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Making Your Step 1 Review Effective

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1 Making Your Step 1 Review Effective
January 14th, 2015 Scott Robertson Regional Medical Programs Director

2 “We estimate that we will see domestic production of medical school graduates functionally surpass our current number of GME postgraduate year one pipeline positions by 2015 or sooner.” Source: Dr. Thomas Nasco, CEO of the Association Council for Graduate Medical education 41 52.5 78 225 765 2015 Source: New England Journal Of Medicine (http://www.nejm.org/doi/full/ /NEJMhpr )

3 Program Decision Making
Specialty Mean US Med scores (2009) Matched Years of residency Mean hrs/ week Schedule type Salary range Family Medicine 213 (214) 3 52.5 Uncontrollable $175k-$220k Psychiatry 214 (216) 4 48 Controllable $173k-$248k ObGyn 220 (219) 61 $251k-$326k Pediatrics 221 (219) 54 $160k- $228k Emergency Medicine 223 (222) 46 $239k-$316k Anesthesiology 226 (224) $331k-$423k General Surgery 227 (224) 5 60 $284k- $383k Neurology 225 (225) 55 $408k (median) Internal Medicine 226 (225) 57 $184k- $231k Pathology 226 (227) 45 $239k- $331k Transitional Year n/a (236) 1 - Orthopedics 240 (238) 58 $397k-$600k Diagnostic Radiology $377k-$478k Neurosurgery 239 (239) 6 $287k- $637k Otolaryngology 243 (240) 53.5 $245k (median) Dermatology 244 (242) $313k-$480k Plastic Surgery 249 (245) $275k-$499k Another reason why your USMLE score is important is because many of you won’t discover your real passion until clerkship, which is after you have taken the Step 1 exam. So lets take a look at some specialty data….. You can see your salary range, Your mean hrs of work per week and years of residency What I want to look at now is the Mean Us Med score that matched in So going back to my earlier point that you won’t discover your real passion until clerkship, lets say right now you are dead set on a specialty in Pediatrics. You love kids, you have nieces and nephews and cousins they smell good an make you feel warm and fuzzy inside when they sing the Smurf song. You have done your home work and you know that the match score for Pediatrics in 2011 was a (221). You know that the overall U.S Senior score that matched in 2011 was Your goal is to achieve a 225. After your clerkship you have now decided that you no longer like kids and you don’t want to have any of your own any more. But you really enjoyed your time in Plastic Surgery and General Surgery, you have a new found love of having surgical knife in your hand. Your 225 may not get you into those specialties. You want to obtain the highest score possible to ensure you have the opportunity to choose the specialty you want to make a difference in and not have your score choose for you. I know it’s a lot to think about. I’m going to now tell you that you can and will succeed. It will take hard work and planning. So I want to try and change how you view the USMLE Step 1 Exam. It is no longer your first 2 years of medical school condensed into 322 questions over 7 hours of testing period. If you look at it this way, it can be overwhelming and seem like you just have to give it your best shot and what happens. It is an important exam and the great news is that you can conquer it. Instead I want you to envision the Step 1 exam as a Big Pink Elephant, wearing a poka dot bikini. For you visual learners I’ll help you out. [Click Slide]

