How to Beat Step 1

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Coxsuckie Virus

Look out, Herpes!
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:luck:

So I learned a little bit about Test Taking these past few weeks. And you guys can do with this as you wish, but it's some advice I had gotten a million times before but never really applied to anything with any amount of diligence. But now, I have seen the light, and hopefully you will too.

Before you read any further, know that I am not telling you anything you probably haven't heard, but I AM asking you to try it, and I'll give some reasoning as to why this may work for you if you haven't already used the techniques.

Step 1

READ THE ANSWER CHOICES FIRST 👍

Everyone has heard this. EVERYONE.

No one does it though. 😡

This is something that MUST be applied to your test taking strategy. Anyone who has listened to Goljian has heard him say it, but it's actually been studied and proven that if you READ the answer choices first, then the Question stem, you'll do better, on average about 10% increase.

:idea: The reasoning:

Your brain already has all the information it needs. There is little to nothing that you will be asked about on the boards that you don't already know, or already knew about before hand. However, by reading the question stem first, your brain gets convoluted, and unless you already know the answer right off the top of your head, you will get more gears turning than need be. As you go through the answer choices with your mind already digesting the craziness that it was just given, it will be difficult to pull the right answer out when there are a few that might apply.


MORE IMPORTANTLY:

By reading the answer choices first, your brain accesses its preformed knowledge of each answer. You read E. coli, and you automatically think MCC of UTI, Montezuma's, hamburger... all those things run through your head. Then you see Proteus underneath it. You think, kidney stones, urease, blah blah blah... Then you see Pseudomonas, and strep and your brain quickly pulls the facts about those things out.


More often than not, when you see clumps of answers together, you'll know what the question stem is going to be asking you before you even read it. Try it and you'll see. Practice this on a Q-bank and be mindful of what you're doing. Read the answers first, pick one of the answers, then read the stem.

After you read the stem, you'll already have primed your mind with the likelihood of each of the answers. You'll read the stem, and it will confirm your gut instinct. 😎



STEP 2

Don't call it a Zebra when you know it's a Horse. 😕

Everyone has heard this, and very few people realize that they're doing it. Especially the people used to TUTOR MODE.

This is the inevitable downfall of tutor mode. I found myself doing this a lot. I would get a list of answers down to 2. And then, it didn't matter because the second you picked one, the answer would pop up underneath and either confirm or deny your pick. And for God Darn sakes, I don't know how many times I picked the weird one "just to see."

This is a mistake that you're going to subconsciously make on the exam unless of course, you get out of that Tutor Mode habit. If you KNOW for damn sure one of the two can do something, but you pick the other one, just in case, you're shooting yourself in the foot. I did this a couple of times, and this is a habit you MUST get out of.

It'll happen to you on Q-bank, you'll be dickin' around on Tutor Mode and from some odd ass reason, you'll have your answers down to 2, you know that scalded skin syndrome is Staph aureus, but pseudomonas is the other answer and you're torn between the two. You read the stem again and again, a kid's skin is scalded and he develops an infection nosocomially. What's the bug? And you're like, ahhh, I'll just pick pseudomonas for the hell of it, even though i can put staph with scalded, and poof, explanation says it is pseudomonas. It wasn't scalded skin syndrome, the kid was burned, and burn patients get pseudomonas, and you just fell into the trap of positive reinforcement. You picked the zebra and were right that one time. (this is just an example, it's not a typical version of what would happen so cut me some slack here) And then you'll do it more and more... Don't let the snowball happen... this is the downfall of tutor mode. You'll say to yourself at the end of the block, oh, it's ok, 6 of those I knew, I just made a dumb mistake, but then you'll find yourself continuing to do it. Get out of that habit come test day.


Okay, hope these tips help. PLEASE PLEASE PLEASE apply them to a 50 question Q-bank and see the increase in your score. Be mindful of it, and do it. Force yourself to. You will see.

If I get some positive responses, I'll throw some more tips in.

cv

:luck: good luck all :luck: (im not irish, the clovers are lucky, so I hear)
 
hey, thanks for the adivce...looking forward to more as I start preparing for the step 1.
 
for point 1, i also want to add that suppose that sometimes it is better to read the question first and sometimes it is better to read the answer first.

