HOW TO PREPARE FOR THE MEDICAL BOARDS

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Contents

Disclaimer...................................................................viDedication...................................................................viiAcknowledgments..............................................................xPreface......................................................................xiIntroduction.................................................................xiii1. USMLE and COMLEX..........................................................12. What is First Aid for the USMLE Step 1?...................................53. USMLEWorld and Kaplan Question Banks......................................74. How to use First Aid for the USMLE Step 1 effectively.....................115. The integration...........................................................206. Studying Practice Questions...............................................337. Studying for the Boards...................................................378. Preparing for the test....................................................439. Time Schedule for COMLEX and USMLE........................................4510. Student concerns.........................................................5411. Advice for osteopathic students..........................................6012. Summary chapter for Board review.........................................67Surviving medical school.....................................................72Resources....................................................................83Authors......................................................................89

Chapter One

Before we begin discussing the USMLE Step 1and COMLEX Level 1 examinations, let us focus on the main themes we want you to understand before reading this book. At no point during medical school should you ignore your coursework and core requirements for the sake of studying for the Boards!

1. Know that studying for your coursework is studying for the Boards. The associate dean for academic affairs and professor of obstetrics and gynecology at UMDNJ School of Osteopathic Medicine, Dr. Paul M. Krueger, DO, always says, "Data clearly showed that how you perform in your schoolwork is the number one indicator of how you perform on your Board exams."

2. You cannot graduate if you fail your coursework, so it is vital that you spend most of your time ensuring that you pass every class and all exams.

The USMLE and COMLEX Exams

USMLE stands for the United States Medical Licensing Exam, which every allopathic medical student in the United States must take in order to be licensed to practice medicine. International students who wish to practice medicine must take this exam too. The passing score for USMLE is 189/75. While no one actually knows what the highest score for USMLE is, students have scored above 260/99 on the actual exam. Check the link for more details: http://www.usmle.org/Scores_Transcripts/minimum_passing.html

COMLEX is the Comprehensive Osteopathic Medical Licensing Exam, required for DOs. Please be aware that COMLEX is not equivalent to the USMLE. These exams are different. DO students are allowed to sit for the USMLE exam if they wish to. The passing score for COMLEX-USA is 400/75. The highest score you can attain is 999/99. Check the link for more details: http://www.nbome.org/score-interpretation.asp

There are three parts to COMLEX and USMLE: Levels 1, 2, and 3 for the COMLEX and Steps 1, 2 and 3 for the USMLE. Every osteopathic medical student must pass all three levels of the COMLEX exam, and every allopathic medical student must pass all three levels of the USMLE exam.

So which of these exams is the most important and why? Many medical students will tell you how extremely important your Step 1 scores are. They are right, in a sense. There is a reason why every medical student focuses so much emphasis on USMLE Step 1 and COMLEX Level 1. Not only is it important for your residency application! These are licensing exams required for you to 1) graduate from medical school, 2) be able to practice medicine in the United States.

In the United States, medical school is a four-year program that includes first two years of basic and clinical sciences and two years of clinical rotations. The basic sciences taught in the first year include clinical biochemistry, anatomy and physiology, histology, embryology, preventive medicine, biostatistics, epidemiology, microbiology, osteopathic manipulative medicine (OMM, which only applies to DOs), et cetera.

The second year of medical school focuses on clinical medicine, pathology, pharmacology, immunology, geriatrics, pediatrics, psychiatry, and OMM (for DO students). After completing the second year, you must take your boards. This is very important. This is Step 1.

The third and fourth years of medical school involves students rotating in the hospital. This is the time when students get the opportunity to meet and interact with patients; they learn to take histories and perform proper physical exams.After the third year or at the beginning of fourth year, you must take COMLEX Level 2 and/or USMLE Step 2.

Then it is time to apply for residency. Remember when you had to prepare for your MCAT, get good scores, and apply to medical schools? At this point, you are back at the same portal, which leads to a different route. Applications for residency can be very stressful for students, for various reasons. This is the time of your life where you have to make major decisions on what career path you want to embark on in medicine. You have completed all the clinical rotations,but sometimes you are still unsure which area of medicine in which you want to practice. This is normal: many students face this dilemma. You will eventually figure out what your passion is!

