Exam scores vs Step

[(;FutureEyeDoc;)]

I am a second year MD student at a mid to lower rank school. Last year step 1 average was 237. Our exams are NBME and my score ranged between 69 and 82 since the beginning of medical school. The average has been consistently around 82-83%.

I do not know what I do not do well! I have tried multiple study techniques (Anki vs. no anki, taking notes with lecture vs. not, hammering practice questions vs. understanding the material) and no matter how much work I put in my score always comes back in the exact same range.

Our curriculum is system based so I have consistently done the Amboss and Uworld questions associated with the system that we study. For the last couple of sets of Uworld questions I do them timed, without tutor mode. I always keep about 120 questions for the last couple of days before the exam and my scores have been 72%, 75%, & 77% for this last module. The Uworld average for those tests were 65%, 64%, and 60% respectively. I ended up scoring 71% on my school exam, and the average is 81%. On Amboss, I get decent/good scores and constantly get "you score above your peers that share the same objective" and my scoring percentile is high.

I feel good before the exam, and I feel good during the exam. The worst part is I feel good after the exam, and then I am slammed with a mid 70s score, below my class average. I have no idea what I do wrong, I have tried everything from increasing the amount of work to changing study strategies. I have talked to academic affairs and I have showed them my Amboss and Uworld scores and they don't know why I don't score better on test day.

I know STEP1 is now pass/fail but I still want to do well especially since there is a correlation between STEP1 and STEP2 scores. I have also never been a very good test taker.

I want to become an ophthalmologist and it is competitive. I have been developing strong connections in the field and have extensive research and multiple pubs. I don't want my poor test-taking skills to be what stops me from accomplishing my goals.

Has anyone been in the same situation? Any advice will be very much appreciated! Thanks you!

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[deleted849476]

I wouldn’t take it as a bad sign that you do better on boards than your in house material per se, but if you’re really wanting to get better grades in school, what about less of the boards Q banks and tests and more just studying your in house material? Just a suggestion. Maybe you have the big concepts down (seems like it) and are just failing to capture the memorization/regurgitation factoids that can make or break you on a test question stem.

I know optho is super competitive and I haven’t read much into the match data for it, and I’m also only an M2 and a DO, but I’d be wondering if your in house stuff even matters if like you say, you have good pubs and connections and are performing well on boards prep.

As for study modalities, I would just say maybe observe a little more how each prof asks questions and cater to what you know they think is important based off of their past questions; and finally, whatever studying you do just be sure it’s active studying and not just passive (e.g actively trying to recall what you just read vs reading alone).

In my DO world I’d trade all the good exam grades on earth for a solid first author pub or two so long as I still passed. Would honestly prefer 1 good first author pub but all straight C‘s than no pubs but “good“ grades.

 

[The Last Ankibender]

I wouldn’t take it as a bad sign that you do better on boards than your in house material per se, but if you’re really wanting to get better grades in school, what about less of the boards Q banks and tests and more just studying your in house material? Just a suggestion. Maybe you have the big concepts down (seems like it) and are just failing to capture the memorization/regurgitation factoids that can make or break you on a test question stem.

I know optho is super competitive and I haven’t read much into the match data for it, and I’m also only an M2 and a DO, but I’d be wondering if your in house stuff even matters if like you say, you have good pubs and connections and are performing well on boards prep.

As for study modalities, I would just say maybe observe a little more how each prof asks questions and cater to what you know they think is important based off of their past questions; and finally, whatever studying you do just be sure it’s active studying and not just passive (e.g actively trying to recall what you just read vs reading alone).

In my DO world I’d trade all the good exam grades on earth for a solid first author pub or two so long as I still passed. Would honestly prefer 1 good first author pub but all straight C‘s than no pubs but “good“ grades.

They said that Exams are NBME. That means standardized so in house material doesn’t matter

 

[Styrene]

I am a second year MD student at a mid to lower rank school. Last year step 1 average was 237. Our exams are NBME and my score ranged between 69 and 82 since the beginning of medical school. The average has been consistently around 82-83%.

I do not know what I do not do well! I have tried multiple study techniques (Anki vs. no anki, taking notes with lecture vs. not, hammering practice questions vs. understanding the material) and no matter how much work I put in my score always comes back in the exact same range.