Which one takes more time to read? So when you approach any problem ab initio, which one should you read first, given this is a timed test 😎
 
I'll make a slight modification to part 1 -- for Step 1 it can be really helpful to skip to the last line of the question (which usually includes the real question) before you think about it too much. It frustrated me to know end when I was doing practice questions that I would read through along paragraph and come up with a nice differential diagnosis in my head, only to see that the diagnosis is actually given later in the question and the *real* question is what is the a side effect of the treatment of whatever disease the question was describing. Spending a lot of time reading the answers first might not be the most helpful, but it's worth glancing at them to get an idea where the question is going.

Doing questions on tutor mode is just a bad idea overall, in my opinion. I suppose it's fine if you're months out from the exam and just trying to learn, not necessarily hone your test taking skills. When you get closer to the exam, however, what you really need to do is simulate test conditions as much as possible so you are comfortable with the idea of sitting still for an hour at a time, using your time wisely, and not getting instant gratification for your answers.

Anyway, generally good advice. I think the main thing with test taking is that you find a strategy that works for you..whatever it is. It will help you feel more confident when test time rolls around, and you'd be surprised how much of a difference that makes.
 
wow amazing👍..i can co-relate to what u are talking about b/c im doing same those stupid dumb mistakes.thanks its really help ful plzzzzzzzzzzzzzzzzzz pull out some more tips we need it...very basic but we usually miss it 🙁
cv-->:luck: are u done with step 1?
 
Great thread!! I think a lot of the gunners could add significantly to this.

For most (NOT ALL) Behavioral Science questions, it always helped me be more efficient to read the answer choices before the question. I could normally narrow down to 2 choices before even reading thru that long-winded scenario. A lot of times, you're still left with 2 choices to pick from. Sometimes, I could even skip reading the stem. Anyone else try this approach?
 
Oh yeah, and as far as horse vs. zebra, Goljan always says, "Play odds". And Dr Francis from PASS program always says, "Go with the 90 percent!"
 
None of these things are by any means, ABSOLUTE. But it is important to use them when they do in fact apply. What I mean is; When you get a question listing 14 bacteria as a possible answer, you know it's a good chance you won't be able to deduce much from it other than the fact that you're probably dealing with an infective process. But again, your brain is primed and you know what you're going into when you do read the stem.

It's kind of like reading the chart of a patient before you walk into the exam room. You'll get some good information before even seeing the patient. You'll see vitals, pmhx, etc. Sometimes, you'll even find it's a returning patient whom you know. And you'll have a pretty good idea what's going on. You read the chart, it's Joey Adder, and he's here for script refills on the chart with good vitals. Boom, you know why he's here, it's for a quick ADD med refill, you've already got the diagnosis etc, and you haven't even walked into the room. That's the idea here. It's not exactly the same, but it's along those lines.

Someone mentioned a little bit about the stem revealing the diagnosis towards the end, and another person stated that sometimes you only need to read the last sentence. These cases are certainly true. But they're not all that definitive either. Like patients, every question is different. But there are trends, and catching on to them and recognizing them quickly is important. Speed, speed, speed is the name of the game here. You want as much time to reason out the tough questions after you pick up all those Mario Points throughout the test.

The point of the stem is to cloud your judgement a little before you even see the possibilities of the answers. These guys don't WANT you to get everything right, they are making these questions to beat you, to hold you back. They don't care who you are. They are trying to weed out the bad eggs and keep who is able to figure them out and progress forward despite their attempts to sway you from ultimate glory 😉

One more illustration:


You get this 7 line long paragraph of a stem. You're reading through it, and you're highlighting the important stuff and steaming along. Then boom, there are a bunch of MOA's listed below and it's asking you what the MOA of the DOC is for this Dx is...

That's a crap load of thinking to do on the fly and some MOA's are similar and can seemingly cross boundaries. And you read the stem, it says this woman has vaginal cottage cheese oozing out. Blah blah blah, previous therapy for some other problem they dont name. Then they ask you what the MOA is for the DOC of the condition that was treated that predisposed for her current presentation.

But you already saw and recognized that A) MOA for Amphoteracin and B) MOA for Valtrex and C) some Antibiotic that let the fungi/yeast have a party...

And it's like, walah, I already read those MOA's and knew what each drug was. It was the ABx one that predisposed her for the current presentation.


