Studying for Step 1 and 2 when you have ADD/ADHD

[sunseeker2021]

Friends, I really need some advice. Some info about my status so far:

1. I barely passed Comlex Level 1 last summer. Didn't take Step 1, even though I was planning on it. Was going to take it just before 4th year (a year form now) like a classmate of mine did who ended up matching well.

2. I'm currently studying for Level 2 and Step 2. Doing a year of clinical research starting in August, so I can take the Step exams whenever, but will be working 40 hours each week starting next month.

I took my first assessment yesterday (the UWorld assessment) and got a 140. I'm supposed to have studied all summer, but have had a lot of distractions (life stuff involving finances, mostly). Now that the distracting issues have been dealt with, I'm struggling to focus during these long, uninterrupted study marathons. I had some stamina while studying for COMLEX, but I'm so burned out from third year (did fine on my shelf exams) and ready to not be in school that it's felt near impossible to buckle down and cram facts into my head. This all sounds like whining, but it's created a huge mental block and I've hit a low point. Stalling out now when I need to move forward!

Also finding out now that my working memory is terrible when it comes to reading these long passages. COMLEX stems are a bit shorter and more memorization-based so I can handle them better. USMLE stems are long and contain a ton of numbers. My brain works much better with stories, not numbers and details. By the time I get to the end of the question, I've forgotten all the facts listed in the beginning of the question. Obviously these numbers are details are of crucial importance in medicine, and you have to have a firm grasp on them during these board exams to do well.

If you could PM me with your story of how you overcome poor working memory issues and tamed your ADD/ADHD tendencies for this test, I would love to hear it. Open to any and all feedback. Thank you so much for your help.

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[The_Sunny_Doc]

Is there any way you can get a comprehensive psychiatric evaluation for ADHD use that for accommodations on the USMLE? Sorry to hear that you are struggling. Hopefully there are other med students with ADD who have successfully taken the boards who can help.

 

[hardpecs]

You'll just have to find strategies to overcome it, frankly. I have a short attention span, and find one of the best ways to control it is NOT to engage my brain on another activity.

Say im going over renal, and either I get bored or it gets too much. I stare at a wall and/or pace in a circle until im ready to go again. The problem with going on facebook or watching a video "just for a minute" is it completely takes me out of the mind frame of studying, and its hard to pick up the same momentum. Hope that helps in some way.

 

[USMLE_Pro]

I work with a lot of students with ADHD; adding frequent short breaks into one's study schedule is often helpful. It can definitely be overcome to do well on Step 1, as others have said.

 

[MedSchoolGurus]

Friends, I really need some advice. Some info about my status so far:

1. I barely passed Comlex Level 1 last summer. Didn't take Step 1, even though I was planning on it. Was going to take it just before 4th year (a year form now) like a classmate of mine did who ended up matching well.

2. I'm currently studying for Level 2 and Step 2. Doing a year of clinical research starting in August, so I can take the Step exams whenever, but will be working 40 hours each week starting next month.

I took my first assessment yesterday (the UWorld assessment) and got a 140. I'm supposed to have studied all summer, but have had a lot of distractions (life stuff involving finances, mostly). Now that the distracting issues have been dealt with, I'm struggling to focus during these long, uninterrupted study marathons. I had some stamina while studying for COMLEX, but I'm so burned out from third year (did fine on my shelf exams) and ready to not be in school that it's felt near impossible to buckle down and cram facts into my head. This all sounds like whining, but it's created a huge mental block and I've hit a low point. Stalling out now when I need to move forward!

Also finding out now that my working memory is terrible when it comes to reading these long passages. COMLEX stems are a bit shorter and more memorization-based so I can handle them better. USMLE stems are long and contain a ton of numbers. My brain works much better with stories, not numbers and details. By the time I get to the end of the question, I've forgotten all the facts listed in the beginning of the question. Obviously these numbers are details are of crucial importance in medicine, and you have to have a firm grasp on them during these board exams to do well.

If you could PM me with your story of how you overcome poor working memory issues and tamed your ADD/ADHD tendencies for this test, I would love to hear it. Open to any and all feedback. Thank you so much for your help.

Sorry you're having trouble. As a USMLE tutor, I recommend improving your test taking strategy and being rigid with how you plan and manage your time by following the following advice.


Regarding test taking strategy:

Try to develop a systematic approach to each question. Read. Every. Word. Especially in the first sentence. Synthesize EACH sentence after you read it. Deliberately pause to think.

Learn to distinguish between essential and non-essential information.

Understand that all vignettes are reverse-engineered with an important testable-concept in mind. Ask yourself "What is the key concept examiner they're trying to get at here?".

