ANSWER TO READER QUESTION: WHY CAN'T I PASS EVEN THOUGH I DI

[tommyk]

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This point is so critical so I will type in CAPITAL LETTERS!!!!

THE REASON THAT I AM WRITING ANOTHER VERY LONG POST IS BECAUSE I KEEP CONTINUOUSLY GETTING EMAIL FROM DESPERATE STUDENTS WHO KEEP FAILING STEP 1. THE REASONS ARE COMPLEX SO I FEEL I MUST ADDRESS THEM AGAIN. PLEASE READ EVERY WORD BECAUSE I HAVE PUT A LOT OF THOUGHT INTO EACH WORD! MANY OF YOU DOUBT MY SINCERITY AND I KNOW THAT...BUT PLEASE TRUST ME AND MY WORDS.

1) STARTING WITH THE MOST OBVIOUS: "LACK OF MOTIVATION". IF YOU CANNOT FIND THE MOTIVATION, THEN YOU MUST FIND IT OR YOU WILL LIKELY NEVER PASS USMLE STEP 1.

2) LANGUAGE BARRIER: I HAVE GOTTEN LIKE A HUNDRED QUESTIONS ON THIS ONE AND I ADMIT THERE IS NO EASY ANSWER. IF YOU CANNOT SPEAK ENGLISH WELL, THEN YOU WILL HAVE TWO BIG PROBLEMS. FIRST, YOU WILL NOT BE ABLE TO UNDERSTAND THE KEY MEANINGS IN THE QUESTIONS. SECOND, YOU WILL RUN OUT OF TIME DURING THE TEST. SIMPLY, THE BEST AND ONLY SOLUTION IS TO KEEP READING AND TALKING THE ENGLISH LANGUAGE, TO YOUR FAMILY, TO YOUR FRIENDS, TO YOUR TEACHERS, ETC...READING ENGLISH MAGAZINES, COMICS, LISTENING TO ENGLISH RADIO...THERE IS NO OTHER WAY EXCEPT TO LET TIME BE YOUR FRIEND, YOU WILL GET THERE, BUT IT WILL TAKE TIME. AFTER ALL, YOU KNOW YOUR HOME NATIVE LANGUAGE RIGHT? MY FIRST LANGUAGE WAS NOT ENGLISH, BUT YOU ALL CAN UNDERSTAND ME RIGHT? IT JUST TAKES TIME!

3) QUESTIONS FROM STUDENTS) WHY CAN'T I PASS STEP 1 BECAUSE I HAVE DONE Q-BANK, NMS, BOARD SIMULATOR SERIES, OVER AND OVER AGAIN. ANSWER) THE REASON IS BECAUSE "YOU ARE MEMORIZING QUESTIONS" AND NOT "CONCEPTS". IN MY HISTORY OF LEARNING EDUCATIONAL THEORY, I LEARNED THAT MANY STUDENTS ONLY TRY TO MEMORIZE ONE DIMENSIONAL FACTS AND THEY DO NOT TRY TO REALLY UNDERSTAND CONCEPTS. I HEARD, AGAIN, FROM MANY FAMILIAR AND RELIABLE SOURCES THAT THE USA NMBE KNOWS ABOUT THIS AND TRIES VERY HARD TO STOP THIS PRACTICE. WHAT MY SOURCES TOLD ME IS THAT UNLIKE ANY OTHER USA TEST, THE USMLE STEP 1 TRIES TO "FOIL" "TEST WISE" STRATEGIES THAT LEAN ONLY ON MEMORIZING FACTS AND NOT GENUINE UNDERSTANDING.