You see what I am getting at? You already knew what you were going into. You already knew which drugs were represented in the answer choices, and they throw this stem at you about a chick who could have all sorts of venereal disease and stuff, but all they were asking is what is the MOA of a drug that can cause the current presentation.

And these guys want to fumble you up, you're in a time crunch. You're not thinking totally straight because you can only sip your coffee on break time. You don't have that straw attached to your bottom lip like you did all that time you were studying. And they throw a curve ball, and how many people are going to pick the fungistatic MOA and not that ABx, or some poor dude who picked the antiviral... That's what they do. And if you had looked those answer choices over right quick, you'll be a little more relaxed going into that long stem with all these intermingling things, and you can spank that curve ball to the opposite field around pesky's pole.
 
So I wanted to make note of one more thing before I leave the board for the day. It's another reason I was able to get a question right because I read the answer choices and then the stem.

In this case I had a phenotypically female patient that had testes, normal testosterone levels but no mullerian structures. When I read the stem, I missed the TINY little word that made the correct answer make sense. It was testes. So, I left it blank and then came back to it at the end of the block. This time, I scanned the answer choices, decreased estrogen, decreased estrogen receptors, anti-mullerien hormone deficiency, no androgen receptors...

And I was hung up on it, because they threw testes in the stem in just a weird place your eye wouldn't catch. And I'm sitting there like, duhhh, maybe she's not making estrogen? Something just didn't make sense with it.

But when I came back I read the answer choices first, and after mapping out what the phenotype should be for each, THEN going to the stem, I knew what to look for, and boom, there it was, testes. Faulty androgen receptor. Ding ding, another Mario point. But having gone through that convoluted stem, and then trying to relate all this hullabaloo of possibilities was just weird. And you'll see it happen to you.

So, I guess the take home is, if you read a stem, and then get confused after reading the answers. Leave it there, come back, read the answers first, then the stem. You'll know what you should be looking for instead of going backwards.

I mean, there are definitely the times you read the stem, think up an answer, and boom, it's right there in the choices and you click it and move on. Everyone loves those. But there are also those times where you read the stem, missed something, think up an answer, and it's not there. Then what do you do?

You back track. Go in reverse. Read the answers, formulate your thoughts on them, and then read the stem, and 9 times out of 10, something should stick.
 
READ THE ANSWER CHOICES FIRST 👍

Just my opinion, but this is a really good way to fall for their distractors! I usually read the question and don't look at the choices and think of the answer in my head....then I look at the answers and if it is there i put that and move on....

GL all :luck:

-tx
 
I'll make a slight modification to part 1 -- for Step 1 it can be really helpful to skip to the last line of the question (which usually includes the real question) before you think about it too much. It frustrated me to know end when I was doing practice questions that I would read through along paragraph and come up with a nice differential diagnosis in my head, only to see that the diagnosis is actually given later in the question and the *real* question is what is the a side effect of the treatment of whatever disease the question was describing. Spending a lot of time reading the answers first might not be the most helpful, but it's worth glancing at them to get an idea where the question is going.

Doing questions on tutor mode is just a bad idea overall, in my opinion. I suppose it's fine if you're months out from the exam and just trying to learn, not necessarily hone your test taking skills. When you get closer to the exam, however, what you really need to do is simulate test conditions as much as possible so you are comfortable with the idea of sitting still for an hour at a time, using your time wisely, and not getting instant gratification for your answers.

Anyway, generally good advice. I think the main thing with test taking is that you find a strategy that works for you..whatever it is. It will help you feel more confident when test time rolls around, and you'd be surprised how much of a difference that makes.


excellent advice

I experimented w/ reading the answers 1st vs. the last line vs. a combination. I ended up prefering to read the last line and it worked really well for me. I read that line to quickly focus on what organ system or basic science discipline I was going to be dealing with. After reading the Q I then thought of my answer w/o even looking at the answers. This led to much less wasted time for me and much less debating b/w answers.

To each his/her own though...you've gotta see what works for you.
 
I think it's better to minimize the reading that you do. Most questions do not require you to read all the answer choices.

First read the last sentence of the question, because the clinical presentation may be irrelevant. If necessary, read the rest of the question.

