May 30, 2008

Question Banks

The most important prep tool to help you with your studying for Step 1 is a good question bank. Initially, it's hard to tell what makes one question bank difficult and obscure and another, representative to the real USMLE yet challenging (read: high yield enough that you will get those 10% off-the-wall questions correct.) That's why you need to do multiple question banks! They used to come in book forms... I acquired a set of these question books from an upperclassman and then I promptly ditched them. The USMLE question and answer format has evolved over the years and your question bank should follow suit.

Here's my breakdown of the different Qbanks.


By far, my favorite qbank. I call it Qworld.

  • It has "world-class" explanations in their tutorial answer choices, making it an extremely good study source.
    To be honest, when I started studying for a new subject, I'd read for half a day and then just sit down and do Qworld in the tutor style. That was all the studying I needed for some subjects! No need to go back to the same old review books and fall asleep reading them if you know enough of it already. It's much better to engage yourself with active learning.
    Just take the time to read all of the answers and take notes directly in First Aid of the material you don't know. I used a fine-point sharpie so these points jump out more.
  • The FRED software format seen on the real NBME is very similar to the Qworld's.
  • The highlighting/greying out function is excellent! Get in the habit of using it as you read through the question. I noticed that when I faded out in blocks 5 and 6, I could still answer the questions because I reflexively highlighted the important facts.
  • You can "mark" questions along the way and test yourself on this material.
  • The Review tab shows your previous tests by Subject matter and Subtopic and Specific topic!
    i.e. Embryology: Cardiology: Tetralogy of Fallot
  • You can also opt to review just the questions you marked, the ones you omitted, the ones you got incorrect or the ones you got correct.
    This makes it very helpful for mentally reciting the correct answers in your head during your second and third review-recall sessions.
  • The only down-side (if it could really be called that) is that there is no way to electronically copy the material. You can't hit "print-screen" or "copy/paste" the text into a picture or document format, for copyright protection purposes.
    If USMLE World provided its tutorial explanations and pictures in a book format, it would surpass Kaplan by far!

By the makers of First Aid!

  • Unfortunately, I don't know much about their question bank.
  • It's the cheapest of all the pay-per-month Qbanks! I was surprised to learn that. I thought Qworld was the cheapest.
  • I was advised to buy Kaplan and USMLE World since I had the softcover book version of First Aid Q&A. I did a few sections of the book and it was decent.
  • Q&A is broken down into subsections (identical to the Subjects in First Aid) with about 25-50 questions per section. Then there are a series of random 50-block questions, for a total of 4 or 5 test blocks.
  • My only regret in taking the exam earlier than my classmates was that I didn't have the time to devote to this test booklet or try out USMLE Rx.
  • If you've used it, let me know in the comment section what you thought about it. :)

Kaplan QBank
This one is interesting. A representative flew in from the mainland to tell us all about the USMLE. I went for the pizza and soda. There's several programs you can sign up for with incremental costs: Qbank, IV QBank, books, lectures, whatever.

  • The books are worthwhile if you don't have any other study material for the subject. I started off using them and soon drifted away as I had a whole set of High-Yields/BRS books to read alongside lecture notes, which sufficed.
  • The lecture series are good if you do them EARLY. Do not wait until your final few weeks to listen to them! I highly recommend the Behavioral Science lectures (the guy is entertaining and memorable) and the Pharmacology lectures.
  • The IV stuff is a waste of time, according to my friends.
  • The only thing you really, absolutely need is QBank. And even there, you run into a few snags.
    Kaplan's Qbank is esoteric at times. It doesn't give you the full stem so you have to rely on the one-fact, one-answer style of recall (IMHO, this is a waste of time!)
    The software is horrible. There is a lot of lag shifting between questions. Sometimes the graphics don't load. The highlighting rarely works, I have to double click or highlight backwards half the time. And then it gets erased or random portions of the answers are highlighted. Oh and most importantly -- you cannot highlight the answers! How are you supposed to review like that?
  • That said, Qbank isn't bad. However, it's not the best. I preferred Qworld because I could see the specific topic of the questions I got wrong when I reviewed (Kaplan just shows the topic header) and it's faster and more reliable.

Wiki Test Prep
The up and coming contender in the question bank world. There are a few gems here -- namely, it's free and you can find out what your score is after each test you take.