THEREFORE, FOR EXAMPLE, THE TEST MAKERS ARE CONSTANTLY REWORKING AND TESTING NEW QUESTIONS THAT ARE ADDRESSING THE SAME CONCEPTS. FOR EXAMPLE, CONSIDER THE CONCEPT OF "A DIABETIC PERSON ON A BETA BLOCKER" THE WARNING HERE TESTED IN A CONCEPT IS THAT THE BETA BLOCKER CAN MASK THE SIGNS OF DIABETIC HYPOGLYCEMIA. THIS "ONE" CONCEPT CAN BE REWORDED, REWORKED, REASKED IN ENDLESS WAYS. BUT THE NBME WANTS A TEST TAKER TO UNDERSTAND THIS LIFE-SAVING FACT.
SECOND, TAKE THE "CONCEPT" THAT "A CHILD COMING IN WITH A COLD CANNOT SIMPLY BE GIVEN AN ASPIRIN FOR FEVER AND SENT HOME" YOU WILL SEE THAT PRESENTATION ENDLESS TIMES ON USMLE STEP 1 QUESTIONS...THAT PRESENT A CHILD WITH "COLD-LIKE" SYMPTOMS BUT ACTUALLY HAS A "LEUKEMIA" OR "LYMPHOMA/CANCER". THIS CRITICAL CONCEPT CAN BE ASKED IN AT LEAST 10,000 DIFFERENT QUESTION TYPES BUT THEY ADDRESS THE "SAME" EXACT CONCEPT. AS A DOCTOR IN THE USA, YOU CANNOT AFFORD TO MISS THIS DIAGNOSIS. IF YOU MISTAKENLY SEND AN "ALL: LEUKEMIA CHILD HOME WITH COLD LIKE SYMPTOMS AND LATER HE DIES OF CANCER RELATED CAUSES, YOU WILL BE SUED. THEN THE HOSPITAL WILL BE SUED AND LIKELY CLOSE DOWN. THEN THE US FEDERAL JUDGE WILL CONTACT THE NBME AND ASK EXACTLY WHY THE USMLE STEP 1 DID NOT HAVE QUESTIONS TO ADDRESS THIS LIFE SAVING CONCEPT! AND THEN THE NBME PRESIDENT AND BOARD MEMBERS WILL BE IN TROUBLE. THAT IS WHY THE NBME KEEPS ON TESTING THE SAME CONCEPTS OVER AND OVER IN DIFFERENT SCENARIOS. IN THE UNITED STATES, THE US IS FAMOUS FOR THE NUMBER OF LAWYERS AND JUDGMENT AWARDS. THAT IS WHY THE USMLE HAS BECOME "MORE DIFFICULT" AND "CONCEPTUAL" AND "PROBLEM ORIENTED" OVER THE YEARS. SORRY, BUT ONE MORE HUGE CONCEPT: IF A PATIENT COMES IN WITH "CHEST PAIN" AND HE JUST HAD A BAD MEAL, YOU CANNOT JUST GIVE HIM AN ANTACID AND SEND HIM HOME. YOU WILL BE TESTED ON WHETHER YOU CAN ASSESS IF HE HAS A HEART CONDITION. THE NBME WANTS TO MAKE SURE YOU DO NOT MISS THIS CONCEPT. AND IT IS A CONCEPT, NOT A MEMORIZED FACT.

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

SO THAT IS WHY YOU MAY SEE ONE OR TWO QUESTIONS OUT OF THE 350 QUESTIONS THAT ARE COMPLETELY DIRECT: LIKE REED STERNBERG CELLS ARE...INDICATIVE OF HODGKIN'S DISEASE. THE OTHER 348 QUESTIONS WILL ALL BE QUESTIONS THAT ARE CONCEPT BASED AND UNLIKE ANY THAT YOU HAVE SEEN BEFORE.
THIS IS WHY ALMOST ALL THE TEST TAKERS FOR THE USMLE STEP 1 COME BACK AND TELL ME THAT THEY SAW QUESTIONS AND GRAPHS AND CHARTS THAT THEY NEVER SAW IN Q BANK OR BSS ETC. I HEARD THAT THE NBME IS PAYING UNIVERSITY PROFESSORS, FIELD EXPERTS, SCIENTISTS, ETC. TO CONSTANTLY RECREATE QUESTIONS THAT WILL TRY TO MAKE IT IMPOSSIBLE FOR A TEST TAKER TO ANSWER CORRECTLY BECAUSE HE TALKED TO A THOUSAND PREVIOUS TEST TAKERS AND HE REMEMBERED ALL OF THE RECALLED QUESTIONS.

ALSO, MANY OF MY STUDENTS AND FRIENDS ASKED ME WHY THE STEP 1 IS SO HARD TO MASTER. EVEN MY FRIENDS WHO SCORED IN THE 99% AND GOT SCORES ABOVE 250 CAME OUT OF THE TEST THINKING THEY MAY HAVE FAILED. THAT IS AGAIN BECAUSE THERE IS A GOOGLE SUPPLY OF CONTENT THE NBME CAN ASK.

