Tag: Step one

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How to Prepare for the Comp

Here is how I approached the comp and used it to help prepare me to succeed on step 1 of the USMLE.

 

It’s just a practice test

At the end of the day the comp exam is a practice step 1 exam and nothing more. I took five practice exams when I studied for step 1 and step 2 respectively. These were NBME practice tests and were just like the comp because the comp is a practice exam that is meant to show you were you stand. Sure, it will suck if you have to retake the comp but your end goal is to crush step 1! So don’t worry about passing or failing the comp. In the long run it doesn’t matter if you pass or fail. If you fail, it means that you aren’t ready to take step 1. And hey, I passed the comp on my first try but I certainly wouldn’t say I was ready for step 1. I still required two more months of studying in order to get my scores up.

 

Pass the comp but focus on step 1

Back in my day we had 4 weeks to study for the comp after our fourth semester final. I understand that times have changed but my study strategy should still ring true. My strategy was simple: I wanted to pass the comp so I didn’t have to worry about it after I left the island. However, at the end of the day the comp doesn’t really matter. All that matters is crushing step 1. No residency program will know if you passed or failed your comp exam but they will certainly know what you got on step one.

 

Don’t try and study everything

It doesn’t pay off to try and study everything before you take the comp because there simply isn’t enough time. During my third and fourth semester I was using the Kaplan step one question bank to study for the NBME final exams so I chose to use a Kaplan diagnostic test to see where I stood. Turns out I sucked at everything but there were certain subjects I was particularly bad at. As I suspected, my best subjects were ones that I had just studied for my fourth semester final. Strategically, I chose not to study these subjects and hoped that I would remember them when I took the comp. Instead, I focused on a few organ systems that I was particularly bad at, specifically pulmonology, nephrology, and gastroenterology. I also chose to focus on cardiology because it is the single organ system that takes up the largest composition of questions on step one.

 

Start studying for step one when you start studying for the comp

When I left the island I had already studied four organ systems (the three I sucked at plus cardio). It wasn’t sufficient enough to allow me to skip them during my two months of preparation for step one but it gave me one hell of a head start. Again, it doesn’t matter if you pass the comp or not. Sure it will suck if you have to take it again but you have to keep the long-term goal in mind of not just passing step one but crushing it. Passing step one might get you a residency but killing step one will get you an amazing residency.

 

And do practice questions. Lots of practice questions.

The more practice questions you do the higher you will score. There is simply not way around it. By the time I took step 1 I had completed half of the Kaplan qbank once, all of UWorld, and all of the questions I answered incorrectly in UWorld once which comes to a grand total of 3,000 questions or so. Some people did all of Kaplan, UWorld, and one or two other qbanks but I personally felt like that’s overkill but everyone is different. UWorld should be the minimum though.

Practice questions will not replace your studying but instead should supplement and guide you in which topics you need to study. Practice questions show you your weaknesses and give you topics to go back and study. I suggest one full question set which should take you one hour followed by three hours to review those questions. Then study for four hours in the afternoon after an hour break. Then eat, sleep, repeat!

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Test Taking Strategies: how to maximize your score

Your USMLE step 1 and step 2 scores are the most important pieces of information in your residency application. However, acing your board exams isn’t just about knowing the science but also about having strong test taking skills. At the end of the day, your score is a combination of how smart you are multiplied by how hard you work divided by your test taking skills. Here are my test taking strategies to maximize your score on test day.

 

Find your weaknesses

It’s hard to improve your test taking skills if you don’t know where to start. So do a question set of UWorld or two and while you are reviewing your answers figure out why you got the question wrong in the first place. In my mind, there are two broad categories of why you get questions wrong. The first is that you straight up didn’t know the answer because you didn’t know the science or medicine behind the question at hand. The second category of incorrect answers is due to poor test taking skills.  So if you get a question wrong because you didn’t remember the auto-antibody that correlates with autoimmune hepatitis then don’t stress out about it. Just go study that subject material. However, did you fluster over this answer choice for five minutes? Did you eat up all of your time trying to remember the answer? That’s a test taking strategy and is something you have to work on.

So first, (1) figure out if you got the answer wrong because of a lack of knowledge versus poor test taking skills. Next, (2) continue to jot down the reasons why you got these questions wrong. Eventually, you might (3) find patterns in why you get questions wrong.

