3 weeks out

[thehundredthone]

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Hello all.

I know there are hundreds of such threads on this subforum, but as you can imagine, when that date looms up ahead things get a bit tense haha. I've read most of them, and have tried to incorporate some of those ideas into my study plan.

I completed UWorld today, 81% overall (82% on last 20 sets, 83% on last 10, messed a couple up). It took longer than expected, I had hoped to have finished last week. Not the high score I was looking for but I'm hoping my 2nd, 3rd (and hopefully 4th) reads of FA (now annotated) will help me improve.

My weakest areas (below 81%) as per the statistics are (I've attached the Uworld stats page)
Anatomy 77% - I hate learning uninteresting minutae
Biochem 74% - although most of it was in the initial period
Biostats 77% - formula errors, misunderstanding of some biases
Histology 76% - 4 incorrect out of 17
Pathophysiology 76% - nagging doubts would make me change correct answers to incorrect ones

Dermatology 76% - another subject I don't care much for
Hepatobiliary 77% - this was surprising

I was thinking along the lines of:

10 days:

• 2nd pass of FA, 60pgs a day.
• Working on my weak points: Anatomy from BRS and Netter's clinical handbook. - Biochem from, well, FA and a skim of Lippincott's Illustrated. Biostats problems to cement the formulae in my mind (I once worked out relative risk as an odds ratio, sigh)
• Online resources: Utah WebPath, Queen's radiology and TeamRads.
• Finish Kaplan Qbook
• 'Acquired' Kaplan Qbank for my weaker subjects + physiology

Although I dunno how I'm going to manage all of that.

6 days:

• 3rd pass of FA, 100pgs a day.
• UWorld incorrect and marked. Would've liked more time between passes but it is what it is.
• Online resources as above
• Revise anatomy and biochem
• Skim through RR (I've annotated it with Pathoma lecture extras)

3 days

• 4th pass of FA, 200pgs a day
• Free 150s (1 a day, or just the latest one)

I have a couple of days here and there, in which I was thinking of doing the offline NBMEs (1-6, 3 at the very least) and the online NBMEs.

NBME 11 at the beginning of October (~2 weeks out)
NBME 12 and/or 13 before my last pass of FA (~4-5 days out)
UWSA1 as a pick me up after the NBME?

I had 82% on NBME7 (510/224) at the start of my study period. 82% again on UWSA2 (770/263) at the beginning of this month. With the 81% average on UWorld I'm a little perplexed at the apparent lack of any sort of progress. I've only ever scored 95% on one block during UWorld so I dunno what kind of score I could realistically aim for. I'm an IMG, so I'll need the highest score I can get. <245 and I'm done wasting my parents' money, no more Steps for me (no sob story included).

Any suggestions would be welcome. Can I do more? Do I need to do less to be able to manage? Any other free resources I could use? Books, I can perhaps find at the library. Thanks for reading.

 

[notamember82]

If you score a 244 you're going to hang it up? I can understand wanting to do well but that doesn't seem reasonable.

 

[Ronin786]

I'd say take another NBME now. You have an 82% in Uworld which is really good. I'd bet your NBME scores jump a good bit now that you've finished Uworld.

Then use that NBME profile to further zone in on your weaknesses.

Also I don't get what you mean by no progress. You went from 224 to 263, albeit on UWSA2. Take an NBME and find out how your progress really is.

 

[Phloston]

I would say that for the last few weeks, instead of focusing on the number of times you get through FA, just get through it once more at a very high-quality retention. If that means repeating certain concepts aloud multiple times, then so be it, but don't think that the mere # of passes is somehow key to a higher score.

Now that you're in the final weeks, it's too late to focus on learning new concepts, so start memorizing as much as you can out of that book. Anything you're still not 1000% sure of, bookmark those corresponding pages and review them more than once, but stuff you know cold, quickly review, then don't touch it again.

If you finished UWorld at 81%, I'd say you're probably at the mid-250s ballpark currently. That's if you did it timed and random. You can still get 260+ if the question allotment on the exam falls in your favor and you prepare well over the next few weeks.

 

[thehundredthone]

If you score a 244 you're going to hang it up? I can understand wanting to do well but that doesn't seem reasonable.

My future doesn't depend on getting a residency in the US. I have to jump through enough hoops as it is, being a foreign IMG. Not having a competitive score will add more, and I'm not going to waste tens of thousands of dollars that I haven't earned on this. I don't have months and years to get USCE or get 20 retrospective studies published in a peer reviewed journal (all my original research has been just that - original and p>0.05 lol). So yeah, I might walk away. Then again, when the score comes out I might just take what I get. But right now those are the lines I'm thinking along.