Don't look at the answer choices until you have given yourself an opportunity to synthesize the vignette and establish a hypothesis or differential diagnosis.

Understand that 90% of the time, you have already have been taught everything you need to know to answer any question correctly. Therefore, focus on what you know and understand as opposed to that which do not remember or are uncertain of or do not understand. Think through the set of important concepts you have previously been tested on in the context of your USMLE exam preparation and ask yourself "which answer is most consistent with a key concept I've already been tested on". Select a single best answer most consistent with your hypothesis or differential diagnosis.

Use process of elimination as each incorrect answer is incorrect along at least single dimension of information. E.g., if a 50 year old smoker with COPD post op day 1 status post knee replacement patient has sudden onset dyspnea, COPD exacerbation is less likely as COPD exacerbations are not sudden in onset.

Think about how you thought about questions you got incorrect. What went wrong in your mind? Did you have a lapse of attention? Were you distracted by an irrelevant detail? Did you fail to identify which information was essential? Did you not carefully read the first sentence? The list goes on. The point is, if you think about how you think, and identify where you went wrong, you'll hopefully improve your thinking. Understand that you are able to improve your thinking. You can change and improve!

Do not read the question before reading the stem. I.e., you should read the first sentence first. Given what you said, you'll forget the question and will just reread it.



Regarding study strategy...


Use SMART goals!

SMART goals, ones that are Specific, Measurable, Attainable, Relevant, and Time-constrained.

A SMART short term goal during a preclinical pathology course would be "This week, I want to watch the Pathoma videos for pumlonary, do all 150 pulmonary pathology USMLE Rx questions at a rate of 22 questions per day, make or unsuspend the all the Anki cards in my Anki Deck covering the facts I learned, and do all my Anki reviews every day."


A SMART short term Step 1 goal during a dedicated study period would be "This week, I want to do watch all the Pathoma pulmonary and GI videos, do 60 UWorld pulmonary and GI questions every day, make or unsuspend the all the Anki cards in my Anki Deck covering the facts I learned, and score above 230 on my practice test on Sunday".


Use a daily checklist

Each day take time to make a checklist of the things you want to get done that will help you achieve your long and short term goals.
A checklist usually includes: do X number of Anki reviews, watch/review Y resource, do Z new Anki cards, and do T number of multiple choice questions.

For each item on the checklist, put a check box and a conservative estimate on the amount of time required to complete each item.


Use a daily schedule

In your calendar, block out the times you are unavailable to study. Block out a half hour for getting ready in the morning and evening, and a half hour for lunch and dinner, and an hour to to whatever you like. Fill the remaining time with your checklist items, sprinkling a couple 10 minute study breaks.


Use the pomodoro technique to be productive during scheduled study blocks

The pomodoro technique is the use of a repeating timer for to go off at regular intervals, usually a 25 minute "on period" followed by a 5 minute break. Set goals for each pomodoro period. E.g., "I want to get 50 Anki cards done per pomodoro". I prefer using a 10-15 minute pomodoro with 2-3 minute breaks.
Google "online pomodoro timer". I recommend using the app 30/30 or the app repeat timer which are a bit more customizable.


Use a countdown calendar for your long term deadlines and goals

I recommend using a countdown calendar to see how many days remaining until your Shelf exams, Step 1, Step 2 CK, exams, and your medical school graduation. The day remaining numbers will help you calculate things like the number of questions to get done each day.


Use downtime to accomplish your tasks

Your phone is a key study resource. Do Anki or question bank questions during mandatory low yield lectures. Listen to Goljan and OnlineMedEd respectively for preclinical and clinical years during your commutes, doing chores, running errands.

I hope you find this helpful!

 

[sunseeker2021]

Sorry you're having trouble. I recommend improving your test taking strategy and being rigid with how you plan and manage your time by following the following advice.


Regarding test taking strategy:

Try to develop a systematic approach to each question. Read. Every. Word. Especially in the first sentence. Synthesize EACH sentence after you read it. Deliberately pause to think.

Learn to distinguish between essential and non-essential information.

Understand that all vignettes are reverse-engineered with an important testable-concept in mind. Ask yourself "What is the key concept examiner they're trying to get at here?".

Don't look at the answer choices until you have given yourself an opportunity to synthesize the vignette and establish a hypothesis or differential diagnosis.

Understand that 90% of the time, you have already have been taught everything you need to know to answer any question correctly. Therefore, focus on what you know and understand as opposed to that which do not remember or are uncertain of or do not understand. Think through the set of important concepts you have previously been tested on in the context of your USMLE exam preparation and ask yourself "which answer is most consistent with a key concept I've already been tested on". Select a single best answer most consistent with your hypothesis or differential diagnosis.