 

Recognize patterns concerning why you are getting questions wrong

So at this point you should have completed a few question sets and collected some data concerning why you are getting questions wrong. Maybe you are a great test taker and you just need to study the science a little more. If that’s you then stop reading this blog post and go study! If you’re like me, you might need to make a plan moving forward concerning how to improve your test taking skills. Some reasons why I got questions wrong in the past were because:

  1. I wasted time on ‘easy’ questions and had to rush through questions near the end
  2. I changed my answer choices
  3. I would be thinking about question number 1 while I was reading question number 2
  4. Test taking anxiety
  5. Stupid mistakes

Next, I will go into how I overcame these test taking weaknesses of mine and hopefully you can mimic what I did and overcome your deficiencies.

 

Overcome minor anxiety by simulating test day

A soccer coach I once knew used to hate when we took practice shots from a stand still. He felt that during a game you rarely had the opportunity to take a shot when the ball wasn’t already moving. It didn’t simulate the game realistically. Likewise, you need to prepare for the exam by answering practice questions against the clock. It will simulate the anxiety of test day and, hopefully, make you more comfortable when answering questions in the hot seat. This helped me get over my minor test taking anxiety. Those butterflies in my stomach.

Power poses are also a great subconscious confidence booster. Long story short, if you have positive, confident posture it will translate into a slight increase in real life confidence. That goes for test day too. Check out this TED talk that goes into more depth on the topic.

As an aside, this post is mainly for test taking strategies. Minor tweaks that can improve your score. Which means that if you have severe anxiety to the point where it is truly inhibiting your ability to take tests then please seek professional help. There is no shame in speaking to a psychiatrist about your test taking anxiety and they are much better equipped to help you flourish come test day. Same thing goes for people whose attention span could use a little artificial endurance.

 

Don’t overthink it and stop changing your answer choices

I recently tried this new ice-cream place in Brooklyn called Ample Hills Creamery (if you live in the area you NEED to go there). Looking at the menu I instantly saw the words ‘Salted Crack Caramel’ and knew what I wanted to try. Except then I saw other delicious looking options like ‘The Munchies’ and ‘Mexican Hot Chocolate’ and I started second-guessing myself even though I knew what I wanted to get. Likewise, when it comes to test day don’t overthink your answer choice. If you think you know the answer then click the bubble and move on to the next one. JUST CLICK THE BUBBLE AND MOVE ONE! Your first inclination is often your best guess…especially if you aren’t sure why you think it’s the correct answer choice (sometimes your gut is smarter than you and not just with regards to ice-cream).

UWorld also has a great tool to see where you are making your mistakes. I found that I had a greater number of answers that I changed from correct to incorrect that the other way round. By making a ‘click and move on’ rule I increased the number of questions I got right. It might only get you one or two questions right in each question set but they add up quickly. Especially when step 1 and step 2 are 7 and 8 question sets long respectively.

The only exception to this rule is if I went back to my question and found that I completely missed something. Oh, the patient had a myocardial infarction because he did cocaine! I’m gonna change my answer from beta-blocker to calcium channel blocker. Boom. Science bitch!

 

Once you eliminate the impossible, whatever remains, no matter how improbable, must be the truth

There were a lot of easy questions on step 2. Things that everyone gets right like ‘give IV fluids’ or ‘compare to old chest x-ray’. Then there are the cluster of questions that make me wonder if I forgot everything or if I just straight up never learned it. For example, on step 1 I remember a question on neurofibromatosis type I but I forgot that it is also often called von Recklinghausen Disease. At the time, I wasn’t sure if von Recklinghausen Disease was the same thing as neurofibromatosis type I or not. Instead of ruling IN the correct answer I simply ruled OUT the incorrect ones. With this approach I was left with only one possible answer choice and ended up picking the right one.

Ultimately, this isn’t anything new or groundbreaking that you haven’t heard before but its worth hearing again. When it comes to these standardized tests every question is worth an equal number of points. I hope that these test taking tips will help you get a few more questions right and help bump up your score because every little bit counts. Happy studying!

