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Feel like I hit a dead end - need help

Discussion in 'Step I' started by Solarium, Dec 24, 2008.

  1. Solarium

    10+ Year Member

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    I've been studying since I passed the CBSSA back in mid september. I took a 7 week kaplan course and tried incorporating most of the high yield notes into FA. The class ended mid november and I've been studying again starting december. I figured that the kaplan class must have helped me, even though I felt that most of the material they've gone over I already know, so I decided to give myself 30 days to finish UW and prepare myself for the steps, hoping that I would improve at least 20 points by the end of the 30 days (5 points per week).

    It was time to measure how far I need to go, and how much I've learned from kaplan, so I planned to take a simulated exam each week to see how much I improved from last week. I took the 1st UW simulated exam, and guess what, I actually managed to decrease my score from my 192 on the CBSSA to a 190. I thought that must have been a mistake, and I got a 195 on the 2nd UW sim next week. I then took the NBME 6 a week later and landed myself a 198, now a week before my scheduled test I got the same score last week, a 198 on NBME 4. What the hell? I mean shouldn't have Kaplan gave me a review of everything I learned? Shouldn't weeks of doing questions on UW at least give me a larger gain? Since I started at the end of november, I've done almost 1000 UW questions, plus 5 200 question exams during this month, so about 2000 in total. Why have I only gained 3 points from way back in mid september? Am I lacking in basic fundamentals and should I go back to the books? Do I need to read RR path, and all the kaplan notes again to refresh my memory? Do I just need to do more questions after question until I run out of UW and kaplan Qbank? Have I hit the "ceiling" of my capabilities and simply cannot improve anymore?

    I'm going to extend my test until January 27th, that gives me about 5 weeks to study this the right way. I still believe that doing question is the right way for me (see my previous post) and that I should finish both UW and Kaplan Qbank before even to attempt this test. What I've been doing so far everyday is listening to goljan audio with his notes for each 1 of my weaker subjects on the practice exams before I start on 50 UW questions on that subject, styled after FA systems with anatomy and the 3 P's, then review them for about 4 hours. After I finish goljan audio, I can do about 100 questions per day, with 2 hours of questions in the AM and 6-8 pure hours of reviewing them in the PM. Perhaps I can increase the number of questions later on when I finally catch on. Then a week before the test, I read FA all over again with all my annotated notes inside, goljan HY notes, and pharm flash cards.

    I don't plan on taking this test until I get a 230, and if I have to study for 3 more months, so be it. How far behind a 230 do you guys think I am? Is it probable that after months of trying, not getting any higher score, that I will improve 30 points in 5 weeks? Are my methods of studying simply not effective? What do you guys think, and how should I improve my study? Any advice would be greatly appreciated.

    Thanks all for listening, and I apologize if that sounded too much like a rant.
     
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  3. MedLover25

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    Hey,
    I can understand your frustration (I'm sure I'll be there too once I start studying in a week or so).

    Perhaps you could try approaching the material in a different angle. Sometimes when we lock ourselves in something that "feels comfortable" we end up limiting ourselves. Also, be sure you're not just reviewing what you already know and understand, and only "thinking" you understand other concepts since you've "seen everything" via Kaplan and Questions. If you're getting a certain topic of questions wrong, that's telling you that you don't have as well a grasp on the concept as you could if you went back and looked at.

    Just a thought. Hope it helps.
     
  4. Noeljan

    Noeljan Senior Member
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    How do you have so long to study for the test? We only get 8 weeks.
     
  5. MedLover25

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    School's vary. We get 14 weeks (if we want).
     
  6. laxman310

    laxman310 TheManWithAPlan
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    Started boards prep in April. Started at a 190. Studied 7 weeks. Got a 230.
    I decided I wasn't ready, so I put it off. I started rotations, and after 5 months of no boards prep came back, and started back up.

    First thing you need to do is take a day or two off. Completely off. No books, no audio, nothing. I think me taking time off gave me the motivation for another intense 6 weeks.

    Analyze whats is going wrong.

    Since it seems you have some basic understanding (with your passing score) I would recommend the following, which is what I did, and it helped immensely.

