Here are my review materials:

-2007 ed. First Aid
-Road Map Immuno & Neurosci.
-Rapid Review for Patho.
-Kaplan Med. Ethics
-Kaplan step 1 Qbook
-First Aid Q&A
-Step-Up to usmle step 1 3rd ed.

Your suggestions are highly appreciated! Thanks a million!

[tommyk]

To my beloved Family of future doctors,

In response to readers, I write to please tailor your study habits to your personal strengths. Mainly, everyone should get the main popular books like First Aid and Kaplan Notes. As long as you do not have a dementia-type illness or another brain lesion, you should be able to "recall". The principle is similar to knowing the names of your uncles, aunts, cousins, sisters, brothers, etc. The difference is that some people do indeed memorize faster than others. The difference is barely noticeable in everyday life because you have only small things to commit to memory like a phone number, street address, etc. But on the Step 1, there are SOOOOOO many things to memorize. Therefore, any "slight" differences in memory will be VERY MARKED and MEASURED.

After I took the Step 1, I pulled out the main resource books like Kaplan, First Aid, BRS, BSS, etc. when I got home. I remembered then a number of questions from the real exam. I could not believe all the small points that I forgot and thus answered incorrectly!

Therefore, you should be able to (rather you MUST) basically MEMORIZE a book like First Aid or Crush the Boards entirely. When I ask, "What is the mech. of action of Drug A?", you should be able to tell me in one second. You can do it. If I ask your birthday, couldn't you tell me in a flash??? Do so likewise with the drugs, bugs, etc.

Think about it. If you had to memorize the 50 state capitals of the United States, the test would be relatively easy. If I ask, "Capital of Alaska?", you should jump and say "Juneau" right away. If I ask for New Jersey, you should yell "Trenton" in an eye blink! Virginia=Richmond! etc.

If you are not retaining, do not just tell yourself you need many more months to study! While that may be part of the problem, you must examine why you are not retaining. Tape or staple a chart and graph the number/percent of answers you got correct from NOTECARDS you are making or from any number of Q-Banks available. Do so in individual sessions weekly or more often.

Chart how you are progressing! Of the information, are you getting 35% correct the first week, then 37% the second, then 42% the third, then 48% the fourth, and then 55% the fifth, etc.??

If so, you ARE improving, and it is just a matter of time before you get that magical "pass" on your score report!

But if the Chart is flatlining or even worse, creeping down, then there is a problem. Doing this exercise will help diagnose the problem. Imagine YOU ARE THE PATIENT, and the "% Correct on the line graph" is the continuing line that shows your progression to HEALTH (passing grade).

It is like if you are hypokalemic. OK, so your potassium is at 2.9. Then you start the drip, and then you are charting the level on a piece of graph paper and the reading is 3.2 after a while. Good... Then later it is 3.5. Great... And so forth. You will then KNOW you are going to get there.

You MUST FIND OUT HOW YOUR BRAIN REMEMBERS and INTEGRATES information!

You need a system of rewards also to buttress your progress. For example, if you recall all the Glycogen Storage Diseases and Immunological Diseases (both VERY VERY HIGH YIELD), then you could reward yourself once you met those objectives. Or you could punish yourself if you miss key questions (However, I like the positive reinforcement method better. BUT, if someone did something extreme like slap you in the face after a wrong answer, you will remember better).

Again, accept that there IS a difference between the speed that people memorize. Just accept that fact of life. It is like height or strength. But know that you can overcome it. You CAN do something about it.

This Step 1 is very much like a 26.4 mile marathon run vs. a short 100-200 meter sprint. The short sprint is like everyday life. Even if you are running against an Olympic champion, you will be some meters behind at the finish line. The difference is just a couple of seconds.

BUT, in a marathon run (which the Step 1 is), the differences between an Olympic champion runner and yourself will show MUCH MORE OBVIOUS differences. The seasoned Olympian will cross the finish line maybe HOURS before you do. If you are not lucky, you may collapse well before the finish line on mile 7 or so from exhaustion.

