Come on, whats the secret?

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On reading almost every major thread in the USMLE Step 1, Allopathic, and General Residency forum, too many times have I come across the "just memorize FA, know pathology "goljian style", and do 10,000 questions including UW and Kaplan QB. The score the end up getting you ask? 99.

As an IMG, we all know that by blindly memorizing facts and other subtleties of the medical literature, one cannot fathom a score that high. USMLE doesn't test student's ability to mug up/rote memorization of random facts; it tests their ability to integrate various sectors of what they've read and then presents the question in a very complicated clinical case setting.

Either the people here are not being honest when they say that by doing this they are getting a 99 or I am missing something.

Please tell me: What is your secret?:confused:
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psychforme said:
seriously; in terms of logic medicine isn't exactly rocket science.
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I understand that it isn't; I never said it was. Fact of the matter is based on whatever little knowledge of the test I know and have studies, that it will present a question first with a CT scan or maybe with a histopathology slide and ask you to deduce information from that and by the time you get to picking the answer, its not even about identifying the slide or scan but what drug you use to treat the condition, or whether the microbe causing the pathology is gram positive or negative?

My point is that the questions aren't linear, that they are multifaceted and make you second guess yourself in the event that you come to a conclusion faster than you had originally anticipated. How is it that people can score a 99 without having a fundamental understanding of the following subjects that nobody talks about:

Integration ofHistopathology, CT/MRI/X-ray, EKG, Biochemistry pathways and more in depth receptors, Pathophysiology, Pathobiochemistry, Embryology among each other.

Some of these sections, again from my very limited knowledge, are tested extensively. (e.g Embryology 10-12%, Histology -- 7-10%)

Problem is not that its enough knowing these subjects alone but assuming the test integrates the two dimensions it tests (systems and process), it is not enough just to know that "x causes this and is treated by that drug" One must know the entirety of the process that occurs to be able to understand the abnormal elements.

Maybe I'm not aware that the format has changed...Please correct me if theres something im missing or not evaluating correctly because its very perplexing...:confused:
 
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(...continuation)

There have also been reports of IMG's from around this area that have taken the exam following advice from members on sites like SDN and others (prep4usmle, blogtopsites, etc..) and upon being pressed on their score, have deliberately lied and said they have got 90+.

Reality of the situation was that he/she didn't even pass:eek:

Either the test had changed dramatically from the previous year as the advice they adopted for the test came from student who apparently achieved a *99* following the same advice he gave one year ago, or this student just totally f****d up.
:idea:
 
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If you memorize FA, read RR Path x2-3, and do all of UW and you STILL aren't hitting a 99...you need to find a new field of work.
 
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Dakota said:
"Dude this is totally sickle cell, I know it's sickle cell," then the question will state: "The patient was diagnosed with sickle cell anemia. What is the most likely cause of his osteomyelitis?"
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Salmonella
 
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There is a lot of key word memorization, but memorization within a certain context. For that I found the best thing to was doing as many practice questions as possible. (For instance that osteomyelitis question completely changes when you hear the words sickle cell anemia. It's a key word when combined with osteomyelitis. The bug becomes obvious. Sickle cell = no spleen = bug with a capsule etc.). They are trying to move away from this, but there's still a lot of it left in there.

The real secret is being a good test taker, and no this is not something you can learn. Had trouble with your MCAT? Welcome back to that world of pain. Some people are just better at taking standardized test. Studying helps, but only so much. If you can't get the hang of approaching the questions the right way all the knowledge in the world won't help you. So utilize those qbanks!

Does having this particular skill make for a good Dr.? Debatable, but it's the system we are stuck with right now.
 
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JAWSCIENCE said:
There is a lot of key word memorization, but memorization within a certain context. For that I found the best thing to was doing as many practice questions as possible. (For instance that osteomyelitis question completely changes when you hear the words sickle cell anemia. It's a key word when combined with osteomyelitis. The bug becomes obvious. Sickle cell = no spleen = bug with a capsule etc.). They are trying to move away from this, but there's still a lot of it left in there.

The real secret is being a good test taker, and no this is not something you can learn. Had trouble with your MCAT? Welcome back to that world of pain. Some people are just better at taking standardized test. Studying helps, but only so much. If you can't get the hang of approaching the questions the right way all the knowledge in the world won't help you. So utilize those qbanks!

Does having this particular skill make for a good Dr.? Debatable, but it's the system we are stuck with right now.
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It says you are an MD/PHd student which is impressive by any standard. You of all people must know the pains of studying and understanding that memorizing will only get you so far.

