Test Guide: Explained, Approach, and Question Advice
Why Board Exams Matter Board exams aren’t necessarily a bad thing. In fact, they can be quite helpful. They force you to learn information you probably should learn but don’t want to. Studying in immense detail feels painful; you forget most of it after the test is over. What you must realize, however, is due to that focus and attention certain things become implicit. What color is the sky? What’s 2+2? They’re implicit in your being. When you read “hepatic dysfunction” We bet a list of things leap into your thoughts. When starting med school, it’s likely you didn’t even know what hepatic meant. Later in life, when you encounter these things again you’ll think, “Oh ya, I remember this,” as opposed to, “So umm, this is new.” It’ll pay off when there’s more nodding, less head scratching in your life. They’re good for another reason; they force you to think. Remember two things: 1) there are no curveballs on the step 2 and 2) in order to answer the hinge question you first must know what’s going on in the vignette and make a diagnosis. These tests are created to force you to learn all the illness scripts for the diseases we know about. You must learn the pathology, presentation, diagnosis, and treatment of disease – effectively the “management” of disease. If you can take these multiple choice tests effectively, you can practice medicine effectively. At the very least you’ll have learned the illness scripts for the way diseases are supposed to present. If you find something different from ordinary, you’ll be able to identify the uncommon presentation of a common disease, or the common presentation of something uncommon. Those are called write-ups; you get to go to a conference or get published when they’re encountered. While studying for your test remember what it’s about. Yes, it’s about getting a high score to help get into residency. Yes, it’s about identifying buzz-phrases to get the answer right. But, it’s also about learning how to take care of real people. You’re learning the illness scripts and management of disease that you’ll use for the rest of your life. It’s what separates a doctor from all others. It doesn’t matter the specialty – this is the foundation for the rest of your life. It’s what you just have to know to practice effectively. Then you specialize. You go to residency to make the scripts more robust for the diseases you’ll care for. In the back of your mind, however, you’ll always have an innate sense of whether something is right or not. With this skill, one day you might just save a life. We hope you find the following information helpful. Whether you use OnlineMedEd or not, we want you to succeed. We’ll give you the roadmap to success. This is a playbook. But remember, greatness comes from within. We can show you the way but it’s up to you to make it happen. - Dustyn and Jamie OnlineMedEd
Test Guide: Explained, Approach, and Question Advice
Phases of Preparation - Phase 1: Learning The learning phase is about establishing and building new knowledge in your memory. Even if you’ve encountered the information before, you presume it’s not ready to be stored or accessed appropriately. The focus is on the promotion of understanding and retention of what you need to learn. To do so, you must engage the content in different learning modalities simultaneously. Visual, auditory, reading, and kinesthetic learning strategies must synergize to maximize potential. Repetition is key. You begin with no knowledge. You learn. Then you reach the point where you can synthesize new knowledge based on what’s already been accumulated. We’re talking high order educational theory here; let’s make it more concrete. 1. Read: The notes cover the reading learning modality. They prime you for the video and allow for repetition. 2. Watch: The videos cover the auditory and visual learning modalities. They allow you to pause, speed up, rewind, and rewatch while you take/compare notes (the kinesthetic learning). 3. Solidify: The questions take what you’ve learned and push you to the next level. You read vignettes related to what you’ve learned and are forced to make decisions about patients you haven’t seen, or answer situations you hadn’t considered. The learning phase is our focus and lasts all year, but we’ve crafted some shorter interval ideas for the great push (see end).
Phase 2: Taper As an athlete must taper before a big race, so must the medical student taper their training for the big test. With about 1-2 weeks left in your studying, it becomes time to stop learning and start simulating. In this time window you want to experience the test: what it’ll look and feel like. It’s essential to know when you’ll get antsy, when you need a break, and how long those breaks will be. Each day should be another 7 block exam. Feel how grueling test day will be. Any new knowledge accumulated during this period will replace knowledge you already had somewhere else. 1. Get up at the same time each day, just as you would on test day 2. Eat the same meals you would each day, just as you would on test day 3. Questions: get UWorld. They simulate the software of the test flawlessly. You’ve used our questions up during the learning phase, right? ;) 4. Turn off tutor mode 5. Turn on timed test mode
Phase 3: Rest The taper period ends three days before the test. You’ll burn out if you keep the grueling pace up to it. Like the sprinter before the race, do nothing the two or three days before the test. Meditate, go to the gym, and sleep in. Go on a date, pet your dog - do whatever helps you relax. You need to be well rested. Come test day, you want to be fresh and ready to race.