However, it's important to obtain a good residency position. What are the requirements to get in? Residency directors focus on several factors when you apply to their residency programs. Most medical students assume our Step 1 scores are the most important factor that will get us a residency. This idea is not the complete truth. Your Step 1 score is only one part of the application process. Other requirements, such as clinical rotation grades, your personal statement, letters of recommendation, Step 2 scores, research and publications, and the interview process all factor into the equation. Therefore, do not rely solely on your Step 1 scores as the key to get you into residency.

Getting to know the right people is another important piece of the puzzle. If you rotate at a hospital as a fourth-year medical student and work very hard, becoming a solid team member, you can make a strong impression on the attending physician, which might encourage the staff to consider you for a spot in their program. Therefore, the impression you make on your attending physician may allow you to be recognized as a great asset to their program. So is it all your scores? No! Is all about who you know? No! It is a combination of everything. Your entire application counts. Do not ever give up your dreams for whatever specialty you are interested in because of your scores!

However, Step 1 scores do have a strong influence when you apply to highly competitive residencies. Thousands of medical students are competing for the small pool of available spots. The exam scores start to matter. Although a solid Step 1 score is not the only thing you need to get into a good residency, it will get you to the door. For example, student A scores 245/99 on his USMLE or 700/96 on COMLEX, while student B scores 205/82 (USMLE) or 500/82 (COMLEX). If they both want to do plastic surgery, who do you think might get an interview first? The one with the higher score is most likely to get an interview, especially for highly competitive programs that lay more emphasis on Step 1 scores. Irrespective of what specialty you are interested in, you should aim for the highest score to make you a strong applicant for any residency of your choice.

Please refer to this website for two digit score conversion for COMLEX- http://www.nbome.org/CBTScoreConv/Default.aspx

Please note this UPDATE-

"Changes to USMLE Procedures for Reporting Scores

Starting July 1, 2011, USMLE transcripts reported through the ERAS reporting system will no longer include score results on the two-digit score scale. USMLE results will continue to be reported on the three-digit scale. This affects the Step 1, 2CK, and 3 examinations only; Step 2 CS will continue to be reported as pass or fail. These changes do not alter the score required to pass or the difficulty of any of the USMLE Step examinations." (source- http://www.usmle.org/General-Information/ announcements.aspx?contentId=63)

"The old brick road to the Oz known as residency is riddled with many twists and turns. The process is a test of endurance and strength of will and chances are, you will be a different person at the end of it than you were before you began your journey." ("USMLE Step 1 Reality YouTube Video," by Dr. Brian Bolante, theusmlezone.com)

Chapter Two

First Aid for the USMLE Step 1 is a familiar book to every medical student, both internationally and across the entire United States. It is the book of choice for studying for the Boards. We strongly recommend that you (and everyone else) buy this book as early as possible in your medical school experience, if you want to do well on the COMLEX and/or USMLE. Do not wait until a month before your Boards to buy this book. And do not buy the book and let it sit around without putting it to good use. Deadly idea ...

First Aid for the USMLE Step 1 is not a textbook, as most students often think. We call it a book of facts, covering information from the first two years of medical school. If you open the book itself, it is not readable unless you have previously studied the material. It simply states facts about everything most likely to be tested on the COMLEX or USMLE. It offers effective mnemonics, which can help you retain information using a concise and easy method as you prepare for the exam. Some students find mnemonics helpful, while others do not. If you are a student who loves mnemonics, it will come in handy. First Aid for the USMLE Step 1 offers high-yield pathology slides at the end of the book for review.

First Aid for the USMLE Step 1 is a comprehensive, high-yield review book that can help you to do well on the exam; we have written this book to help you get the most out of First Aid for the USMLE Step 1, offering you a different perspective on how to approach reading that allows you to make mental notes and associations that are not emphasized in the book.

Can students memorize all the facts in this book for the Boards? No. After studying for the Boards the effective way we will describe, you will be able to understand most of the materials that you need to excel on your Boards. We want you to realize that you cannot answer all Board questions correctly. So even if you memorize First Aid, you still won't be able to get all the answers correct. Read more to discover why.

Chapter Three

Begin preparing for the Boards in advance, in small steps. We highly recommend that you purchase a year's subscription to The USMLEWorld Step 1 Qbank. Buy the subscription online: http://www.usmleworld.com.