    1. Read Levinson's immunology. Nice and short, good precursor to starting path (and micro). Should take you about 5 days or less. As you go through, memorize the interleukins and cell types, and their functions. Draw out pathways and quiz yourself. Don't just memorize, but ALSO understand. This will help a lot when you start up Path. Do a total of 100 immuno questions (any boards questions source), divided evenly over the days, in TUTOR mode. Do not continue until you can get at least 70% of new questions right.

    2. Read Robbin's Basic Path, chapters 1 and 2. This is critical to understanding pathology. Everything else from path is derived from these two chapters. Do the Robbins Questions after each chapter, one question at a time, checking answers and reading explanations after each question. Do not continue unless you are doing better than 70%.

    3. Do an organ based review as per Taus method.

    When you've done the above, let me know what your new score is.

    P.S. An assesment test every week will more often than not demoralize you. Thats because each one has a different emphasis. Try doing one every 3 weeks, until you get the score you want, then stop doing them, and push through your final 2 weeks.
     
  7. Noeljan

    Noeljan Senior Member
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    I think our school doesn't allow start of rotations until you take Step 1....then if you fail I believe you are pulled off rotations untilyou pass
    Also, what is this Taus method?
    thanks
     
  8. GMDMD

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    While I have not read this book, I would suggest you not spend 5 days studying immunology. The material is important but I don't think you should spend 1/7 of your allotted time on this one subject.

    I learned the stuff really well before boards, but didn't spend more than one day on this material and I did SDN well.
     
  9. BoneTwister

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    I agree with the above poster. Her score of 210 is passing and so follow what she said and you do fine. Also just relax!:sleep:
     
  10. Solarium

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    Believe me, if I were doing something I'm comfortable with, I would be reading my kaplan notes over. However, I feel like that would be too low yield, since I'm going through much material I already understand. I found my weakness to be tieing the knowledge I already have together, and applying them, since many times when I review my wrong answers I realize that I know the concept behind it, but I wasn't applying it effectively or understanding what the question was trying to ask. I figured that the best way to learn is through my mistakes and my weakness, thus my strategy. However, what you said is correct, perhaps I should stand back and have a good look what I'm doing, and construct a better way to work at it.

    Reading through robbin's chapter 1 and 2 sounds like a good idea, since one of my lower scores is general principles of health and disease. I've read through Tau's method before starting my studies, and tried to follow his ways, but it was simply too fast for my taste since I don't feel like I was learning at all going at that pace. Perhaps I will start at the 2nd run through with 50:50 study and Q's, and do his last 2 week crunch. I understand that immuno is a pretty low yield subject, why do you recommend running 5 days through it before starting anything else?

    Thanks all for the advice! Please keep them comming.
     
  11. DarlynVMD

    DarlynVMD Junior Member
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    Solarium,

    Understand that everyone here has different methods of studying and I highly suggest you take what everyone tells you with a grain of salt, but don't completely disregard their advices.... instead, take each into consideration and pick out the bits and pieces that you feel are more of your learning style and formulate a study schedule that is suited to your specific needs. And like the above poster mentioned, alloting 5 days for immunology sounds like a bit too much, I read the Immuno section off of Levinson and read the entire ~90 pgs (this includes chapter 8 for intro to Immuno) in half a day, while annotating my notes onto the Immuno section of FA. As for myself, I didn't really learn immuno that well because it was poorly taught at my school, but reading Levinson just that one time was more than enough, and the immuno q's on my actual exam were extremely easy, just simply identifying which IL did this and that, etc.
    Also, if your school's curriculum follows a Systemic approach, then don't deviate and try something you're not used to, stick to that when reviewing for the Step 1... but in my case, my school taught at a Subject base level, and even though FA was organized to follow a Organ-based approach, I stuck with what I was used to.
    And to tie things up, Lexman has his personal reasons for reviewing Immuno before anything else, you should wait for his response, but as for myself, I started my board prep with Physiology... I left Micro/ID/Immuno for mid-prep after I had done Pathology. My schedule worked out really well for me, it just all depends on what makes sense to you.

    At any rate, best of luck on your studies.
     