Ultimately, the point I want to emphasize is that I think a determined medical student can eventually pass the Step 1. Don't make the mistake of comparing yourself to the top USMLE scorer in the class! SERIOUSLY, honestly, I tell you that my own mentor, who was in the top THREE of my entire medical school class failed in his intern year and has to repeat it this year!!! (It had to do with his skill at quickly formulating a differential. He knows way too much and kept on stating TOO MANY "zebras", and not "getting to the point". This angered the senior residents.) Different people have different strengths.

Know which books work best for you (but stick to the highest rated books). Know how long you personally need to study overall and how many hours per day. Know if you have a handicap. Know (most important) which study method works best for you.

For example, I myself study much better in groups. I studied with a group of people and asked questions to others in the group. I was a VERY "ORAL" learner. I would even read aloud when alone. Just reading the chapters over and over alone in silence did NOT help me much.

It was the same with ME PERSONALLY with the MCAT. When I took my first diagnostic test, I really really did horrible. Then I found a method that worked for me. I formed the study group I spoke of, then we all took turns explaining things to each other. It really helped me personally. Subjects/concepts that I "thought" I knew... I found that I really did NOT know them cold because I had trouble explaining it to others. Once I learned it enough to explain to others, not only did I understand the concept better, the concepts STUCK LIKE SUPER GLUE in my brain. In the final MCAT diagnostics, I found I was missing only a few questions out of 77. I confess in the first diagnostic I missed almost HALF OF ALL THE QUESTIONS!!! The experience with the USMLE Step 1 was VERY similar. I went on to score over 95% percentile on the MCAT. I found the method that worked for me, and I ran with it. (However, you may be better studying alone. Or maybe you study well in a coffee shop. Only YOU can find this out). Keep POSITIVE.

Please please follow your dreams, as this life is a JOURNEY, not a DESTINATION. We are all climbing Mt. Everest together. Once you all personally reach the summit, please appreciate it, love mankind, and lend a rope down to others trying to get there.

All the best in this New Year 2007,
And Merry Christmas,
Love,

Tommyk

[tommyk]

Family members,

To address another question, I personally believe that the NBME was wrong to raise the pass level. I think it was just fine where it was at. I do not understand why they would increase the bar just because more people were studying harder. Long ago, people studied MUCH LESS for Step 1, 2, and 3. One older doctor I asked said there was a 2, 2, 2 rule (Triple 2's Rul): You study 2 weeks for Step 1, you study 2 days for Step 2, and you bring 2 Number-two lead pencils for Step 3.

Anyone studying that little nowadays and passing is either God Himself or the Director of Research at the NBME who peruses the questions.

Just because people are studying so much more and thus doing better on Step 1 should not make the NBME raise the score level. It sort of penalizes medical students in general. If they are so worried about patient safety, I think they should just ask more questions about deleterious side effects of certain drugs and incorrect clincial judgments. I do NOT THINK that any patients would be more at risk if they left the pass level alone at 182. Rather, I think it will just end up frustrating many soon-to-be-doctors.

Anyhow, that is how I feel.

Much love in Christ,


Tommyk

[tommyk]

Dear Brothers and Sisters,

Since I have been getting many questions about difficulty of progress, I must address yet another uncomfortable reason...

"The student may have lost motivation or is doing it (studying for Step 1) for the wrong reasons."

I have communicated with many who are studying just because their parents want them to be doctors. That is a sure fire recipe for disaster. How on earth could you memorize this encyclopedia of information if you really deep in your heart wish NOT to become a doctor?

For illustration, when my guy friends and I went to frat parties in college, we would meet lots of people. However, my friends and I ALWAYS HAD A KEEN memory of the prettiest girls. During conversation, we would know and MEMORIZE her phone number, favorite poet, pet peeves, last good movie they saw, etc. But of the guys... well, it was just a blur of blue jeans. The difference was that in one case we CARED and in the other case we did NOT CARE.

It makes all the difference in the world. For many, not all, but for many, they should ask themselves hard if they really truly want to become doctors for life (You all KNOW it is a very hard job). If they have hidden doubts, poor motivations, wrong reasons to be, then the answer to their failure of progression on Step 1 becomes manifest.

Know thyself.

Yours truly,

Tommyk