If you're able to answer the question at this point, you've saved the time you would have spent thinking about the other answer choices, and reduced the risk of falling for a distractor.
 
excellent advice

I experimented w/ reading the answers 1st vs. the last line vs. a combination. I ended up prefering to read the last line and it worked really well for me. I read that line to quickly focus on what organ system or basic science discipline I was going to be dealing with. After reading the Q I then thought of my answer w/o even looking at the answers. This led to much less wasted time for me and much less debating b/w answers.

To each his/her own though...you've gotta see what works for you.

👍👍👍

I do the same thing. I especially read the last line of the question if its a really long question....those USMLE writers know sometimes we are lazy and might not read the whole question if its long or might lose focus and put the important stuff at the end!

-tx
 
well i obviously haven't started my long road to the boards yet, but by just reading these posts i could see how each strategy can work. But i personally at this point like reading the answer choices first and then hitting the question..believe it or not i have used this strategy in college, I used to take tests on the computer for a couple of classes and it was pretty stressful to stare at the monitor and read the questions which were generally lengthy and detailed. By the way the classes iam talking about were Molecular and Biochem...anyways the strategy worked i would instantly think of things associated with the answer choices which would eventually make it easier to pick out the right answer after reading the question. I dont know i suppose when i start practising q-bank's a lot of scenarios could challenge this particular strategy but i sincerely think one must spend less time on the answer choices and rather pay more attention to the question.
 
Everyone has their own method. I just read the last sentence of the question and then look at the answer choices. I was able to eliminate a bunch of answers just by doing that. And then go back and extract more info from the passage. It's all about time. Do it quick and don't second guess yourself. Then when you have time left, go back and check the ones you marked.
 
I made it a habit to skip any question that required a calculation and save it for the end. I think that is worth doing.
 
👍👍👍 simply rocking thread..each post :idea:
:luck: keep them coming 🙂
 
THE BACKGROUND


This is about a man, in his 30's, who had an enlarging mass in the left side of his scrotum superior to the teste over the past 5 years. It was soft, and it was not painful, and could not be reduced (couldn't be pushed up into the abdomen). Also, no bowel sounds were present in it. It was now up to 5 cm in diameter. The testicles were normal to palpation and were non-tender.


Now let's think about this for a minute. The guy is coming in and just wondering what the heck this thing is. And you were given the typical answer choices for this type of presentation. Hernia, varicocele, cancer, torsion among others. What do you think it was?


Well, I am pretty sure it was a varicocele. He has no bowel issues, and it's on the left side. They may even have mentioned a hard non-tender mass in his left flank medial to the insertion of the renal vein on the left kidney... ding ding.

Notice how weird all that information relates. It's there, but they describe it in ways that are just round about. And this is where it gets interesting...



The COMLEX doesn't allow you to highlight the stems. The USMLE does.

But these guys at the COMLEX, designed this Stem to absolutely
MESS YOU UP.

How did they do this?


Well, it looked like this:

blah blah blah blah blah blah blah blah blah blah blah blah blah blah blah
blah blah blah blah blah blah blah blah blah blah blah blah blah blah blah
blah blah blah blah blah blah blah blah blah blah blah blah blah blah blah
blah blah blah blah blah blah blah bblah blah blah blah blah blah blah no
bowel sounds were present in the mass.
blah blah blah blah blah bla
blah blah blah blah blah blah blah blah blahblah blah blah blah blah blah
blah blah blah blah blah blah blah blahblah blah blah blah blah blah blah.

Did you look carefully?

look again...

Now do you see this? If you read that stem. And then look at the answer choices, and then skim the stem again one more time... you see that

bowel sounds were present in the mass.


But if you looked more carefully, you'd notice they stuck that 2 letter word on the top right at the end of all this crap. That's going to mess you up hardcore. You read; "bowel sounds are present," and you have it wrong.

You're definitely writing hernia.

You can't help it. You see bowel sounds are there, you put hernia, and you never look at the question again. And then you go to the next question, regarding the same stem, asking about something about your last answer choice, you don't re read the stem, you just say, oh, he has a hernia, and then you answer it based on that. And BOOM, you have two questions wrong, just like that, and you went home and to sleep, never thinking about that question again. But damn, it's going to affect your score. You will see. And it's MEAN that those guys would do that to you. But it's how they separate the men from the boys, and the women from the ladies.