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How To Pass The Comprehensive Shelf Exam

“I am a third semester student and I would like to ask you for some advice. I am deeply worried about the comprehensive shelf exam pass rate (~ 50%). I do not wish to have to retake it in the US. My goal is to focus on step 1 during that time. I have heard of a few people failing out of Ross because they did not pass COMP the 3 or 4 chances given. I plan on coming back a week early before school starts to start studying for COMP. In addition, is your study habits the same in which you applied for the step exam as well? They make the comp sound impossible…but it has to be possible.”

Short answer: the fact that you are already thinking about your study strategies for the comp exam and step 1 shows me that you will pass.

Long answer: Let’s get down to the dirty details now that I’ve delivered my mandatory inspirational quote for the day. First off, if you haven’t already check out my original post where I describe some general advice on how to pass your comprehensive shelf exam. That post is meant for fourth semester students who just took their final and now have one remaining month to study for the COMP. I know the curriculum has changed at Ross since I left the island and I’m not sure if they still give you one month for the COMP but the basic philosophy I describe should still be applicable.

I don’t know what the COMP passing rate is but even if I had those statistics I would be willing to bet that they would include quite a few confounding variables. Frankly, if you put in the time and effort you should be able to pass the COMP on your first try. The few people I know who failed the COMP failed because they didn’t put in enough effort. They treated the month before the COMP as a mini vacation more than a dedicated study period (see previous blog post above).

When I was on the island I also heard those alleged rumors of students failing the COMP on multiple attempts. They are just rumors. Even if they are true then those students are likely the outliers on the standard bell curve. They are the exception, not the rule. From here on out your mindset is not whether you pass or not. Your new mindset is how well you will do when you pass.

Now everyone is different and every student has his or her own study habits. Personally, when I left the island in between each semester I did zero studying. I may have organized and reprinted some notes but I certainly didn’t study. Let alone come back early to study. So for the sake of sanity do not go back early. That being said, everyone is different and you know yourself better than I do. So if you want to go back early to study then do it! I am simply concerned that you will burn out. Especially since during my fourth semester we had those dreaded eight hour days of lecture three days a week. I don’t know if that has changed or not but an entire semester of medical school is enough of a reason for me not to go back to the island early to study. So, again, if you are the type of person who alleviates their anxiety by studying then by all means go ahead but before you make any rash decisions check out my original post. Specifically the part about recharging your batteries.

Lastly, the study strategies that I employed for the COMP were identical to what I did for step one. A morning question set took me one hour to take and three hours to review. Then a one hour break followed by a four hour block of videos in the afternoon. That was followed up by an evening run on the beach, pick up game of basketball, or lifting session at the gym. Followed by a calm review session of everything I looked over that day after dinner. Then sleep, eat, study, repeat. Sleep, eat, study, repeat.

In the end, your step one score = (how smart you are) x (how hard you work). There is always someone out there who is smarter than you but there is no excuse for there being someone who works harder than you.

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My Three Favorite Study Aids That Every Medical Student Should Have

Besides caffeine, there are three study aids that got me through medical school. These resources speed up the memorization process, enhance your learning for long-term retention, and help you understand the required mountain of material you learn during the first two years of med school. They were my favorite resources to use during the basic science courses and while I studied for step one. The more I found myself using them the more useful they became. As I’ve written about before, don’t half ass anything– and that includes your study aids. So try these out, see if they help you, and then commit to using them. Without further ado, here are my three favorite med school study tools…you know, besides note cards of course:

First Aid for the USMLE Step One

This is every medical student’s bible. If you ask a med student studying for step one, ‘if your house was on fire and you were only allowed to retrieve one item’, their First Aid book would be the answer. If you are about to start med school just go ahead and buy it. This book provides a backbone outline of your medical education and its up to you to fill in the details. You can almost always tell the first semester students apart from the fourth semesters based on how much white space is left on the pages of their First Aid book. Just remember, post-it notes are your friends, don’t use ink that will run, highlight in moderation, write small but legibly, and always double-check to see if the information you are about to scribble in your book isn’t already there.

Picmonic

Imagine that instead of forcing yourself to memorize every bug, drug, syndrome, system, and tumor that you could just watch cartoons and all the information would just magically diffuse into your consciousness. Picmonic is as close at it comes. Instead of just listing information and letting you figure out how to inject the information into your brain, Picmonic provides you with tons of notecard sized cartoon illustrations that tell unique and memorable stories. Each cartoon represents vital information about the subject at hand. With pathognomonic pictures and rhyming raps about almost everything that med students need to memorize and differentiate between, Picmonic makes memorizing the minutia of med school both easy and fun. I seriously would not have made it through med school without it.