Test Guide: Explained, Approach, and Question Advice
Beating Questions Questions are for one purpose - beating the tests. Whether good or bad that’s the game we must play. Train the right way by learning the rules to beat them. Let’s get our high score and move on with our lives. Here are the rules to the game. The test writers start with an educational objective. That’s the clinical question being asked. “Diagnosing Multiple Myeloma,” or, “treatment for a CHF exacerbation.” Then they pick a right answer. They affix the appropriate question to that right answer. Usually this is done in the way of, “what is the best next step in management?” Then they write wrong answers, called distractors. A good distractor is one that COULD be right given the right situation. That is to say, if the writer adjusted the vignette in some small way, the wrong answer could become right. It can also be something that sounds attractive to someone who hasn’t really studied a topic, but rather is using loose word association. From there, they write the vignette. Within it, the vignette contains the diagnosis. You must first make the diagnosis before you can answer the question. The question is called the hinge. You answer the clinical vignette by determining either the diagnosis or by figuring out where in the diagnostic pathway you are, then you answer the question loosely related to whatever you’ve diagnosed. Due to time and space restrictions board exam questions can’t be infinitely long. Generally speaking, that means if they tell you something is there it’s probably useful in making the diagnosis. But here’s what’s great: if they tell you something is absent then that is most certainly crucial to the vignette. After all, they don’t have space to say all the negatives – if they take the time to say it you can bet it’s relevant. So when doing questions it’s not just about, “getting the answer right,” or, “reading the explanations.” Training for the test is about figuring out how the test writers think. You should at least think about how you would rewrite the vignette to make each of the other answers right. In doing so, you engage the content in greater detail and consider more possibilities from that one vignette. No. No one who writes for the tests also writes review questions. No. You won’t see a question word for word in a review material and on a test. Yes. Training for test day will let you perform well when you get there; you’ll pass the test.
Test Guide: Explained, Approach, and Question Advice
Resources 1. Review Book: This is what you carry around. It’s meant to be glanced at; it’s for recall and recognition. The book isn’t about learning – use it to preview the content. It won’t make sense, but you’ll prime the brain for the critical information. It can also be used to review the content. Then, it’ll all make sense; you’ll build crucial associations by reengaging the material. This is what the QUICKTABLES (July) are for. First Aid, Step Up, etc also work. 2. Reading Book: This is to be fully consumed. It’s short enough that you can actually get through it, but longer than the review book. It’s usually written in complete sentences. You’ll retain only a little of this information (research shows about 20%), but it’s just one modality. This is what the NOTES are for. ACP essentials for medicine is another example 3. Reference Book: This is the one you’ll rarely look at; it sits on your shelf. Its utility is for when you have to do an oral presentation or really want to know EVERYTHING about a topic. It’s Harrison’s, Cecil’s, and UpToDate. We DON’T recommend using one of these books to prepare for usual clerkship material. Don’t buy it yet - most schools offer an electronic version for free through the library. 4. Qbank: The Qbank acts not just as another modality for repetition of information, but it trains you. At the end of every block there’s a test; it makes sense to train for it. A sprinter can run all year and have the endurance, but they must also practice technique to win. Reading and watching videos doesn’t cut it - you have to practice. Answer explanations also provide a second pass of the content in a different context. We have a QBANK for this purpose. If you’ve done ours already, UWorld is a solid alternative. 5. Lectures: Humans are audiovisual; 30% of the brain is dedicated to sight and sound. Hearing knowledge delivered: the tone of voice, rhythm, pace, etc is another way to solidify information. These take the longest because you have to wait for us to speak. But, that’s why we made them electronic; you control the pace and time (+ YouTube lets you control speed). BE CAREFUL. Lectures can be detrimental. If you have superfluous information (a 150 slide PowerPoint), it goes too long (an “hour lunch lecture”), or the speaker is boring you won’t learn anything. We’ve consciously built the lectures to make them meaningful, useful for knowledge and retention, and not terribly boring. More importantly, the information’s been parsed down to what you need to know – not the information a grey beard thinks is important. The VIDEOS are free. 6. Flash cards: All learning strategies stress the importance of repetition. How you approach it is up to you: any of the above can do it. But, if you’ve learned and understood the material it might just take some quick repetition of trigger words and buzz-phrases to make it stick. That’s where FLASH CARDS (July) are useful. We’ve created targeted cards for every topic on the site. Firecracker is another popular option. At OnlineMedEd we’ve used these concepts to create resources with purposeful precision. Read the notes to introduce topics. Then watch the video; the audiovisual cues will further embed the knowledge you just read. Consolidate it with questions; apply your learning to a test scenario and get real exam training. Drill it in with repetition via the Quicktables and flash cards. Learn to recognize trigger words and buzz phrases likely to appear on the tests.