Our curriculum is system based so I have consistently done the Amboss and Uworld questions associated with the system that we study. For the last couple of sets of Uworld questions I do them timed, without tutor mode. I always keep about 120 questions for the last couple of days before the exam and my scores have been 72%, 75%, & 77% for this last module. The Uworld average for those tests were 65%, 64%, and 60% respectively. I ended up scoring 71% on my school exam, and the average is 81%. On Amboss, I get decent/good scores and constantly get "you score above your peers that share the same objective" and my scoring percentile is high.

I feel good before the exam, and I feel good during the exam. The worst part is I feel good after the exam, and then I am slammed with a mid 70s score, below my class average. I have no idea what I do wrong, I have tried everything from increasing the amount of work to changing study strategies. I have talked to academic affairs and I have showed them my Amboss and Uworld scores and they don't know why I don't score better on test day.

I know STEP1 is now pass/fail but I still want to do well especially since there is a correlation between STEP1 and STEP2 scores. I have also never been a very good test taker.

I want to become an ophthalmologist and it is competitive. I have been developing strong connections in the field and have extensive research and multiple pubs. I don't want my poor test-taking skills to be what stops me from accomplishing my goals.

Has anyone been in the same situation? Any advice will be very much appreciated! Thanks you!

Do you have significant anxiety while taking the tests? That will alter cerebral blood flow and potentially inhibit logical thinking processes. I had a friend who did much better on tests with small dose of propranolol beforehand.

 

[Maximus2020]

Sorry to hear about this. Step 1 being a Pass/Fail is a good thing in this situation so should lessen your anxiety. You will pass - that is the key.

Agreed that ophtho is competitive. It will come down to your clinical grades and Step 2. Worry less about the scores currently and set your sights on the rotations and Step 2, the latter of which is easier/more straightforward than Step 1. Have faith - we all struggle, we have all been there. You can and will overcome this.

 

[(;FutureEyeDoc;)]

I wouldn’t take it as a bad sign that you do better on boards than your in house material per se, but if you’re really wanting to get better grades in school, what about less of the boards Q banks and tests and more just studying your in house material? Just a suggestion. Maybe you have the big concepts down (seems like it) and are just failing to capture the memorization/regurgitation factoids that can make or break you on a test question stem.

I know optho is super competitive and I haven’t read much into the match data for it, and I’m also only an M2 and a DO, but I’d be wondering if your in house stuff even matters if like you say, you have good pubs and connections and are performing well on boards prep.

As for study modalities, I would just say maybe observe a little more how each prof asks questions and cater to what you know they think is important based off of their past questions; and finally, whatever studying you do just be sure it’s active studying and not just passive (e.g actively trying to recall what you just read vs reading alone).

In my DO world I’d trade all the good exam grades on earth for a solid first author pub or two so long as I still passed. Would honestly prefer 1 good first author pub but all straight C‘s than no pubs but “good“ grades.

Thank you for the encouraging words! I will try to hone in on the smallest details just for this upcoming unit and see how it goes. Really wondering if that is truly what I am missing. I definitely feel comfortable with the big concepts for sure (despite my poor school grades). And yes, I will keep prioritizing research because with STEP1 being pass/fail, I have no doubt it will be what is most important (after step2).

Do you have significant anxiety while taking the tests? That will alter cerebral blood flow and potentially inhibit logical thinking processes. I had a friend who did much better on tests with small dose of propranolol beforehand.

It is not the first time this has been suggested to me! I do not feel like I stress tho... I've never really stressed about much, but as a psychiatrist maybe you can help me by answering this one question: is is possible to be stressed without consciously knowing it? I was found to have gastric ulcers recently (H. Pylori related tho) and I am known to get oral aphthous ulcers frequently. But frankly, compared to how others experience stress, I certainly don't feel like I do.

Sorry to hear about this. Step 1 being a Pass/Fail is a good thing in this situation so should lessen your anxiety. You will pass - that is the key.

Agreed that ophtho is competitive. It will come down to your clinical grades and Step 2. Worry less about the scores currently and set your sights on the rotations and Step 2, the latter of which is easier/more straightforward than Step 1. Have faith - we all struggle, we have all been there. You can and will overcome this.