  12. Solarium

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    Thanks Darlyn, I'm currently constructing my 5 week schedule based on Tau's subject and system organization, as well as my own weaknesses. I've looked at my past NBME's and UW assessments and noticed weaknesses in micro and pharm. Looking at the performance scale, I'm confused what areas the systems versus the subjects represent and whether they overlap. If I look at the GI bar, does it include all the GI questions, like physio, path, pharm, anatomy, etc? And for the path or pharm bar, does it include the GI questions, or only general questions unrelated to any particular system?
     
  13. DarlynVMD

    DarlynVMD Junior Member
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    Solarium,

    As for the performance profile for each NBME, you should not overanalyze each performance band as like it mentions at the very end, this exam is very integrative and there are areas of significant overlap. For example, you can get a question where they they describe a GI pt, and show you a CT of the abdomen and ask you to localize a particular structure that is causing the pts presenting Sx.... you can never really know if this q's will fall under Anatomy/Embryology or under Gastrointestinal System. So don't bother trying to overinterpret these areas of overlap, but in general as per usmle.org's breakdown, to follow with your example, yes, GI system carries every subject through (i.e., phys, pharm, path, micro, anat, etc).

    Edit: Forgot to entertain your q about pharm and path.... so for the Pharm performance band, this involves pharmacodynamic/kinetic processes, which include ADME, autonomic pharm, etc. And path includes general principles such as neoplasia, inflammation and reparative processes, which you'll see in great depths with Goljan.

    D
     
    #12 DarlynVMD, Dec 26, 2008
    Last edited: Dec 26, 2008
  14. Solarium

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    Here's my new schedule I made. I've already gone over cardio, most of heme, endocrine, renal, respiratory, skin and musculo in the past month, so I don't plan to spend much time on those. I plan on focusing approximately 30% on path, 20% pharm, 20% physio, 5% BS, 10% biochem, 5% anatomy, and 10% micro.

    12/26 – GYN
    Goljan: GYN 1, 2
    Physio BRS – Repro
    48 Repro & GU Q's (anatomy, path, pathophys, phys)
    Repro Pharm + Micro (FA + cards)
    40 Repro & GU Q's (pharm, micro)

    12/27 – GI
    Goljan: GI 1, 2
    Physio BRS – GI (memorize hormones)
    48 GI Q's (anatomy, path, pathophys, phys)
    GI Pharm + Micro (FA + cards)
    27 GI Q's (pharm, micro)

    12/28 – Hepatobiliary
    Goljan: Hepatobiliary/pancreas 1, 2
    Physio BRS - GI
    48 Hepatobiliary Q's (anatomy, path, pathophys, phys)
    Hepatobiliary Pharm + Micro (FA + cards)
    31 Hepatobiliary Q's (pharm, micro)

    12/29 – Hematology
    Goljan: Hematology 7, 8
    Goljan: Neoplasia 1, 2
    Review Heme & Oncology Pharm (FA + cards)
    Biochem – coagulation
    80 Hematology & Oncology Q's + review

    12/30 – CNS 1
    Goljan: CNS
    Physio BRS – CNS (with FA)
    75 CNS Q's (anatomy, path, pathophys, phys)

    12/31 – CNS 2
    Review CNS Pharm (FA + cards)
    Review Psych Pharm (FA + cards)
    Review CNS Micro (FA + CMMRS)
    Review Micro CNS Pharm (FA + cards)
    75 CNS Q's (Pharm, micro)

    1/1 – Biochem 1
    Goljan: Nutrition 1, 2
    Review Biochem (FA, Kaplan bookmarks)
    75 Biochem Q's + review

    1/2 – Biochem 2
    Review Biochem (FA, Kaplan bookmarks)
    75 Biochem Q's + review

    1/3 – Micro 1
    Review Micro general principles (FA + CMMRS)
    75 Micro Q's + review

    1/4 – Micro 2
    Review Micro (FA + CMMRS)
    Review Micro Pharm (FA + CMMRS)
    75 Micro Q's + review

    1/5 – Molecular Bio & Genetics
    Review Molecular Bio & Genetics (HY + RR Goljan)
    75 Molecular Bio & Genetics Q's (Kaplan)

    1/6 – Pharm general principles
    Review Pharmacodynamics & Autonomics (FA + cards)
    48 Pharm general principles Q's (Kaplan)
    Review Immuno (FA + Levinson)
    48 Immuno Q's (UW)