ONE OF MY STUDENTS CAME OUT OF THE TEST A YEAR AGO AND TOLD ME HE GOT ALL THESE QUESTIONS ON THE BRANCHIAL EMBRYOLOGICAL ARCHES. THEN A SECOND STUDENT TOLD ME HIS TEST HAD SO MUCH IMMUNOLOGY, MUCH MORE THAN ANY OTHER SUBJECT. A THIRD STUDENT CAME TO ME AND SAID SHE GOT NO QUESTIONS ON THE EMBRYOLOGICAL ARCHES AND FEW IMMUNO QUESTIONS BUT GOT A LOT OF BIOCHEM QUESTIONS...SHE EVEN SAID SHE GOT FOUR UREA CYCLE QUESTIONS IN A ROW! SO EVERY SINGLE TEST IS DIFFFERENT AND THE NBME TRIES SO HARD TO MAKE IT SO THAT A TEST TAKER MUST BE READY FOR ANYTHING AND EVERYTHING!!!!! THAT IS WHY THE STEP 1 I HEAR IS THE MOST FEARED TEST IN THE WORLD!
THE TEST IS MADE FROM THE BEGINNING TO BE A TEST THAT A SMART PERSON CANNOT MASTER, IT IS MADE SO A PERSON WILL NEVER GET THE SAME TEST AS THE EXAMINEE SITTING NEXT TO HER...THE NEW COMPUTER PROGRAMS MAKE THIS EASILY POSSIBLE.

BUT THE MAIN MESSAGE FROM ME AND THE REASON I SPENT MY VACATION WITH HUNDREDS OF HOURS SPENT WRITING CONCEPTS IS BECAUSE THERE IS HOPE! AGAIN, THERE IS HOPE!

IF YOU READ, ALWAYS, ALWAYS BE ASKING THE QUESTION "WHY?" AND WHEN YOU ARE DOING QUESTIONS, AGAIN KEEP ASKING THE QUESTION "WHY?" THEN YOU WILL DEFINITELY MAKE PROGRESS.

I THINK THE KAPLAN SERIES AND FIRST AID ARE THE BEST OUT THERE. BUT COUNTLESS STUDENTS OF MINE CAME BACK AND FAILED AND ASKED ME WHY. THE REASON IS BECAUSE THEY READ THE BOOKS PASSIVELY AND NOT ACTIVELY. THEY TRIED TO MEMORIZE QUESTIONS HOPEFUL THAT A SIMILAR QUESTION WILL APPEAR ON THEIR REAL TEST...AND IT NEVER DOES.

THE NBME'S MISSION IS TO ENSURE THAT EXAMINEES ARE FOILED TO TAKE SHORTCUTS THEY WERE USED TO THEIR ENTIRE LIFE. SO MANY STUDENTS IN GRADE SCHOOL HAD THIS ADVANTAGE. THEY WOULD ASK THEIR "FIRST PERIOD" FRIENDS, "WHAT IS ON THE TEST?" THEN THEIR FRIENDS WOULD TELL THEM THAT THE ANSWER TO THE FIRST QUESTION IN LITERATURE WAS "FAUST", THE ANSWER TO THE SECOND QUESTION WAS "WAR AND PEACE", ETC.

BUT THE NBME USMLE STEP 1 IS DIFFERENT. BECAUSE THE US GOVERNING BODIES ARE CONVINCED THAT PRACTICING MEDICINE ON HUMAN BEINGS IS ONE OF THE MOST IMPORTANT AND SERIOUS ACTIVITIES, THEY TRY THEIR BEST TO ENSURE THAT ANYONE AND EVERYONE WHO GETS A "PASSING" SCORE IS CAPABLE OF "SAFELY" MANAGING HUMANS AND THEIR DISEASES. THIS IS WHY STEP 1...MORE THAN STEP 2 OR 3, TESTS SIDE EFFECTS AND DRUG INTERACTIONS. AS I SAID BEFORE, THE US NBME WANTS TO MAKE SURE THAT THE WOULD BE DOCTORS ARE SAFELY HANDLING THEIR PATIENTS AND NOT DOING ANY HARM TO THEM.

SO, I AM SORRY THAT I TALKED FOR SO LONG, BUT I FELT I HAVE TO ANSWER SO MANY OF YOUR EMAILS THAT ARE ASKING THE SAME QUESTIONS.

YES, YOU CAN STUDY EFFECTIVELY FOR STEP 1...

NO, YOU CANNOT RELY ON PAST TEST TAKING STRATEGIES TO PASS STEP 1...

YES, YOU SHOULD BE HOPEFUL BECAUSE AS I SAID IT IS ONLY A MATTER OF TIME, NOT "IF" YOU WILL PASS...

NO, YOU CANNOT EXPECT TO PASS WITHOUT MOTIVATION, WITHOUT A GOOD STUDY ENVIRONMENT, WITHOUT TIME TO STUDY, WITHOUT ENGLISH SKILLS.