Make sure you purchase it at the right time. Suppose you have to take the exam in June 21, 2012. Do not purchase the yearly Qbank subscription until July 15, 2011, which gives you a thirty-day buffer, in case you change your exam day. In that case, you'd still have access to the Qbank for practice. We understand some people might be opposed to this idea because it is quite expensive. However, we firmly believe it is a worth while investment. To reduce the cost, buy a year's subscription only if you are absolutely sure you will be disciplined enough to use it throughout the year. Some people buy the six-month subscription plan, while others subscribe for thirty days. We are fully aware of the financial burden many students already carry. If you cannot afford to buy the one-year subscription, make an effort to buy the six-month plan and begin studying early. Do whatever works for you, but we advise you to buy it as soon as possible. You will discover our reason as you continue this book.

The second year of medical school is highly intense. It is probably the most challenging, if not the hardest, part of your medical education. The year is so critical because you will learn various aspects of clinical medicine, pathology, and pharmacology in one year. It took the professors teaching these courses an entire career to master the material; and you are expected to memorize, understand, retain, and regurgitate the information in one year. That is madness, isn't it? Yes, we know—that's just medical school. Doctors are expected to know everything.

We know it is very difficult for most students to adjust to the intensity of medical school. Most students enter medical school with a different perspective toward studying. They suddenly find themselves in the midst of a nonstop flow of information, and they do not know how to deal with it. If you are such a student, read chapter 13 on how to survive medical school before continuing.

If you are already a very studious and well-prepared student, a student who has efficiently mastered the best and most efficient way to study any material given to you in a short time—and you still find time to sleep, eat, and exercise—then you are on the right track.

Please realize that studying for your second-year classes is equivalent to studying for Boards, since these are the materials you are most likely to be tested on for the exam. Students' coursework performance is the best predictor for their Board scores.

Although the second year of medical school does not provide enough time to balance studying for the Boards with your coursework, it is your responsibility to make the time. We disciplined ourselves to set aside one hour every night to do the USMLEWorld Step 1 Qbank questions. We started this as soon as we started the clinical medicine, pathology, and pharmacology courses. Since these courses are often taught in modules, it correlates well with the Qbank style.

Question: How do I start doing questions when I do not know what I am looking at yet?

Answer: That is why Boards study is different! As we told you at the beginning, forget everything you know about Board prep.

If you are on the cardiology module at your school, the ideal approach is to start doing ten cardio questions from the question bank every day. Do not underestimate ten questions. It will take you approximately ten to fifteen minutes to complete these ten questions from the question bank. It takes about thirty to forty-five minutes to review the answers for these ten questions. However, taking the test is not what is important. The most important thing is to review every single question and answer from the question bank you are using. Both the right and wrong answers must be reviewed in great detail. This is the best way to learn the material. In order words, preparing this way is the most efficient method of preparing for your actual board exam.

The clinical vignette questions are much harder than you predict. The USMLEWorld Step 1 Qbank is probably one of the most difficult and most valuable question bank you can use to study for Boards. Although the questions are difficult, they help reinforce the very high-yield concepts for the exam. The Qbank also prepares you for how Board-style questions are often phrased.

Reviewing both your right and wrong answers to the Qbank questions is both very time consuming and painful. It is not an easy process. But that is the only way you will know exactly what you need to know for the exam. Most students have a habit of taking exams without reviewing the answers. This is not the way to study for Boards. USMLEWorld Step 1 Qbank is an excellent tool because it thoroughly explains the reasons why one answer is right and not the others. It also explains why the other answers are incorrect. These explanations are often long but very concise. At the end there is an educational objective summary, a short summary of what the test question wants you to know.

Question: How do I know if I am doing well when answering questions?

Answer: Initially, you will perform poorly on when you take USMLEWorld Step 1 Qbank tests. As a medical student, you are not used to getting between 30 and 50 percent on an exam. But with USMLEWorld Qbank, expect to be within that range, especially at the beginning. You do not know most of the material yet; even if you do, you are not familiar with how the concepts are tested in a Board-style clinical vignette format. So do not feel depressed when your scores are really low. Most students who actually do well on the real exam score an average of 65 percent on USMLEWorld Step 1 Qbank.

If you are scoring between 40 and 50 percent from the start, you are actually doing really well and getting ready for the test. However, do not focus on your scores initially. Learn the material, understand the questions, and get used to the style of the exam.

(Continues...)

Excerpted from HOW TO PREPARE FOR THE MEDICAL BOARDSby ADELEKE T. ADESINA FAROOK W. TAHA Copyright © 2011 by Adeleke T. Adesina and Farook W. Taha. Excerpted by permission of iUniverse, Inc.. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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