Crack the Code

USMLE STEPS are not your regular type of exam, in fact their design is really one of the most elaborate type of test you will ever see, it has it all, images, calculations, two step answers, double negatives, best possible, choosing the wrong answer, second best option, clinical cases, ethical cases, all against the clock. 

The series are really hard to master, in fact there are fewer and fewer direct questions and every year it gets tougher by using less high yield contents, hiding key signs and symptoms, using more clinical cases for everything and increasing the volume of contents specially for new treatments.

As every exam the series has a code, a way of doing their questions, breaking the code means knowing and being comfortable with all types of questions, knowing what to expect is half of the battle, for these exams is something that will help you in your preparation, it will give you a way to anticipate contents that may be asked while reading them. Think of these as a feeling or a sense to anticipate what could be asked.

Some people seem to have an easier way than others with these type of tests, and this is because they are more comfortable with the type of questions, maybe they have a more attentive mind for details, it’s hard to say, but it is also something that you can learn to do, it’s possible to learn the skill of test taking and making your own way of doing it at the same time.

Practice, that’s the key for cracking the code behind these exams, practicing questions that are similar in structure will give you a sense of how things can be asked, question banks have to be an integral part of your preparation, including questions early on your preparation will give you a sense as to when you need to memorize things like, second best treatment, lab data differentials, relevant images, ETC uncouplers etc.

When taking question banks every day you will form your own method to read and answer to blocks, not everyone has the same way of doing things and in practice you will find a way that feels more comfortable with both your way of analysis and the allotted time for each block.

To start practicing with questions, after you have finished a subject let’s say biochemistry, at the end of each day studying other subject take some blocks of questions from biochemistry this will refresh those contents while giving you a way of understanding how questions are made, then apply this insight to your next day studies, and so on until you finish all your subjects and then start making questions from subjects where you feel are weaker.

Again thanks for listening, if you have any comments leave them below, and don’t forget to visit us at www.usmleprepguide.com

Relative Value Units and Medical Billing

There is a lot to be said about RVUs and medical practice, today we considered it to be important for all  medical candidates to know a little better what RVUs are and how they are being used in medical practice today, since sooner than later you will be dealing with this topic it’s important to your formation to understand it and have a better idea of how it works.

RVUs apply to almost all medical payments, even when working in private practice, many patients have their own health insurance and so these insurance companies work with the RVUs system.

 What are RVUs?

To be clear about it, RVUs stands for Relative value units, this is a formula that is used to determine the fee a physician should get for their work in practice although it also serves to measure resource consumption in medical institutions, RVUs were part of the Resource-Based Relative Value Scale (RBRVS) adopted by Medicare in 1992.

The system used by Medicare and many HMOs is called the Resource Based Relative Value Scale (RBRVS). Every CPT code (a code for each type of procedure or service) has been assigned something called a relative value unit, or RVU, that determines the cost of a service.

The RVU is determined by first adding up three components:

·        The work required by the physician: This component takes into consideration the amount of time, skill, training, and intensity that was necessary to perform the procedure. Each CPT code is reviewed at least every five years to determine whether this value should remain the same.

·        The cost of doing business or maintaining a practice: This includes rent, equipment, supplies, and staff.

·        The malpractice expense or liability expenses borne by the provider: Malpractice/liability expenses vary among providers. Certain specialties such as obstetrics tend to involve higher malpractice premiums than a primary care physician is likely to face.

For each service, a payment formula contains three RVUs, one for physician work (RVUsw), one for practice expense RVUPE, and one for malpractice expense RVUMP. On average, the proportion of costs for Medicare is 52%, 44% and 4%, respectively. 

 

The RBRVS reimbursement schedule assigns certain values to procedures/costs based upon Total RVUs. The total RVU consists of three separate components:  work (RVUw), practice expense (RVUPE) and malpractice (RVUMP). Further, Medicare adjusts payment by designating a geographic price cost index or GPCI and pays differently for the same procedure depending on the practice location. Another important component is the Conversion Factor (CF), which converts the RVU into a charge and reimbursement, the value of the last conversion factor comes from a private group of 29 (mostly specialists) physicians—the American Medical Association's Specialty Society Relative Value Scale Update Committee (RUC)—have largely determined Medicare's RVU physician work values.

The payment formula is: 

[(RVUw x work GPCI) + (RVUPE x PE GPCI) + (RVUMP x malpractice GPCI)] x CF for the year in question.

It’s kind of a complicated subject, but also one that affects every physician practicing in many

institutions, what this formula gets is how much you are paid for every consultation or procedure, it so happens to be that the same procedure can be more valuable in a different geographical location, and also prices change in time.

This is something to take in consideration when deciding your specialty, since some prefer top tier medical procedures although there are less in the market, or a large amount of simple consultations being this a more steadly income, it’s something you should know about, consider when deciding your residency and the way you will work in the future.

Above all this formulas and methods, there’s always vocation, doing something you like is always the best choice, but having some knowledge about this topic might give you a better idea how you will be working in the future in the area you like.