How do I know this happens? I had the same test as a friend of mine. I mentioned that stem that had that evil little trick in it, and what did this person put as an answer? Yup. Hernia. ouch.

And now you know what they're doing to you. What they're trying to do. But I caught them. And now I can illustrate to you a technique that these monsters use to eat you alive. They eat you so fast you don't even know they're doing it. And you leave that test center, not even knowing you got gobbled up and crapped out on the side of the garbage can on trash night. No clue.

But now you know, and they won't get you with tricks like this. Because I told you, that they are going to try to pull fast ones on you. Fast ones like this, that are just butt nuggetish.

Again, I wish you all luck. I'll report my scores when they come in... but I'll continue to write more tips, every so often, and y'all do the same. This thread can become legendary...
 
I made it a habit to skip any question that required a calculation and save it for the end. I think that is worth doing.

This is definitely sound advice. But the opposite is also true.

I had one of two ways of approaching this dilemma. If you're good with these questions, and you know how to do them, they are EASY points. It's like, oh good, here's a question about p2+2pq+q2=1... you know how to do it...

Why save it for the end if you MIGHT be in a time crunch? It's better to sit there, do it, get it done, so that it might not be left for the end when you can't do it, when you KNOW you could have?

That's why this is somewhat double sided. So if it's a math question you know you can do, then DO IT, get it done, get the points, and move on. If it's a little ambiguous and may eat more time than is relevant if there's a good chance you won't get it right, then sure, save it for the end...

The key is knowing the difference between the two.
 
My recommendations are the same as the recommendations of Lippincott's Biochemistry: First Read the question (most often the las sentence), think of the possible answer, if you have no idea what this is read the rest of the question (clinical scenario) and FINALLY read the options. It have worked for me during my practice exams.


"The best runner is the one that ignore being in a race"
 
ok here's my contribution, this is what worked for me -

DO THE QUESTIONS BACKWARDS (sort of):

You start out with a 60 minute countdown timer and 50 questions to do.

So I would make sure to do the first 10 questions (1->10) in 10 minutes and then jump to # 50 and do them backwards (50 -> 11)- with 50 minutes remaining.

This way, when looking at the countdown clock it will be a very good pacer (i.e., 35 minutes remaining = i should be on #35 etc.)

Also I would get down to question #11 with about 10 minutes to spare- thus allowing me 10 min to go back and review questions I had marked.

This may seem a bit convoluted- but it worked well for me. Try it out on UWorld, you'll get used to it.
 
Yeah, that's a bit convoluted for my tastes, but if it works for you that's great. I just wanted to add a comment -- if you don't have trouble finishing your practice tests in time, don't start doing a bunch of weird stuff to try to "pace yourself" or save time. Some people do have issues pacing themselves and finishing in time, and I'm not saying that's not important..but don't risk introducing more careless errors just to get faster if you're already finishing in time. For me, it was more important to read the question and answers carefully the first time around than it was to spend a lot of time going back and double checking because most of the time if I read something wrong the first time, I would make the same mistake when double checking.
 
you know i find this method interesting cause ever since college days we were taught to read the question and then predict the answer before looking at the answer choices.

i'll try this method out on a couple practice exams ...
 
when do you know when your ready to take the exam??
is there like certain scores on UW, NBME, Kaplan, etc....
 
:luck:
This is something that MUST be applied to your test taking strategy. Anyone who has listened to Goljian has heard him say it, but it's actually been studied and proven that if you READ the answer choices first, then the Question stem, you'll do better, on average about 10% increase.

which studies are these -- do you have a citation?
 
The best way is in the test they will give you several answers choices try to select the correct answer the more you have correct the better your score.
 
The best way is in the test they will give you several answers choices try to select the correct answer the more you have correct the better your score.

🙄 Never thought about it that way; truly appreciate your constructive input
 
That's why this is somewhat double sided. So if it's a math question you know you can do, then DO IT, get it done, get the points, and move on. If it's a little ambiguous and may eat more time than is relevant if there's a good chance you won't get it right, then sure, save it for the end...
Very true. When it came to calculations, I usually read the entire question before I made the decision to skip it. If it wasn't obvious, then I'd immediately mark and save for later.
which studies are these -- do you have a citation?
I'd like to know this as well.
 
you know i find this method interesting cause ever since college days we were taught to read the question and then predict the answer before looking at the answer choices.

i'll try this method out on a couple practice exams ...
That's what I do for all the questions. Don't have my marks back but when I do I'll let you know how it worked out for me!
 