4 Program Decision Making
Specialty Mean US Med scores (2009) Matched Years of residency Mean hrs/ week Schedule type Salary range Family Medicine 213 (214) 3 52.5 Uncontrollable $175k-$220k Psychiatry 214 (216) 4 48 Controllable $173k-$248k ObGyn 220 (219) 61 $251k-$326k Pediatrics 221 (219) 54 $160k- $228k Emergency Medicine 223 (222) 46 $239k-$316k Anesthesiology 226 (224) $331k-$423k General Surgery 227 (224) 5 60 $284k- $383k Neurology 225 (225) 55 $408k (median) Internal Medicine 226 (225) 57 $184k- $231k Pathology 226 (227) 45 $239k- $331k Transitional Year n/a (236) 1 - Orthopedics 240 (238) 58 $397k-$600k Diagnostic Radiology $377k-$478k Neurosurgery 239 (239) 6 $287k- $637k Otolaryngology 243 (240) 53.5 $245k (median) Dermatology 244 (242) $313k-$480k Plastic Surgery 249 (245) $275k-$499k Another reason why your USMLE score is important is because many of you won’t discover your real passion until clerkship, which is after you have taken the Step 1 exam. So lets take a look at some specialty data….. You can see your salary range, Your mean hrs of work per week and years of residency What I want to look at now is the Mean Us Med score that matched in So going back to my earlier point that you won’t discover your real passion until clerkship, lets say right now you are dead set on a specialty in Pediatrics. You love kids, you have nieces and nephews and cousins they smell good an make you feel warm and fuzzy inside when they sing the Smurf song. You have done your home work and you know that the match score for Pediatrics in 2011 was a (221). You know that the overall U.S Senior score that matched in 2011 was Your goal is to achieve a 225. After your clerkship you have now decided that you no longer like kids and you don’t want to have any of your own any more. But you really enjoyed your time in Plastic Surgery and General Surgery, you have a new found love of having surgical knife in your hand. Your 225 may not get you into those specialties. You want to obtain the highest score possible to ensure you have the opportunity to choose the specialty you want to make a difference in and not have your score choose for you. I know it’s a lot to think about. I’m going to now tell you that you can and will succeed. It will take hard work and planning. So I want to try and change how you view the USMLE Step 1 Exam. It is no longer your first 2 years of medical school condensed into 322 questions over 7 hours of testing period. If you look at it this way, it can be overwhelming and seem like you just have to give it your best shot and what happens. It is an important exam and the great news is that you can conquer it. Instead I want you to envision the Step 1 exam as a Big Pink Elephant, wearing a poka dot bikini. For you visual learners I’ll help you out. [Click Slide]

5 This is the average number of years you’ll be spending practicing in the specialty you Match to, a little over two years from now. A lot of factors influence what specialty you match to, but your Step 1 score is one of the biggest factors.

6 NRMP Program Director Survey Results (2014) Percentage of Programs Citing Each Factor in Selecting Applicants to Interview Source: 2014: NRMP Program Director Survey Results (2014). National Resident Matching Program. p. 3

7 First Step: Understand what you need to know and do in order to solve USMLE questions

8 Step 1 Evolution Single Jump, 1980’s
Which of the following is the drug of choice for a patient diagnosed with oral thrush? A. Amphotericin B B. Fluconazole C. Griseofulvin D. Ketoconazole E. Nystatin

9 Step 1 Evolution Double Jump, 1990’s
A 28-year-old HIV-positive man complains to his physician of a recurrent whitish film that seems to grow on his tongue and oral mucosa. A germ tube test is positive. Which of the following is the drug of choice for this patient? A. Amphotericin B B. Fluconazole C. Griseofulvin D. Ketoconazole E. Nystatin

10 Step 1 Evolution (Triple Jump, today)
1. What is the diagnosis (based on a clinical scenario and laboratory interpretation)? Oral thrush 2. What is the drug of choice? Nystatin 3. What is the mechanism of action of nystatin? It complexes with ergosterol and causes membrane leakage. [ANSWER B] By the way, this is also an example of a visual question, of which there are more and more on the USMLE. (Visual questions may include Diagrams, CT scans, Path slides, Tables, etc.) Multimedia questions have recently been added (a total of 5 per exam, so not extremely worrisome). Such questions will link to an audio or video clips, such as a heart sound or lung sound, or a video of patient exhibiting cogwheel rigidity. Examples of these clips are on USMLE’s website. Kaplan’s Qbank also features a small number of A/V questions for practice [coming Fall 08.] So the moral of these three slides is that you may have a good handle on certain basic science information (i.e., what drug is used to treat oral thrush); but the format of the exam questions as they are currently written require you to integrate your knowledge among various disciplines to solve a clinical vignette. Multiple conclusions must be drawn, and a misdrawn conclusion anywhere along your chain of logic will result in an incorrect answer. Note that the majority of questions on the exam are double and triple jump questions. Incorrect answer choices are known as “distracters” and are there for those that misread one or more key elements in the question. Answer = B

