This is not an easy answer. The best way to interpret your score report is by visiting a faculty member at your school. I'm also assuming that you're referring to Level 1. What you've listed is the
Dimension II (Physician Task) categories of the NBOME Blueprint. It would probably be best for you to focus on which specific categories you were most deficient in (Anatomy, Biochem, etc.) rather than the Dimension II topics when studying in the future, however, this can lend some insight on how to review your material. I'll come back to this.
In order to break down what these sections mean I'm going to use an example of a patient who has signs and symptoms consistent with a gouty tophus toe. I can't go through all of them because it's very exhaustive. The NBOME would characterize this in two ways:
Dimension 1 (Patient Presentation) and
Dimension 2 (Physician Task).
- The Dimension 1 listing depends on what the chief complaint is; this patient may either be here for swelling of his toe (extremity masses/swelling listed under Patients with presentations related to trauma, masses, edema, discharge, and the skin, hair, and nails), pain of his foot (extremity pain listed under patients with presentations related to cognition, behavior, sensory & central nervous systems, substance abuse, and visceral and sensory pain), or toe pain (joint pain listed under patients with presentations related to the musculoskeletal system, including somatic pain). Thus, someone with a gouty tophus could potentially be listed in multiple categories depending upon how the patient is presented. Each of these sections have defined ranges of how often the presentation is given to students on the exam.
- The Dimension 2 listing is focused on how the final question is oriented. For Level 1, the highest yield section is the Scientific Understanding of Health & Disease Mechanisms (Anatomy, Biochemistry, etc. - the hard sciences). These questions will ask about the underlying mechanism involved in the patient's condition (e.g., Fluid aspiration will most likely reveal negative birefringence = pathology section).
- Health Promotion & Disease Prevention
- Biostatistics & Epidemiology: Which of the following patients most likely has gout? 40-year-old male
- Also this is any question that deals with statistics. It is an easily understudied area and likely the main reason you did poorly in this section.
- Clinical Prevention: Recurrent flares of his most likely condition can be prevented by allopurinol or some lifestyle change or changing a causative medication. (Note that this could be a pharmacology question that could also be listed in the Scientific Understanding of Health & Disease Mechanisms section but is better served here)
- Disease Transmission Processes: (if it was septic arthritis due to gonorrhea) Which of the following places this patient at highest risk of developing the most likely condition? unprotected sexual activity (note that this is a microbiology question that could also be listed in the Scientific Understanding of Health & Disease Mechanisms section but is better served here)
- International Health Care Issues: If it was septic arthritis due to tuberculosis and there was some population-based question on TB.
- History & Physical Examination
- Examination & Recognition: The swelling is most accurately described as a gouty tophus. (These describe physical exam findings, interpret neuromusculoskeletal exam findings,
- Gathering patient information: The most likely diagnosis is gout.
- Management
- OMT: The most appropriate manipulative therapy at this time is myofascial release to XYZ. The most appropriate initial patient position for X treatment is Y. (Note that this could be an Osteopathic Principle question that could also be listed in the Scientific Understanding of Health & Disease Mechanisms section but is better served here)
- Non-Pharmacologic Medical: If lab values were also provided displaying some electrolyte abnormality and they want to know the proper correctional fluids. (Note that this could be a physiology question that could also be listed in the Scientific Understanding of Health & Disease Mechanisms section but is better served here)
- Pharmacological: The most appropriate pharmacologic treatment (acute presentation) is colchicine. (Note that this could be a pharmacology question that could also be listed in the Scientific Understanding of Health & Disease Mechanisms section but is better served here)
- Psychosocial: The patient has an eating disorder; the most appropriate recommendation is cognitive behavioral therapy.
- Diagnostic Technologies: think of this as the management items that ask you to order a test or interpret the results of a study or test.
- Electrophysiologic: interpreting ECGs, peak flow readings, or any other graphical information-related diagnostic studies. (Note that this could be a physiology question that could also be listed in the Scientific Understanding of Health & Disease Mechanisms section but is better served here)
- Imaging: The most appropriate imaging modality to order is answer. An exhibit is shown; the most likely diagnosis is answer.
- Laboratory: The most appropriate laboratory study to order is answer. A lab value is provided and you answer accordingly primarily based upon interpretation of the lab.
- Scientific Understanding of Health & Disease Mechanisms - goes without saying but do not that many items that you believe may be more related to a hard science may actually be listed in the above categories.
Now, to circle back to your original question. Review topics that you did poorly on the past two years; focus on classes that you had the lowest grades. When reviewing that content, focus on the signs and symptoms that are pathognomonic for the conditions (History and Physical of Dimension 2 - making the diagnosis). Most importantly, for the Health Promotion section, focus on biostatistics. Focus on the preventive aspects of those conditions (lifestyle, treatments, monitoring) including general screening and prevention of all chronic conditions (Health Promotion & Disease Prevention of Dimension 2). Focus on the disease transmission processes in Micro if you did poorly in that course. Again, using the courses that you did poorly in, focus on the diagnostic technologies surrounding the diagnosis of those conditions.
