HY Concept 452 (This 4 page concept post answers MULTIPLE VA

[tommyk]

Dear Future M.D.s,

I am now flooded with questions in my various mails. I love them because helping is fun! At least I think so. And the same questions come again and again..

1) For IMGs, a serious problem that just won't quit is the language barrier. I think this is the MOST difficult one to handle because time is a necessity. Please read one of the past posts which addresses this well.

2) Some of us IMGs are asking what books to study. This question is definitely one of the top five questions ever asked. I feel you need to start with First Aid and choose ONE or TWO of the series:

BRS, Kaplan Notes, HY series, or Board Simulator Series or Step-UP.
AND two additions are Goljan's Notes and a GOOD PATHOLOGY/MRI atlas! (Here you could do Robbins or do Webpath). People do not realize how visual the test is. They had 99.9999% of their tests in life without any pictures. But whoa, some of my students get image after image which all look like a case of pharyngitis.. or they get these abnormal HISTO PATH pics of lung diseases which all look the same. So, you must must pick a VISUAL source for your studying.

Then, you must read and re read the same material. If you keep switching, I saw students getting confused and lost. Also, the ones who stuck to JUST ONE SOURCE like BRS Biochemistry, ended up almost MEMORIZING the words and pictures. It happens to everyone. You pick up like FA over and over and then you for example....know that in the Pharm section the microbiology drugs are discussed first. It helps with memory skills.

3) Many asked about question banks. That IS critical. I have heard some say they passed with ONLY DOING QUESTIONS. I think this approach MAY work for some who have the basics DOWN but I do NOT recommend this for most. But if you lack the fundamentals, then doing Kaplan QBank or BSS is really just wasting your time. You are better off watching a movie or giving your significant other a backrub/backsctrach. Because you will not retain the information. I saw students continue doing like QBook over and over and over and they were getting higher scores because EDUCATIONAL THEORY TELLS US THAT YOU ARE ONLY MEMORIZING QUESTIONS. It comes up again…you are like driving down the road to your work and there are vague stuff around that guide you. But you cannot stop and tell me the name of the road after “USMLE avenue” or the number of right turns after the gas station. The brain forms these patterns…and they will not repeat on your real exam. Especially if you are doing questions at random without linking subject material together in a “SPIDER WEB” like configuration in your brain.
SO...my advice is… YES, do ValueMD questions first, they are done by former Step 1ers who are constructing new novel material that will prepare you for the real exam because they understand the focus and theme and flavor of the exam to make you a better doctor. Also, when you sit for the real exam you will be amazed at the sheer VARIETY of the questions. Some are detailed, some are short answer, some are IMPOSSIBLE, some (just a couple) will actually just like point an arrow to the nose and ask, “What is this?”…meaning, a couple of the questions will be very easy. But the sheer variety is what makes me believe the NBME USMLE Step 1 is like the universe. Of my hundreds of students, hardly a single exact question repeated when they naturally discussed them over nights, lunches, etc. BUT, THE SAME CONCEPTS CAME UP IN ALMOST EVERY TEST. A perfect example of this is the second messenger concept. I tried to give a mnemonic that works miracles for me…but it may NOT work for you.
Thus, I suggest doing questions (after the ValueMD ones) by grouping them. Kaplan is good, but then do BSS and Princeton Review, and then Board Review Series, then Pathology Review by Robbins (with pictures), then NMS. Naturally, you will run out of time, but at least you are using the right method. Again, do questions by system and subject or you will not retain anything. That is why in the OLD DAYS prior to the printing press people memorized by LUMPED stories, using rhyming techniques, timed repetitions, etc. to memorize texts as thick as the BIBLE. They had to…how do you think you got the present version of Homer’s “The Iliad”. If those same people just picked up the BIBLE at random, read a verse, shuffled the pages, read another verse, they may someday catch up, but the time for mastery is unacceptable. Admittedly, there are some, just a few of my students that blew me away in their capacity. They were only a couple out of thousands, and many never wanted to use their powers of memory for anything. So again, doing organized systemized questions in a formalized interval is the solution.