11 Step 1 Evolution (Triple Jump, today)
A 72-year-old woman is brought to her physician by her husband. He states that she is having trouble recognizing her grandchildren, and is having increasing difficulties in the planning and executing her daily activities. Furthermore, she is having a more difficult time recalling the names of common objects. He states that he often finds her wandering around the house with an “absent” look on her face. Which of the following structures is most likely affected in this patient? A B C D E F A 72-year-old woman is brought to her physician by her husband. He states that she is having trouble recognizing her grandchildren, and is having increasing difficulties in the planning and executing her daily activities. Furthermore, she is having a more difficult time recalling the names of common objects. He states that he often finds her wandering around the house with an “absent” look on her face. Which of the following structures is most likely affected in this patient? A B C D E F

12 Using my Kaplan Step 1 Qbank and other programs EFFECTIVELY!!
Effective Prep Establish a S.M.A.R.T plan Spaced Repetition Active Learning Question Practice For Effective Prep you have to establish a S.M.A.R.T plan: A SMART plan is: Specific – Measurable – Attainable – Realistic – Timely Know the Who, What, Where, When, Which and Why of your plan. Proper study breaks, proper nutrition and yes Proper sleeping habits Spaced repetition – learning small pieces of information over longer periods of time. Active Learning - Putting into practice what you just learned. Put it in your own words. Question Practice – Use exam like questions Using my Kaplan Step 1 Qbank and other programs EFFECTIVELY!!

13 “We estimate that we will see domestic production of medical school graduates functionally surpass our current number of GME postgraduate year one pipeline positions by 2015 or sooner.” Source: Dr. Thomas Nasco, CEO of the Association Council for Graduate Medical education 41 52.5 78 225 765 2015 Source: New England Journal Of Medicine (http://www.nejm.org/doi/full/ /NEJMhpr )

14 To excel on (not simply “pass”) your exam…
Set up a strategic study plan and stick to it Anticipate that questions can present the basic clinical sciences in a different format than you are typically used to seeing Review the material in ways that mimic current question demands Study actively, not passively Build in tactics to minimize forgetting key information Focus on understanding, not just memorizing Know the USMLE testing software by appropriate use of Kaplan diagnostic, Qbank, and sim exams

15 NRMP Program Director Survey Results (2014) Percentage of Programs Citing Each Factor in Selecting Applicants to Interview Source: 2014: NRMP Program Director Survey Results (2014). National Resident Matching Program. p. 3

16 Getting Started… or Planning Ahead…

17 Speak the Language: Build your test question vocabulary
Glossary of Terms Frequently Used in Test Questions Term Definition Abolish To do away with, to eliminate Absolute value The distance from zero, disregarding + or - sign Abundant Plentiful, numerous Account for Explain, justify Acquire Get, obtain, gain Acrid A sharp taste or smell Adjacent Near or next to Aggravate Irritate, make worse Alter Change, modify Amenable Changeable, yielding, pliant Amplify Enlarge, make bigger Apparent Visible, evident Arrest To stop, check or hold Attenuate To weaken or reduce in force or amount Attributable to Result from, be caused by Bear To support, hold up, endure, show or exhibit some feature Causative agent Cause Cessation Discontinue, end Cloying A too sweet smell or taste Coalesce To grow together, combine as one thing Comprise To include or contain Concomitant To accompany or occur at the same time, along with Concurrent Same as concomitant, but associated with time Confer To give

18 “We estimate that we will see domestic production of medical school graduates functionally surpass our current number of GME postgraduate year one pipeline positions by 2015 or sooner.” Source: Dr. Thomas Nasco, CEO of the Association Council for Graduate Medical education 41 52.5 78 225 765 2015 Source: New England Journal Of Medicine (http://www.nejm.org/doi/full/ /NEJMhpr )