The example you brought about osteomyelitis is more an association instead of memorization. The more associations you can make in your head, the better your score will be probably, but in the end, you can only cram so much stuff in. Its a lot better to understand thoroughly and think it through in a conceptual manner.

Whether it makes a good doctor? Definitely not. We were on the wards the other day when the chief here asked one of the students in my group to name the cranial nerves (CNS case). As always, one of the locals here started naming them off faster than I could recite the alphabet. Then came the shocker for all the "mug up kids" as I like to call them. He then said, "Excellent, now tell me which ones are sensory?"

"Mug up kids": *staring cluelessly into the air*:thumbdown:

Kids didn't even know theyre were such thing as pure sensory, pure motor, and mixed.

If you don't mind me asking, what field are you studying your MD/PHd in?
 
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Even if you have the lowest IQ in your class, if you do 10000 questions you will be making these "associations" you are so concerned about.

Conceptual learning and reasoning skills are important perhaps from taking you from 240 -> 270, but brute memorization is the key to this test and will get you the internationally-acclaimed "99"
 
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lisichka said:
ha. i vote staph aureus. but who knows, those salmons in salmonella may eat bones too:cool:
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True that S. aureus is the most common cause of osteomyelitis. However, in children with sickle cell anemia, the etiology of osteomyelitis is actually Salmonella. Goljan also mentioned it. I'm not trying to show off or anything. I just wanted to give the answer in case anyone sees this question on their tests.
 
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Doctor4Life1769 said:
I wouldn't judge people if you've not taken the exam, just sayin' ...
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Wasn't trying to judge (considering I didn't even call anyone out by name), all I'm saying is that if you can truly memorize First Aid, learn the concepts from Rapid Review, and honestly use USMLEWorld as a learning tool...I cannot fathom the idea of you not getting a "99" (which is 235ish).
 
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relapse said:
It says you are an MD/PHd student which is impressive by any standard. You of all people must know the pains of studying and understanding that memorizing will only get you so far.

The example you brought about osteomyelitis is more an association instead of memorization. The more associations you can make in your head, the better your score will be probably, but in the end, you can only cram so much stuff in. Its a lot better to understand thoroughly and think it through in a conceptual manner.

Whether it makes a good doctor? Definitely not. We were on the wards the other day when the chief here asked one of the students in my group to name the cranial nerves (CNS case). As always, one of the locals here started naming them off faster than I could recite the alphabet. Then came the shocker for all the "mug up kids" as I like to call them. He then said, "Excellent, now tell me which ones are sensory?"

"Mug up kids": *staring cluelessly into the air*:thumbdown:

Kids didn't even know theyre were such thing as pure sensory, pure motor, and mixed.

If you don't mind me asking, what field are you studying your MD/PHd in?
Click to expand...

That is exactly what I meant when I said the memorization must be IN CONTEXT. If you purely memorize bugs associated with osteomyelitis you will jump to the wrong answer. The experienced test taker will thoroughly read the question, make the sickle cell association and pick up the right bug. Did this require memorization of what bugs are causes of osteomyelitis? yes. Did it require memorization of the properties of certain bugs and the consequences of sickle cell? yes. But is that memorization enough? no. You need to know how to make associations and put things into context. You need the information and the test taking skill. Lack of either is not good.

My main point was that there is no secret that someone can give you to suddenly boost your score. Is it painful to realize that all your studying and hard work will only get you so far? yes. But it is something that should be faced so that people can plan accordingly. These are skills that are acquired over a lifetime. There are people who start out with the advantage of being good at taking standardized tests. It is an unfortunate fact as I do not think that ability necessarily correlates with competency as a physician.

Why anyone would memorize cranial nerves without knowing their functions is beyond me. What;s the point of knowing a random list if you can't use the information in any way? It is this sort of pointless spinning of your wheels that I was trying to argue against.

I'm an immunologist, but I'm not sure what that has to do with anything.
 
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The big secret starts with understanding that a 99 means nothing, nobody in the US cares what your two digit score is. A 99 means that your three digit score (the one that actually means something) is around ~235 which unfortunately limits your residency choices especially as an IMG as this score is slightly less then 1 SD above the mean, a nice score but nothing to write home about.

The second big secret is that there are no secrets, UWorld, RR Path/goljan, FA are the gold standard for step I at this time.

Integration ofHistopathology, CT/MRI/X-ray, EKG, Biochemistry pathways and more in depth receptors, Pathophysiology, Pathobiochemistry, Embryology among each other.
Click to expand...
Pathophysiology is the only important one in the group, don't even think about trying to master the details of the others if you don't know path/physio cold. Embryology is no where close to 10% (35 questions) of step I, anything outisde of whats in first aid or UWorld for embroy is a complete waste of time.

