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I am 9 days away from my exam and looking for advice because I scored a 166 on NBME form 15 19 days before my exam, and 173 on NBME form 17 12 days before my exam.
I feel pretty depressed because I've had almost 7 weeks of dedicated time and don't seem to understand where to go from here.
As far as what I've done to prepare:
-I finished UW 1st pass 49 days before my exam and I am 276 questions away from finishing UW 1.5x
-I re-watched 13 of 19 chapters worth of Pathoma videos
-I have gone through 43% of USMLE RX Flash Facts (Cumulative performance, 58%)
-I did 200 USMLE RX questions and 200 Kaplan questions
-I re-watched sketchy micro
-I read a few chapters of FA out loud with a classmate and discussed annotations
So the questions are,
(1) should I delay my exam at the expense of taking an academic leave of absence
(2) if yes, how much time off should I take to realistically reach a 220
(3) why have I done so many things but not had any of these preparations reflect in my score?
(4) when should I take another diagnostic
(5) Since I'm getting 75+ questions wrong on the NBMEs, should I be reviewing these questions
(6) what is the best way to address knowledge gaps for weaknesses during dedicated time
Delay. Nothing worse than failing it. Easier to explain a LOA than a failed Step.
First you need to talk to your dean's office.
Second, it sounds like you need to change up your study methods in some way. Whatever you're doing is not working. Whether you're trying to relearn too much detail, are too superficial, aren't paying attention to your question thought process or what not, you need to hit the reset button.
My guess is that you're not utilizing the questions well. It's not enough to just do the question and see if you got the right answer. Nor is it enough to just read the explanations. You might try a technique that Kaplan calls "post phrasing" - you read the question, find out what the correct answer is and then without reading the "official" explanation, you come up with (and if you're like me, write out) the exact reasoning why the wrong answers are wrong. The other option is to do that process as you go through an untimed exam, and then compare all your reasoning with the explanations provided. This generates a lot more data and allows you to identify faults in your thought process, areas where you don't have a good grasp of the content, or even if you actually are thinking about a lot of the information correctly.
Third, if you do take a LOA, I would caution against the idea that you take off a super extended period. Studying is usually subject to the law of diminishing returns. At some point you're going to plateau and depending on your level of test anxiety, may actually begin to regress. I probably wouldn't take leave longer than 8 weeks, and even then I'd say that 4 or 6 weeks makes more sense. That's also a lot more reasonable to make up third year clerkships as an M4.
EDIT: deleted this original response. That moment when 500+ people read your thread in the course of nearly a week after posting, and not a single one of those readers can offer even a suggestion, even if to acknowledge that the answer to my question would be best answered by a dean or program director etc. I thought this site was designed to help students become doctors, when running into issues. Disappointing.