Hey, I'm glad he came back here with the honest truth about what his score was, instead of making up a BS score just to show off (as I'm sure others have done). He was trying to help, and maybe someone will find these strategies are useful to them even if they aren't enough on their own to guarantee a good score.
Personally, I feel that sheer luck is a big factor in these exams (like whether you get an exam heavy on topics you're good at or heavy on topics you're terrible at, and how confident/relaxed you are that day, etc.) so I wouldn't judge someone for their score on it. It's a big accomplishment just to get through it. 🙂
 
Hey, I'm glad he came back here with the honest truth about what his score was, instead of making up a BS score just to show off (as I'm sure others have done). He was trying to help, and maybe someone will find these strategies are useful to them even if they aren't enough on their own to guarantee a good score.
Personally, I feel that sheer luck is a big factor in these exams (like whether you get an exam heavy on topics you're good at or heavy on topics you're terrible at, and how confident/relaxed you are that day, etc.) so I wouldn't judge someone for their score on it. It's a big accomplishment just to get through it. 🙂

QFT 👍
 
i agree, it does take a man to own up to his score no matter what it is.
 

I don't know why you're apologizing for that. I take it you guys both did significantly better than me. MOST people did.

If you didn't notice, this thread was named "How to Beat Step 1" which is just what I did. I passed. I didn't name it "How to ACE Step 1."

At any rate, I'm happy to have passed. Most people on this planet don't even come close to the opportunity to take this test, so just being able to qualify is a feat in and of itself. Passing, is another. Being the best, well, I'm not sure what it feels like, but I'm sure it's cool.

My score: 194/79

If you want to critique me, feel free, but do it in another thread, I made this in an attempt to help the folks who aren't quite there. Also, 2 months before I took the test, I took one of the NBME administered exams and got a XXX/57. So, progressing that far with that much improvement, at least from my standpoint, is pretty profound.

Let's keep the tips coming for anyone who hasn't taken the test, that's what this thread is for, not score reporting or personal bashing.
 
Just got my COMLEX, did a bit better than on the USMLE.

I got a 485/81

So, I'm pretty happy with that, more happy w/ that than what I got on the USMLE, even though I felt a lot better coming out of the USMLE than the COMLEX. Oh well, Hope you guys do well, and even though I didn't put a ton of holes in these exams like a typical gunner, i hope you still found some of the advice I gave y'all helpful.

Take care, I don't think I'll be writing much on here anymore. A lot of peeps are makin' me feel like a dick and i doubt anyone wants my advice with these scores...

peace
 
Congrats on your score. Only about 2% of medical students get the kind of scores that are mentioned on here. But yeah, those are usually the students people want to get advice from.

But you shouldn't feel bad! Passing the exams is an accomplishment and should be a celebration. Congrats!
 
Just got my COMLEX, did a bit better than on the USMLE.

I got a 485/81

So, I'm pretty happy with that, more happy w/ that than what I got on the USMLE, even though I felt a lot better coming out of the USMLE than the COMLEX. Oh well, Hope you guys do well, and even though I didn't put a ton of holes in these exams like a typical gunner, i hope you still found some of the advice I gave y'all helpful.

Take care, I don't think I'll be writing much on here anymore. A lot of peeps are makin' me feel like a dick and i doubt anyone wants my advice with these scores...

peace


Hey, don't let them get to you. A lot of people come on to these sites to let out some steam/frustration. So, they happened to take it out on you a bit. It doesn't say anything about the value of the advice that you have given on here. Like others have said, it takes some guts to be honest about your score, especially when it isn't quite as high as you were hoping for. If you find that you gain anything from hanging around on this site, then you should stick around. If not, that's okay too. Good luck!
 
hey cox--congratulationsss:luck:
ur advice are good and practical..if u have scored low it could be luck draw of question set on real exam..dont worry..dont pay much attention on comments..
and here all were participating in giving their tips off,and all are great..
cheers,👍
 
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