Test Guide: Explained, Approach, and Question Advice
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Study Plans
Study Plan #1 Once-A-Day, Year-Long (Our Vision): Assumptions we made: 1. 2. 3. 4. 5. 6.
Medicine is 3 months Surgery is 2 months Ob / Gyn is 2 months Pediatrics is 2 months Neurology is 1 month Psychiatry is 1 month With these assumptions, the course was designed to have roughly 210 total videos. Taking the annual approach you’ll easily be able to get through every lecture if you just do one a day. Each topic has a video, notes, Qbank and a corresponding section in the QuickTables (coming in July).
The idea is that you’ll: 1. Prime: Read the notes 2. Reinforce: Watch the video 3. Practice: Do the Qbank …………….. 4. Repetition: Read the QuickTables (July) once a week, Flashback Flash Cards (July) every day. Here’s the rationale: By reading, listening/watching, then practicing you take maximum advantage of understanding and retention. The question answer explanations provide feedback and let you know whether or not you need to go back over the material. We could put this into fancy schmancy educational words, but the point is you have to learn the content (read, watch) then follow it up from a perspective you haven’t seen yet (the questions). Everyone knows repetition is essential to hold onto what you’ve learned. That’s what the QuickTables and flash cards (coming in July) are for. Buzzwords, memory queues, and word association; it builds the necessary synaptic connections needed to really solidify the information. The only time this gets a little hairy is in Internal Medicine. It’s a HUGE topic. If you have a 2 month rotation you have to selectively choose what to learn and leave off, or double-up the effort.
Study Plans
Study Plan #2: Step Prep - After OnlineMedEd This plan is for someone who used us through the entire year. You watched every video, read every note, and did our questions to prepare for shelves. You’re already armed with the knowledge needed. It may not be apparent, but it’s there. Let’s make you into a powerhouse. There are two ways to do this: 1. Thanks OnlineMeded, but peace. Get a review book like First Aid, Step Up, Master the Boards and grab a UWorld sub (our competitors). Never look at our content again; the foundation’s been built. You might look at your notes from your time with us, but since you crushed the shelves using our course already, you’ve gotten what you needed from us. We recommend 2-4weeks of UWorld, a read or two through a review book, and then take the test. 2. Remind me what’s in my head OnlineMeded. Watch every video again; do it at 1.5-2x speed (right corner, click gear). DON’T TAKE NOTES. Just watch the videos again. Read through the QuickTables. Assure you get through them twice. Grab UWorld and do it on timed mode Or, if you never used our Qbank, get training. Practice! Why are you telling me to buy UWorld? Why don’t you do it better than they do? UWorld doesn’t have good questions. Their answer explanations are often weak and have some crap article to, “cite evidence.” They often mold their questions (test the same thing 5 different ways) so they appear to have, “so many questions.” But what they do REALLY WELL is give you the feel for the test on test day; their software is nearly identical to the way the real thing looks and functions. We purposely didn’t do that – we use the questions as an advanced education principle to solidify the knowledge you learn from us. But UWorld is great study fodder. If you’ve already gone through our material there’s little utility in doing it again. It will certainly help, but if you’re pushing to score really high you should grab UWorld.
Study Plans
Study Plan #3: Step Prep, Augmentation = 250+ This plan assumes you didn’t use our program during your clerkship. Instead, you’re here to use it for the first time to study for the step 2. It doesn’t matter what you’ve done so far in your training; follow this plan and we’ll get you through all the material. Most people won’t use this plan. If you think you will, please read through the ENTIRE plan before committing. Step prep can be grueling. YOU have to decide how much effort you’re willing to put in, your daily limits, and how long it’ll take to get through everything. People who can sustain a grueling pace (12 hours a day, 6 days a week) can do it all in 6-8 weeks. People who can sustain a normal pace (8 hours a day, 5-6 days a week) can do it in 8-12 weeks. By the way, this is why our Step Prep option is 3 months. This strategy is about augmentation. When you get the standard review book and Qbank you’re getting the core information; what’s almost guaranteed to be on the test. It’s essential to know as everyone else is getting the same thing – they’re using one review book and a Qbank. It’s a great way to pass/get average, but to get into the 240s and higher you need to be learning what others aren’t. The problem is you might not see some of these things you learn in augmentation. In fact, you likely have to learn 10 for every 1 you’ll actually see on the test. At OnlineMedEd we teach you the core and augmentation content. Again, augmentation isn’t for everyone. You can’t score a 250+ If you don’t have the desire, commitment, and dedication to excel. More importantly, if you don’t need to, don’t waste your time with this course for step prep. Time and money are finite resources – save them. But, if you’re the type of person who wants to excel, be the best, and score the highest, do this. It’ll work. It’s complex, but we’ll get you through it. We also include some sample schedules for you to follow. And if you need a helping hand, we’re available via email.