  • Since it's a wiki, you have to be somewhat cautious and you shouldn't take the answers (sometimes, even the question) at face value.
  • I'd say the best exercise comes from reading "Tips on Question Writing" and "See Question Template" (under the Question Body subheading.)
    Learn how question stems branch off of basic scenarios into variant physical exam and lab findings.
    Be capable of predicting at least one prompt question in each subject.
    Predict what answers will be provided alongside the real answer: similar names to confuse you? similar etiology? perhaps its the right answer except for that one (or two, or three) lab findings that don't seem to fit?
  • Submit questions! I'm planning on doing that next week as I fire up SuperMemo for my computer and flip through First Aid to recall the questions (and style, mostly) I had on the USMLE Step 1.

Well, hopefully that helps. :)

I'll talk more about mental question formation, subject review and methods for recall in upcoming posts. Stay tuned!

May 29, 2008


The whole reason why I took my USMLE early was to go on a family vacation. My brother graduated from college and he was moving to Boston to pursue a Ph.D in Aeronautical Engineering (so in some ways, it was a "last chance" at a family trip before he got even farther away from Hawaii.) His girlfriend's family organized most of it and we spent the majority of our time at a few national parks: the Grand Canyon, Glen Canyon/Lake Powell and Bryce Canyon. There were a lot of breathtaking vistas, splendid hiking trails, interesting wildlife and great family-family bonding moments.

Now that I've settled in back at home in Hawaii and I still have another month before school starts up again, I find myself almost at a loss for what to do next.

Perhaps I'm not quite capturing the feeling exactly, as there's a lot of things that I want to do. I want to go SCUBA diving, take guitar lessons, learn how to read facial expressions and tell stories, do some ballroom/salsa/tango/swing dancing, relax at the beach, bike, hike and play frisbee more.

Why do I feel aimless?
Why have I spent my third day back in Hawaii sitting around at home watching TV?
Where has my motivation gone?

My list of things to do is a list that I wrote as a "distractor" from med school and if I can be perfectly honest... a lot of it I felt would help me branch out from medicine and ground me better. I might even meet someone nice. I'd like to have an activity partner to call me up and inspire me to go out and do something on a nice and bright shiny day like today.

However, it wasn't until I did some catch-up blog reading and came across R.W.'s note on Cognitive errors in medicine that I realized -- it's hopeless for me.

There's no escaping my enthusiasm for learning about medicine. More than my list of desired hobbies, I found myself getting truly passionate again about academic medicine. It was as if I were denying a part of myself by saying "nope! no medicine for a month, you've had enough of that already" and now that it's back, I feel joy again.

Sure, I'd still like to SCUBA and strum and sing and samba.
I'll also read and blog and celebrate my learning even if my classmates catch me and call me out on it -- "You're on break! get a life!"... this is my life folks!

I feel validated. I feel passionate. I feel... relieved. I hope I can continue feeling this way for the rest of my life.

May 28, 2008

USMLE Experience

A lot has transpired these past few weeks.

I've studied very hard for and I have taken the USMLE Step 1. Contrary to popular belief, it really wasn't that difficult. When compared to the difficult subject matter and questions asked in question banks offered by Kaplan and USMLE World, the USMLE was a cake walk. Sure, there were some obscure things that I didn't know, but I figure that's always the case and I don't beat myself up over it. The real trick in the pursuing the answers in the sample question banks is finding the patterns. Learning WHAT is important -- recognizing it, predicting the answers and selecting the right one and then -- immediately moving on.

One of my classmates was thrilled about finally getting to the good stuff. "This is what the entire first two years of medical school should be like! None of this 'PBL' BS" he exclaimed to me (on multiple, multiple occasions!) By that, he meant something along the lines of: insane study schedules, insular learning (people rarely met in study groups except to 'pimp' each other on random facts, do question after question after question after question....

Yikes! I sometimes felt as though I were half-assing it. I didn't study as hard as some of my dedicated colleagues, as I would wake up around 9am, eat a leisurely breakfast and googleread my blogs, have lunch and stroll into school around 1pm and do questions until I maxed out on my daily learning (my daily max was around 150.) I spent extra time reviewing ALL of my answers, trying to decipher why each answer was selected by the writers and a possibility. Sometimes this schedule would take me to 2am. Sometimes just 7pm and I'd go have dinner with a friend. Regardless, it was a relatively "easy" life of studying, after the rigor of Unit 4 (where I routinely studied until 2am EVERY DAY for four months straight.)

There's two basic methods in approaching the Step 1.
1) Study very hard to memorize facts and vocabulary to the point of reflexive recall between two seemingingly nonsense words i.e. cough=captopril, pigeons=cryptococcus, odds ratio=case control.
2) Love medicine and learn it.