Use process of elimination as each incorrect answer is incorrect along at least single dimension of information. E.g., if a 50 year old smoker with COPD post op day 1 status post knee replacement patient has sudden onset dyspnea, COPD exacerbation is less likely as COPD exacerbations are not sudden in onset.

Think about how you thought about questions you got incorrect. What went wrong in your mind? Did you have a lapse of attention? Were you distracted by an irrelevant detail? Did you fail to identify which information was essential? Did you not carefully read the first sentence? The list goes on. The point is, if you think about how you think, and identify where you went wrong, you'll hopefully improve your thinking. Understand that you are able to improve your thinking. You can change and improve!

Do not read the question before reading the stem. I.e., you should read the first sentence first. Given what you said, you'll forget the question and will just reread it.



Regarding study strategy...


Use SMART goals!

SMART goals, ones that are Specific, Measurable, Attainable, Relevant, and Time-constrained.

A SMART short term goal during a preclinical pathology course would be "This week, I want to watch the Pathoma videos for pumlonary, do all 150 pulmonary pathology USMLE Rx questions at a rate of 22 questions per day, make or unsuspend the all the Anki cards in my Anki Deck covering the facts I learned, and do all my Anki reviews every day."


A SMART short term Step 1 goal during a dedicated study period would be "This week, I want to do watch all the Pathoma pulmonary and GI videos, do 60 UWorld pulmonary and GI questions every day, make or unsuspend the all the Anki cards in my Anki Deck covering the facts I learned, and score above 230 on my practice test on Sunday".


Use a daily checklist

Each day take time to make a checklist of the things you want to get done that will help you achieve your long and short term goals.
A checklist usually includes: do X number of Anki reviews, watch/review Y resource, do Z new Anki cards, and do T number of multiple choice questions.

For each item on the checklist, put a check box and a conservative estimate on the amount of time required to complete each item.


Use a daily schedule

In your calendar, block out the times you are unavailable to study. Block out a half hour for getting ready in the morning and evening, and a half hour for lunch and dinner, and an hour to to whatever you like. Fill the remaining time with your checklist items, sprinkling a couple 10 minute study breaks.


Use the pomodoro technique to be productive during scheduled study blocks

The pomodoro technique is the use of a repeating timer for to go off at regular intervals, usually a 25 minute "on period" followed by a 5 minute break. Set goals for each pomodoro period. E.g., "I want to get 50 Anki cards done per pomodoro". I prefer using a 10-15 minute pomodoro with 2-3 minute breaks.
Google "online pomodoro timer". I recommend using the app 30/30 or the app repeat timer which are a bit more customizable.


Use a countdown calendar for your long term deadlines and goals

I recommend using a countdown calendar to see how many days remaining until your Shelf exams, Step 1, Step 2 CK, exams, and your medical school graduation. The day remaining numbers will help you calculate things like the number of questions to get done each day.


Use downtime to accomplish your tasks

Your phone is a key study resource. Do Anki or question bank questions during mandatory low yield lectures. Listen to Goljan and OnlineMedEd respectively for preclinical and clinical years during your commutes, doing chores, running errands.

I hope you find this helpful!

This post is full of so much good information. Thank you for taking the time to write it out! I really really appreciate it. Will let you know how some of these tips work out.

 

[MedSchoolGurus]

This post is full of so much good information. Thank you for taking the time to write it out! I really really appreciate it. Will let you know how some of these tips work out.

I'm glad you found this info helpful!

 

[TheIllusionist]

Ritalin

 

[MedSchoolGurus]

This post is full of so much good information. Thank you for taking the time to write it out! I really really appreciate it. Will let you know how some of these tips work out.

Did you see any improvement?

 

[novgoober11]

i'm late posting on here but to wrote this up anyways in case it can help someone out

I have adhd and i'm in med school, and tackling step 1, and here are my tips:

1. the pomodoro method has been great.. experiment with the intervals that work best for you (start with your phone and use the timer to count up in order to determine how long it takes until you lose your focus ... do this a few times and take an average to make it a little more accurate--> start with that... the shorter that time ends up being, the shorter you should set your break... over time you can improve as well - to give you a sense, when i started I had my study intervals set to 17 min with 3 min breaks)... these intervals makes studying feel more like a sport and helps keep you interested. for the short break, totally fine to reward yourself with a short youtube video or something, as long as you trust yourself to get back to work when the timer goes off. I personally have trouble using my short breaks for that, but what i do is get up and walk a lap around the library or something. basically, find ways to make studying feel like a game ... for the long breaks, if you think it will help you, change tables!