My point is that the questions aren't linear, that they are multifaceted and make you second guess yourself in the event that you come to a conclusion faster than you had originally anticipated.
Click to expand...

The questions are actually designed so that you should be able to come up with the answer without having to look at the choices if you have a through understanding of the topic they are asking. IF you find yourself second guessing yourself constantly you do not have an understanding of the level of detail they expect you to know.

If you plan on taking this test with anything more then the goal to simply pass and you don't complete every single question in UWorld (and read the explanations) you have not prepared to the best of your ability. The same goes for reading RR pathology.

(im not saying FA sucks just that UWorld and RR path should have a higher priority in your studying if you have to chose between the three)

If you have more time there are a lot of good review books out there but UWorld, RR Path, and FA are by far the most important. In my experience i used these three along with 4-6 other books and felt very burnt out after 30 days. I wish I could have read over RR path one more time before the test (i read it twice during m2, and twice in the month before my test) but after a while nothing else will fit in your brain. I though FA was nice but way to simple in some areas and would be very inadequate if used alone. It is very good for pharm and some smaller subjects like embyro. I credit most of my score to Uworld which i finished 100% with an average of 78% all tutor mode. The nbme exams 3,4 predicted my score to be 267-269 and my actual score was 265.
 
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Elixir86 said:
True that S. aureus is the most common cause of osteomyelitis. However, in children with sickle cell anemia, the etiology of osteomyelitis is actually Salmonella. Goljan also mentioned it. I'm not trying to show off or anything. I just wanted to give the answer in case anyone sees this question on their tests.
Click to expand...

tru dat.

salmons like 'em bones.
 
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So let me get this straight for the record:

Assuming that the only thing that matters for an IMG is the score (which for the most part to get back into the system, it is),

An IMG/FMG is at no more of a disadvantage of taking this test than a high school student is if you gave them both five years to take the exam.

Facts:
1)The whole "undergrad" experience in terms of learning your fundamentals of basic science is horsesh** in terms of scoring well on USMLE

2) MCAT scores don't dictate how well you will do on USMLE as USMLE is not a test of conceptualization and just a test of how much of FA, RR, and UW and practice questions you can do.

3)Since ability doesn't have anything to do with competency, a high school graduate that spends 5 and a half years memorizing first aid, rapid review path, U world, Kaplan q bank questions, and 10,000 practice questions in total with in depth reading of the answers as well will have just as good of a score as someone with an undergrad degree, a fundamental science understanding, knowledge and experience of a U.S. medical student that went to two years of medical school?

this is very confusing.:confused:
 
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relapse said:
So let me get this straight for the record:

Assuming that the only thing that matters for an IMG is the score (which for the most part to get back into the system, it is),

An IMG/FMG is at no more of a disadvantage of taking this test than a high school student is if you gave them both five years to take the exam.

Facts:
1)The whole "undergrad" experience in terms of learning your fundamentals of basic science is horsesh** in terms of scoring well on USMLE

2) MCAT scores don't dictate how well you will do on USMLE as USMLE is not a test of conceptualization and just a test of how much of FA, RR, and UW and practice questions you can do.

3)Since ability doesn't have anything to do with competency, a high school graduate that spends 5 and a half years memorizing first aid, rapid review path, U world, Kaplan q bank questions, and 10,000 practice questions in total with in depth reading of the answers as well will have just as good of a score as someone with an undergrad degree, a fundamental science understanding, knowledge and experience of a U.S. medical student that went to two years of medical school?

this is very confusing.:confused:
Click to expand...

Coco the Gorilla could get a 275 on Step I with enough time and patience. What's your point? A high USMLE score =/= a good physician.
 
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I think most medical students would agree that the first two years of medical school are not what make you a good Dr. nor are they what make you get a good USMLE score. In fact most schools pride themselves on NOT teaching to the boards.

Sit anyone who can read and think down with some qbanks and good medical review books for a year and they can get a decent score.

Most students who take a practice test before studying get a terrible score despite their two years of education + undergrad. In a few weeks they bring it up. That's the nature of the exam.
 
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Take the doctors in training course. www.doctorsintraining.com. Dr. Jenkins will teach you exactly what you need to know to ace Step 1. Watch his 30 minute video, then do exactly what he tells you to do.

This course also helped me a lot on the wards - I can bust out random details like its nobody's business.