4) Many many questions are coming up about QBank analogies and the general time frame for preparation that I recommended for STEP 1. Mastery of QBank is only a rough measure of how you will score on the real exam.
After taking many polls, I found all sorts of statistical anomalies. One of my best friends matched in a competitive Radiology program and blew through 250/99 but was reportedly scoring about 65% on QBank. NOW, before you get too excited, there were students beating 70%-75% on QBank but failing!!!!!!! Also, a close relative of mine was scoring consistently around 50% and barely passed. After many many statistical points, I would argue that if you are getting around 50% on QBank, you are “close” to passing. But what examinees do not realize is the REAL STEP 1 is HIGHLY VARIABLE IN MATERIAL. Thus, good sources told me that some had deep emphasis on pharm, others on pathology, others on virology…one girl said she got mostly all immunology. And through a third party, I heard of a brilliant US med student who was aceing med school and doing 80% on QBank but failed his first time because he got a lot of questions on difficult new research in Molecular Biology. Thus, I recommend what I said before. I do think QBank is a VERY good source of questions, but you need varied question sources but you have to organize them properly.
Also, many asked me for a solution and detailed their situation where time was a serious problem. Some had to prep for STEP 1 within a few days only, and some had the time for prep but the situation was too unwieldly…many, because we are the IMG family have unusual circumstances. Several desperate mails came because the students had children or sick parents. My heart breaks…because how will you push a square peg into a circle? YOU MUST RECEIVE THE TIME YOU NEED. Unlike a few tests that rely on math, or interpretation skills (LSAT comes to mind), life experience in literature (SAT I Verbal Section), the USMLE STEP 1 material cannot be gathered by life’s chance or opportunity. For instance, you will see Xeroderma Pigmentosum because it is a wonderful concept involving DNA and thymindine dimers and repair defects. But did you know that maybe if you are lucky you will find only 1000 people in the entire WORLD of 7 Billion with the disease? That is why THIS TEST NEEDS AND DEMANDS YOUR 100% ATTENTION and SUITABLE TIME that you need. Again, if you need maybe six months of 12 hours/day prep, do not feel that you are less smart than someone who studied in three months. Common society has determined that the second person is “twice” as smart, but that is NOT TRUE. There can be ONE MILLION reasons why one needs more time, but what I personally found was a “VARIABLE” related to reading speed and another “VARIABLE” related to processing speed. I knew of one of my friends who went to U of MICHIGAN and works at NASA. He was a super smart guy and blew everyone in my high school away (For you IMGs, U Michigan like U California, U Virginia, U Miami, U Washington, U Texas are among an ELITE GROUP OF COLLEGES EQUAL TO THE USA IV LEAGUES LIKE HARVARD.) Anyhow, my point is that some people are smart enough but I researched there are about a dozen measurable quantifiable “intelligence” points of reference. It is like a MACHINE that has many parts. All the machines can finish the work, but some take longer because maybe one part of the machine is not as efficient. BUT, that “slower” machine may produce higher quality products. Think of a HP PHOTOJET and HP LASERJET series #. The PHOTOJET makes BETTER CLEARER pictures, but the LASERJET is faster. But BOTH make copies and BOTH have value and BOTH are HELPFUL. So, you need to understand yourself and your limits and what exact time you need. If you do not approach this properly, then you WILL BE ONE OF FAILURE STATISTICS.

5) I will need to continue this thread of concepts because I note that there are additional questions in my mailbox. But please digest the above information. Oh, by the way, I believe my suggestion of notecards are effective. Make some up with say Pharm which are easier to develop. Then start front card #1 and move backwards. If you are getting say card #26 wrong, then move that card forward so your repetition schedule for that question/concept will be seen more often. If say you mastered cards 40-46#, then they will end up toward the back of your index card box. Thus, you can start scientifically measuring your RETENTION LEVEL and READING SPEED LEVEL. There is a whole science to this that I feel I should tell you, but I need to go for a while. So, for the 2 Ross students and 4 East European students, etc. you SHOULD be worried about the time and scheduling.

6) Quickly, also know that the US students are NOT smarter than IMGs but they are better at the STEP 1 because of many reasons. Some include that they JUST FINISHED THE BASIC SCIENCES while some of the IMGS had them long ago. Also, many of them are “coached” by their schools from Day ONE with USMLE type questions (pics and all). Plus, the ones that write the test are mostly the ones that teach and test the US students. So, I believe that ALL IMGs and USAs are equally smart for the most part…Even if that was not true, it is NEVER a reason to give in.

Love, Tommy

[Anonymous]

which one to use for GOOD PATHOLOGY/MRI atlas????


thanks

[tommyk]

There are SO many pictures, but I recommend:

1) Webpath
2) Robbins Review of Pathology (The shorter version)
3) HY Anatomy for the CT scans
4) The newest edition of FA has good pictures (but don't buy the entire book if you have the 2001 edition. But browse through it!)