NO, I AM NOT AGAINST THE NBME. ACTUALLY, I HAVE DEEP RESPECT FOR THEM AND I AM SERIOUSLY TRYING TO HELP THEM CONVEY TO THE PUBLIC WHAT IT IS THAT THEY EXPECT.. AND HELP EVERYONE TAKING THE TEST BECOME BETTER AND SAFER DOCTORS.

BUT TOGETHER, LET'S ALL HELP EACH OTHER AND LET EVERY SINGLE GOOD HEARTED SOUL WITH HUMANITY PASS USMLE STEP 1 SO THEY CAN SERVE GOD, SOCIETY, AND GENERAL WELFARE...

IT CAN BE DONE, BUT AS I SAID IT IS LIKE CLIMBING MT. KILAMANJARO...BUT WITH DETERMINATION, YOU WILL MAKE IT, NO DOUBT...

BUT WHEN YOU ARE STUDYING AND DOING QUESTIONS, KEEP THINKING CONCEPTS AND CONCEPTS, NOT WHETHER THIS SCENE OR QUESTION WILL REPEAT...BECAUSE IT LIKELY WILL NOT.

SO, FOR EXAMPLE, IF YOU HAVE A PREGNANT WOMEN, KEEP THINKING OF THE CONCEPTS INVOLVING HOW YOU MUST MANAGE THIS DELICATE SITUATION. I KNOW I SOUND FOOLISH TO REPEAT MYSELF AGAIN, BUT REALLY THERE IS A UNIVERSE OF WAYS AND QUESTIONS TO TEST IF AN EXAMINEE UNDERSTANDS THE BASIC CONCEPTS OF MANAGEMENT OF A PREGNANT FEMALE WHO IS IMMUNOCOMPROMISED AND HAS SPECIAL NEEDS.

SO, LET'S ALL STOP TRYING TO TAKE THE EASY WAY OUT. THERE ARE NONE, THE NBME HAS CLOSED THEM ALL ON PURPOSE. THEY ARE NOT UNFRIENDLY AND UNKIND PEOPLE. THEY JUST HAVE A RESPONSIBILITY TO MAKE SURE THE USA PUBLIC IS SAFE.

I AM SO SORRY IF THIS MESSAGE IS TOO LONG AND TOO "PREACHY", BUT I REALLY WANT TO HELP...ESPECIALLY THE ONE WHO ARE CONTACTING ME WITH MULTIPLE FAILURES...

AGAIN, YOU WILL SEE QUESTIONS TESTED AS CONCEPTS THAT ARE SO NOVEL THAT YOU NEVER SAW IN REGULAR TEXTBOOKS. THAT IS WHY YOU SEE SO MANY QUESTIONS LIKE "DRUG 1" IS ACTING ON "DRUG 2" AND "DRUG 1 HAS THE SAME PROPERTIES OF AN ALPHA 2 AGONIST" AND ITS AFFECTS ON "DRUG 2" ARE...SUCH AND SUCH...AND THEN THEY GIVE YOU A BUNCH OF GRAPHS AND MAKE YOU THINK HARD. OR THEY GIVE A HYPOTHETICAL CONDITION AND THEN ASK AN INDIRECT QUESTION REGARDING TREATMENT...

THAT IS WHY THEY ALSO NEVER GIVE YOU DIRECT STUFF. FOR EXAMPLE, YOU MAY BE GIVEN A CASE WHERE YOU KNOW THE DISEASE IS OSTEOGENESIS IMPERFECTA...BUT THEY WILL NEVER ASK THE RATHER OBVIOUS DIAGNOSIS...THEY WILL INSTEAD ASK A SECOND OR TERTIARY QUESTION TO TEST IF YOU REALLY UNDERSTAND THE CONCEPT UNDERLYING THE DISEASE PROCESS OF COLLAGEN FORMATION...AT THE GENETIC LEVEL TOO....

WITH ALL THIS IN MIND, PLEASE PLEASE LET ME ASK...IN A FEW DAYS I HAVE TO START BACK IN THE HOSPITAL AND DOING OVERNIGHT CALLS AGAIN. SO I CANNOT BE SO ACTIVE. CAN ONE OF YOU LIKE MR. STEP 1 TAKE OVER SO THAT THE OTHER HONORABLE STUDENTS CAN CONTINUE TO UNDERSTAND CONCEPTS? THIS BOARD IS SO FULL OF GREAT PEOPLE AND BIG HEARTS. IT WOULD BE A NATURAL DISASTER IF THIS BOARD WENT SILENT....EVEN THOUGH BEING A DOCTOR IS NOT AN EASY JOB AND NO LONGER PAYS GREAT MONEY...IT IS WORTH IT BECAUSE LIKE A LOT OF JOBS YOU CAN REALLY HELP OTHER PEOPLE.

