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From:
Date: 08 Nov 2005
Time: 11:55:58 -0500
Remote Name: 165.154.153.75
Hi everybody! I took exam 1 week ago. Sorry, I didn’t write sooner. I was doing something that was a long time overdue – paying bills, taking care of my pregnant body, etc. Well, now I’m ready, and I’m not going to wait until my score arrives. I’m pretty sure I’ll be very busy at that time with my newborn. About exam: physically and mentally exhausting. No chance to relax and think carefully. Decisions must be made very fast and therefore in order to be right, require a good solid base of knowledge. Half of questions had a long stem. Highlighting feature of FRED was helpful. Advise: read last lane first and scan choices quiqly, so you’ll have an idea of what they want from you. This enables you to work through the stem more efficiently. About type of the questions: as I said, about 50% are moderate - to very long. TIn this type you are presented with the challenge of having too much information, which is mostly irrelevant. Your task is to find out what is pertinent and what is not. Just like Jesus Christ would presumably do on a judjement day - separating grain from weed. Beginning with reading last line of the question and scanning choices is helpful. Anothet type of questions is short question. These usually do not have enough information. In fact, some were really annoying, like - patient is generally in good health, no complains, just a little bit of this or that - your diagnosis, please. Very vague, very tricky. I felt like Sherlock Holmes trying to determine the breed of a dog from the sample of his poop. You either have to know topic in depth, or rely on your gut instinct, or may be both. Overalall, I have noticed one major difference between step 1 and step 2 questions: for step 1 they want your deep understanding of concepts and ability to apply them for clinical situations. On step 2 they challenge your analitic power, much more than on step 1. In a very short time they want you to classify bits and pieces of information and fit it in a preformed "schema". By schema I mean mechanism, diagnosis and management. So, in order to succeed you have to: 1. Know schema. That's why we are reading all these books. 2. Be able to analize the information and fit it into the right schema. That's why we are doing all these questions. I believe that this is most important part of our job, and therefore we should spent no less than 50% of our time solving questions. Work hard to boost your analitic power. You will be very greatful to yourself. So, your preparation should be focused on these two things. How much time you spend is a personal desision. I didn't have much, with all other things going on in my life, so I settled for waht I had. Probably, not enough to avhieve sense of deep satisfaction, but hopefuly enough to pass the test with the decent score. Well, will see. I used mainly Kaplan, didn't like it at all, especialy IM. Very badly written. Needs total revision. But, sadly, one of the best tools on market right now. I had to supplement all topics with CMDT. Hard book to read, but at least reliable and complete. I eventually got used to it's style and started to like it. As for other subjects - Kaplan is ok. During my preparation I figured that the "nosological" approach Kaplan uses is ineffective. We would be better off having studied clinical medicine with "syndromal approach". I'm not sure if this is the right term, but hope you understand what I mean. Example: take back pain and draw an algarythm of differential diagnosis and management. Or take Shortness of breath, and do the same. Or chest pain, or - whatever. It would be enourmously helpful on the exam. Tell you this: approximately 30% of questions starts with Pt complaints of Shortness of breath. Lots of Chest pain. Lots of urinary incontinence. Lots of weakness and fatigue. See, I don't tell nosological entitees, I mention syndromes only. And that's the best way to organize your preparation, I think. I wasn't able to do them all, but here are some syndromes which worth your time and extra-effort: Shortness of breath Chest pain Palpitations Urinary incontinence in men and women Breast mass in men and women Muscle weakness Back pain Abdominal pain Dysphagia upper and lower GI bleeding Fever (incl uknown origin) Rash (with/ without fever; H/o drugs - no H/o drugs) May be more. Do all you feel uncomfortable with. Will be very greatful to yourself. About doing questions: I only did UW and some of the Qbook and Qbank. UW was very helpful. Spend a lot of time with this. Read explanations, make notes, and review books if your answers are consistently wrong on a particular topic. I took it for 1 month, didn't have time for more.As I said, excellent source. Some questions on the real exam are almost a clone of UW, but - many are not. They don't ask for as much knowledge, but require a lot more thinking because of the way they're constructed. That was my impression. And - good news!!!! - some questions are actually easier. Overall, exam is very doable. Study syndromes. Learn how to manage your time. Prize yourself for every little victory. And you will get over it sooner and easier that you think you would. My UW score 70,19% NBME 1 560 (before UW, 1 month before exam), NBME 2 660 (after UW, 1 week before exam), USMLE CD 43, 41, 38. I'll post my actual exam score later for you to see if there is a correlation. I wish best of luck to everybody. Many thanx to everyone. I mean - literraly - every One. You guys are one of the best thing that ever happened to me. I wish you all achieve your goals and glory. Be happy. Love. Julia Perch.