*Use my link to get 30% off your Picmonic subscription!*

Pathoma

The only thing worse than not being able to pronounce the diseases you are studying is not being able to understand your professor teaching you. Whether your professor has a thick accent or is just a terrible teacher, Pathoma is the answer to your troubles. It’s the gold standard when it comes to studying pathology. The textbook has clear illustrations and descriptions of every disease process you learn about in the first two years of medical school and the accompanying videos explain the pathophysiology in a clear and concise manner. I honestly don’t know a single med friend of mine who doesn’t use it.

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My Review of Step One Review Courses

The most highly requested topic about studying for step one has easily been which step one review course to use. The problem when giving advice about which course to use it that it is incredibly subjective. Choosing which step one review course to use is like choosing between mac or PC, Xbox or play station, vanilla or chocolate. They’re both good. It just depends which one you have a personal preference towards. Which one best fits your study habits and study style?

I have been exposed to two major step one review courses- Doctors In Training and Becker (formerly Falcon). Although I have watched Kaplan videos during my first two years of medical school I do not know enough about their step one review course to constructively comment on it. I used Becker for the comp but I’m biased towards DIT because I used it for step studying. I like DIT because it consists of multiple online videos that you can watch at your own speed. I needed to be alone so I could discipline myself to focus on subjects that I needed to spend more time on, like HIV pharmacology, while I could fast forward through sections I was more adept in, like anatomy. Becker on the other hand is a live review course that is done in a small group that I knew would be too distracting for me.

DIT also provides students with personalized daily schedules and long-term study calendars. The daily schedule has blocks of time for resources you use like Picmonic, Pathoma, and UWorld whereas the long-term calendar provides you with a week-by-week overview of what you are going to study. For instance, six days of studying and then a practice test. While creating your schedule, DIT also asks about any scheduled holidays or study breaks and etches them into your calendar for you. They take some of the stress out of studying. For instance, I went on a weekend snowboarding trip and had three guilt-free days spent outside of the library on the mountain with nothing but fresh powder and a few shots of tequila (not at the same time of course). To be fair though, after speaking with friends who have completed the Becker review course it seems like Becker also creates a calendar and daily schedule for you too.

Two big differences between Becker and DIT are the cost and the overall style. DIT can be done alone with your review book and an internet connection whereas Becker is an in person review course completed with a small group of students. Financially, Becker is the clear winner for Ross students. Becker offers a free live review course for Ross students. DIT offers a student discount which takes the price to around seven hundred dollars. Now just like your career decisions, you shouldn’t make your choice about which review course to use based solely on the financial aspect. Make sure that whichever review course you choose is the right fit for you and that you mesh well with their overriding philosophy.

Ultimately, both DIT and Becker are great review courses. Friends of mine have done wildly successful with both of them. So don’t stress out about which one is more or less qualified. If you dedicate yourself to studying for step one and don’t cut any corners then there is no reason that either one of these two resources will provide you with the tools necessary to earn above a 240 on step one. At the end of the day your personal preference toward one or the other matters the most. So try out DIT for one day when you are studying for your final this semester and try out Becker for a day when you are studying for the comp. Do your research about the daily and monthly schedule that each one follows, find out which system works best for your specific needs, choose one, and go with it. Happy studying!

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Preface

After passing step one, I’ve decided to write a series of posts that will encompass everything involved in studying for step one of the United States Medical Licensing Exam for fellow Ross University students. During my fourth semester on the island I felt lost in a sea of resources, conflicting study ideologies, and differing mindsets on how to approach studying for the comprehensive shelf exam…let alone the step. Thus, my study timeline that I will describe will begin with passing your fourth semester, studying for the comp, and extend until your step test day. My discussion on how to study for step one will include my guiding philosophy on how to approach studying for the exam, different study strategies, resources, and a few tangential but entertaining topics. My hope is to illuminate shades of confusion that plagued my studies while on the island and give current Ross students a little hindsight to make more informed decisions about their study strategy with even greater confidence.

As always, if you have a specific question or concern that you’d like me to address please post a comment below or hit me up directly on twitter via @MarcKittyKatz. Enjoy!