I'd say take another NBME now.

Also I don't get what you mean by no progress. You went from 224 to 263, albeit on UWSA2. Take an NBME and find out how your progress really is.

I wanted to wait till I've done my second pass of FA to give the next online NBME. How about I take the 'offline' NBME3? And yes, UWSA2, which overpredicts by 20+ points, so that's just a 20 point improvement, and certainly not enough to be competitive as an IMG.

I would say that for the last few weeks...
...don't touch it again.

That's actually what I'm planning to do. It's not about the number of passes. This 2nd pass, I'm going to note what I cannot remember, and read those things over and over to retain them. Repeat for the next pass. The 4th pass is just the pre-exam pass. Concept wise I have very few issues, an overwhelming majority of my mistakes have been due to poor recall/concentration. For example just this morning for some inexplicable reason I chose ALS as the diagnosis for a lesion that affected the dorsal column and lateral CST!
Towards the end of UWorld, 70-90% of my mistakes in a set were marked, meaning I knew I couldn't confidently recall the answer.

If you finished UWorld at 81%, I'd say you're probably at the mid-250s ballpark currently. That's if you did it timed and random. You can still get 260+ if the question allotment on the exam falls in your favor and you prepare well over the next few weeks.

Timed and random. I did about 8 sets subjectwise in the beginning, before my UWSA2 but those were 23 question sets. i just want to make sure that the questions I get are the only truly uncontrollable variable.

I'm well aware that I might be overreacting. Tomorrow I'll probably laugh at these (rants) posts. But imma try to get all the damn minutae into my head and kick some ass on test day, fo' sho'.

 

[Phloston]

Concept wise I have very few issues, an overwhelming majority of my mistakes have been due to poor recall/concentration. For example just this morning for some inexplicable reason I chose ALS as the diagnosis for a lesion that affected the dorsal column and lateral CST!
Towards the end of UWorld, 70-90% of my mistakes in a set were marked, meaning I knew I couldn't confidently recall the answer.

We're probably all in that same boat. I feel like a third of the questions I get wrong are stupid mistakes, and about a third of that third are unforgivable. Your mistake this morning actually wasn't too bad. I had one just this morning (glad we can both rant) where it gave a simple vignette of a kid with asthma (decreased FEV1/FVC and eosinophils), then it asked for what should be avoided in this pt, and I put beta-agonists because apparently I "read" it as a treatment question. I spent 14 seconds answering it, got it wrong because obviously I have Wernicke's, and ~70% got it right to top it off.

In turn, just realize that percentile-wise in UWorld, everyone has those errors that somewhat cancel out, so the accuracy is still there I suppose.

 

[thehundredthone]

Those mistakes hurt oh so much more though, knowing you could've easily got them right.

So how does one do this bookmarking and highlighting business? I may only need to re-read parts of pages sometimes so I figured I should give highlighting a go. I read a post somewhere where the person said they would highlight the parts the already knew/remembered and go over the book until it was completely highlighted. Is that counter-intuitive? Or maybe I should just make/type up notes for those bits instead and re-read the notes.

 

[Phloston]

Those mistakes hurt oh so much more though, knowing you could've easily got them right.

So how does one do this bookmarking and highlighting business? I may only need to re-read parts of pages sometimes so I figured I should give highlighting a go. I read a post somewhere where the person said they would highlight the parts the already knew/remembered and go over the book until it was completely highlighted. Is that counter-intuitive? Or maybe I should just make/type up notes for those bits instead and re-read the notes.

Different things for different people. I have personally never picked up a highlighter in my life, but if it makes you remember something by seeing a neon bar over it, then so be it. At this point, we've seen FA enough to know which sections are more conceptual vs those which require pure memorization vs those that are worth more point-wise. For instance, you don't need to spend extra time reading FA's info about peptic ulcers or Parkinson's drugs in the final days because you know that stuff already, but in contrast, all of your annotations should be read over again. My plan is probably a bit less organized than others'. I don't plan on doing a topic per day, for instance, but I'll instead just blast through the whole book in order, and anything that's not yet 100% locked in stone, I'll spend time memorizing, while also writing it down on separate paper, and then moving on. Then, at the end of subsequent review days, quickly go back and look at anything I've written on that separate paper (so essentially building a cumulative review of the less solidified FA material). That way, each study day, there's new FA reading + end-of-day review of previously less solidified stuff.

 

[thehundredthone]

Okay so I just gave NBME13. Got a 650/257. 15 incorrect answers. Was very disappointed because the exam was not nearly as hard as everyone was making it out to be and I was hoping for <10 answers at the end of it.

