mellantro said:
How does a person do well on these exams? I do well during the clerkship but then I do below the class average on the shelf. I did fine on Step 1 (235+) so I'm not that bad at test taking.
I just get to the exam and panic. And my grade goes from pretty good since I had gotten good evals to just satisfactory/pass becus of the shelf.
any tips on how to study?
I had the same problem last year. Studied really hard for the surgery shelf, bombed it (70-something). Changed the way I studied and then did well from then on (84-98).
In short, know one good book really well, do quality questions, and learn from your patients (flesh out their diseases... just because your patient doesn't manifest symptoms/signs, learn every aspect of their disease).
1. Limit yourself to one good source, and know it well. Almost every rotation has at least one book that people consistently recommend. Instead of reading NMS, First Aid, and Blueprints, focus on knowing that one good book inside and out. I read a bunch of different surgery texts (Lawrence, occassionally NMS and Recall) and just got confused. From then on I mastered one text per subject.
2. Study consistently. Some rotations are more time intensive than others. It'll be tough on surgery and the such, but read a little every day. Memory, like working out your body, tends to improve if you do a little per day rather than a glut toward the end. There's just too much to know.
3. Broad knowledge base. It's all well and good to know about your patients, their diseases, etc. But you're not going to see everything in a couple of months. Some key concepts and pathologies you'll only see in a book or an exam during your clerkship. I've never seen a myocardial infarction in progress or an active asthma exacerbation. Those things are still essential to know for an internal med exam. That's why you should read the one good book thoroughly.
4. Questions/scenarios. Do as many questions as you can the last two weeks or so of your rotation. If you take quizzes or have lecture, maybe do them before those as well. There's a few things I found that were consistently strong sources. Kaplan Q-Book, Step 2 Secrets ,Blueprints Q&A (not the texts) had high quality questions. Pretest (except for Peds) and A&L were generally abysmal. MKSAP is great for Medicine. For scenarios, Case Files is a safe bet.
5. Do learn from new patients. When I took Step 2, there were questions I knew only because I saw them in real life. That said, during third year, a lot of patients I had on the floor for a few days had had their acute problem solved. They remained due to social issues, too low/high INR, spiking a temp, etc. You usually don't learn much after the initial workup and treatment. If your team gets a new patient, pay attention. If you're rounding on that one guy who still has ileus or can't get into rehab, zzz....
6. Go home. I never heard a resident say they didn't work enough, but I heard several wish they had more time to read. As a matter of principle, I never asked to go home, but don't look twice once someone suggests it. Very rarely are they tricking you. The only reason to stay is to see/do something cool. You can help your patient... but it's usually something menial that's going to be managed without difficulty. Go home and rest! You're
paying them to LEARN to be a better doctor.