Does a good Step I score make you a good doctor? No, but if residencies are going to judge you based on some numbers you got for your ability to memorize ****, you may as learn how to play their game, and then play it well.

I did for the record score in the 99% on Step I, while I scored average on the MCAT. I'm not brilliant, this course just teaches you literally what you need to know and tells you what not to waste your time on.

Hope this helps!


relapse said:
On reading almost every major thread in the USMLE Step 1, Allopathic, and General Residency forum, too many times have I come across the "just memorize FA, know pathology "goljian style", and do 10,000 questions including UW and Kaplan QB. The score the end up getting you ask? 99.

As an IMG, we all know that by blindly memorizing facts and other subtleties of the medical literature, one cannot fathom a score that high. USMLE doesn't test student's ability to mug up/rote memorization of random facts; it tests their ability to integrate various sectors of what they've read and then presents the question in a very complicated clinical case setting.

Either the people here are not being honest when they say that by doing this they are getting a 99 or I am missing something.

Please tell me: What is your secret?:confused:
Click to expand...
 
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relapse said:
Does the DIT course really help them score that much higher?
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the average score of students taking his class is in the 230's. you can expect your NBME baseline sample exam score to increase 30-40 points. that being said, the class is based on you having a solid foundation of knowledge in the first two years of med school. it is not going to teach you two years of material in 5 weeks. its a review, but its a HY review. its an incredibly intense class and it all depends on how much you put into it. go the website and watch the video. if you're not convinced after that, don't take it. i swear to god i dont work for them or anything, im just an extremely satisfied customer.
 
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for the people that have already taken it, what was your score after using the materials I described in the first post?
 
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relapse said:
for the people that have already taken it, what was your score after using the materials I described in the first post?
Click to expand...

I have a classmate who was an IMG (obviously) and took Step I after studying UW and FA for 3 months. He got a 253. I have another friend who studied FA, UW, RR, Kaplan and got a 230.

My point is using x materials doesn't guarantee y result. The general consensus is FA, UW, RR (in that order) but it's up to you to make it work out by using those sources effectively. Focus on FA for memorization, UW for testing that memorization and adding some info, and RR for understanding the basis of diseases.
 
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i think the "secret" is what you did in the 2 years leading up to step 1. there's only so much you can learn and integrate in the study period before the step. having a large base knowledge, plus weeks of the right studying is what allows people to do great on step 1. having one or the other will put you in the middle of the pack. just my two cents.
 
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Hi girls and boys :) I started preparing for Step 1. It seems it'll take quite a long time for me, as I'm going to read all the review books for it. That's because the textbooks I studied that materials were out of date and what's more, that was 3-4 years ago.

I'm little bit confused :( And what's more the review books are not sold in my country. To order them from Amazon.com requires me to be Bill Gates with $45 bln-s :| they are expensive + shipment. Anybody have some books for charity? :)

I started with High-Yield Histopathology. Is it a good choice?

Captopril
I have a classmate who was an IMG (obviously) and took Step I after studying UW and FA for 3 months. He got a 253. I have another friend who studied FA, UW, RR, Kaplan and got a 230.
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when you say RR, you mean Goljan RR particularly, or you mean RR series for all subjects?
 
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lukazo said:
when you say RR, you mean Goljan RR particularly, or you mean RR series for all subjects?
Click to expand...

I'm talking about RR Path, although I've heard great things about RR Biochem (I used Kaplan Biochem myself for both Molecular Bio and Biochem)
 
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Captopril said:
I'm talking about RR Path, although I've heard great things about RR Biochem (I used Kaplan Biochem myself for both Molecular Bio and Biochem)
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OK, thanks mate. And what book did you use for anatomy stuff (Gross + Neuro) ?
 
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relapse said:
capto, when r you plannin on takin the exam?
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in a few weeks. cramming FA daily right now.

lukazo said:
OK, thanks mate. And what book did you use for anatomy stuff (Gross + Neuro) ?
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I used RR and Kaplan for Neuroanatomy (made some flashcards from Kaplan so dont read the book itself when reviewing anymore). I did Gross from FA + whatever obscure stuff is in UW.
 
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Captopril said:
in a few weeks. cramming FA daily right now.



I used RR and Kaplan for Neuroanatomy (made some flashcards from Kaplan so dont read the book itself when reviewing anymore). I did Gross from FA + whatever obscure stuff is in UW.
Click to expand...

hows the preparation going
 
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relapse said:
hows the preparation going
Click to expand...