19 5 + 1 common EARLY preparation mistakes
1. PASSIVE studying – wholly focused on content review or video review or curriculum notes review… 2. Insufficient or INAPPROPRIATE practice with questions MEMORIZING content, but not understanding MISREADING, misinterpreting questions DEVELOPING inappropriate test day strategies INSUFFICIENT exam-like question practice

20 NRMP Program Director Survey Results (2014) Percentage of Programs Citing Each Factor in Selecting Applicants to Interview Source: 2014: NRMP Program Director Survey Results (2014). National Resident Matching Program. p. 3

21 The ACTIVE study cycle for all subjects…
Analyze Remediate Self Test

22 Review Actively…from the start!
Make summary notes of key aspects Color code to cluster and highlight similarities/exceptions Use diagrams and charts to summarize key data Do questions before and after reviewing Know “most commons” and “hot topics” Change study modes frequently to refocus your attention Use Qbank properly Work with a question partner Consider other Kaplan online resources to offer a fresh view of Step 1 topics you find difficult

23 “We estimate that we will see domestic production of medical school graduates functionally surpass our current number of GME postgraduate year one pipeline positions by 2015 or sooner.” Source: Dr. Thomas Nasco, CEO of the Association Council for Graduate Medical education 41 52.5 78 225 765 2015 Source: New England Journal Of Medicine (http://www.nejm.org/doi/full/ /NEJMhpr )

24 Use Your Qbank Properly
Begin using timed mode as soon as possible Cover answer choices initially to focus on question stem information Look at why, not just what you missed when testing Look for patterns among your errors, then adjust study to minimize these errors View questions as a guide to what content to focus on and how to store the material in memory for easier application to questions Avoid thinking of practice test scores as a judgment on your intelligence Keep mixing in items on content reviewed previously to better retain and to adjust to random nature of real exam

25 NRMP Program Director Survey Results (2014) Percentage of Programs Citing Each Factor in Selecting Applicants to Interview Source: 2014: NRMP Program Director Survey Results (2014). National Resident Matching Program. p. 3

26 Try Question Partnering
An activity that can help you identify habits that are costing you points on exams A nice change of pace from solo reviewing An opportunity to learn new approaches to solving questions A chance to provide these same benefits to your partner An ACTIVE learning technique!!

27 “We estimate that we will see domestic production of medical school graduates functionally surpass our current number of GME postgraduate year one pipeline positions by 2015 or sooner.” Source: Dr. Thomas Nasco, CEO of the Association Council for Graduate Medical education 41 52.5 78 225 765 2015 Source: New England Journal Of Medicine (http://www.nejm.org/doi/full/ /NEJMhpr )

28 How many questions is “enough?”
Too many too soon wastes questions and may reinforce incorrect beliefs about the depth / difficulty of the Step 1 subject material Too few too late will not adequately prepare you for test day – cramming suppresses learning!! Sources: Kaplan Step 1 High Yield, Step 1 Qbank, Step 1 sims (2), a 2nd Step 1 Qbank (min. 1 month)

29 NRMP Program Director Survey Results (2014) Percentage of Programs Citing Each Factor in Selecting Applicants to Interview Source: 2014: NRMP Program Director Survey Results (2014). National Resident Matching Program. p. 3

30 Create an Effective Study Plan
Get organized TODAY!!! Note important spring school dates and deadlines Schedule review tasks around those dates Self-assess TODAY!! Hard to know where you need to go until you first know where you are starting from! Online Kaplan Diagnostic is your answer!! DO IT – NOW!! Integrate use of study resources TODAY!! Print materials like the First Aid pages Online resources like Qbank, NBME assessments Interactive resources, e.g. classmates, med advisors

31 “We estimate that we will see domestic production of medical school graduates functionally surpass our current number of GME postgraduate year one pipeline positions by 2015 or sooner.” Source: Dr. Thomas Nasco, CEO of the Association Council for Graduate Medical education 41 52.5 78 225 765 2015 Source: New England Journal Of Medicine (http://www.nejm.org/doi/full/ /NEJMhpr )

32 Using Extra / Vacation Time
Link review of 1st year content to topics of current course lectures, such as systemic Pathology Use extra / vacation time to review 1st year content that doesn’t easily link to current classes WHAT?!?! Begin using USMLE-style questions at exam pace ASAP Note problem topics revealed by testing for extra attention once 2nd year classes end Where will you go for fresh questions for use in final prep period -> Kaplan Sim exams!!