Thank you for the encouraging words! My advisor emphasized that there is a big correlation between step1 and step2 scores which is why I have been worried with my school grades. Some M4s I have talked to told me that it wasn't quite true because the two exams test very different things and it is not uncommon for someone to feel much more comfortable and score much higher on step2 than step1. In your experience, would you say that someone who does not ace preclinical years is at a huge disadvantage when it comes to shelf exams and step2 or are they totally separate?

Thank you all! I appreciate you taking the time to respond to my thread.

 

[operaman]

Yeah that’s strange. Your class is about one std deviation above the mean for step 1 so that may be part of it (but not all). There’s also a high likelihood of some recall bias in that you’re taking the world questions right after studying so you may be getting a few from short term recall that hasn’t solidified into longer term memory. Or it’s simply a matter of test conditions and time and whatnot. Hard to say. It may also be that world, being a teaching tool, is giving you more hints in the stem than the nbme does. I started using World at the beginning of M2 and was scoring 80-90% on blocks of random questions simply by using test taking strategy for the material I hadn’t learned yet. You may be doing some of that too. Sadly nbme isn’t so generous!

Ooh, the other thing nbme/usmle do is mess with your mind. They frequently include really weird answer choices just to make you doubt yourself. If you notice yourself second guessing yourself more in the nbme tests, that may be part of it too.

The only nit I would pick would be in your saving world questions for the end. I hear that idea repeated all the time which makes zero sense to me. World’s strength is in its explanations, the way it can teach the material. People seem to want to use it for last minute score assessment and reassurance but it just isn’t as good at that. I would use it early and often so you can do the questions and really review the explanations and maybe even have time to repeat the ones you missed or flagged.

 

[Chromium Surfer]

One thing I would also say is that even though you’re doing NBME exams the material that you’re covering might still be heavily tailored towards lecture specific materials.

At our school when we take NBME exams the professors can still choose which questions they want to feature. Often a good portion of these questions are things that aren’t highly emphasized in most of the boards resources and instead align with lecture material details.

So if you don’t use school lecture notes heavily you might miss those types of questions. I imagine on step these super specific questions would make up less than a school curated nbme exam.

 

[Goro]

I am a second year MD student at a mid to lower rank school. Last year step 1 average was 237. Our exams are NBME and my score ranged between 69 and 82 since the beginning of medical school. The average has been consistently around 82-83%.

I do not know what I do not do well! I have tried multiple study techniques (Anki vs. no anki, taking notes with lecture vs. not, hammering practice questions vs. understanding the material) and no matter how much work I put in my score always comes back in the exact same range.

Our curriculum is system based so I have consistently done the Amboss and Uworld questions associated with the system that we study. For the last couple of sets of Uworld questions I do them timed, without tutor mode. I always keep about 120 questions for the last couple of days before the exam and my scores have been 72%, 75%, & 77% for this last module. The Uworld average for those tests were 65%, 64%, and 60% respectively. I ended up scoring 71% on my school exam, and the average is 81%. On Amboss, I get decent/good scores and constantly get "you score above your peers that share the same objective" and my scoring percentile is high.

I feel good before the exam, and I feel good during the exam. The worst part is I feel good after the exam, and then I am slammed with a mid 70s score, below my class average. I have no idea what I do wrong, I have tried everything from increasing the amount of work to changing study strategies. I have talked to academic affairs and I have showed them my Amboss and Uworld scores and they don't know why I don't score better on test day.

I know STEP1 is now pass/fail but I still want to do well especially since there is a correlation between STEP1 and STEP2 scores. I have also never been a very good test taker.

I want to become an ophthalmologist and it is competitive. I have been developing strong connections in the field and have extensive research and multiple pubs. I don't want my poor test-taking skills to be what stops me from accomplishing my goals.

Has anyone been in the same situation? Any advice will be very much appreciated! Thanks you!

Read this:
Goro's Guide to Success in Medical School (2019 edition)

 

[altblue]

Those are good block scores to be starting off with. Don't worry

It's been my experience that in-house exams and even the NBMEs test more brute force memorization than UWorld does, which demand more critical thinking instead. That could be part of the difference

 

[srirachamayonnaise]

Thank you for the encouraging words! I will try to hone in on the smallest details just for this upcoming unit and see how it goes. Really wondering if that is truly what I am missing. I definitely feel comfortable with the big concepts for sure (despite my poor school grades). And yes, I will keep prioritizing research because with STEP1 being pass/fail, I have no doubt it will be what is most important (after step2).