I took the second approach for the most part. Over the past two years, I've spent a lot of my free time acquiring links to different blogs and websites that inform me about medicine. I've shared my silliest mnemonics with my study groups and I've taken extra time to truly learn the learning issues from our paper cases. For a while, I studied for the boards just by reading the old cases and thinking about them. It was a helpful exercise, especially on the physiology heavy subjects like cardiology, pulmonology and nephrology.

I found that I didn't have to learn very much new material during my studying for the boards. Most of it I had already learned along the way in our Problem-Based Learning curriculum.

There's a lot more that I'd like to say, but I would prefer to show examples along the way in an upcoming series of entries. If you want to just get a high-yield version of my message, it's this: make everything relevant to your learning. Engage yourself. Most importantly, learn about learning. The more you understand heuristics, algorithms and cognitive processes, the more powerful your pattern recognition and fact recall will be.

May 05, 2008

Recipes for Harried Students

Too busy to figure out how to eat healthy?

Let the commenters of PurePedantry @ help you come up with some quick and easy recipe ideas to spice up mealtime. :)

May 04, 2008

Ideal Learning

Want to remember everything you learned? Surrender to this algorithm.
I stumbled across this Wired article a few days ago and I was stunned by the concept of the program SuperMemo. SuperMemo = Super Memory (not memorandum)

The concept is simple: make a series of flash cards either with questions or "cloze" statements. The program will randomize them and as you rank them based on a 6 point scale, it will reorganize them to determine (with some magical precision) WHEN you will forget this fact and it will prompt you with the flash card again at the EXACT time when you are about to forget it. Apparently this is the perfect time to relearn a fact and solidify it in your long term memory. In a lot of ways, I have been attempting to mimic this method(poorly) in my board review/study period and I wish that I learned about it earlier. It sounds like an excellent idea, even though the website is totally awful (and I assume the program is equally dense.)

I think that SuperMemo's website is very "90s" and hasn't been updated to a slick Web 2.0 edition because its Polish creator Piotr Wozniak is so focused on using SuperMemo that he puts everything at a lower priority. (The cost of dedicated brillance, I suppose.) I'd be inclined to use SuperMemo right now! if it had a better "how-to" manual, wiki-style.

Although it is too late for me to begin implementing this program for the purposes of board studying, I think I will buy it in June and play around with it to get it working for me for my third year clerkships. I agree with a lot of the fundamental .concepts that Wozniak shares on his website... hopefully I remember to blog about it in the future!

via Lifehacker

A side-liner to this is another program I found recently.

is is an outline note-taking program with a built in wiki-linking system. It can be exported to html for viewing on PDAs or online. However, I don't think it has the ability to allow you to edit the files on the Palm itself.
Dunno if I'm going to implement this system... SuperMemo sounds much more engaging (and more time-consuming.) I'll keep you updated.

May 03, 2008

Touching story: Johnny the Bagger

What is it that you find most striking whenever you meet someone new?

Are you impressed by how intelligent they are?
Do you laugh at their jokes?
Do you enjoy sharing a common interest together?

For me, whenever I meet someone new, I'm struck when they treat me with kindness and respect, sometimes caring enough to really mean it when they inquire with "how are you?"

I find this sort of love and camaderie touches me most... and that's the feeling I got from this clip. Pregnant women over 40 have an increased risk of getting trisomies, which can lead to miscarriages and Down Syndrome. Down syndrome is the most common genetic cause of mental retardation, usually resulting from Trisomy of chromosome 21. Mental retardation is the combined deficit of IQ and daily functioning... which is why Johnny had a job of bagging groceries at a local supermarket.

However, a low IQ has no impact on the "emotional quotient" aka EQ. People with Down syndrome are often very loving and caring individuals. They may be naive with strangers, but their friendliness is endearing. This is the quality that enabled Johnny to touch people when he started thinking of something he could do to "make memories and motivate customers to come back."

I challenge you with this question:
How often do YOU do something simple to make memories with other people?
Yeah. Me too. Thankfully, it's never too late to start. The last time I did something super thoughtful like this was around Christmas time -- I donated $15 in the name of a bunch of my friends at school and I wrote little notes to each of them on a Christmas card. I outlined a characteristic that they possessed which I admired and thanked them for being a part of my life. Kinda cheesy and kinda difficult because I didn't want to rewrite anything for any of them... but I think they liked it. :)

via A Storied Career