33 NRMP Program Director Survey Results (2014) Percentage of Programs Citing Each Factor in Selecting Applicants to Interview Source: 2014: NRMP Program Director Survey Results (2014). National Resident Matching Program. p. 3

34 Organize Yourself After 2nd Year Classes End

35 First 2/3 of remaining time:
1. Take first overall assessment early (Kaplan sim #1), rank order subjects by test results! 2. Complete planned review of all Step 1 subjects! 3. Final subject content review occurs in weakest to strongest order! Final 1/3 of remaining time: 1. Cycles of practice testing --- identify weak spots - review these again to refresh + clarify! 2. Refresh highest yield topics + rote during final 2 weeks! 3. Take final overall assessment (Kaplan sim #2); plan last week of review! No study the final afternoon and evening before exam day!!! Allow for final assimilation and accommodation processes!

36 “We estimate that we will see domestic production of medical school graduates functionally surpass our current number of GME postgraduate year one pipeline positions by 2015 or sooner.” Source: Dr. Thomas Nasco, CEO of the Association Council for Graduate Medical education 41 52.5 78 225 765 2015 Source: New England Journal Of Medicine (http://www.nejm.org/doi/full/ /NEJMhpr )

37 Final Review - KEY POINTS
Self-assess comprehensively (sim #1) approximately 1 month to six weeks before exam date Allocate final # days to spend per topic based on sim #1 results, as shown below Take simulated exam #2 approximately 7 to 10 days before exam date; review completely for final most challenging study review Optional: take NBME self-assessment ($50 – 4-hour exam) Assessment Scores Study Sequence # FINAL Study Days Anatomy 70% 7 2 Physiology 45% 1 5 Biochemistry 60% 6 3 Behavioral Science 75% 8 Pathology 50% Microbiology Immunology Pharmacology 55% 4 Plan your last month of review carefully—this is CRUNCH TIME: Your last month of study will go by very quickly, and it’s going to be challenging. This is now the time to re-assess your performance with a diagnostic or simulated exam, and how many days you’ll allocate to each subject Use your assessment results to guide how you’ll allocate your time. Ideally the sim exam should be taken 7 days prior to test day, allocating 1 day for taking the exam under test-like conditions and 1 day for reviewing the exam.

38 NRMP Program Director Survey Results (2014) Percentage of Programs Citing Each Factor in Selecting Applicants to Interview Source: 2014: NRMP Program Director Survey Results (2014). National Resident Matching Program. p. 3

39 Plan Your CURRENT & LAST Month Carefully
Questions* should drive you BACK to study SPECIFICS! Content Questions T o t a l S t u d y T i m e EXAM DAY During your last month, it’s important to remember the proper relationship between content review and question review. After your self assessment it’s time to review content, using questions to help you narrow down remaining weaknesses so that you can continually narrow your focus on the subjects needing further study. Topical Question Review Test Simulation *Questions do not TEACH…they “TEST!” Always remember that!...

40 Questions* should drive you BACK to study MORE!
*Questions do not TEACH…they “TEST!” Always remember that!...

41 “Whether you believe you can, or you can’t, you're right.” Henry Ford

42 “We estimate that we will see domestic production of medical school graduates functionally surpass our current number of GME postgraduate year one pipeline positions by 2015 or sooner.” Source: Dr. Thomas Nasco, CEO of the Association Council for Graduate Medical education 41 52.5 78 225 765 2015 Source: New England Journal Of Medicine (http://www.nejm.org/doi/full/ /NEJMhpr )

43 NRMP Program Director Survey Results (2014) Percentage of Programs Citing Each Factor in Selecting Applicants to Interview Source: 2014: NRMP Program Director Survey Results (2014). National Resident Matching Program. p. 3

44 Thank you for your attention today! What are your questions?
Scott Robertson Regional Medical Programs Manager


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