It is not the first time this has been suggested to me! I do not feel like I stress tho... I've never really stressed about much, but as a psychiatrist maybe you can help me by answering this one question: is is possible to be stressed without consciously knowing it? I was found to have gastric ulcers recently (H. Pylori related tho) and I am known to get oral aphthous ulcers frequently. But frankly, compared to how others experience stress, I certainly don't feel like I do.


Thank you for the encouraging words! My advisor emphasized that there is a big correlation between step1 and step2 scores which is why I have been worried with my school grades. Some M4s I have talked to told me that it wasn't quite true because the two exams test very different things and it is not uncommon for someone to feel much more comfortable and score much higher on step2 than step1. In your experience, would you say that someone who does not ace preclinical years is at a huge disadvantage when it comes to shelf exams and step2 or are they totally separate?

Thank you all! I appreciate you taking the time to respond to my thread.

Step 2 tests very different things than Step 1, namely clinical stuff. So I agree with those M4's

 

[Maximus2020]

To respond to your Q above, acing preclinical years, shelf exams, and Step 2 all comes down to studying books/question banks. The real challenge is 3rd year. Rotations and your grades on them have next to no relationship with studying. Sure, you have to know your stuff, but it's more of a game of people skills than pure knowledge assessment.

 

[Styrene]

It is not the first time this has been suggested to me! I do not feel like I stress tho... I've never really stressed about much, but as a psychiatrist maybe you can help me by answering this one question: is is possible to be stressed without consciously knowing it? I was found to have gastric ulcers recently (H. Pylori related tho) and I am known to get oral aphthous ulcers frequently. But frankly, compared to how others experience stress, I certainly don't feel like I do.

Anything is possible, but I've never heard of performance anxiety that was not accompanied by physiologic symptoms. I'd say it's highly unlikely.

 

[Phloston]

I am a second year MD student at a mid to lower rank school. Last year step 1 average was 237. Our exams are NBME and my score ranged between 69 and 82 since the beginning of medical school. The average has been consistently around 82-83%.

I do not know what I do not do well! I have tried multiple study techniques (Anki vs. no anki, taking notes with lecture vs. not, hammering practice questions vs. understanding the material) and no matter how much work I put in my score always comes back in the exact same range.

Our curriculum is system based so I have consistently done the Amboss and Uworld questions associated with the system that we study. For the last couple of sets of Uworld questions I do them timed, without tutor mode. I always keep about 120 questions for the last couple of days before the exam and my scores have been 72%, 75%, & 77% for this last module. The Uworld average for those tests were 65%, 64%, and 60% respectively. I ended up scoring 71% on my school exam, and the average is 81%. On Amboss, I get decent/good scores and constantly get "you score above your peers that share the same objective" and my scoring percentile is high.

I feel good before the exam, and I feel good during the exam. The worst part is I feel good after the exam, and then I am slammed with a mid 70s score, below my class average. I have no idea what I do wrong, I have tried everything from increasing the amount of work to changing study strategies. I have talked to academic affairs and I have showed them my Amboss and Uworld scores and they don't know why I don't score better on test day.

I know STEP1 is now pass/fail but I still want to do well especially since there is a correlation between STEP1 and STEP2 scores. I have also never been a very good test taker.

I want to become an ophthalmologist and it is competitive. I have been developing strong connections in the field and have extensive research and multiple pubs. I don't want my poor test-taking skills to be what stops me from accomplishing my goals.

Has anyone been in the same situation? Any advice will be very much appreciated! Thanks you!

What is your actual question here.

 

[DiveShallow]

One thing I would also say is that even though you’re doing NBME exams the material that you’re covering might still be heavily tailored towards lecture specific materials.

At our school when we take NBME exams the professors can still choose which questions they want to feature. Often a good portion of these questions are things that aren’t highly emphasized in most of the boards resources and instead align with lecture material details.

So if you don’t use school lecture notes heavily you might miss those types of questions. I imagine on step these super specific questions would make up less than a school curated nbme exam

This is true at my school too. They use a nbme question bank of 16,000+ questions and the profs can basically ask any detail they want. So, they’re nbme questions, but not necessarily representative of an nbme exam. Profs can also see the difficulty rating and the percentage of students who picked the right answer according to nbme data provided to school (a prof told me all of this).