    1/7 – Path general principles
    Goljan: Cellular Injury 1, 2
    Goljan: Inflammation 1, 2
    Review general Path (FA)
    48 Path general principles Q's (Kaplan)

    1/8 – Anatomy & Embryo
    Review Anatomy muscular (FA)
    Review embryo (FA)
    44 Embryo Q's (UW)
    48 Anatomy Q's (Kaplan)

    1/9 – BS and biostats
    Review Behavioral (FA + HY)
    48 BS Q's (UW)
    Review Biostats (FA + HY)
    48 Biostats Q's (UW)

    1/10 – Pharm complete review 1
    Review Pharm (FA + cards)
    100 Pharm Q's (Kaplan)

    1/11 – Pharm complete review 2
    Review Pharm (FA + cards)
    100 Pharm Q's (Kaplan)

    1/12 – NBME #5 + review Q's

    1/13-26 – choice 1:
    Follow Tau's last 2 weeks (To be organized later)

    1/13-26 – choice 2:
    1st week: 200 random Kaplan Q's (or incorrect UW questions) + review each day
    2nd week: Read through all of FA, review all pharm cards, review my own goljan notes

    1/27 – USMLE Step 1 Test Day :)

    Please feel free to comment and revise. Thanks again.
     
  15. DarlynVMD

    DarlynVMD Junior Member
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    Solarium,

    Your schedule looks well organized; however, I noted that you have General Pathology for review after you've covered all the Systems... If this makes sense to you, then by all means leave it as is, but you should've reviewed those general pathologic principles at the very beginning as they tend to be seen in almost every system. But again, if you feel that what you have makes sense to you, then don't bother messing with it.
    Also, Immuno should be alloted a day on it's own, reading Levinson may take you a whole day or less depending on how fast you read and grasp the overall concepts. Like I mentiond before, it took me half a day to read Levinson, and for the rest of the day I just read the Immuno section from FA memorizing all the IL, CD markers, etc., followed by the 80 some q's from UW.
     
  16. Solarium

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    Rearranged a few things to make more sense, any critics?
     

    Attached Files:

  17. Doctor4Life1769

    Doctor4Life1769 **tr0llin, ridin dirty**
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    If it is taking me 2-3 days to read Levinson's, am I going too slow? This is my 1st review cycle for the boards.
     
  18. GMDMD

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    3 days seems like a lot for immunology. I dont know what your schedule is like but one of the best pieces of advice I was given prior to starting is to create a schedule and stick to it as much as possible. It is okay to give yourself half a day here and there leeway, especially if you have planned days with nothing scheduled at the end. But be very very careful to avoid getting bogged down in any one subject and consequently ignoring other subjects.

    For a subject like immunology I would get through the material as fast as I can (with some thoroughness) and move onto something else. Revisit if you find you have time later on. Immuno is something you could spend 2 weeks on if you wanted but I thought 1 day (and 1/2 day on 2nd run through) was more than sufficient for the high yield stuff.
     
  19. Doctor4Life1769

    Doctor4Life1769 **tr0llin, ridin dirty**
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    Ok, I'll try and finish it up tomorrow. I'm starting boards studying early. I take it in June, but we are not alotted much time for study following our MII finals, so we have been advised to start now. I know I'm a slow reader, but hopefully I can be done with it all tomorrow and move on to Micro, followed by Path. Thanks for the advice, it's much appreciated and I will take that into consideration when dealing with other lower-yield subjects.
     
  20. DarlynVMD

    DarlynVMD Junior Member
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    Doctor4life,

    It all depends how long you have allotted to study for this exam. I gave myself 42 days exactly, utilizing review books for the first 4 weeks, and reviewing FA 2 more times during the last two weeks. But then again, you choose which topics need extreme (and slow) thoroughness, and which ones you can read at a quicker pace. I tend to read fast as it is, so the 90 or so pages of Immuno from Levinson took me tops 4 hours, I started at like 9 and ended at 2 with 12-1 being a lunch break. The rest of the day was spent like I mentioned on my previous post. But to show you a difference, it took me 7 solid days for Pathology as this topic comprises the majority of the Step 1 exam... so I read nice and slow and made sure I filled in any gaps in my path knowledge on my first read, and left the last read (1 week before the exam) for the margin notes and pics from RR Path. But it all depends on you, don't freak out or change the pace at which you're covering things because others (myself included) moved through certain topics at a much faster pace... you're challenging no one but yourself for this exam, do your best to score the highest score possible for YOU not for any of us on this board... so with that said, if it takes you 3-4 days to cover Immuno adequately to a level at which you'll be comfortable with the material, then take those 3-4 days. Just don't obsess over the smaller moderate yield topics and skip out on the major players of the exam (ie, Path, Physio, Pharm, etc). So if you alloted 3 days for Immuno, and following that you have pharm to cover and alloted 4 days for Pharm... DO NOT cross over and take time from your alloted Pharm review days... leave immuno at where you were able to get and keep moving... your schedule should have "OFF/Catch-up" days for situations like these, so use them to your discretion.