1. 2. 3. 4. 5.
We’re going to start you in the learning phase. Your resources are: The notes The video lectures The Qbank QuickTables (coming in July) Flashback Flash Cards Engage each topic, one at a time. Read the notes. Watch the video. Do the questions. The Qbank here isn’t to practice USMLE style testing (you are, but that isn’t the point). This takes you from an introduction to the memory cues of the video to the solidification and synthesis of that knowledge in the Qbank. You’ll also notice the Qbank is harder than the video initially lets on; that’s intentional.
Study Plans
Study Plan #3: Step Prep, Augmentation = 250+ (cont) We didn’t design this to make you feel good or pat you on the back when you get a question right. It’s meant to be hard, to teach you as much as possible. Anything you learn, any question you get wrong (or even right), should go into the white space (the margins) of the QuickTables. You’ll review the QuickTables weekly for repetition. And, because we know you need forced repetition at ~48 hours for maximium retention, the Flashback Flash Cards will prompt you two days after a lesson is completed. In all reality, any single topic will take, on average, 2 hours to get through for a normal student. Some sections might go faster, others slower. There are ~200 topics, which means you can expect 400 hours of training. Do the read-watch-questions routine Monday through Friday. On Saturday you’ll read through QuickTables cover to cover. Don’t engage or ponder – just read it. You’ll do this twice a month. Like a sprinter preparing for a race, you need a rest day – one a week. You won’t succeed if you over-train so please take a day to decompress. If you insist on working every day, space your read through the QuickTables over two days. After 8-10 weeks of learning your brain will be swollen with information. The taper should occur about two weeks prior to test day. When it begins you should not acquire new knowledge. From here on it’s about practicing for the test. See Phase 2 Taper on page 2. Some rules here: 1. DON’T READ EXPLANATIONS 2. DON’T USE TUTOR MODE 3. DO 7 (SEVEN) BLOCKS OF 44 TIMED QUESTIONS EVERY DAY Everyone else says I should read all the answer explanations in UWorld. Why don’t you advise that? If you’re doing UWorld as your only source of studying you should read their answer explanations. Many people don’t care about Step 2 so they do as a little as possible to get through it. This is foolish, of course, because Step 3 is just more Step 2. If you don’t really learn it now you’ll be playing catchup for Step 3. Not good. But if that’s the study strategy they’ve chosen, they should be reading the answer explanations. This strategy condenses the time needed to commit substantially. It essentially has you trying to taper and learn at the same time. It may work for some, but for most it will yield an average score at best. So truly, UWorld is meant for preparing for game day. Get the look and feel of the test. It’s the best simulator of the real deal. On test day, you CAN’T check your answers or look at explanations. You CAN’T stop whenever you want. So even though the option’s there, don’t do it during your training. Train for how it’ll be. This is why students are often confused by predicrted vs real score: Uworld only predicts your score if you treat it like the actual test. Timed test mode, not tutor. Seven blocks of 44 questions every day.
Study Plans
Study Plan 4: Step Prep, First Time Here (6 weeks or less) DISCLAIMER: We’ve set up OnlineMedEd to be a comprehensive curriculum that takes advantage of multiple educational modalities. We feel there just isn’t enough time to do the full course in this amount of time. That said, a nice thing about this platform is versatility. There are elements you can use to make an effective strategy, even if you don’t use everything we’ve got to offer. In this scenario you don’t have time for separate learning and taper phases; you’ll be doing both simultaneously. Resources: 1. A Review Book: QuickTables (July), Step Up, First Aid 2. A Qbank: Qbank or UWorld 3. Something Else: the Videos or the Notes or another review book from #1 What to do: 1. Read. Over the course of the month, you will read through the Review book twice. You have 4 weeks to do so. Just read through it. Twice. 2. Questions. Do the Qbank. Make it random (not by subject). Do it UNtimed and ON tutor mode. You’ll get some training in board-style questions, but most of your learning will come from the answer explanations. 3. Take your own notes from the Qbank into your review book. On your first pass, you won’t have many notes. On your second pass, you’ll have many. 4. Augment your studying by using either the notes or the videos to explain what isn’t clear to you. We want you doing well on the test. IF that means you get Uworld and Step Up, so be it. We’re always here with free videos if you need something explained. If going this route, just be sure you have a rigid plan for your test prep and stick to it. The one way you can be hurt in a