I END WITH MY HEARTFELT OPINION THAT THE GREATEST THING A HUMAN BEING CAN DO IS TO HELP ANOTHER IN NEED... SO LET US PUSH FORTH TOGETHER WITH LOVE, UNDERSTANDING, AND BENEVOLENCE TO OUR FELLOW MAN/WOMAN. TRUST ME PLEASE, MY WORDS ARE TRUE AND SINCERE!! AND THANKS FOR YOUR CONTINUED PRAYERS FOR ME!!!!

LOVE FOREVER, TOMMY

[tommyk]

Dear Brothers and Sisters,

I have received numerous questions if study groups can be formed in different cities. While this is a GREAT idea, I am afraid I may not be able to participate because of rotations. But if I DO have a chance to take off a rotation, I will let this board know so I can get in contact with them.

PLUS, MY ILLNESS HAS ALL BUT RESOLVED DUE TO YOUR PRAYERS! IT WAS A PHYSICAL ILLNESS MORE THAN ANYTHING ELSE, AND TONIGHT I FEEL SO MUCH BETTER BUT I STILL FEEL WEAK. IT MUST HAVE BEEN A VIRUS OR SOMETHING...AND I HAD A LOT OF GI SYMPTOMS...MAY ROTAVIRUS...

QUICK TELL ME, WHAT IS THE MORPHOLOGY OF IT (I AM JUST ASKING FOR FUN, BUT REALLY TRY TO THINK AND TELL ME QUICK!!!) I WILL ANSWER BELOW, BUT NOOOOO PEAKING...FIRST GUESS PLEASE!!



ANSWER FOR ROTAVIRUS....IT IS AN..

RNA VIRUS, FAMILY REOVIRUS, NO ENVELOPE, IT IS THE ONLY RNA VIRUS THAT IS DOUBLE STRANDED, SEGMENTED, LINEAR, AND SQUARE. USUALLY YOU FIND THIS CASE IN DAYCARE CENTERS WHERE KIDS COME HOME AND LATER HAVE VERY SERIOUS DIARRHEA!!!!

SEE, EVERYTHING CAN BE A CONCEPT...EVEN MY OWN SICKNESS!!!!

I SLEPT TODAY FOR LIKE 12-18 HOURS, SERIOUSLY, THAT IS WHY THERE ARE SO FEW OF MY POSTS.....LOVE TOMMY

[tommyk]

THAT REGARDING MY QUESION ON ROTAVIRUS, THE REASON I INCLUDED SO MUCH INFORMATION IS BECAUSE ON THE REAL TEST YOU MAY SEE ANSWER CHOICES FROM A TO J OR SOMETHING CRAZY LIKE THAT.

SO, IF YOU DON'T KNOW ALL THE FACTS COLD, YOU WILL BE STUCK ON TWO CHOICES...LIKE IF ROTAVIRUS HAS AN ENVELOPE OR NOT.

OF COURSE, KNOW THEY COULD GIVE AN EXPERIMENT AND GIVE YOU ALL THE MORPHOLOGY...THEN YOU HAVE TO TELL ME HOW THE CHILD/PT WILL PRESENT OR WHAT THE BUG IS...

ALSO, YOU COULD BE ASKED THE TREATMENT/DRUG.

OR, YOU COULD BE ASKED WHAT OTHER COMMON BUG/VIRUS IS IN THE GROUP...IN THIS CASE IS REOVIRUS

OR YOU COULD BE ASKED WHAT IS THE VECTOR VIA TRANSMISSION, AND THEN YOU HAVE TO GUESS IF IT TRANSFERS BY CYSTS IN WATER, AEROSOLS, OR IN THIS CASE...IT IS THROUGH TICKS.

OR YOU COULD BE ASKED IN WHAT PARTS OF THE WORLD ARE THE BUGS/VIRUS MOST COMMONLY FOUND...

I AM VERY SERIOUS ABOUT ALL THE ABOVE INFORMATION...

PLEASE E MAIL ME IF YOU HAVE FURTHER QUESTIONS.

THE NBME WANTS ME, I THINK..I HOPE...TO TELL YOU WHAT TO EXPECT AND TO KNOW ALL THAT A GOOD DOCTOR WILL KNOW ABOUT THE SICK PATIENT IN FRONT OF HER/HIM..