Mostly stupid mistakes, even one where I missed a crucial part of the question stem in the very first sentence. There were only 4-5 questions where I genuinely didn't know the answer and was guessing (a couple turned out to be right). I was done with the blocks when the timer showed ~35-40min remaining, and went over marked questions 4 times, unmarked 2-3 times.

How the heck am I supposed to bring down these types of errors?

I realise this might not be taken the right way (watch out we've got a badass over here, thinks it's so easy - I think it was just very fortunate that the questions on this NBME were what they were) but I'm genuinely looking for advice on how to keep my concentration, and specifically how to look at questions completely afresh during the review of blocks.

Should I give both NBME 11 and 12 in the next 2 weeks? I'm going to work on my anatomy (since I hear they're asking about random origins and insertions) and my notes (everything in FA that I couldn't remember during my last pass), and this time actually do WebPath and TeamRads. I'll also try and do a couple of blocks of NMBE1-6 every day. Is there any source for gross specimens (esp. neuroanat) that anyone can recommend?

 

[Phloston]

Okay so I just gave NBME13. Got a 650/257. 15 incorrect answers. Was very disappointed because the exam was not nearly as hard as everyone was making it out to be and I was hoping for <10 answers at the end of it.

Mostly stupid mistakes, even one where I missed a crucial part of the question stem in the very first sentence. There were only 4-5 questions where I genuinely didn't know the answer and was guessing (a couple turned out to be right). I was done with the blocks when the timer showed ~35-40min remaining, and went over marked questions 4 times, unmarked 2-3 times.

How the heck am I supposed to bring down these types of errors?

I realise this might not be taken the right way (watch out we've got a badass over here, thinks it's so easy - I think it was just very fortunate that the questions on this NBME were what they were) but I'm genuinely looking for advice on how to keep my concentration, and specifically how to look at questions completely afresh during the review of blocks.

Should I give both NBME 11 and 12 in the next 2 weeks? I'm going to work on my anatomy (since I hear they're asking about random origins and insertions) and my notes (everything in FA that I couldn't remember during my last pass), and this time actually do WebPath and TeamRads. I'll also try and do a couple of blocks of NMBE1-6 every day. Is there any source for gross specimens (esp. neuroanat) that anyone can recommend?

Now that you're 1.5 wks out, don't touch anything other than practice questions and FA. Webpath has a few discrepancies, so I'd avoid it between now and your exam. Focus on UWorld, Rx or NBME Qs only. Don't study anatomy minutiae right now, unless you feel supremely deficient/diffident in that area. A 257 isn't terrible, but I totally understand that you want 260-security. I'd do all of the NBME exams if you can. I also recommend employing the ijn method for the NBMEs, which is making a Powerpoint of all of your incorrects and then blitz-reviewing them the day before your exam. What you need to do is look at the questions you get wrong on your NBMEs and then think hard and make an intelligent connection as to where exactly your small gaps in knowledge are.

 

[thehundredthone]

Gaps in my knowledge included being ******ed enough to forget that thoracocentesis is done the upper and not lower margin of the ribs. I should've got 10 or less incorrect.

I'm already doing the NBME mistake list thing, I have 7 and 13's mistakes screenshot-ed - a copy with and one without the right answer. I don't know how I'll do that for NBME 1-6 though, seeing as the keys aren't exactly perfect, and it's so time consuming to find the right answers.

 

[Phloston]

Gaps in my knowledge included being ******ed enough to forget that thoracocentesis is done the upper and not lower margin of the ribs. I should've got 10 or less incorrect.

I'm already doing the NBME mistake list thing, I have 7 and 13's mistakes screenshot-ed - a copy with and one without the right answer. I don't know how I'll do that for NBME 1-6 though, seeing as the keys aren't exactly perfect, and it's so time consuming to find the right answers.

Be glad you made mistakes on the NBME and still came out with that score. Why? Because you're going to make stupid mistakes on the real thing too. Then, in the days following the exam, when you're thinking about all of the ******ed things you got wrong but shouldn't have, you can rest assured that you'll still do okay. Just smarten up and read the questions very carefully. Part of doing well on the USMLE is not making stupid mistakes. No one cares how brilliant a surgeon is. If he ligates the wrong vessel by accident, then what good is that?

 

[thehundredthone]

I'm a medicine guy anyway, so I wouldn't find it very surprising haha. But I know what you mean, and that's what irks me. Gotta take it in stride though, and hope I only make this many mistakes on the entire 322 on test day. By hope I mean dream.