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It's not the "What" It's the "Why"
by Maruthas 01-02-2010, 05:25 PM

I've taken USMLE Step 1 recently and I wanted to write about a different side to the exam.

I felt the exam was very clinical. It is 100% American - Female with Cancers, Old, Obese, High Cholesterol, High Fat diets, Smoking, Lack of exercise = 100% on the exam. It's AMERICA...think why would I see an American patient? Understand the "what" in questioning from the biochemical to the gross of every major US MCC of death and MCC disease "X" found in America population (including RECENT immigrants).

The exam had some tough questions. However if you spent time on the UW or Kaplan qbank (I did both of them) then you realize that the questions are in fact very similar except that UW is much more difficult in concept which is great because you are learning while doing questions not testing...
Kaplan Qbank brought me back to reality and out of the fetal position in the corner after UW questions, which I feel is needed. I did a few NBMEs so it wouldn't be too new or scary.

I am an IMG at a small Carib school, and it wasn't too bad at all.

The questions are not "what" questions.
They are "why" questions, which is more important to me that my doctor thinks "why" and not "what" because it is impossible to memorize everything, but thinking "why" will never cease in learning. Its your parietal lobes not the hippocampus doing the work in "why" questions, Honestly.

Please read the websites on one's exams and follow the status on ones biggest exam. If its the most important thing, one should be responsible and show disregards of the "I don't have time" speech. Especially before going all mob like scared and confused wrapped up in a shower curtain with a bucket on your head running down the street.

Going to the websites one would know that the NBME is trying to incorporate Step 1 and Step 2 together, IT IS going to happen folks, Now something as big as say THE USMLE, one would like to collect data over a period of time blindly to the subjects and never report the data results to the subjects, thus being able to turn questions on a dimmer switch (weighted grade assuming this is how it is graded) vs an on - off switch in questions without the subjects ever knowing they are being tested on the throw away questions! So what does that mean? If I know that my test takers are trying to incorporate step 1 and step 2 (more clinical), I should prepare for battle by at least reviewing some clinical findings (UW has a ton of these questions) in the top ten of diseases in all organs, it takes about another 20 minutes per system of time. Now it would stand to reason that the really clinical question in STEP 1 (how does one judge this is beyond all me) it is safe to assume on the side of statistics that this question probably is going to be thrown out.

Thus everyone should calm down, take the time to read the websites and follow what is going on. The audio's were ridiculous but there was only maybe 4 out of 336. Yep 4 out of 336. I am not going to cry over that. Why would I? I focus on the "why" in the question.

UW questions: read the website! -they say students that use their question banks score higher than average. I believe namely that one can say average being 220 SD 20 = UW scores for greater than 50% are from 200-240. If you read the research on NBME and apply it to UW stats which they are using. This is simple math.

UW qbank scores are 50-60% for first time! 60-70% second time, So what does that mean? - first time stay above 55% (on random 48 ?s) REVIEW REVIEW REVIEW, RETAKE THE the qbank exams you made. Don't click on the answer because you memorized. Read the entire questions with the answer you know to be 100% true (you just did it!) find out in the question WHY would you pick the answer by reciting the answer to yourself as you read the question take the next 4 or whatever question's wrong answers and read the vignette and figure out WHY you WOULDN'T YOU pick this answer that you know is 100% to be wrong. THIS BUILDS CONFIDENCE IN YOUR THINKING PROCESS = a HIGH STEP ONE SCORE. It takes time and it sucks but it pays off, because understanding why, you don't have to know the material you just know that these 4 answers are dead wrong and this last one here letter E is the only way physiologically that makes sense in any question.

I reviewed my NBME and studied the questions I got wrong, looked up the answers and tried to UNDERSTAND WHY the test writer wrote like this. this was the biggest gold nugget. Don't disregard though about knowing the "what's" though, It is medicine. Its not the for the weak, It shouldn't be. You have to be confident in your answers be confident in yourself even before stepping into the patients room or in the test room. Believe...even if you are scoring something that you don't like, find your weakness, fix them, understanding your weakness is crucial because after the step 1 I can say I knew my weaknesses two weeks prior before the exam and their they were right on the exam right there to haunt me, but I felt I prepared for these weaknesses, I accepted that my weakness will be on the exam and not be in denial and think they wont be on there, ALL my weaknesses will be on there. Almost all were. Denial is not the same thing as confidence in yourself.

First Aid, Goljan Rapid Review Path and Clinical Lab, and Questions are all you need for this exam. But use everything you personally love. Understand the "why" in the question when you review them.

On practice exams:
SLOW DOWN on DOING QUESTIONS at first, Do 5-10 questions a day at first read all the multiple answers, understand WHY you DO and why YOU DON'T pick one of the 5 answers. 10 Questions review all 5 possibles answers = 50 total possible questions.

Develop this thinking pattern. I KNOW it SUCKS, its ANNOYING..
It's SLOW...but it is so worth it, I can not tell you enough. Thanks to a Path II teacher, THANK YOU teaching ME THIS! Understanding how to read charts and graphs too for every disease that has one in FA =100% chance you have one on the exam so do it!

Good luck Good luck God bless those taking the exam. Have a little faith in yourself.

Good luck to all those taking it.

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Old 12-02-2014
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Posts: 292
Threads: 5
Such a helpful post! So true, the test is more clinical these days.
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