I know I haven’t covered ALL there is of this topic, but while you are studying for the boards this information will be helpful, if you have any comments as always leave them in our comment section, and don’t forget to visit us at www.usmleprepguide.com

Do not get distracted.

Don’t get distracted.

In our days where everything moves fast, everyone is available and connected there is an issue for medical students that is constantly undermining our efforts while preparing for any USMLE test, that is distractions, to learn we must remain focused, to memorize we have to actually pay attention at what we are looking at, it is a common mistake to keep yourself available for distractions while studying.

Remember that it’s not just time that you are using for studying it’s also attention, and that is a key factor when you are reviewing topics that requiere a lot to understand, like mechanisms, cycles, enzymes, math formulas, phases, stages, images etc. 

It’s logical to understand the importance of a clear mind to learn, but avoiding all contact with our connected civilization may prove to be a real challenge nowadays, here are some tips to have a correct space to prepare for your exams:

First of all find  a good place to study, that may be different from person to person but it has some

requirements like being a place with enough light to read, quiet, somewhere that has no people walking by, some place with the least amount of distractions like noises, cars passing, dogs barking etc. anything that can break your concentration. A bunker would be ideal. If there are no available maybe the far end corner of a big library. Although a corner in your home may as well be it.

2- go socially offline: that means no phone, no sms, no chats, no Skype, Fb, tweets, photos, etc. it’s important that when you are in study mode actually be focused in what you are reading and not be distracted by constant updates that are not important for your exams. All that social interaction should wait for a break.

3- stay away from the TV, internet except for study purposes, no radio, no music, no magazines etc. if your tablet is not being used for doing questions or reading something turn it off.

4- Learn to study alone: for theorical exams it is important to study by yourself, many of us like to

have a study partner to help us stay awake or for consulting or to keep each other in company, while sometimes your study partner may be really dedicated, most of the time people have different study schedules and habits, some more annoying than others but also distracting, after a month or so of studying by yourself you will find that you can get more done, have more retention of each topic and be more flexible in your own schedule.

5- Take a break, our minds are not designed to stay focused more than 45 to 50 min. before everything starts to look like incoherent doodles, maximize your study periods but also learn to use your breaks, that means physically move to other place, play videogames, maybe talk to people (not in the medical profession) for a while that seems to work really good as a distraction instead of just turning the tv on.

Avoiding distractions is a big part of taking your exams seriously, remember that your performance is mostly dependent on your preparation, by taking away any kind of distraction from the study table you will increase your retention and performance on your tests.

If you have any suggestions or comments for our blogs please leave them in the comments section.

Read the question.. a USMLE advice

Read the question...

a USMLE ADVICE

 

It appears to be a simple assumption, but for CLINICAL VIGNETTE questions this is a really

important issue, the amount of clinical cases in step 1, step 2 ck and step 3 have been increasing over time getting in some cases to about half the test, this makes even more important to be advised on this type of questions.

When dealing with clinical cases it is important to read the whole case before trying to solve it, it is common that when reading a question we immediately try to give an answer before finishing our reading, the reason of this advice is because many clinical cases are not about the pathology, lab data or treatment, currently there are many questions using this format to evaluate biostatistics, population genetics, medical ethics, etc. 

You have to ask yourself, what do they want me to answer here?, generally the question lies in the bottom of the case but you should read the whole case first, many try to anticipate the answer reading the bottom question first, this may confuse you by giving an answer based on the first lines, its common that many information is hidden in the middle of the case that changes and obvious diagnosis, so again read the whole thing first, then try to answer.

In the exams you will find many questions using different words to ask for biostatistics terms, say

specificity, sensitivity, odds, median, etc. learn to identify what they are trying to ask first, so you can give a correct answer and make the appropriate calculation, you may find questions where they use the definition of a term instead of saying it directly, or rephrase that definition to confuse, or may ask for a negative trait of the specific term for example how many false positives will this test give, memorize the definitions of all terms that include a formula, since you will need to solve first what term are they asking to make the calculation.

In the case of laboratory tests and treatment, it is common to be asked about the second best, or the one that doesn’t apply to the case from the list of answers in this cases you are required to identify the wrong one, or the best second alternative, remember when studying to memorize the treatment in order of importance or according to protocol because this may be asked in a clinical case.

Other topic used in clinical cases is medical ethics, for example in child treatment, consent information, NDR forms etc. it is important to identify the type of ethical case first to be able to give a correct answer, although these are less common and you may find only a couple of questions in each exam, having them secured is really helpful.

The best way to improve for these exams is to practice, make as many questions as possible during your preparation, remember that is better to start practicing early for example when you finish your first subject make everyday questions about this subject while preparing the next one and so on, look for questions that are as real as possible, there are many question banks that are really accurate, but also even when doing questions that resemble the real thing there will be differences so the most important part of your preparation is to memorize definitions and curiosities or odd information about each topic  as much as possible and keep the mnemonics to a minimum.

If you have other suggestions for clinical vignette questions please leave them in the comments.

Wishing you as always success 

HFY Team.