Going OK...started DIT so just tryin to not undergo brain atrophy every night when it's time to do 6hrs of review after spending the day doing 6hrs of video. It's def a drain, but that's what the last few weeks are all about I suppose. Using DIT for structure's sake.
 
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the secret is there is no secret. Some students memorize. Others memorize but spend considerable time understanding the underpinnings. The USMLE picks a perfect blend of questions to reward the latter student enough to get him or her a better job.

Yes, first aid is the bible. They say know pathology "goljan style," but that's only because Goljan spends so much time making you understand the underpinnings of the content you are expected to know.

I cannot stress how often I see a USMLE question start out with a presentation of findings and then at the last second pull the ol' switcheroo and say, 'so *why* is this patient like this?' They assume you know the diagnosis; they ask questions that are tangential to it. Students with backgrounds in physical sciences, who have spent their collegiate careers doing calculus-based derivations, have the advantage because they tend to be interested in justification of the facts or observations. (Another poster wrote, "One study from a group at the University of Colorado Denver presented their study at a medical education conference this year that showed that MCAT physical science score, number of test questions studied, and total hours spent studying were significant predictors of USMLE scores"). No shock here because these students are interested in understanding the fundamental underpinnings that justify the facts they know. At first, this strategy works against them in year 1 because there is just so much underpinnings that are not presented and that are unknown, making navigation difficult. With continuous effort, however, they will start doing better, and they will have a distinct advantage come year 2 with pathology because a huge portion of pathology is justifying what you observe under the microscope.

That being said, there is a certain amount of material that you simply must know and can get correct even if you don't know why. This is especially true of pharmacology (because the cure to any side effect is simple: remove the drug), and knowing what tests to order. I read somewhere that at a NBME conference they all declared that their single goal was to make a test that, if the student did well, meant s/he could perform his/her job on his/her own *without* supervision.

I do well on our shelf exams, and I anticipate I will do well on the step I (fingers crossed!). I have a study guide I'm making for first pass of the material, well before I sit down to memorize. As you can see, my focus is on using the underpinnings to combine several phenomenon so that I can have the same mentality with similar questions. For me, this elevates my score on the boards. Here is an excerpt:

-----
CD8+ type IV hypersensitivity
1. virus or intracellular bug infects organ tissue
2. expression of non-self antigen using MHC I
3. CD8+ T cells secrete perforins and gramzymes, liquefying area
* occasionally, persistent viral infection or molecular mimicry can lead to repeated episodes or autoimmune disease (HLA subtype dependent)
- CD8+ T cells also secrete IFN-γ to activate macrophages

THYROID: any intracellular pathogen
1. de Quervain's (subacute) thyroiditis (viral cause)

VESSELS: any intracellular pathogen
1. Kawasaki's (new haven coronavirus; all viruses are intracellular)

KIDNEY: any intracellular pathogen
A. glomerulus – diffuse proliferative glomerulonephritis; FSGS
B. tubules - interstitial nephritis

LUNGS: any intracellular pathogen
A. all viral infections are intracellular
1. RSV
2. parainfluenza (croup)
B. certain bacteria are intracellular
1. Mycobacteria tuberculosis (interstitial pneumonia)
2. Chlamydia pneumoniae

PNS:
A. type I diabetes
1. coxsackie B, via MHC I molecular mimicry, causes CD8+ type IV immune reaction (viral deja vu theory)
2. later in life, via HLA DR3 or DR4, an MHC II-dependent autoimmune reaction can occur (not CD8+)
B. Guillian-Barré
1. C. jejuni, via MHC II molecular mimicry, leads to CD8+ type IV autoimmune reaction

ENDOCRINE: any intracellular pathogen
1. diabetes type I (coxsackie B, mumps)

CNS: any intracellular pathogen
1. multiple sclerosis (MS-associated retrovirus; chlamydia)

KIDNEY: chronic pyelonephritis
1. "thyroidization of kidney" refers to CD8+ T cells liquefying the area with perforins and granzymes
----
 
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La Sustancia P said:
Actually, I'm sorry to harp on this point, but S. aureus is the most common cause of osteomyelitis in all patients, including those with sickle cell disease. Sickle cell disease patients are at higher risk for Salmonella infection, but you can find this stuff in textbooks. Some people have overmemorized this particular association.
Click to expand...

a) Actually there is a surprising amount of debate on this. There are several small retrospective studies showing as high as 70-80% of osteo cases in sickle cell being d/t salmonella, and several others showing a predominance of staph. Either way, it's hardly a simple "textbook" answer

b) If you get to step 1 and there is a sickle cell/osteo question --> choose the salmonella answer.
 
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