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

[tommyk]

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

For a recent string of emails, I conclude that the reason so many smart med students fail the Step 1 is because mainly their study "technique" is ineffective and wrong. Most students HAVE the right ingredients: Brains, Effort, Materials, etc. However, many are studying incorrectly. So many have, Dr. Goljan's Notes, Kaplan, First Aid, etc., but they are reading the material like a magazine or a mystery novel. NO! You MUST ATTACK each concept. Many just report that they "memorize questions". That may have worked wonders in high school and college and even medical school since many teachers REPEATED QUESTIONS almost word for word on tests. But the NBME is very powerful. They charge literally an ARM and a LEG for the test so they have so MUCH MONEY to ask people (professors and doctors) to write an "ENDLESS STREAM" of questions so students do not have any "short cuts".

You cannot just read these Hy Concepts like a newspaper like the New York Times. You must attack them and dissect them…make up flash cards, make certain guesses BEFORE looking at the answer, quiz friends with them, make up a “board game” with them, etc.

But that is why this message board is SO KEY. We can ask each other for their exam experiences, and then make up legal questions/concepts to help others.

However, know that you need that key ingredient of TIME and MONEY to give yourself adequate preparation. You NEED a SOLID window of studytime to pass.

If you do not have it, ask for it and beg your family and friends for it. Live with a friend/family in their basement to save money and buy time to study UNINTERRUPTED w/ TOTAL CONCENTRATION.

If you cannot find time and money to study, it may be a waste of time and cost you your mental health. Please ask others to pray for you. However, know that you are not alone and many of the students I knew who finally reported passing did so even after more than TEN ATTEMPTS at the USMLE Step 1. Seriously, I called the NBME to verify it! OVER 10 ATTEMPTS! If they could have the dedication and finally passed, they achieved a dream even if they don't even go on to practice medicine! Abandon your dreams of doctoring only after ALL LIFE SUPPORT measures are taken.

I think of it if I am caring for an ICU baby. I won't give up my efforts at saving his or her life until there is no heartbeat for an hour or more!

Sincerely,

Tommyk

[farrahsamrinsiddiqui]

hi can u send me step1 questions on FARRAHSAMRINSIDDIQUI@YAHOO.COM

[shania]

encouraging post... thank you.... this is exactly what i think is needed to score

thanx.. needed this encouragement.. specailly at this time when i have 55 days to go for my step 1..

[md90]

Thank you tommyk for your positive and encouraging words, and wisdom...

[tommyk]

Dear Brothers and Sisters,

You all "rule"! It is I who is thankful that I can help. This is part of my calling in my life. So many students emailed/PM'd me in the past couple of years telling me that my posts helped them pass. Each message like that is worth a year's salary as a doctor to me. It is really encouraging for me personally.

Really reach out to others on this message board. It IS like "family". If you pass, let others know. If you did NOT pass, share with others and ask for their advice. Share your strategies and coping skills.

And I forgot to mention how important it is to find a close MENTOR if you are having a lot of trouble passing or improving your score. If you are in trouble, it is VERY hard to really SEE yourself and understand where you are going wrong. You need someone fresh from the outside to come in and gracefully and honestly tell you what is going on.

It should be someone who is familiar with the Step 1 and how you are picking up the material and how learning works. They should be able to sit with you periodically and see if you are really understanding the mechanisms and how the boards likes to ask questions. The NBME loves to string together different subjects like pathology and biochemistry and pharm and then ask a question based on it.

Do not pay someone outrageous sums of money to help you. In fact, try to find a kind soul without paying them. In truth, they will do the most sincere work. In many of my own studies in college and medical school and now in residency, all of my own mentors helped me for free. That is when you KNOW you have quality and a good mentor. A person willing to help without payment truly DOES have your interests in mind. A person asking for a lot of money...well that person has your money in mind. A good mentor should live close by you so you can meet with him/her at least once a week.

I would love to mentor more, but I am quite busy with my own students too, plus doing the concepts for this board. But I did do a LOT more mentoring in the past. You CAN find someone. Look first in your medical school at professors. A PERFECT person would be someone like Dr. Goljan who IS your current professor AND who teaches Step 1 AND is really a nice guy.

Again, seek out a mentor who can look over your shoulder and can ANALYZE how you are PROCESSING the information and recalling it. Someone in medical school did that for me too! In a few subjects, my friend had made a computer program that would ask me questions like a Q-Bank, and figure which areas and concepts I was slower to grasp and the speed at processing and remembering the information. Then my friend would suggest reasons as to WHY I was having trouble. It was sometimes motivation related (I was not a big fan of Histology). Or other times it was just hard for me to grasp (Cardiology). So I had to adjust my studies. He was, I am almost sure, ranked like 3rd in our ENTIRE medical school class. He was a perfect mentor for me.