    At any rate, keep plugging away and like the previous poster said, STICK to your schedule.... and that's only if it's productive. Just know this... and I speak for myself here but I'm sure most other students would agree here... while everything made decent sense throughout my prep... concepts were still fuzzy with a few loose screws here and there... if you feel this happening to you... worry not.... everything, and I mean everything makes sense on those last few days you've schedule as a wrap-up/review of FA... it all comes together then.

    Best of luck.

    D
     
  21. Doctor4Life1769

    Doctor4Life1769 **tr0llin, ridin dirty**
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    Thank you very much for that, it's greatly appreciated and probably one of the more important pieces of advice given on this forum.
     
  22. Solarium

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    DarlynVMD, I took a look at your USMLE studying plan. Did you end up doing Kaplan questions after you finished UW, or did you concentrate redoing the incorrect questions over?

    For the last 2 weeks, I was thinking of going with your plan, doing 100 random questions everyday and reviewing FA over. Which would be higher yield you think, new Kaplan Q's or old UW Q's?

    Also, how much of a difference did you score 2 weeks before the step and the actual score? How much of a difference does the last 2 weeks of complete review make?

    Thanks again.
     
  23. DarlynVMD

    DarlynVMD Junior Member
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    Solarium,

    First, Happy New Years! The last 2 weeks played a crucial part on my score... at least I like to believe.... but I guess only you can determine how many days of wrap-up you really need before taking the exam. Remember that during this time you're simply bringing everything together and adding that extra touch of spice to the knowledge you attained throughout your study period. It's just crazy cram fest going down. At any rate, I only used incorrect q's during that last 2 week period... so I only stuck with UW... no Kaplan. It's not wise to start a new Q-bank so late in the game, especially a week before taking your exam, but then again, it's all up to you. So my advice would be to keep hitting UW, and focus more and more on your weaker areas while branding your already stronger subjects.
    As far as scores go.... my actual score was 2 points higher than my last few NBMEs. The last NBME I was at a 247, I took a 150 exam from USMLESteps123, and scored a 247 there too... and a few days before the exam I took the USMLE.org's 150 free exam (FREDv.1) and scored a 95% or a 270 as per medfriends.org... but yeah... deuce points higher for the actual (from the 247s, I wish from the 270...haha... the 150 from USMLE.org was no way reflective of the new q's on the exam, but some ppl have found correlation b/w this and their score, but definitely not for me... NBMEs all the WAY!!)... so to give you an idea of a 2 weeks difference, 2 weeks before, I had a 221, and the week before shot up to a 247 and slightly peaked there... I was massively burnt out by the end of the 5th week.... so 2 whole weeks of review is not that necessary... unless you have the stamina for it, but it was burnt by then.
    Hope I answered your q's.... My head is a bit fuzzy still... too much mixing of ETOH last night... haha.

    Best wishes,

    D

    P.S.
    Depending on how much of the minutia you can memorize... a whole lot!
     
    #22 DarlynVMD, Jan 1, 2009
    Last edited: Jan 1, 2009
  24. Solarium

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    Thanks for the words of encouragement Darlyn, and happy a late new years. I plan to use the last 2 weeks as a comprehensive review as well. I was wondering exactly what you did for the last 2 weeks to get an idea what to focus on.
     
  25. DarlynVMD

    DarlynVMD Junior Member
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    Solarium,

    Good to hear from you, hope all is well. If you want, just drop me your e-mail address via PM and I'll send you the last two weeks.

    Good luck.

    D
     

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