2. my second piece of advice is do NOT stay the same task for longer than 2-3 hours... especially if it's something that you know you have a tough time with... seriously. i know task shifting can be a mission sometimes and it can also be hard to stay on top of how much time you're spending on something, but remember, you have the timer to help you!! Just as an example, when I first started studying for step 1 I'd start my day with reading first aid... but after 5-10 pages i started lagging, slowing down, having difficulty focusing, and wasted a lot of time (sometimes hours to be honest) getting frustrated... but the mistake I made was continuing to "read first aid" until I finished the chapter... I have to trick myself into finishing things haha so try this --> every 2-3 rounds, just stop where you are and change tasks... do a couple rounds of FA... then use a round to do 5 UW questions... then a round of anki... you will be SOOO much more productive, you'll stay engaged, and it will start to feel more like a game which will help keep you in line. Keep in mind that the problem with adhd is not intelligence, but boredom. when you get bored (sometimes without even realizing how much time you're wasting due to being bored) you waste time... losing that time has an adverse effect on your performance. it is NOT a reflection of your capability or ability to learn. you just need to find a way to manipulate your brain into cooperating. So keep your brain on its toes and keep it stimulated by running through your tasks as if it were a circuit. i can assure you that your productivity will increase.

3. don't compare yourself to your peers. going back to my first aid reading example, I had classmates that just tore through 40 pages of first aid, cranked out 80 uworld questions and anki , and called it quits like 10 hours later... when i tried to do it the same way i was just setting myself up to fall short and then feel like I was destined for failure because i knew i couldn't keep up (you then run the risk of giving up on yourself, which is not what anybody with adhd deserves)... SO... i figured out how to get the same amount of work done, but realized that I have to do it differently... basically, if you measure your productivity against people that don't have adhd, and on top of that, you try to approach your work the same way, and even worse, then compare yourself, it's a perfect recipe for feeling like pure crap. so DON'T do that. just don't haha. try some of these little brain hacks and strategies, be really accepting of the difference in approach that you may need to adopt, and don't question yourself about it. you can definitely perform as well, learn as much, be as productive, and get some good scores...you'll just approach it from a different angle.

4. don't completely resist your unanticipated moments of hyperfocus. the strategies mentioned already work well when you have to crank out the tasks that bore you, but people with adhd have a tendency to hyperfocus like crazy when they run into something they actually like. if you happen to be studying something that day and you find yourself completely tuned in without even meaning to be or expecting it - aka really damn focused, interested, and working straight through your timer on something related to your exam or task - my friend just ride the wave.

5. don't expect yourself to be able to focus for that full hour during blocks if you're prepping for a board exam. edit - more like don't be too hard on yourself if you do find that you start having trouble...seriously. I personally can't even on timed/ simulated tests... sometimes i'll be fine, but other blocks are so damn brutal ...have like a little action plan or routine to prophylactically address this in your back pocket... so what i do is every 10-15 questions or so, I just stop and take like a 10-second break in the middle of the block. another less common thing I do is if i hit a question that's just not jiving with me (e.g. tried to read it a couple times and i'm still not focused on it), just skip it and come back (i can guarantee that when you come back to read it you'll have no trouble..) if you let yourself do this, it might help. and regarding the 10 second ish break, even with doing this, ultimately you end up saving time because you're more in control of when that break happens + they give you smaller goals to aim for while you're trapped in a block for an hour or however long they are on that exam

6. when you start reading each question, read the first couple words introducing the case very SLOWLY.... basically, you're getting a mental grip on the fact that you're shifting to a new question and scenario. i used to go to the next question and attempt to carry on reading at a normal speed, only to realize that mid vignette that i had no clue what I read. you end up rereading the sentences over and over, start feeling all frantic, and lose more time/ get nowhere... 3 minutes later you finally comprehend what's going on and it's some easy gimme question... take a timed block and where this could potentially happen a couple times and you screw yourself in terms of time... so take one step back to take 2 steps forward and just start slow from the beginning until you feel yourself gaining a handle on the next question. seriously read like a snail and imagine the person being described... e.g. "a 3-year old boy present with"... straight up imagine a 3 year old boy... or "a 61-year old man (imagine the man) comes to the ED (picture the guy walking into the ED) with crushing substernal chest pain etc etc " ... by now you'll be focused on and you can gradually pick up speed. And honestly, adhd aside, this help your grasp the gist of what's going on in a very deliberate way if that makes sense... you can confidently get through questions feeling more secure that you didnt miss something.

good luck