Oh, if you are forced to guess on a tough question on the Step 1, let broad principles guide you to a "best guess". Eliminate the most obvious traps (things that seem too easy). Be suspicious of answer choices that seem like something that a completely uneducated person would be drawn to. Recall that distractors are distractors for a good REASON. If they do not distract and trick someone, then it would NOT be among the answer choices. And other broad principles are to pick the LEAST invasive and the LEAST side effects medicines or tests and the LEAST expensive and the most easy for the patient to follow. For instance, you would pick Amoxicillin before Vancomycin for a gram positive bug due to the side effects and lower cost. Second, you would pick "reduce salt and water & reduce weight" before using Lasix/Furosemide for treating HYPERTENSION, etc. Another broad principle that you will find is true when you analyze the NBME's released items and past retired questions is that they generally prefer the more common disease among the answer choices given a non specific question/chief complaint. And so on. There are other such broad principles to guide you, but you will either pick them up more as you go along, or you will need a mentor to guide you.

Again, to answer more student questions, stopping your pursuit for medicine IS ok, if it is for the right reasons. If you have the HOPE, time, money, motivation, life circumstance, love for medicine, then you should continue your quest. Life IS a journey, not just a passing of one test. If your heart is in medicine, it makes no sense to drop out if you are going to continue to regret it all the days of your life. However, if you are "at the end of your rope" and are going to go nuts and lose your hope, joy for life, etc. then you should pray about it and maybe take time off from studying or maybe seek another path altogether. If you run out of money and time or if you have to take care of your sick mother, then you SHOULD stop running for Step 1. But that is SUCH a tough decision. I think that would be another question for a mentor that would take ENORMOUS soul searching.

I am reminded of that U2 song, 'Stuck in a Moment.' Even if this time of trial seems so hard and never ending, "this too shall pass"...

And I also recall in the Old Testament regarding Job. Even though he suffered immeasurably, in the next stage of his life, God Blessed him more than ever with endless grace.


God Bless you all,


Much love, Tommyk

[voon]

Hi there,
thanks. Can you sent me USMLE step1 question to vpliaw@excite.com

Thanks again

[dr2bee]

I am about to take this exam in just 3 weeks... I am very nervous, sometimes I have great days and others I just feel as if all the information I have studied for 12-14 hours a day for 3 months has made no difference and my scores on the q-bank are very low. I seem to feel so nervous about this exam, I totally agree with everything you have mentioned regarding the startegies for learning and attacking these questions! Can you please be so kind to email me these questions if its at all possible? Thank you so very much for your help and your amazing advice!
vikisgr8@yahoo.com

[IMG SURVIVOR]

you can get it here in tommy concepts

[tommyk]

*** LACK OF CONCENTRATION ***

Another reason called to my attention is that suffering students often have LACK OF CONCENTRATION. The Step 1 is about understanding yes, but more importantly... can you memorize??!!! You need "total concentration" (like Bruce Lee said in the movie, "Enter the Dragon") to memorize effectively. If you are distractable, you can not memorize the ROTE information like what disease is on which chromosome, etc.

Again, I knew many students who completely BOMBED the MCAT, which is MORE a test of comprehension and understanding than the USMLE Step 1. Then, then went on to SAIL past the Step 1!! When I tested a few of them, I noted that they HAD SUPERIOR MEMORIES. I would test them with picture recall, story detail recall, numbers+letters recall, etc. They were superior. But, some of them could NOT write a poem or compose a serious argument on paper!

I see the Step 1 as mainly a test of recall. If a person can function effectively in society, then I believe it is a matter of needing time AND CONCENTRATION to absorb all the MASSIVE MOUNTAIN of information.

Intelligence alone cannot do it. As I wrote so many times, I knew of even Ivy League level students from University of Chicago, Harvard, Brown, Yale, etc. that had SERIOUS numbers of failures in the Step 1. It is a closely guarded secret that medical schools love to protect. But there are failures all around. If you doubt it, just really ask around...

Make sure you have a strategy for memory with concentration. We often recall if we are in an altered state of excitation. For example, in the movie "Kingdom of Heaven", the actor Orlando Bloom was slapped in the face after a quote by actor Liam Neeson and was told, "This is so you will remember it..." That IS true. Look back on things you remember. You can often note that there was some level of distress, anxiety, or pleasure... basically a HEIGHTENED sense of awareness during that time. You may remember the name of the first boy or girl you kissed, the time you were so anxious due to an embarrassing moment, and so on.

Use that strategy in your studies. You could SHOUT OUT YOUR ANSWERS so that you can "pair a loud" angry noise to help RECALL. Or you could DRAW PICTURES... which I read helps A LOT. You could explain each concept to another whom you are studying with to SOLIDIFY. You could pair a concept with a MUSICAL PIECE which I read helps. You of course "could" pinch yourself or hurt yourself after trying to memorize a difficult concept (BUT I WOULD RATHER CHOOSE ANOTHER WAY)... it would leave ugly marks on your skin. There are MANY other strategies. But after you study for a day, you must ask yourself not just "How many hours did I study?", but rather, "Did I study EFFECTIVELY during that time?"

By all means though... Rid yourself of ALL distractions! I get constant feedback on this board about the distractions that destroy "CONCENTRATION". Movies... TV... The telephone... Googlesearch ... YouTube ... Novels ... Girlfriends ... Boyfriends ... Unrelated work at a job ... Email...

BLACKOUT ALL THE BACKGROUND NOISE. Stick to your schedule. Make sure you are NOT TIRED while studying. Those times you are nodding off will yield absolutely NOTHING. If you have to, drink lots of coffee or tea.

Go and CONQUER!

Sincerely,

Your friend, Tommyk